P-OGC70 Chyle leak management and long-term survival post esophagectomy for oesophageal cancer

Background Chyle leak can be a serious complication following oesophagal cancer resection. The aim of this study is to determine the rate of chyle leak, its management and impact on short-term surgical outcomes and overall long-term survival. Methods Analysis of a prospectively maintained database of patients undergoing esophagectomy for oesophagal cancer between January 2011 and April 2019 were undertaken. Short term and survival comparisons were made between the chyle leak and non-chyle leak groups. Results A total of 190 patients underwent esophagectomy at our hospital over this time period, of whom 3.7% (n = 7/190) had a chyle leak. The length of stay was longer in the chyle leak group (27 days, IQR 13-55 vs 12 days, IQR 11-14 days, P=0.001), they had a higher rate of return to theatre (42.9% vs 8.8%, P = 0.003) and higher rate of overall mortality (57.1% vs 35.0%, p = 0.039) compared to the non-leak group. They also experienced worse survival ( 9.0 months, 95% CI 5.5-12.4 vs 66 months, 95% CI 59.6-73.6, P = 0.001). Conclusions Chyle leak can occur in approximately 1 in 25 patients and is associated with prolonged intensive therapy unit stay, higher risk of return to theatre as well as a lower overall cancer survival.

A Novel Approach to Risk Management of Belowground Natural Gas Migration From Leaks on Low-Pressure Pipelines

Small-diameter, low-pressure pipelines (operated at pressures below 40 percent of specified minimum yield strength [SMYS]) are unlikely to experience a rupture but may be vulnerable to leaks. In general, gas leaks result in less significant consequences to public safety than ruptures; however, under certain circumstances leaks may represent a significant threat. In particular, leaks resulting in belowground gas migration from low-pressure pipelines to a nearby confined space (e.g. the basement of a nearby structure to which the pipeline is not physically connected) may result in significant consequences as accumulation of gas to flammable or explosive levels may be possible. This paper explores the methods by which an Operator may address the threat of gas migration from leaks on low pressure pipelines in its risk assessment and leak management programs. Research was conducted into the specific conditions that contribute to belowground gas migration and included: a literature review of studies into gas migration phenomena, and a review of historical incidents within the United States on similar pipeline systems which resulted in significant property damage, injuries, or fatalities. The research included consideration of the effect of pipeline operating conditions, pipeline attributes (including diameter and depth of cover), leak duration, proximity of nearby structures, attributes of nearby structures (including presence of basements, slabs, and openings in the foundations), leak severity (e.g. pinhole, full separation), ground conditions (including soil permeability and presence of belowground features), and gas odorization. Key conditions impacting the potential for belowground gas migration are identified, and risk assessment methods and leak management practices are recommended based on the likelihood of migration. Based on the research conducted and the environmental conditions identified, a quantitative risk assessment approach, taking into account the likelihood of a leak on a low-pressure pipeline, the likelihood of belowground gas migration, and the potential consequences to public safety, is proposed.

Fifteen-Year Single-Center Experience of Biliary Complications in Liver Trauma Patients: Changes in the Management of Posttraumatic Bile Leak

Introduction Management of posttraumatic bile leak has evolved over time in our unit, from endoscopic retrograde cholangiopancreatography (ERCP) stenting to intraperitoneal drainage (IPD) alone as first-line treatment for intraperitoneal bile leak. Materials and Methods Retrospective review of liver trauma patients from 2002 to 2017. Demographics, time and mode of diagnosis of bile leak, management, and outcome were analyzed of the box plot. Results In 118 patients, there were 28 traumatic bile leaks. Eighteen were free intraperitoneal and 10 were localized bilomas. The median time of diagnosis was 6 days following injury. The modes of diagnosis were preemptive hepatobiliary scintigraphy (18), computed tomography (CT) or ultrasound (7), and laparotomy (3). Free intraperitoneal biliary leak management included 11 IPD alone, 3 IPD plus ERCP, 2 IPD plus transcystic biliary stent (TBS), 1 operative cholangiogram, and 1 no intervention. Median time of IPD duration was 7 days (4–95) in IPD alone versus 14 days (6–40) in IPD + ERCP/TBS (p = 0.3). Median inpatient length of stay was 13 days (8–44) in IPD alone versus 12 days (8–22) in IPD + ERCP/TBS (p = 0.4). Conclusion Placement of IPD alone, as first-line treatment, is safe and effective in the management of intraperitoneal bile leaks, avoiding the costs and potential complications of ERCP.