ObjectivesNasal obstruction is a common presentation in ENT practice, and yet decisions on its management are challenging, with high rates of patient and clinician dissatisfaction following surgery. The aim of the study was to investigate the practice of UK ENT clinicians in the subjective and objective evaluation of nasal patency. DesignVoluntary, written questionnaire. SettingBritish Academic Conference in Otolaryngology 2015, Liverpool, UK. Participants UK-based ENT professionals. Results UK based rhinologists were surveyed at the 2015 British Academic Conference inOtorhinolaryngology (BACO) from a cohort of 250 delegates attending two symposia on rhinology with a response rate of 78/250. Clinical history and examination were found to be almost universally used in the evaluation of nasal blockage. The most commonly used clinical test was the nasal misting pattern demonstration on a metal spatula (73%), followed by the peak nasal inspiratory flow rate (19%). The most commonly used subjective measure was the sinonasal outcome test (SNOT-22/23), with a 29% uptake.63% of the responders reported that non-availability of suitable equipment was the main reason for not using objective measures, followed by time consumption, and the lack of correlation with subjective symptom scores. ConclusionsOur study demonstrated that British clinicians rely largely on clinical skills to evaluate nasal blockage. There is a desire for a simple, practical, non-invasive device which a) objectively measures airflow during physiological resting nasal breathing, b) correlates with subjective symptom scores, and c) is capable of simultaneous measurement of each nostril.

Background The four-port laparoscopic technique is the standard approach for cholecystectomy. A three-port technique has been described, but there is no consensus over the outcomes and efficacy of this approach. The aim was to perform a systematic review and meta-analysis to compare the three- and four-port techniques in laparoscopic cholecystectomy for benign diseases of the gallbladder. Methods The review was conducted according to a predefined protocol registered on PROSPERO. Two authors independently conducted an electronic database search of CENTRAL, MEDLINE, Embase, CINAHL, WHO International Clinical Trials Registry, and ClinicalTrials.gov. Outcomes are reported as risk ratios (RR), mean difference (m.d.), or standardized mean difference (s.m.d.) with 95 per cent confidence intervals. Results Eighteen trials were included with 2085 patients. Length of hospital stay and postoperative analgesia requirement favoured the three-port group (m.d. −0.29, 95 per cent c.i. −0.43 to −0.16 (P < 0.001); and s.m.d. −0.68, 95 per cent c.i. −1.03 to −0.33 (P < 0.001), respectively). There were no differences in length of procedure or success rate between the two groups (m.d. 0.90, 95 per cent c.i. −3.78 to 5.58 (P = 0.71) and RR 0.99, 95 per cent c.i. 0.97 to 1.01 (P = 0.17), respectively). There were no differences in adverse events. The overall quality of evidence was low. Conclusion The three-port technique for laparoscopic cholecystectomy is an option for appropriately trained surgeons who perform it regularly. However, the decision to use three ports should not be at the expense of safe dissection of Calot’s triangle.

Many patients are dissatisfied with current assessment techniques; a novel device with visual or numerical results may help. Obstruction duration determines willingness to undergo longer assessment.

Background The four-port technique is currently considered the gold standard technique for laparoscopic cholecystectomy. A three-port technique has been described but there is no consensus over the safety profile and efficacy of this technique compared to the four-port technique.  Methods A comprehensive systematic review and meta-analysis comparing the three-port technique to the standard four-port technique in laparoscopic cholecystectomy for benign diseases of the gallbladder was performed. Two authors independently conducted an electronic database search of CENTRAL, MEDLINE, EMBASE, CINAHL, WHO ICTRP and ClinicalTrials.gov. For each outcome, we calculated the risk ratio (RR), mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals.  Results Eighteen trials were included which randomised 2085 participants. Length of hospital stay and postoperative analgesia requirement favoured the three-port group [(MD -0.29, 95% CI -0.43 – -0.16, p < 0.0001) and (SMD -0.68, 95% CI -1.03 – -0.33, p = 0.0001) respectively]. There were no differences in length of procedure and success rate between the two groups [(MD 0.90, 95% CI -3.78 – 5.58, p = 0.71) and (RR 0.99, 95% CI 0.97 – 1.01, p = 0.17) respectively]. There were no differences in the rate of any measured adverse events. There were no mortalities in either group. The GRADE quality of evidence was low. Conclusions The three-port technique for laparoscopic cholecystectomy can be chosen by experienced surgeons who perform it regularly. However, the decision to use three ports should not be at the expense of safe dissection.

Introduction Acute pancreatitis (AP) is a potentially life-threatening condition. The audit looks at its management and compares it versus the British Society of Gastroenterology guidelines. Method The study retrospectively assessed plans and results for patients with AP over 4 months. Targets were mortality rate below 10% (<30% for severe cases), correct diagnosis at 48h from admission, ultrasound examination of the gallbladder within 24h of diagnosis, severity stratification within 48h of diagnosis, cause established in over 80%, management involving intensive care settings for severe cases and definitive treatment of gallstone pancreatitis in less than 14 days. Results 34 patients were identified, 3(8.6%) had severe acute pancreatitis (SAP). Mortality was 2.9% overall (33.3% in SAP). AP was diagnosed within 48h of presentation in all cases with severity stratification undertaken in 91.2%. Determination of aetiology was achieved in 82.4% with the rest documented as unknown/idiopathic/requiring further investigations post-discharge. Ultrasound studies were undertaken in 58.8% of cases but, as the hospital did not offer ultrasonography on the weekend, 41.2% actually had this type of imaging performed within 24h. Within those who did not have ultrasound at 24h, 50% had had computer tomography imaging. All SAP cases were discussed with intensivists and 7.1% of gallstone pancreatitis underwent definite treatment within 2 weeks. Conclusions Current practice in the hospital mostly meets the reference standards. However, the percentage undergoing definitive treatment of gallstone pancreatitis is low. We aim to re-audit in 4 months following meetings with local surgical leads to discuss implementation of a suitable pathway.