Gastrointestinal Unit Research Articles

188 Incidence and Root Causes of Surgical Site Infections After Gastrointestinal Surgery at a Public Teaching Hospital in Sudan

Abstract Aim Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays and additional financial burden. Patients undergoing gastrointestinal tract procedures carry a high risk of SSIs. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries. Method A hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between September-December 2017. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05. Results 80 participants were included in the study. (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) underwent large bowel surgery. 27.5% developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated was E coli (47.8%), followed by Enterococcus faecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%). Conclusions The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.

415. STEP-BY-STEP APPROACH TO CERVICAL LYMPHADENECTOMY IN ESOPHAGEAL CANCER

Abstract https://drive.google.com/file/d/1sByes2_wNgSmb8DW9BjNQknjN7HCXtf1/view Background Cervical lymphadenectomy is an essential component of the treatment of esophageal cancer. Over the last six years, our upper gastrointestinal unit has carried out 180 esophagectomies, with 20% of them involving 3-field lymph node dissection. According to our unit’s protocol, the procedure is indicated for the following conditions: supraclavicular lymph node metastases, upper thoracic esophageal cancer, and recurrent nerve lymph node metastasis. We aim to present a step-by-step approach to cervical lymphadenectomy. Methods Our upper gastrointestinal unit has implemented several learning protocols that aim to design the most efficient and effective training environment. The primary objective is to enhance the learning process and surgical performance while maintaining quality standards. One of the essential components of this learning environment is video coaching, which provides a powerful tool for demonstrating and deconstructing surgical procedures. In recognition of the importance of cervical lymphadenectomy, we have developed a video that is incorporated into our unit’s existing curriculum. Results As an essential component of our comprehensive teaching protocol, we have included a video demonstrating the systematic approach to cervical lymphadenectomy. It offers a clear and concise overview of the anatomical landmarks that must be identified during the procedure, as well as the steps involved and the main pitfalls that must be avoided. Conclusion Our unit is committed to a phased and systematized approach to learning based on steps through the deconstruction of complex procedures. The unit’s structured teaching protocol allows the acquisition of competencies that enable the performance of cervical lymphadenectomy in an effective and efficient way, without compromising patient safety. We believe that our step-by-step approach to cervical lymphadenectomy will be a valuable resource for healthcare professionals working in our upper gastrointestinal unit.

421. UNVEILING THE COMPLEXITY—DISSECTION OF 106 LYMPH NODES IN ESOPHAGEAL CANCER

Abstract https://drive.google.com/file/d/1mKXEdCEEyOmzHo0bWJoRs4qAUDpr3LAk/view Background Surgical resection with thoracic lymphadenectomy is currently the sole curative option for treating non-cervical esophageal cancer. While a minimally invasive approach can achieve an efficient lymphadenectomy with reduced morbidity, its intricate and complex technical nature has limited its routine utilization in many centers. We aim to present a step-by-step approach to thoracoscopic thoracic lymphadenectomy. Methods Our upper gastrointestinal unit has developed multiple training protocols to create an optimal learning environment that aims to enhance surgical comprehension. Video coaching is a fundamental component of this learning environment, effectively demonstrating and deconstructing intricate surgical procedures. In recognition of the importance of minimally invasive thoracic lymphadenectomy, we have developed a video that is now incorporated into our existing curriculum. The video coaching and debriefing process enables us to continuously refine and optimize our training protocols, ultimately reducing the learning curve. Results We present a video showcasing a systematic and minimally invasive approach to total thoracic lymphadenectomy. This video offers a comprehensive overview of the key anatomical landmarks that require identification during the procedure, the sequential steps involved, and the critical pitfalls. Additionally, it provides valuable insights into the recognition of these landmarks and emphasizes the significance of 3D visualization of the ganglionic station for a better understanding of this procedure. Furthermore, the long-form video presentation will include additional correlation with the patient’s CT scans for a more in-depth comprehension of the procedure. Conclusion In high-volume centers that utilize a standardized technique, thoracoscopic total thoracic lymphadenectomy for esophageal cancer can be performed in a safe and reproducible manner with minimal morbidity. The use of a minimally invasive approach not only provides optimal anatomical visualization but also facilitates video revision and debriefing of the surgeries, ultimately improving the understanding of this complex surgical procedure.

FTP5.12 Incidence and Root Causes of Surgical Site Infections After Gastrointestinal Surgery at a Public Teaching Hospital in Sudan

Abstract Aim Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays and additional financial burden. Patients undergoing gastrointestinal tract procedures carry a high risk of SSIs. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries. Methods Hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between September-December 2017. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05. Results 80 participants were included in the study. (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) underwent large bowel surgery. 27.5% developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated was E coli (47.8%), followed by Enterococcus faecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%). Conclusions The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.

Outcomes of diode laser haemorrhoidoplasty in treatment of second, third and fourth grades of haemorrhoids. a retrospective study

Introduction Management of hemorrhoidal disease had been always a challenge for colorectal surgeons. Recently, the use of diode laser in proctology has emerged as an alternative to conventional surgical treatment. The laser beam causes shrinkage and degeneration that depend on the power and the duration of laser light application. It is also associated with minimal postoperative pain, bleeding, discharge and short hospital stay. Patients and methods This prospective study was carried out on 104 patients with second, third and fourth grades of hemorrhoids in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (18 months, from February 2021 to August 2022). All patients underwent laser hemorrhoidoplasty lasotronix device, bare fibers, wavelength 1470 nm and 8 watts of power. Mucopexy was added in 28 patients with grade 4 hemorrhoids. Results Postoperative pain was evaluated using VAS score, in the first 6 h VAS ranged from 4-9 with mean of 5.81±1.23 SD, after 12 h ranged from 1 to 7 with mean of 4.19±1.70 SD. There was significant relation between the grade of hemorrhoid and postoperative edema (P value was less than 0.001) as all of the 24 patients who developed edema, they were grade 4 hemorrhoids. Also, there was relation between grade 4 hemorrhoid and the development of other postoperative complications but P value was not significant (0.066 in infection and 0.260 in recurrence). There was no incontinence or stenosis in all of the 104 patients and recurrence occurred only in 4 cases (3.8%) and underwent conventional hemorrhoidectomy after six months of follow up. Conclusion Diode laser is a safe minimally invasive procedure for the treatment of second, third and fourth grades of hemorrhoids with less postoperative pain and early return to normal activities but high cost remains the only limitation.

Caregiving Strain, family functioning, and effort to change diet for patients with gastrointestinal cancer: A cross-sectional descriptive study.

Among patients with cancer, it has been found that the family system influences health-related behaviors and may promote a healthy diet. This study assessed the associations among cancer patients between family caregiver strain, family functioning, and efforts to change diet. This cross-sectional descriptive study was conducted in gastrointestinal outpatient units at two tertiary university hospitals in South Korea. This study included 401 main family caregivers of patients with gastrointestinal cancer. The caregivers were evaluated using structured, face-to-face questionnaires measuring family strain, family functioning, and effort to change diet. Greater effort to change diet was associated with higher family functioning, having a spouse, and more caregiving time per week. Less effort to change diet was associated with greater levels of caregiving strain and with a son providing caregiving. The efforts of family caregivers to alter diet are influenced by family strain and family functioning, as well as family caregivers' characteristics, such as marital status, health problems due to caregiving, care time and duration, and relationship with the patient. This study suggested that reducing family strain and improving family functioning in clinical settings facilitate the success to change dietary strategies for cancer families.

Emergence of extensively drug-resistant and multidrug-resistant Shigella flexneri serotype 2a associated with sexual transmission among gay, bisexual, and other men who have sex with men, in England: a descriptive epidemiological study

Shigellosis, also known as bacillary dysentery, is caused by Shigella spp that spread through fecal-oral contact and was traditionally associated with international travel in England. However, sexual transmission of Shigella flexneri and Shigella sonnei among gay, bisexual, and other men who have sex with men (MSM) is now common. In September, 2021, emergence of extensively drug-resistant (XDR) S sonnei harbouring plasmid-encoded blaCTX-M-27 raised concerns over further spread of this extended-spectrum β-lactamase-producing gene. Using national surveillance in England, we identified and characterised isolates of S flexneri harbouring blaCTX-M-27. In this epidemiological study, we identified and phylogenetically characterised S flexneri isolates harbouring blaCTX-M-27 that were referred to the Gastrointestinal Bacterial Reference Unit (GBRU) at the UK Health Security Agency. All isolates referred to the GBRU undergo whole-genome sequencing, enabling antimicrobial resistance determination using genetic markers. Cases were defined as individuals diagnosed with S flexneri harbouring blaCTX-M-27 in England, with a specimen date between Sept 1, 2015, and June 12, 2022, who were phylogenetically confirmed as part of two t10 (approximately ten single nucleotide polymorphisms) clusters. Long-read sequencing elucidated the genomic location of blaCTX-M-27. Laboratory data, integrated with available demographic and clinical information from patient questionnaires, were summarised using descriptive statistics. A sustained increase in cases of S flexneri harbouring blaCTX-M-27 (n=26) occurred from September, 2021, having been sporadically reported (n=11) in the preceding 6 years. blaCTX-M-27 acquisition events within S flexneri 2a established an XDR paraphyletic (n=8) cluster and a multidrug-resistant monophyletic (n=18) cluster. Cases were among adult male individuals (median age 37 years [IQR 31-46]) and, of the 13 individuals who completed a patient questionnaire, ten (77%) identified as MSM. Antimicrobial treatment was received by seven (54%) of 13 individuals, and four (31%) individuals were admitted to hospital. The IncFII plasmids harbouring blaCTX-M-27 showed high similarity to the XDR S sonnei outbreak plasmid, with 82% and 99% nucleotide similarity between the cluster plasmids and the XDR S sonnei outbreak plasmid. We report emergence of XDR and multidrug-resistant S flexneri 2a harbouring blaCTX-M-27 among MSM in England. Epidemiological and plasmid similarities with the XDR S sonnei outbreak support horizontal acquisition events, emphasising the importance of mobilisable antimicrobial resistance and the need for genomic-based surveillance. National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections at the University of Liverpool in partnership with the UK Health Security Agency.

ABDOME AGUDO EM UNIDADE DE TERAPIA INTENSIVA: ETIOLOGIA, COMORBIDADES E SEVERIDADE DE 1.523 PACIENTES

ABSTRACT BACKGROUND: Clinical features and outcomes of patients admitted to the intensive care unit due to acute abdomen are important to be investigated. AIMS: To evaluate the outcomes of critically ill subjects with acute abdomen according to etiology, comorbidity and severity. METHODS: Outcomes of 1,523 patients (878 women, mean age 66±18 years) consecutively admitted to a specialized gastrointestinal intensive care unit with different causes of acute abdomen from January 2012 to December 2019, were retrospectively evaluated according to etiology, comorbidity and severity. RESULTS: The most common causes of acute abdomen were obstructive and inflammatory, particularly large bowel obstruction (27%), small bowel obstruction (18%) and acute pancreatitis (17%). Overall mortality was 13%. Surgery was required in 34% of patients. Median length of stay in the hospital was 9 [1-101] days. On univariate analysis mortality was significantly associated with age, APACHE II, Charlson comorbidity index, requirement for surgery and malignancy (p<0.0001), but only APACHE II, Charlson comorbidity index and surgical interventional remained significant on multivariate analysis. CONCLUSIONS: Critically ill patients admitted to the intensive care unit with acute abdomen constitute a heterogeneous group of subjects with different prognosis. Mortality is more related to the severity of the disease, comorbidity and need for surgery than to the etiology of the acute abdomen.

Critical Care Nurses' Compliance with Blood Transfusion Guidelines in Gastrointestinal Intensive Care Units

Critical Care Nurses' Compliance with Blood Transfusion Guidelines in Gastrointestinal Intensive Care Units

The impact of the COVID-19 pandemic on elective laparoscopic cholecystectomy: A retrospective Cohort study.

The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on elective surgery for benign disease. We examined the effects of COVID-19 related delays on the outcomes of patients undergoing elective laparoscopic cholecystectomy (LC) in an upper gastrointestinal surgery unit in the UK. We have analysed data retrospectively of patients undergoing elective LC between 01/03/2019 to 01/05/2019 and 01/04/2021 to 11/06/2021. Demographics, waiting time to surgery, intra-operative details and outcome data were compared between the two cohorts. Indications for surgery were grouped as inflammatory (acute cholecystitis, gallstone pancreatitis, CBD stone with cholangitis) or non-inflammatory (biliary colic, gallbladder polyps, CBD stone without cholangitis). A p value of <0.05 was used for statistical significance. Out of the 159 patients included, 106 were operated pre-pandemic and 53 during the pandemic recovery phase. Both groups had similar age, gender, ASA-grades and BMI. In the pre-pandemic group, 68 (64.2%) were operated for a non-inflammatory pathology compared to 19 (35.8%) from the recovery phase cohort (p < 0.001). The waiting time to surgery was significantly higher amongst patients operated during the recovery phase (p = 0000.1). Less patients had complete cholecystectomy during the pandemic recovery phase (p = 0.04). There were no differences in intraoperative times and patient outcomes. These results demonstrate the impact of COVID-19 related delays to our cohort, however due to the retrospective nature of this study, the current results need to be backed up by higher evidence in order for strong recommendations to be made.

463. OESOPHAGEAL PERFORATIONS: CAUSES, MANAGEMENT, AND OUTCOMES AT A SPECIALIST UPPER GASTROINTESTINAL UNIT OVER A TEN-YEAR PERIOD

Abstract Perforation of the oesophagus is a relatively rare but life-threatening condition, which requires early laparoscopic or surgical intervention. The aim of this work was to describe the causes, management and outcomes of emergency patients treated at a single high volume upper gastrointestinal specialist unit in the United Kingdom. In this retrospective case series, we identified all patients who presented to a tertiary upper gastrointestinal surgery unit with a spontaneous or iatrogenic oesophageal perforation. Patient demographics, clinical management, and outcomes were identified by hand review of the medical notes. Between March 2011 to July 2020, 58 patients were identified. The median age was 71 years (interquartile range 52 years to 83 years) and 64% were male. A total of 83% of patients had benign perforations, the rest being malignant. Management of all patients was supportive in 41%, endoscopic in 19% and surgical in 40%. In total 63% of spontaneous benign perforations were managed surgically, and only 6% endoscopically. The median length of hospital stay for all patients that survived more than 90 days was 13 days. The 90-day mortality rate for all patients was 42%. Oesophageal perforations are a relatively rare but lethal disease, carrying a mortality. Whilst surgery has historically been the most common management of benign spontaneous perforations, endoscopic treatments are likely to become increasingly common in the future.

541. DO WE NEED ANOTHER QUESTIONNAIRE FOR GASTRO-ESOPHAGEAL REFLUX DISEASE? PRELIMINARY ANALYSIS OF A NEW QUESTIONNAIRE

Abstract Gastroesophageal reflux is a very frequent condition and different questionnaires to describe it have been proposed overtime. Nevertheless available questionnaires don’t allow to fully describe all different aspects of the disease. The aim of this study was to validate a new questionnaire (RoRex) on gastroesophageal reflux disease. The RoRex questionnaire was administered via web in two Italian centres, Rovereto and Verona, to patients attending specialized gastrointestinal surgical units, and to volunteers. Up to now, 54 patients and 50 volunteers participated in the study. Median age was 52 years (range 23-75 years) in patients and 47.5 years (range 25-80 years) in volunteers. Women were more prevalent than men in both groups (57% and 56% respectively). The RoRex questionnaire comprises 15 questions, where symptoms are scored on a frequency base: no, sometimes, several times per week, every day. Information on smoking habits, alcohol use, diet was also collected. The two groups largely differed as regards major symptoms. Regurgitation, heartburn, epigastric pain, retrosternal pain, laryngospasm were reported several times per week/every day in 50%, 39%, 30%, 22%, 23% of patients and 9%, 11%, 7%, 7%, 0% of volunteers. Preliminary analysis showed a different pattern in principal components between patients and volunteers. The 1st component, comprising heartburn and epigastric/retrosternal pain, was similar in both groups. The 2nd component comprised reclage, peevish cough, hoarseness in patients, and postnasal drip, hoarseness, dysphagia in volunteers. The 3rd component included regurgitation/laryngospasm in the former and peevish cough/belching in the latter. The new questionnaire, based on symptom frequency, allows to distinguish among major symptoms, i.e. heartburn/pain, upper airways irritation, and regurgitation in patients suffering from gastroesophageal reflux disease. These results, as well as the comparison of RoRex questionnaire with already validated ones and its usefulness as a screening tool in the general population, will be verified in larger samples.

CN45 The Gastrointestinal and Lymphoma Unit Advanced Nurse Practitioner role in clinical research at The Royal Marsden Hospital

The Advanced Nurse Practitioner (ANP) role is a new concept in all fields of nursing practice, dating back to 1990. The role of the ANP is invaluable, allowing patients to receive timely care and negates delays in treatment. In the UK, the role continues to develop in response to the changing healthcare needs of our population including an ageing society, increasing prevalence of chronic conditions, the advancement of new treatments, inefficient healthcare policies and the rising cost of healthcare.

Thermal grill illusion of pain in patients with chronic pain: a clinical marker of central sensitization?

The thermal grill illusion of pain (TGIP) is a paradoxical burning pain sensation elicited by the simultaneous application of innocuous cutaneous warm and cold stimuli with a thermode ("thermal grill") consisting of interlaced heated and cooled bars. Its neurophysiological mechanisms are unclear, but TGIP may have some mechanisms in common with pathological pain, including central sensitization in particular, through the involvement of N-methyl- d -aspartate receptors. However, few studies have investigated TGIP in patients with chronic pain and its clinical relevance is uncertain. We hypothesized that the TGIP would be increased in comparison with controls in patients with fibromyalgia or irritable bowel syndrome, which are regarded as typical "nociplastic" primary pain syndromes related to changes in central pain processing. We compared the sensations elicited by a large range of combinations of temperature differentials between the warm and cold bars of a thermal grill applied to the hand between patients with fibromyalgia (n = 30) or irritable bowel syndrome (n= 30) and controls (n = 30). The percentage of TGIP responses and the intensity and unpleasantness of TGIP were significantly greater in patients than controls. Furthermore, positive correlations were found between TGIP intensity and clinical pain intensity and between TGIP intensity and the cold pain threshold measured on the hand. These results are consistent with our working hypothesis of shared mechanisms between TGIP and clinical pain mechanisms in patients with nociplastic chronic pain syndromes and suggest that TGIP might represent a clinical marker of central sensitization in these patients.

Characterization of Exposure to Cleaning Agents Among Health Workers in Two Southern African Tertiary Hospitals.

Whilst cleaning agents are commonly used in workplaces and homes, health workers (HWs) are at increased risk of exposure to significantly higher concentrations used to prevent healthcare-associated infections. Exposure assessment has been challenging partly because many are used simultaneously resulting in complex airborne exposures with various chemicals requiring different sampling techniques. The main objective of this study was to characterize exposures of HWs to various cleaning agents in two tertiary academic hospitals in Southern Africa. A cross-sectional study of HWs was conducted in two tertiary hospitals in South Africa (SAH) and Tanzania (TAH). Exposure assessment involved systematic workplace observations, interviews with key personnel, passive personal environmental sampling for aldehydes (ortho-phthalaldehyde-OPA, glutaraldehyde and formaldehyde), and biomonitoring for chlorhexidine. Overall, 269 samples were collected from SAH, with 62 (23%) collected from HWs that used OPA on the day of monitoring. OPA was detectable in 6 (2%) of all samples analysed, all of which were collected in the gastrointestinal unit of the SAH. Overall, department, job title, individual HW use of OPA and duration of OPA use were the important predictors of OPA exposure. Formaldehyde was detectable in 103 (38%) samples (GM = 0.0025 ppm; range: &lt;0.0030 to 0.0270). Formaldehyde levels were below the ACGIH TLV-TWA (0.1 ppm). While individual HW use and duration of formaldehyde use were not associated with formaldehyde exposure, working in an ear, nose, and throat ward was positively associated with detectable exposures (P-value = 0.002). Glutaraldehyde was not detected in samples from the SAH. In the preliminary sampling conducted in the TAH, glutaraldehyde was detectable in 8 (73%) of the 11 samples collected (GM = 0.003 ppm; range: &lt;0.002 to 0.028). Glutaraldehyde levels were lower than the ACGIH's TLV-Ceiling Limit of 0.05 ppm. p-chloroaniline was detectable in 13 (4%) of the 336 urine samples (GM = 0.02 ng/ml range: &lt;1.00 to 25.80). The study concluded that detectable exposures to OPA were isolated to certain departments and were dependent on the dedicated use of OPA by the HW being monitored. In contrast, low-level formaldehyde exposures were present throughout the hospital. There is a need for more sensitive exposure assessment techniques for chlorhexidine given its widespread use in the health sector.

Prevalence and treatment of peptic ulcer at educational Al Hussein Hospital and review of antibiotics from global sources

Infection with Helicobacter pylori (H. pylori) is a prevalent global infection that is a leading cause of peptic ulcer disease and stomach cancer. Determine the prevalence of H. Pylori in the province of Thi-Qar from 2017 to 2018. Data was collected utilizing a periscope on the second floor of Educationa Al Hussein Hospital's Gastroenterology Unit for patients with gastrointestinal ulcers on the basis of age, gender, housing area, and month. A survey of the therapies utilized throughout the world was performed to get information on ulcer therapy. The current study found that the number of people infected with H. pylori in 2017 was higher than the number of people infected in 2018, in both sexes, with the overall number of people infected in 2017 being higher than the total number of people infected in 2018. (250). Females between the ages of 15 and 35, living in the countryside during the month of May, had a significant frequency of H. pylori with gastric ulcer. The treatment of stomach ulcers employed in the gastrointestinal unit of the patients was positive tests for H.pylori infection.

Laparoscopic one anastomosis gastric bypass: A revisional procedure for failed laparoscopic sleeve gastrectomy

AbstractBACKGROUNDThe indications for bariatric surgery revision are weight loss failure, complications or weight regain so laparoscopic one anastomosis gastric bypass (LOAGB) is a promising revisional bariatric procedure for failed laparoscopic sleeve gastrectomy (LSG).AIM OF STUDYThe aim was to evaluate LOAGB as a revisional bariatric procedure for failed LSG regarding weight loss, improvement in comorbidities and complications.PATIENTS AND METHODSThis prospective study was carried out at the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University, between Jan 2018 and June 2019. It included 40 patients who underwent LOAGB as a revisional bariatric procedure for failed LSG.RESULTSThe study population included 32 females and 8 males with a mean age of 28.20 ± 7.22 years. The mean preoperative body mass index (BMI) was 45.54 ± 5.24 kg/m2. The mean operative time was 80.59 ± 35.42 min and the mean postoperative hospital stay was 3.35 days. Neither conversion to open or to other bariatric procedures, nor mortality occurred. Revisional surgery was performed 45 ± 10.5 months after primary LSG Concomitant procedures were cholecystectomy in 4 patients (10%) and re‐sleeve for wide proximal pouch occurred in 15 patients (37.5%). Early complications were encountered in 4 patients (10%), intraluminal bleeding was recorded in 1 patient (2.5%). Late complications included 8 patients (20%). The mean postoperative excess body weight loss percent achieved was 45.23 ± 12.35 at 1 year, 58.85 ± 14.60 at 2 years. The mean BMI achieved was 34.52 ± 4.26 at 1 year, 29.37 ± 6.95 at 2 years.CONCLUSIONLaparoscopic one anastomosis gastric bypass is an easy, safe and effective revisional bariatric procedure for failed LSG producing satisfactory weight loss and improvement or resolution of comorbidities with low perioperative complications.

GARLAQs vs. Multiple Choice Questions: Do First‐Year Medical Students Perform Similarly on their Anatomy Examinations?

PURPOSEMedical students at the Case Western Reserve University School of Medicine are assessed on their knowledge of anatomy using an essay exam that tests clinically relevant anatomy/radiology concepts (Gross Anatomy, Radiology, and Living Anatomy Questions, or GARLAQ). GARLAQs are uniquely designed to facilitate student collaboration, as such these essay questions are given to students months prior to examination. This format has raised concerns about student memorization and a lack of in‐depth understanding of GARLAQ answers. The purpose of the present study is threefold: 1) to examine whether students perform similarly on GARLAQs and Multiple Choice Question (MCQ) examinations, 2) to assess whether students perform similarly to the GARLAQs on MCQs throughout the hierarchy of Bloom’s Taxonomy, 3) to collect qualitative data on student opinions of both assessment formats.METHODSFirst‐year medical students will be assessed during the gastrointestinal unit of their clinical anatomy curriculum. Volunteers will be recruited from a class of 184 students. A crossover study design will be employed, wherein participants will be randomly placed into one of two cohorts: 1) first complete the required GARLAQ exam, second the MCQ exam, or 2) first complete the MCQ exam, second the required GARLAQ exam. A paired t‐test will determine if there is a difference in overall examination performance for each respective student. Each MCQ will be categorized using Bloom’s Taxonomy. A paired t‐test will compare each student’s mean scores by Bloom’s category to their GARLAQ performance. Participants will also complete a post‐test survey in which they will be asked to rate their opinions about contrasting exam modalities on a 5‐point Likert scale.RESULTSData collection is currently ongoing and will be completed in February, 2022CONCLUSIONInformation gained through review of student assessment scores and responses can guide future curricular changes at our institution in a cycle of continuous improvement.

Setting up a surgical complex gallstone service in a non-HPB unit

Complex gallstone disease is associated with a higher risk of complication during laparoscopic cholecystectomy than biliary colic and simple cholecystitis. It is traditionally managed in a hepatopancreaticobiliary (HPB) unit where there is expertise for common bile duct exploration and repair. We developed a mentorship scheme for a busy upper gastro-intestinal (UGI) unit, with support from a specialist HPB unit to treat complex gallstone disease, to reduce the burden on the HPB unit and enable local treatment of patients. Through the creation of a service level agreement, the specialist HPB unit were commissioned to provide mentorship for two surgeons at a large UGI unit with an interest in providing a complex gallstone service to their local population. Eight sessions of mentored operating were supported, with the provision for additional support if complications occurred. There were 14 patients included in the mentorship phase of the programme from November 2015 to May 2017. Cholecystectomies were performed on patients with previously complex histories, which included: previous cholecystostomy; CBD stones and multiple ERCPs; suspected choledochoduodenal fistula; suspected cholecystoduodenal fistula; suspected Mirrizzi's syndrome; previous significant intra-abdominal operation; and significant medical co-morbidities. There was one post-operative complication requiring a return to theatre, and one minor wound infection associated with the complex gallstone lists. We demonstrated a method to reduce the burden on specialist HPB unit for the operative management of complex gallstone disease and safely implement such a service at large UGI unit with an interest in providing a complex gallstone service.

COVID-19 screening before gastrointestinal procedures

BackgroundIn March 2020, the World Health Organization declared coronavirus 2019 (COVID-19) a global pandemic. We aimed to assess the ability of COVID-19 screening to detect preprocedural infection at the gastrointestinal units. One hundred and three patients indicated for gastrointestinal tract interventional procedures were included. All patients surveyed for COVID-19-related symptoms and COVID-19 rapid IgM/IgG antibodies. Symptomatic and COVID-19 antibody-positive patients further tested for COVID-19 reverse transcriptase by polymerase chain reaction (RT-PCR). All patients contacted, 14 days after the procedure and asked about the possible development of COVID-19. All health care workers (HCWs) (n=18) were screened weekly for COVID-19-related symptoms.ResultsThe mean age was 46.11 ± 17.16 years of them 58.25% were males. 2.9% patients had COVID-19-related symptoms and 97.1% were asymptomatic. All symptomatic patients tested positive for COVID-19 IgM antibody and RT-PCR. Among asymptomatic patients 23% had positive COVID-19 antibodies, of them 56.5%patients had positive RT-PCR. One HCW developed COVID-19 during the study. None of the included patients developed new onset of COVID-19 infection, two weeks after the procedure.ConclusionCOVID-19 antibody test may be a reasonable preprocedural screening method for low-income countries and COVID-19 RT-PCR screening for symptomatic patients and those with positive COVID-19 antibody test.