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A prospective cohort study of radiofrequency-assisted splenic preservation and conventional treatment of blunt splenic injury
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Electronic Poster Abstracts
surgery specialist with cross-sectional basic knowledge and skill and global outlook in 2014. Program for laparoscopic hepatectomy: The purpose of this program is to bring up the operator who can safely perform laparoscopic partial hepatectomy and lateral sectionectomy. We designed it so that this program became able to be completed by about 9e10 postgraduate years based on the experience of laparoscopic surgery in other fields because the number of open hepatectomy will gradually decrease in the future. Cross-sectional program: Our new program, which is funded by Ministry of Education, Culture, Sports and Technology of Japan, consists of basic course (2 years) by lectures about fundamental knowledge of endoscopic surgery for HPB, GI, Urology and Gynecology and performing endoscopic surgery for HPB, GI, Urology and Gynecology, large animal training and cadaver training and Advanced course (2 years) by the training in the domestic top institution in each specialty field, training in the overseas institution and Class of robot surgery and the management.
EP04C-006 IMPROVING RESULTS IN COMPLEX PROCEDURES: PANCREATOGASTROANASTOMOSIS (PGA), A MODEL OF TEACHING G. Miranda Devora, A. E. Padilla Rosciano, H. N. Lopez Basave and D. Garcia Ortega Oncology Surgery, Instituto Nacional de Cancerologia/ UNAM, Mexico Introduction: The pancreatoduodenal resection is a technical challenge, which improves as the number of procedures performed by the surgical team. It is clear that the duodenal and pancreatic head resection, have lower morbidity and mortality in high-volume centers with specialized multidisciplinary teams. Method: In the Instituto Nacional de Cancerologia, Mexico City, development a model of complex surgical techniques to pancreatic cancer, performed by residents in the last year of training, using the pancreato-gastro anastomosis (PGA) reconstruction technique for the Whipple procedure in a selected group of patients since 2013. Result: The results achieved in a group of 13 patients (7 male, 6 female) operated entirely by residents in oncological surgery supervised for a Master Surgery, are compared with previously published results in highvolume centers. Our results were: Mean operative time of 501 min (range 420e610 min). Mean days of hospital stay after surgery; 12 (range 7e30 days). Pancreatic fistula 7.5%, initial enteral diet mean of 9.6 days (range 2e23 days), admission to ICU of 23%, mortality 0% and morbidity 35%. Conclusions: The pancreatogastro anastomosis for Whipple procedure is a feasible and reproducible model reconstruction, and have a special facility to perform in a young teams for the treatment of cancer.
EP04C-007 INTESTINAL DUPLICATION (ENTEROGENOUS) CYSTS: POSSIBILITIES OF DIAGNOSTICS AND SURGICAL TREATMENT Y. Stepanova1, G. Karmazanovsky1, Y. Starkov2, A. Krieger3 and E. Dubova4 1 Radiology, 2Endosdcopy, 3Abdominal Surgery, and 4 Pathological Anatomy, A.V. Vishnevsky Institute of Surgery, Russian Federation Intestinal duplication (enterogenous) cysts (DC) are congenital anomalies which can develop in any place of intestinal. Purpose: To show possibilities of diagnostics and surgical treatment of DC. Materials and methods: 4 DC (3 women and 1 man, aged 33e57 years) were diagnosed and treated during 2007e 2015. Preoperative inspection: ultrasonography, MSCT, gastroscopy with endosonography. All patients were operated on with morphological verification. Results: Complaints at arrival: the aching pain in the top part of abdomen (3), wasn’t (1). Radiology showed the cystic nature of neoplasm. Its wall accumulated contrast agent at MSCT. There’re partitions of various degree of expressiveness. Contents of neoplasms were from mucilaginous transparent till “coffee with milk” color dense. Neoplasms proceeded from stomach in 3 cases (2 in cavity, 1 extra-organ), 1in duodenum (extra-organ, without visible communication with gut). In 1 case in contents of a cyst revealed the high level of tumor marker (stomach resection was made in the delayed period). Conclusion: DC is diagnosed extremely seldom because of the doctors haven’t enough knowledge of this disease. Classical cases of DC, when there’s a communication with a digestive tract wall are presented, and also case when there wasn’t communication of neoplasm with a gut wall is given.
EP04D - Electronic Poster: 4D e HPB Evidence Based Medicine
EP04D-002 A PROSPECTIVE COHORT STUDY OF RADIOFREQUENCY-ASSISTED SPLENIC PRESERVATION AND CONVENTIONAL TREATMENT OF BLUNT SPLENIC INJURY K. Ma1, K. Feng2, W. Zhang2 and X. Ren2 1 Hepatobiliary Surgery, and 2The Third Military Medical University/The Southwest Hospital, China Objective: To compare the efficacy of radiofrequency (RF)-assisted spleen-preserving surgery with that of conventional splenorrhaphy/splenectomy in the treatment of blunt splenic injury. Summary background data: RF can be used to treat splenic trauma because of its excellent coagulation hemostasis.
HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts Methods: A total of 122 patients with splenic trauma admitted to two tertiary referral centers from June 2011 to June 2014 were included in this prospective cohort study. The 67 patients at one center were treated by radiofrequency-assisted spleen-preserving therapy (RF group), and the 55 patients admitted at the other center underwent conventional treatment (CT group). Demographics and clinical characteristics of the two groups were comparable. Results: Mean operative time (126.2 45.7 min vs 148.3 57.1 min, p = 0.041) and intraoperative bleeding (331.8 136.7 ml vs 585.2 191.2 ml, P = 0.000) of the RF group were less than in the CT group. Binary logistic regression analysis showed that the primary risk factors associated with failure of splenorrhaphy in patients with American Association for Trauma (AAST) grade I and II splenic injury were the length of the splenic laceration (odds ratio 28.123; 95% CI: 1.713e461.580; P = 0.019). After radiofrequency-assisted partial splenectomy, the volume of the residual spleen increased apparently in the first postoperative year. Conclusions: Compared to traditional splenorrhaphy and splenectomy, RF-assisted splenic hemostasis and salvage was easy to use, safe, and effective in the treatment of splenic injuries. In particular for high-grade splenic injuries, these techniques preserved sufficient splenic tissue without any increase in patients with surgical risk.
EP04D-003 ENHANCED RECOVERY AFTER SURGERY (ERAS) POST LIVER RESECTION: SAFETY AND FEASIBILITY STUDY A. C. Ariffin1,2, A. W. Ahmad2, Z. Zuhdi2, I. S. Mohamad3, A. Azman2, H. A. Othman2 and R. Jarmin2 1 Universiti Sains Islam Malaysia, 2Universiti Kebangsaan Malaysia, and 3Universiti Sains Malaysia, Malaysia Introduction: Liver surgery has undergone a long and arduous journey with its complications and delayed recovery. The postoperative recovery and discharge has been reported ranging between 9 and 15 days. ERAS protocol has been introduced to reduce length of stay and enhanced recovery. This study aims to determine ERAS safety and feasibility in our population. Methods: This study was conducted in PPUKM from September 2014 to April 2015. All patients undergoing open liver resection were recruited and divided to minor and major resection. They were then managed post operatively according to ERAS protocol. Demographics data, preoperative and postoperative data were reported. The ERAS key target protocol is evaluated and morbidity and mortality were recorded. A discharge target of 3 and 5 days were planned for minor and major resection respectively. Results: The overall mean length of hospital stay was 7.4 3.9 days. The targeted discharge time were successfully only in 10% and 28.6% in the minor and major resection group respectively. Majority of the patients were discharge on day 5 and day 7. All complication was managed successfully. There was no mortality recorded. Most of the key target protocols were successfully achieved (50% e 88.24%). Most delayed key target protocols were achieved after the next two days.
HPB 2016, 18 (S1), e385ee601
e539
Conclusion: ERAS in hepatectomy is safe and feasible. Most complications were minor and successfully manage with no mortality. However, a modified protocol would be appropriate to achieve a more practical result. Keywords: ERAS, Recovery, Hepatectomy, Liver, Discharge
EP04E - Electronic Poster: 4E e HPB Cost Effectiveness
EP04E-001 RECIPROCAL CARE ARRANGEMENTS IN HPB CANCER SERVICES e HELPING SWALLOW THE BITTER PILL OF CENTRALIZATION R. Gandy1, A. Ling1, H. Hook2 and K. S. Haghighi1 1 HPB & Transplant Surgery, University of New South Wales, and 2Orange Base Hospital, Australia Centralization of cancer services in Australia has been shown to improve oncological outcomes and procedure related mortality and morbidity (1, 2). Economies of scale can also reduce the costs of service provision (3). However, it has also been shown that rural and regional patients prefer to be treated closer to home in familiar hospitals and by local clinicians (4). General practitioners are also happier to refer to a local clinician and familiar hospital for treatment (5). We present a system that integrates regional and metropolitan cancer care for complex upper gastrointestinal malignancy. The aim of this system is to provide the best oncological outcomes of multidisciplinary cancer care, to have most of this care provided in regional areas and reduce the need for extended metropolitan stay. Since 2009, 36 patients have undergone assessment or treatment under the reciprocal care agreement. All 36 patients were discussed at regional and then metropolitan MDT meetings. 8 Patients underwent liver resection and 1 microwave ablation, 6 patients underwent standard PD, 4 patients extended PD, 3 RAMPS procedures and one total pancreatectomy. 2 Procedures were performed at regional centres in the presence of a metropolitan surgeon and 10 procedures performed by a regional surgeon at the metropolitan centre. Early inter-hospital transfer facilitated relocation and discharge of patients and all follow up care was provided in regional settings by regional surgeons. This reciprocal care agreement has led to an increase referral from regional centres and increase the number of patients undergoing radical resection.
EP04E-003 IS ROUTINE ULTRASOUND ABDOMEN NECESSARY PRIOR TO DISCHARGE AFTER LAPAROSCOPIC CHOLECYSTECTOMY? S. Kadiyala1, S. Gavini2, V. Venkatarami Reddy2 and A. Dinakar2 1 Radiology, and 2Surgical Gastroenterology, SVIMS, India Introduction: The aim of this study is to assess the value of routine ultrasound abdomen prior to discharge in patients undergoing laparoscopic cholecystectomy. Routine
Electronic Poster Abstracts
surgery specialist with cross-sectional basic knowledge and skill and global outlook in 2014. Program for laparoscopic hepatectomy: The purpose of this program is to bring up the operator who can safely perform laparoscopic partial hepatectomy and lateral sectionectomy. We designed it so that this program became able to be completed by about 9e10 postgraduate years based on the experience of laparoscopic surgery in other fields because the number of open hepatectomy will gradually decrease in the future. Cross-sectional program: Our new program, which is funded by Ministry of Education, Culture, Sports and Technology of Japan, consists of basic course (2 years) by lectures about fundamental knowledge of endoscopic surgery for HPB, GI, Urology and Gynecology and performing endoscopic surgery for HPB, GI, Urology and Gynecology, large animal training and cadaver training and Advanced course (2 years) by the training in the domestic top institution in each specialty field, training in the overseas institution and Class of robot surgery and the management.
EP04C-006 IMPROVING RESULTS IN COMPLEX PROCEDURES: PANCREATOGASTROANASTOMOSIS (PGA), A MODEL OF TEACHING G. Miranda Devora, A. E. Padilla Rosciano, H. N. Lopez Basave and D. Garcia Ortega Oncology Surgery, Instituto Nacional de Cancerologia/ UNAM, Mexico Introduction: The pancreatoduodenal resection is a technical challenge, which improves as the number of procedures performed by the surgical team. It is clear that the duodenal and pancreatic head resection, have lower morbidity and mortality in high-volume centers with specialized multidisciplinary teams. Method: In the Instituto Nacional de Cancerologia, Mexico City, development a model of complex surgical techniques to pancreatic cancer, performed by residents in the last year of training, using the pancreato-gastro anastomosis (PGA) reconstruction technique for the Whipple procedure in a selected group of patients since 2013. Result: The results achieved in a group of 13 patients (7 male, 6 female) operated entirely by residents in oncological surgery supervised for a Master Surgery, are compared with previously published results in highvolume centers. Our results were: Mean operative time of 501 min (range 420e610 min). Mean days of hospital stay after surgery; 12 (range 7e30 days). Pancreatic fistula 7.5%, initial enteral diet mean of 9.6 days (range 2e23 days), admission to ICU of 23%, mortality 0% and morbidity 35%. Conclusions: The pancreatogastro anastomosis for Whipple procedure is a feasible and reproducible model reconstruction, and have a special facility to perform in a young teams for the treatment of cancer.
EP04C-007 INTESTINAL DUPLICATION (ENTEROGENOUS) CYSTS: POSSIBILITIES OF DIAGNOSTICS AND SURGICAL TREATMENT Y. Stepanova1, G. Karmazanovsky1, Y. Starkov2, A. Krieger3 and E. Dubova4 1 Radiology, 2Endosdcopy, 3Abdominal Surgery, and 4 Pathological Anatomy, A.V. Vishnevsky Institute of Surgery, Russian Federation Intestinal duplication (enterogenous) cysts (DC) are congenital anomalies which can develop in any place of intestinal. Purpose: To show possibilities of diagnostics and surgical treatment of DC. Materials and methods: 4 DC (3 women and 1 man, aged 33e57 years) were diagnosed and treated during 2007e 2015. Preoperative inspection: ultrasonography, MSCT, gastroscopy with endosonography. All patients were operated on with morphological verification. Results: Complaints at arrival: the aching pain in the top part of abdomen (3), wasn’t (1). Radiology showed the cystic nature of neoplasm. Its wall accumulated contrast agent at MSCT. There’re partitions of various degree of expressiveness. Contents of neoplasms were from mucilaginous transparent till “coffee with milk” color dense. Neoplasms proceeded from stomach in 3 cases (2 in cavity, 1 extra-organ), 1in duodenum (extra-organ, without visible communication with gut). In 1 case in contents of a cyst revealed the high level of tumor marker (stomach resection was made in the delayed period). Conclusion: DC is diagnosed extremely seldom because of the doctors haven’t enough knowledge of this disease. Classical cases of DC, when there’s a communication with a digestive tract wall are presented, and also case when there wasn’t communication of neoplasm with a gut wall is given.
EP04D - Electronic Poster: 4D e HPB Evidence Based Medicine
EP04D-002 A PROSPECTIVE COHORT STUDY OF RADIOFREQUENCY-ASSISTED SPLENIC PRESERVATION AND CONVENTIONAL TREATMENT OF BLUNT SPLENIC INJURY K. Ma1, K. Feng2, W. Zhang2 and X. Ren2 1 Hepatobiliary Surgery, and 2The Third Military Medical University/The Southwest Hospital, China Objective: To compare the efficacy of radiofrequency (RF)-assisted spleen-preserving surgery with that of conventional splenorrhaphy/splenectomy in the treatment of blunt splenic injury. Summary background data: RF can be used to treat splenic trauma because of its excellent coagulation hemostasis.
HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts Methods: A total of 122 patients with splenic trauma admitted to two tertiary referral centers from June 2011 to June 2014 were included in this prospective cohort study. The 67 patients at one center were treated by radiofrequency-assisted spleen-preserving therapy (RF group), and the 55 patients admitted at the other center underwent conventional treatment (CT group). Demographics and clinical characteristics of the two groups were comparable. Results: Mean operative time (126.2 45.7 min vs 148.3 57.1 min, p = 0.041) and intraoperative bleeding (331.8 136.7 ml vs 585.2 191.2 ml, P = 0.000) of the RF group were less than in the CT group. Binary logistic regression analysis showed that the primary risk factors associated with failure of splenorrhaphy in patients with American Association for Trauma (AAST) grade I and II splenic injury were the length of the splenic laceration (odds ratio 28.123; 95% CI: 1.713e461.580; P = 0.019). After radiofrequency-assisted partial splenectomy, the volume of the residual spleen increased apparently in the first postoperative year. Conclusions: Compared to traditional splenorrhaphy and splenectomy, RF-assisted splenic hemostasis and salvage was easy to use, safe, and effective in the treatment of splenic injuries. In particular for high-grade splenic injuries, these techniques preserved sufficient splenic tissue without any increase in patients with surgical risk.
EP04D-003 ENHANCED RECOVERY AFTER SURGERY (ERAS) POST LIVER RESECTION: SAFETY AND FEASIBILITY STUDY A. C. Ariffin1,2, A. W. Ahmad2, Z. Zuhdi2, I. S. Mohamad3, A. Azman2, H. A. Othman2 and R. Jarmin2 1 Universiti Sains Islam Malaysia, 2Universiti Kebangsaan Malaysia, and 3Universiti Sains Malaysia, Malaysia Introduction: Liver surgery has undergone a long and arduous journey with its complications and delayed recovery. The postoperative recovery and discharge has been reported ranging between 9 and 15 days. ERAS protocol has been introduced to reduce length of stay and enhanced recovery. This study aims to determine ERAS safety and feasibility in our population. Methods: This study was conducted in PPUKM from September 2014 to April 2015. All patients undergoing open liver resection were recruited and divided to minor and major resection. They were then managed post operatively according to ERAS protocol. Demographics data, preoperative and postoperative data were reported. The ERAS key target protocol is evaluated and morbidity and mortality were recorded. A discharge target of 3 and 5 days were planned for minor and major resection respectively. Results: The overall mean length of hospital stay was 7.4 3.9 days. The targeted discharge time were successfully only in 10% and 28.6% in the minor and major resection group respectively. Majority of the patients were discharge on day 5 and day 7. All complication was managed successfully. There was no mortality recorded. Most of the key target protocols were successfully achieved (50% e 88.24%). Most delayed key target protocols were achieved after the next two days.
HPB 2016, 18 (S1), e385ee601
e539
Conclusion: ERAS in hepatectomy is safe and feasible. Most complications were minor and successfully manage with no mortality. However, a modified protocol would be appropriate to achieve a more practical result. Keywords: ERAS, Recovery, Hepatectomy, Liver, Discharge
EP04E - Electronic Poster: 4E e HPB Cost Effectiveness
EP04E-001 RECIPROCAL CARE ARRANGEMENTS IN HPB CANCER SERVICES e HELPING SWALLOW THE BITTER PILL OF CENTRALIZATION R. Gandy1, A. Ling1, H. Hook2 and K. S. Haghighi1 1 HPB & Transplant Surgery, University of New South Wales, and 2Orange Base Hospital, Australia Centralization of cancer services in Australia has been shown to improve oncological outcomes and procedure related mortality and morbidity (1, 2). Economies of scale can also reduce the costs of service provision (3). However, it has also been shown that rural and regional patients prefer to be treated closer to home in familiar hospitals and by local clinicians (4). General practitioners are also happier to refer to a local clinician and familiar hospital for treatment (5). We present a system that integrates regional and metropolitan cancer care for complex upper gastrointestinal malignancy. The aim of this system is to provide the best oncological outcomes of multidisciplinary cancer care, to have most of this care provided in regional areas and reduce the need for extended metropolitan stay. Since 2009, 36 patients have undergone assessment or treatment under the reciprocal care agreement. All 36 patients were discussed at regional and then metropolitan MDT meetings. 8 Patients underwent liver resection and 1 microwave ablation, 6 patients underwent standard PD, 4 patients extended PD, 3 RAMPS procedures and one total pancreatectomy. 2 Procedures were performed at regional centres in the presence of a metropolitan surgeon and 10 procedures performed by a regional surgeon at the metropolitan centre. Early inter-hospital transfer facilitated relocation and discharge of patients and all follow up care was provided in regional settings by regional surgeons. This reciprocal care agreement has led to an increase referral from regional centres and increase the number of patients undergoing radical resection.
EP04E-003 IS ROUTINE ULTRASOUND ABDOMEN NECESSARY PRIOR TO DISCHARGE AFTER LAPAROSCOPIC CHOLECYSTECTOMY? S. Kadiyala1, S. Gavini2, V. Venkatarami Reddy2 and A. Dinakar2 1 Radiology, and 2Surgical Gastroenterology, SVIMS, India Introduction: The aim of this study is to assess the value of routine ultrasound abdomen prior to discharge in patients undergoing laparoscopic cholecystectomy. Routine