Oral (pre-recorded)
Biliary 		  
OB06 Biliary: Miscellaneous 
Selection of Presentations from Abstract Submissions
OB06-01 Impact of Iatrogenic Biliary Injury during Laparoscopic Cholecystectomy on Surgeon's Mental Distress: A Nationwide Survey from China
Tian Yang, China

H.-S. Dai1, L. Liang2, C.-C. Zhang1, Z.-J. Cheng3, Y.-H. Peng4, X.-P. Geng5, H.-J. Qing6, Y. Lau Wan7, T. Yang8
1Southwest Hospital, Third Military Medical University (Army Medical University), China, 2Eastern Hepatobiliary Surgery Hospital, China, 3Zhongda Hospital, School of Medicine, Southeast University, China, 4Mianyang Center Hospital, China, 5The First Affiliated Hospital of Anhui Medical University, China, 6Armed Police Crops Hospital of Sichuan Province, China, 7Chinese University of Hong Kong, Prince of Wales Hospital, China, 8Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, China

Background: Iatrogenic biliary injury (IBI) following laparoscopic cholecystectomy (LC) is the most common and recognized iatrogenic complications. Little is known whether LC-IBI would lead to surgeon's mental distress. This study reports the incidence of surgeon's mental distress who have caused LC-IBI and risk factors of surgeon's severe mental distress (SMD).
Methods: A cross-sectional survey in the form of electronic questionnaire was conducted among Chinese general surgeons who have caused LC-IBI. The six collected clinical features relating to mental distress included:
1) feeling burnout, anxiety, or depression,
2) avoiding performing LC,
3) having physical reactions when recalling the incidence,
4) having the urge to quit surgery,
5) taking psychiatric medications, and
6) seeking professional psychological counseling.
Univariable and multivariable analyses were performed to identify risk factors of SMD, which was defined as meeting ≥ 3 of the above-mentioned clinical features.
Results: Among 1,466 surveyed surgeons, 1,236(84.3%) experienced mental distress following LC-IBI, and nearly half (49.7%, 614/1236) had SMD. Multivariable analyses demonstrated that surgeons from non-university affiliated hospitals (OR:1.873), patients who required multiple repair operations (OR:4.075), patients who required hepaticojejunostomy/partial hepatectomy (OR:1.859), existing lawsuit litigation (OR:10.491), existing violent doctor-patient conflicts (OR:4.995), needing surgeons' personal compensation (OR:2.531), and additional administrative punishment by hospitals (OR:2.324) were independent risk factors of surgeon's SMD.
Conclusion: Four out of five surgeons experienced mental distress following LC-IBI, and nearly half had SMD. Several independent risk factors of SMD were identified, which could help to make strategies to improve mental well-being of these surgeons.
[Figure.Numbers of valid questionnaires from different districts in China.]
OB06-02 The Upper Gastrointestinal Cancer Registry: Biliary Cancer Clinical Quality Registry Pilot Results
Charles Henry Caldow Pilgrim, Australia

C.H.C. Pilgrim1,2, J.F. Holland1, T. Muhlen-Schulte1, M. Quinn1, J.R. Zalcberg1,2, UGICR Hepatopancreatobiliary Working Party and UGICR contributors
1Monash University, Australia, 2Alfred Health, Australia

Introduction: The Upper Gastrointestinal Cancer Registry (UGICR) is a multi-modular clinical quality registry established to measure and report on the quality of care provided to people with newly diagnosed cancer arising from the pancreas, oesophagus, stomach, liver and biliary system. The aim of the biliary module pilot was to trial data collection for a quality indicator (QI) set; analyse pilot data and use results to review and refine the QIs.
Methods: The UGICR's hepatopancreatobiliary (HPB) working party reviewed the existing literature and clinical practice guidelines, to develop a provisional set of QIs. Participants with hilar cholangiocarcinoma, intrahepatic cholangiocarcinoma or gallbladder cancer were recruited from Victorian UGICR participating sites. Pilot data were abstracted from medical records and preliminary data analysis conducted. Pilot data collection is due for completion mid-2020.
Results: A set of 19 QIs covering the patient care pathway from referral through to end-of-life care were developed. Data collection for over 150 participants recruited to the pilot is nearly complete. Mid-pilot results for three QIs show: 35% of patients had documented disease specific gold standard imaging prior to treatment; 74% of patients had disease management discussed at multi-disciplinary team meeting; and 92% of patients were referred to palliative care.
Conclusion: The UGICR biliary module pilot data will be used to inform the selection of a final set of QIs. Once sufficiently mature, risk-adjusted benchmarked QI reports will be provided to participating sites, with the intention of reducing unwarranted variation in the quality of care received by patients with biliary cancer.
OB06-04 What Are the Long-term Clinical and Economic Consequences of Delayed Biliary Strictures after Cholecystectomy?
James Halle-Smith, United Kingdom

J. Halle-Smith1, R. Marudanayagam2, R. Sutcliffe1, J. Isaac1, D. Mirza1, K. Roberts1
1HPB and Transplant Unit, Queen Elizabeth Hospital Birmingham, United Kingdom, 2Queen Elizabeth Hospital Birmingham, United Kingdom

Introduction: Delayed biliary stricture after cholecystectomy is a rare complication for which little is known of the aetiology or long-term clinical and economic consequences. The aims of this study were to investigate the risk factors, clinical outcomes and economic impact of this rare but serious complication.
Method: Patients who developed a delayed biliary stricture after cholecystectomy were identified from a prospectively collected and maintained database. Risk factors for stricture development, long-term biliary complication rates, quality of life and complete treatment and follow-up costs were investigated for each patient.
Results: Some 44 patients were identified, of whom N=17,12 and 3 developed hilar, subhilar, and sectoral biliary strictures respectively. Patients were commonly treated with Roux-en-Y hepaticojejunostomy (90%) and followed up for a median of 8.9 years (IQR5.8-14.8) during which time 16 (36%) developed biliary complications and 5 (11%) patients died. Costs of all operations, interventional radiology and diagnostic imaging were assimilated and the mean cost of treatment and follow-up was £14,309.26 per patient, similar to previously reported costs for major bile duct injury. Both general and disease-specific quality of life were assessed using the SF-36 tool and EORTC QLQ-C30 with Bil21 add-on. Scores were statistically similar for patients with delayed biliary stricture and those with bile duct injury.
Conclusions: Delayed biliary strictures may develop after uneventful cholecystectomy and are typically managed with biliary reconstruction. They are serious complications that lead to considerable long-term morbidity and costs to the health service, similar to those previously reported for major bile duct injury.