bluuebunny/crossref_metadata_2025 huggingface dataset:
BS SO16 - How to improved quality of life and prevented long term vomiting after laparoscopic sleeve gastrectomy(Vertical and Buttress technique)
Authors: Likidkarnchanakornkij Thanakorn
Published: November 2024

Background

The clinical nausea/vomiting and clinical GERD are most common symptom after laparoscopic sleeve gastrectomy for treatment the morbid obesity patients and impaired to quality of life. We observed the other technique, laparoscopic vertical sleeve gastrectomy, is less in clinical nausea/vomiting and quality of life is better tan classical laparoscopic sleeve gastrectomy.

Method

This retrospective cohort study includes patients morbid obesity who underwent laparoscopic vertical sleeve gastrectomy(50 patients) at King Taksin Memorial Hospital(between January 1st 2023- January 1st 2024, mean and average follow up 7 months).

Results

The morbid obesity patients who underwent laparoscopic vertical sleeve gastrectomy was female 76%, average age 38.60 +/-9.67 years old, body weight 119.35+/-24.65 kg and BMI 44.48+/-7.0 kg/m2.

There was no clinical vomiting and only 13.33 % had clinical GERD symptom(GERDQ score). The average % total weight loss was 23.66+/-10.24 kg, total weight loss was 29.95+/-16.66 kg within 1 year(comparable to other standard technique). There were no perioperative complications, no reoperation and no readmission with improved comorbidity. The total score gastrointestinal quality of life was 81.94%.

Conclusion

The laparoscopic vertical sleeve gastrectomy had % total weight loss comparable to other standard technique. There was 0% of the patient had clinical vomiting and only 13.33% of the patient had clinical GERD symptom. There were no intraoperative or postoperative complication, reoperation, readmission and improved comorbidity. In this study, laparoscopic vertical sleeve gastrectomy is less in clinical vomiting and GERD symptom and improve the gastrointestinal quality of life. However, the data comparison between laparoscopic vertical sleeve gastrectomy with laparoscopic classical sleeve gastrectomy in nausea/vomiting, gastrointestinal quality of life with long term outcomes and randomized controlled studies are still needed.
EGS SO19 - Outcome Analysis of Laparotomies in the Elderly Population in Devon: A Retrospective Cohort Study
Authors: Hale Emily , Davis Heather , Bowling Kirk
Published: November 2024

Background

Emergency laparotomy is understood to be high risk in the elderly, but there is limited long term outcome data. This study assesses long term outcomes in the elderly including: survival and functional outcomes.

Method

Patients, aged 80 and above, were identified from the prospective National Emergency Laparotomy Audit (NELA) database, who underwent surgery between: January 2020 and August 2023 at Torbay Hospital. Surviving patients were followed up. 132 cases were undertaken. Mean age was 85 years. Most common ASA was 3. Preoperative clinical frailty score was 6, and 89% were living at home without care.

Results

50% of patients were admitted to intensive care. 17% were readmitted within 30 days of discharge. The most common reason for was fall.

20% of patients did not survive to discharge. 38% did not survive to August 2023.

46% of patients returned home independently; 5% had care at home; 26% were discharged to community hospital and 2% to care home.

By January 2024 61% of survivors were living independently with no functional decline. Most commonly, patients needed support with bathing/stairs/dressing (37%). 11% of respondents were completely dependent.

Conclusion

Emergency laparotomy confers a significant mortality, morbidity and risk to an elderly patient’s long term functional status. We believe this information is essential for surgical decision making and the consent process.
EGS SO25 - Ingestion of Sharp Foreign Bodies- Emerging Trends in a Large UK NHS Trust
Authors: Bibi Ayesha , Khan Yasmeen , Hameedullah Atiya , Jayakrishnan Anushka , Malik Ulya , Tucker Olga , Nijjar Rajwinder , Hossain Tanvir
Published: November 2024

Background

Foreign body (FB) ingestion is a common medical problem. The type of object ingested depends on age, sex, socio-economic factors, geographical area, and nutritional habits. Accidental ingestion of hijab pins as a phenomenon has not been widely reported in the UK previously.

Method

Retrospective cohort study on all patients presenting with foreign body ingestion from July 2010 to January 2024. Patient medical records were reviewed, and data collected including mode of presentation, demographics, FB type and mode of ingestion (accidental/deliberate), admission details, radiology, management (conservative, endoscopic, surgery), morbidity and mortality and readmission rate. Data was recorded and analyzed using Microsoft Excel.

Results

94 patients presented with FB ingestion of whom 39 ingested hijab pins. Median age was 19 (11-50) years. Median time from ingestion to presentation was 5 hours (0.5-120). All patients had abdominal Xray. The most common hijab pin location on presentation was in the stomach; n=27 (69%). Data on management was available in 38 patients, of whom 29 (76%) were managed conservatively, 6 (15%) had endoscopy and 3 (8%) had flexible nasal endoscopy (FNE). The reintervention rate was 3% with one patient managed conservatively subsequently having endoscopy. No complications, readmissions or mortality was observed. One OGD was therapeutic

Conclusion

We report increase in the incidence of FB ingestion with a significant proportion involving hijab pins. Young girls hold pins between their lips while styling their hijabs which can result in accidental ingestion. Although we report low morbidity and readmission rates, there is a 22% intervention rate. We believe there may be a causal link between increased accidental ingestion and popularity of social media content on elaborate hijab styling, some with millions of views each. There is a need to increase awareness on dangers of holding pins in the mouth whilst styling hijabs and alternate options such as hijab magnets
EGS SO29 - Therapeutic Endoluminal Vacuum Therapy (EVT) as first line management for oesophageal and selected gastric and duodenal perforations
Authors: Ribbits Alexander , Saqib Imad-Ud-Din , Abdelrahman Mohamed , Afzal Zeeshan , Amin Irum , Bennett John , Butler Andrew , Gourgiotis Stavros , Hardwick Richard , O’Neill Robert , Safranek Peter , Sujendran Vijayendran , Noorani Ayesha , Hindmarsh Andrew
Published: November 2024

Background

Upper gastro-intestinal (GI) perforations and leaks affect roughly 2,800 patients annually in the UK. They can occur spontaneously, as a complication of medical intervention, or be due to trauma. Mortality rates are around 20%, rising to 50% if diagnosis and treatment is delayed. Around a third of cases fall into the delayed category. Traditionally, management of this group of patients involved surgery with long hospital stays and poor outcomes. Our Unit has adopted EVT as first line management for these cases, using an ad-hoc Endoluminal Vacuum Device (EVD), which has significantly improved patient outcomes compared to traditional treatment strategies.

Method

The primary aim of this study was to assess the successful perforation/ leak healing rate, the overall mortality rate, and the complication rate of EVT. A retrospective analysis of a prospectively collated database for all patients who received EVT between May 2011 to November 2023 was performed. Patients who had oesophageal, gastric or duodenal perforations were included. The ad-hoc EVD was constructed using an open pore sponge (granufoam, KCI) sutured to the end of a nasogastric (NG) tube. This was inserted endoscopically into the site of perforation and with negative pressure (125mmHg) applied using a negative pressure vacuum pump.

Results

104 patients received EVT, with a median age of 65years (range 23-92years), and median ASA of 3 (range 1-5) at presentation. Eighty-five cases were oesophageal, 15 gastric and 4 duodenal. Post-operative leaks accounted for 42 cases, 26 were iatrogenic, 30 spontaneous, and 6 traumatic. Leak resolution was achieved in 94 patients (90.4%). Twelve (11.5%) patients died; 7 (6.7%) deaths were due to treatment failure. Seven (6.7%) patients had a significant bleeding event during EVT of which 4 (3.8%) were directly related to the leak because of undrained sepsis. One patient had an oesophageal mucosal injury during EVD removal.

Conclusion

EVT is a safe and effective treatment for upper GI tract leaks regardless of their cause. It achieves a significant reduction in mortality compared to traditional treatments, especially in patients with delayed presentation. Adequate drainage of surrounding sepsis is essential to ensure therapy success and avoid bleeding complications. Given the improvement in patient outcomes that EVT delivers, it should be considered for first line management in patients with delayed diagnosis and presentation of oesophageal perforation, following anastomotic leak after resectional surgery, as well as in select patients with gastric and duodenal perforations.
EGS SO30 - Management of Iatrogenic Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study
Authors: Baili Efstratia , Ibrahim Ahmed , Alasmar Mohammad , Farooq Naheed , Powell Arfon , Alkhaffaf Bilal
Published: November 2024

Background

Iatrogenic oesophageal perforation (IOP) following diagnostic and therapeutic interventions at the oesophagus or adjacent organs are responsible for nearly half of oesophageal perforations. If not recognised within 24 hours of injury, then they are associated with devastating morbidity and mortality. Available treatment options encompass non-operative for early perforation without sepsis, endoscopic with endoclip/stent and surgical including primary repair, exclusion and diversion or oesophagectomy. Recently, Endoscopic Vacuum Therapy (EVT) has been introduced as safe and effective alternative approach. We sought to assess treatment outcomes in patients with IOPs prior to and during periods where EVT was available as treatment option.

Method

A single-centre retrospective cohort study incorporating all consecutive patients (N=30) presented or transferred to our tertiary oesophagogastric unit for IOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or spontaneous perforation secondary to malignancy or benign pathology were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day and 1-year mortality.

Results

In 2009-2017 pre-EVT period, 11/30 patients were managed a) non-surgically 7/11, b) endoclip 3/11 and stenting 1/11. 30-day and 90-day mortality were 1/11, 90-day morbidity Clavien-Dindo >IIIa 3/11 (27.3%), 90-day reintervention 8/11 (72.7%), median LOS 27 days. In 2018-2023 EVT period, 19/30 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 5/19, b) non-surgical 7/19, c) IR NJT, stent or PEG in 6/19 d) EVT in 4/19. 30-day mortality was 0/19, 90-day mortality 1/19 (5.2%), 90-day morbidity Clavien-Dindo >IIIa 7/19 (36.8%), 90-day reintervention 9/19 (47.4%), median LOS 61 days. 1-year mortality was 0/19 for both.

Conclusion

EVT therapy appears to be a feasible additional treatment modality in the management of iatrogenic oesophageal perforations. Careful patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is a sine qua non.
EGS SO33 - Management Strategies and Outcomes of Non-Malignant Oesophageal Perforation at a Tertiary Care Hospital
Authors: Bhatti Khalid , Laulloo Sufia , Subramaniam Sheena , Lilley Jaiesh , Ward Jeremy , Pursnani Kish , Turner Paul , Sarantitis Ioannis , Nandi Sumit , Ball Christopher , Shetty Vinutha Daya
Published: November 2024

Background

Oesophageal perforation is a life-threatening emergency that requires prompt and effective management. This study aims to evaluate the outcomes of different management strategies—conservative, surgical, and endoscopic washout with stent insertion—for non-malignant oesophageal perforations at a specialist Upper GI unit in a tertiary care hospital.

Method

This is a retrospective study conducted over a 10-year period from 2012 at a specialist Upper GI Unit in a tertiary care hospital. All patients aged 18 and above who were referred to or admitted with oesophageal perforation were included, with exclusion of those with underlying oesophageal cancer. Data were collected from hospital records. Variables studied included age, gender, Charlson Comorbidity Index (CCI), WHO performance status, site and size of oesophageal perforation, treatment modality (Conservative, Surgery, or Stent), type and size of stent used, length of hospital stay, and mortality. Data analysis was performed using SPSS v.25.

Results

Over 10 years, 72 cases of non-malignant oesophageal perforation were managed (M:F, 37:35, median age 62.5 years (range 20-86), median CCI 3). The causes of perforation were spontaneous (n=45, 62.5%), iatrogenic (n=22,30.6%), foreign body (n=4,5.6%), and post-corrosive intake (n=1,1.4%). Most perforations occurred in the distal oesophagus (n=52, 72.2%) with an average size of perforation of 3 ± 1.38cm. Management included surgery (n=43,59.7%), conservative treatment (n=22,30.6%), and stent insertion (n=7,9.7%). Overall, in-hospital mortality was 20.8% (n=15). Survival rates varied: 90.9% for conservative treatment, 79.1% for surgical management, and 57.1% for stenting; however, the differences were not statistically significant (p=0.134).

Conclusion

Oesophageal perforation is a life-threatening condition. This 10-year observational study assessing conservative, surgical, and stent treatments for non-malignant perforations confirms that survival rates varied among the different treatment groups. However, there was no statistically significant survival advantage observed. This underscores the importance of developing individualized management plans based on patient factors to improve outcomes.
OGC SO02 - Analysis of routine upper gastrointestinal endoscopy referrals and outcomes in a single tertiary service
Authors: Lawton Aimee , McElvaney Joseph , Glen Paul
Published: November 2024

Background

Routine (category 3/4) upper gastrointestinal endoscopies (UGIE) constitute a significant proportion of endoscopy workload in the National Health Service. Referrals are varied and there are opportunities for service improvement to reduce clinician burden and improve patient outcomes. This is of particular relevance to the early detection and prevention of cancer.

This work aimed to analyse routine UGIE referrals and subsequent endoscopies in a large tertiary service to identify quality improvement opportunities within the health board.

Method

Referral indications for all males over 50 years awaiting routine UGIE in the health board on 02/03/2023 were reviewed. Referrals were categorised into 7 groups based on primary presentation and indication for UGIE; “Liver/variceal”, “Gastric”, “Oesophageal”, “Anaemia”, “Dysphagia”, “Tissue transglutaminase (TTG) positive” or “Other”. Data on findings, biopsy, and follow-up were gathered where UGIE was subsequently performed. To analyse routine cases only, patients referred for anaemia or dysphagia were excluded from final analysis.

Results

471 records were reviewed and 332 patients included in final analysis; 210 had undergone UGIE at assessment point (3 records unavailable), with 99 waiting and 23 died/did not attend/declined. The most common referral indications were “Gastric” (41.6%), “Liver” (29.2%), and “Oesophageal” (21.4%) (n=207). 84 were excluded due to anaemia/dysphagia.

At UGIE, 6.3% identified Barrett's oesophagus/malignancy across all groups with 1 case of new malignancy. 80.2% received medical/conservative management following their scope.

Conclusion

While pathology was identified at routine UGIE, a large number of procedures were required to identify this and there was no Barrett's oesophagus rich group. We have identified opportunities for improvement in the delivery of routine UGIE service in the health board which may reflect nationally. These include altered vetting practices and potential UGIE-saving procedures including cytosponge.
OGC SO10 - Modification of the Complications Parameter for ‘Textbook Outcome’ in Oesophageal Cancer Surgery
Authors: Vardon Henry , Brown Leo , McGregor Richard
Published: November 2024

Background

Surgical resection is cornerstone of curative treatment for most patients with oesophageal cancer. ‘Textbook outcome’ (TBO), a composite outcome measure, was proposed to benchmark quality of care for patients undergoing oesophagogastric cancer surgery. One required parameter for TBO is the absence of ‘severe’ complications (defined as Clavien-Dindo (CD) grade ≥2). In recent years there has been debate regarding whether a CD grade 2 complication should be considered a significant deviation from the desired post-operative course. This study aimed to assess whether revised a TBO parameter of CD≥3 is associated with improved overall survival in patients undergoing oesophagectomy for cancer.

Method

Data were collected for consecutive patients who underwent oesophagectomy for cancer at a single tertiary centre in the United Kingdom, between January 2018 and February 2020. Patients were identified from a prospectively maintained regional database with additional datapoints sought from electronic patient records. These included baseline clinicopathological characteristics, treatment details and the previously defined postoperative outcomes required for assessment of TBO. The primary outcome of interest was overall survival.

Results

Ninety-one patients (68.1% male, median 67 years (IQR: 59-72)) underwent oesophagectomy. Most had clinical stage III (61.5%) or IVA disease (28.6%) and underwent neoadjuvant chemotherapy (82.4%). When classified using the CD≥2 parameter, 15.4% achieved TBO compared with 41.8% when using CD≥3. Improved overall survival was observed in patients with a TBO using CD≥3 complication parameter (p=0.033). Survival was comparable between TBO and non-TBO group with the CD≥2 cut-off (p=0.550). TBO using CD≥3 remained associated with better survival, following adjustment for confounding variables, (HR:0.50 (95%CI:0.26-0.97), p=0.042)) while TBO using CD≥2 was not (HR:0.81 (95%CI:0.33-2.00, p=0.648)).

Conclusion

This study demonstrates that an association between TBO and overall survival in our patient population was only evident when the parameter requiring no ‘severe complication’ was re-defined as CD≥3. Consideration of TBO for specialist units may be useful for benchmarking quality and for prognostication.
OGC SO16 - International upper GI robotic fellowship on the CMR Versius platform
Authors: De Rosa Antonella , Alqudah Abdallah , Mitchell Benjamin , Lasheen Omar , Cotton Arthur , Dwerryhouse Simon , Upchurch Emma , Hornby Steve , Vipond Mark , Higgs Simon
Published: November 2024

Background

The impetus for UGI surgery trainees to attain skills in robotic surgery is likely to increase following the global acceptance and utilisation of robotic platforms. UGI robotic fellowship programs are few in number and highly desirable providing trainees with a unique selling point when embarking on independent consultant practice. We describe the first UGI robotic surgery fellowship on the CMR Versius platform at the Gloucestershire Royal Hospital which has the largest experience of UGI robotic surgery on the CMR Versius platform in the UK, having performed over 200 cases including the first robot assisted minimally invasive oesophagectomy.

Method

A structured robotic training curriculum was created in collaboration with CMR Versius. It consists of a pre-clinical phase of E-learning (10 modules), simulator training (16 assessed tasks) and dry-laboratory training (a two-day course encompassing robotic system set-up, bed-side assist and assessed dry lab practical tasks). The clinical phase begins with bed-side assisting of robotic cases followed by supervised operating on the console. Operations performed on the console are recorded for review and evaluation. The videos will be scored by two independent surgeons using the modified Global Evaluation Assessment of Robotic Skills (mGEARS) score to track growth and progress.

Results

The E-learning modules and assessments were completed prior to commencement of the fellowship. The remainder of the pre-clinical phase of the curriculum were completed within 4 weeks of commencement followed by bed-side assisting. Once competent at bed-side assisting and able to demonstrate proficiency in set-up (selecting port site placement, docking, arm spacing and configuration), supervised console training was commenced 6 weeks into the fellowship. Console training began with robotic assisted laparoscopic assisted cholecystectomy to gain familiarity, confidence, and efficiency. After 6 cases as the only console surgeon, the surgical complexity of cases was progressed to hiatal surgery and Heller’s cardiomyotomy

Conclusion

A structured training curriculum with defined phases provides a feasible and effective framework for robotic fellowship training. Adherence to the pre-clinical phase of training allows safe and efficient progression to hands-on console experience. This is achievable within relatively short timeframe to allow for ample independent console surgeon experience and the development of proficiency within a 12-month fellowship period.
OGC SO19 - Management and outcomes for Barrett’s oesophagus with dysplasia in a tertiary centre
Authors: Longbotham David , Kane Jack , Khiyar Yassir , Mitton David , Jain Prashant
Published: November 2024

Background

Barrett’s oesophagus is a premalignant condition. Development of high-grade dysplasia (HGD) formerly was an indication for oesophagectomy, but endoscopic treatment (ET) is now recommended as first-line therapy: radiofrequency ablation (RFA) or endoscopic mucosal resection (EMR). Oesophagectomy is only considered for cases where ET was unsuccessful.

Previous review of our institution’s outcomes between 2014 and 2017 showed a 54% complete EMR excision rate and 20% salvage oesophagectomy (n=25). Since then, RFA has been utilised in our institution. We aimed to review our recent data to assess current outcomes.

Method

Retrospective analysis was performed of patients identified via registration at the Hull University Hospital Trust oesophagogastric MDT between March 2017 and December 2023. Inclusion criteria was confirmed histology of HGD on 2 occasions by 2 specialist pathologists, 6 weeks apart. EMR was performed for focal oesophageal lesions and non-nodular segments were treated by RFA. Patients were included once they had at least one surveillance endoscopy and 6 months had passed following treatment.

Patients who were either unfit for ET and managed medically (n=6), and those who were subsequently proven to have more advanced disease and treated surgically (n=4) were excluded.

Results

35 patients were identified: 20 underwent EMR, 15 RFA.

55% of EMR patients had successful excision, 9 required additional RFA for residual low-grade dysplasia (LGD). 66% RFA patients had successful ablation. 3 patients required further EMR for residual LGD. Overall 82% had successful ET with no HGD on surveillance. 5 patients had persistent HGD and 1 T1b disease: 4 underwent oesophagectomy, 2 managed oncologically.

Barrett’s tended towards being longer in patients where ET failed to eradicate HGD (median 6cm vs 3cm MWU p=0.07).

No patient in the series died because of disease-related pathology. 1 patient developed stricture post-RFA requiring dilatation.

Conclusion

ET for HGD is effective with a high rate of successful treatment. It can be used as a single or dual modality. Salvage oesophagectomy rates are lower than previously reported (8% vs 20%) and complications are low (3% stricture rate). Longer segment Barrett’s may be less likely be responsive to ET, although not reaching significance in our series. ET should continue to be offered as the first-line treatment for oesophageal HGD.
OGC SO22 - Accuracy of CT and FDG/PET clinical staging within a dedicated multidisciplinary service for patients with oesophago-gastric cancer
Authors: North Samuel , Tokhi Ashraf , Reid Eleanor , Clarke Simone , Vohra Ravinder , Parsons Simon
Published: November 2024

Background

Accurate staging for oesophago-gastric cancer is important in ensuring correct treatment pathways, avoiding unnecessary surgery and providing prognostication for patients. Previously, cross sectional imaging in accurately providing tumour (T) and nodal (N) staging has been variable for upper GI malignancies, with usage of invasive investigations such as EUS to provide more specific local staging. With the increased utilisation of specialist multidisciplinary involvement and improved technology, we aimed to assess whether CT and PET imaging may be able to provide sufficiently accurate staging required for treatment decision making.

Method

All patients who underwent oesoophagogastric resections between January 2022 and March 2024 were identified from our surgical database. Patients were included if they had oesophago-gastric cancer, and underwent curative resection without neo-adjuvant treatment. Data collected included age, gender, location of primary tumour, CT/PET staging, and final histology. Outcomes assessed included rate of understaging in clinical and pathological T and N staging, and sensitivity and specificity of imaging in identifying presence of nodal disease.

Results

38 patients were included in this analysis. For oesophageal and GOJ cancers, T stage under-reporting occurred in 6/27 (22%) patients, and N under-reporting in 7/27 (27%) patients. Radiological staging correlated with final pathological staging in 55% of T staging and 59% of N staging. Sensitivity (55.56%, 95% CI 21-86%) and specificity (72.2%, 95% CI 46.5-90.3%) for nodal disease on CT/PET was low, however no tumour or nodal under-staging would have impacted management.

Gastric cancer staging accuracy assessment was limited by small numbers (n=12), however T under-staging occurred in 5/12 (42%) patients and N under-staging occurred in 5/11 patients (45%).

Conclusion

Involvement of dedicated radiology services in multidisciplinary care for oesophago-gastric cancer provides adequate radiological staging to guide treatment. Gastric cancer clinical staging requires laparoscopic and endoscopic assessment for accurate tumour assessment and management guidance. Radiological under-staging is less common in oesophageal and GOJ tumours than gastric cancer and has minimal impact on patient management.
OGC SO41 - Omentopexy Technique in Robotic Assisted Minimally Invasive Oesophagectomy
Authors: Mitchell Benjamin , Morman-Dodd Jessie , De Rosa Antonella , Alqudah Abdallah , Lasheen Omar , Cotton Arthur , Dwerryhouse Simon , Upchurch Emma , Vipond Mark , Higgs Simon , Hornby Steve
Published: November 2024

Background

Laparoscopic omentopexy has been shown to reduce the rates of post-oesophagectomy diaphragmatic hernia (PODH) in a retrospective cohort study in a UK specialist centre. We aimed to demonstrate the technique during robotic-assisted minimally invasive oesophagectomy (RAMIE) with video capture.

Method

The Versius (CMR Surgical) robotic system was used in the abdominal stage of RAMIE performed on a 63 year old male with a poorly differentiated oesophageal adenocarcinoma. No previous abdominal surgery had been performed on this patient. Video capture was used to record this part of the procedure.

Results

Ports were inserted in standard configuration to allow fashioning of a gastric conduit. Following this the greater omentum was secured to the anterior abdominal wall around the jejunostomy site. No immediate complications were observed.

Conclusion

The Versius system can be used to successfully perform omentopexy with standard port positioning. Omentopexy was successfully performed with no immediate complications, did not significantly prolong procedural time and may reduce risk of PODH. The authors support the use of this technique in robotic-assisted surgery for reducing risk of PODH and support further work to validate this technique in cohort studies.
OGC SO43 - Management of oesophageal adenocarcinoma in the Covid-19 Pandemic – What have we learnt?
Authors: Goh Yan Mei , Claridge Abigail , Gillies Richard
Published: November 2024

Background

The management of oesophageal adenocarcinoma in the UK has been standardised to neoadjuvant chemotherapy followed by surgery. However, during the early phase of the Covid-19 pandemic, oesophagectomy was considered to be too high risk, and alternative treatment options were explored . In our unit, patients were offered definitive chemoradiotherapy with a view to performing salvage oesophagectomy if there was residual disease or disease recurrence.

Method

We retrospectively screened all patients referred to the UGI MDT between March 2020 to February 2021. Patients included were those with first diagnosis of oesophageal carcinoma, on the curative pathway, planned neoadjuvant FLOT chemotherapy and oesophagectomy then converted to definitive CRT (dCRT). Data collected were patient demographics, cancer staging and cancer outcomes including progression to salvage surgery, disease free survival and overall survival at 1 year and 3 years post treatment.

Results

Ten patients with distal or junctional adenocarcinoma were included. Median age at diagnosis was 70.5 years. Five patients had T3 or T4 disease. All patients had N0 disease. After one year, one patient had undergone salvage surgery for residual disease and two for recurrent disease. One other patient was unfit for surgery and not offered salvage surgery. At three years, only two patients had no disease recurrence. Nine of 10 patients were alive at one year and seven alive at three years.

Conclusion

The Covid-19 pandemic was an unusual event in our most recent history that influenced the way we managed patients with oesophageal adenocarcinoma. Little data exists as to what alternative treatments were effective. Our limited data indicates that dCRT may be used as an alternative to surgery in a subgroup of patients – although disease recurrence was common, 3-year survival was high (70%). Our data appears to be comparable to 3-year survival in our own unit and that reported in NOCGA 2024 (63%). Nevertheless, these numbers are small and thus require further study.
OGC SO46 - Improving outcomes after oesophagectomy: The benefits of full robotic-assisted minimally invasive oesophagectomy (RAMIO) demonstrated in the first 100 cases, at a high-volume UK unit
Authors: Rayner Charles , Paine Heidi , Mahmood Fahad , Luangsomboon Aphiwat , Mcguire Anna , Walker Robert , Madhavan Anantha , Singh Pritam , Abbassi-Ghadi Nima , Preston Shaun
Published: November 2024

Background

There is a rapid movement towards adoption of robotically assisted minimally invasive oesophagectomy (RAMIO) in the United Kingdom. Transition from an open or laparoscopic oesophagectomy to a RAMIO programme, which carries considerable financial and training cost, must ensure parity of oncological and perioperative outcomes. We sought to compare our centre’s results of the three standard approaches to two-phase oesophagectomy: Open/Open (Open); laparoscopic/robotic abdomen with open chest (Hybrid); and RAMIO.

Method

This prospective cohort study investigated the experience of five surgeons in a single high-volume UK institution. We analysed consecutive patients undergoing two-phase transthoracic oesophagectomy for oncological reasons between 2018 and 2024. The study period was divided into three cohorts: Open (2018-2020, n=61), Hybrid (2020-2023, n=82) and RAMIO (2023-2024, n=100). Patient demographics, tumour characteristics, perioperative outcomes, and oncological data were compared. Data were analysed using Kruskal-Wallis and Chi-squared statistical tests.

Results

No significant differences were observed in patient demographics or tumour stage between the groups. Comparison of Open vs. Hybrid vs. RAMIO demonstrated a significant reduction in major complications (Clavien-Dindo ≥III), 34.4% vs. 23.2% vs. 14% (p=0.0014); pulmonary complications, 36.1% vs. 25.4% vs. 13% (p=0.0004); anastomotic leak rate, 11.5% vs. 2.4% vs. 4.0%, (p=0.0370); median length of stay, 14 vs. 12 vs. 8 days (p=0.0001); and mortality, 4.9% vs. 1.2% vs. 0% (p=0.0133) all favouring the RAMIO group in sub-group analysis. Median lymph node yields were comparable across groups, 49 vs. 43 vs. 43 (p=0.0876).

Conclusion

This single-institution study demonstrates potential benefits of transitioning from open or hybrid to RAMIO for oesophagectomy. RAMIO was associated with significantly reduced pulmonary complications, major complications and a shorter length of hospital stay. Oncological outcomes were maintained across all 3 techniques. These findings have important patient, financial, and resource implications, and support the continued adoption of RAMIO in the UK.
BN SO04 - The value of routine histopathology analysis of gallbladder specimens after elective and emergency laparoscopic cholecystectomy
Authors: Elafandy Abdelrahman , Riaz Amjad
Published: November 2024

Background

Gallbladder cancer is not among the 20 most common cancers in the UK, accounting for less than 1% of all new cancer cases with a peak rate at 85-89 years of age. There is a dominant routine conception among surgeons to send the gallbladder specimen for histopathology even if there is no gross features that raise suspicion for neoplasm.

In this study, we are trying to get evidence of the value of routine histopathology analysis of gallbladder specimens after elective and emergency laparoscopic cholecystectomy surgeries in Warwick hospital.

Method

The record of all the patients who underwent laparoscopic cholecystectomy ( elective, expiated and emergency ) in Warwick hospital in the period between 01/07/2023 – 30/01/2024 ( 7 months) were collected, reviewed and underwent data analysis

Results

A total of 171 specimens were sent for histo-pathology analysis. Only one patient had low grade dysplasia with no malignant features. No routine follow-up decided for him/her after upper GIT MDT discussion. The incidence rate was 0% of neoplasm and 0.6% of low-grade dysplasia.

Conclusion

No specimen in the study had suspicious gross features of malignancy. Using a selective system is more logical and economic than the routine sending for histopathology after elective and emergency laparoscopic cholecystectomy if there are no suspicious features in the specimen.
BN SO09 - Same day discharge after laparoscopic cholecystectomy: Getting It Right First Time (GIRFT)
Authors: Hammett Felix , Foley Sinead , Saha Arin
Published: November 2024

Background

A key component of elective recovery strategy is to increase day-case provision. GIRFT standards recommend that at least 85% of elective laparoscopic cholecystectomies (LC) should day-cases; most hospitals struggle to achieve this and we aimed to identify barriers to same day discharge after LC.

Method

Consecutive patients who had LC between December 2022 and March 2023 were identified. Electronic patient records were interrogated to analyse outcomes, length of stay and in-patient treatment.

Results

138 patients included, 93 (67%) had elective surgery: ConditionNumber of patients (%)Proportion of elective:acuteBiliary Colic66 (47.5%)60:6 (91.0%:9.0%)Pancreatitis17 (12.2%)4:13 (23.5%:76.5%)Cholecystitis40 (30.0%)19:21 (47.5%:52.5%)CBD stones11 (7.9%)8:3 (72.7%:27.3%)Gallbladder polyp2 (1.4%)2:0 (100%:0%)Cholecystitis and CBD stones2 (1.4%)2:0 (100%:0%)

66 elective patients (70%) were discharged on the same day. Common reasons for staying overnight were late finish (11, 15%), drain or antibiotics (10, 14%) and anaesthetic reasons (10, 14%). Of admitted patients, 15 (21%) did not have any post-operative investigations and 21 (30%) had no in-patient treatment.

Conclusion

Most patients were managed on a day-case basis, though not to national GIRFT standards. Of admitted patients, 30% did not need in-patient treatment; these patients could have safely been sent home and had they been, the unit would have met national standards. These results highlight the potential for an extended stay area or a post-operative next-day treatment area to increase day-case activity.
BN SO14 - Evaluation of local cholecystectomy service and outcomes (Local Data for GECKO study)
Authors: Sakr Mohamed , Albendary Mohamed , Elarian Mohamed , Abbasova Aisel , Jacob Preethi
Published: November 2024

Background

Cholecystectomy is a common procedure performed for different biliary pathologies. Patients have their procedure as elective, emergency, or prioritised bases (Hot Gall bladder service).

Method

GECKO is a prospective, international, observational collaborative cohort study

Consecutive patients undergoing cholecystectomy, between 23rd Oct – 19th Nov 2023 with follow-up at 30-day and one-year postoperatively

Results

Over a 4-week period , 38 cholecystectomies were performed, with 47.5% of patients having prior cholecystitis or cholangitis and multiple admissions. Half of the surgeries occurred within 6 months, and the longest wait was 13 months. Procedures were split equally between elective and emergency cases. Indications included acute cholecystitis (13), biliary colic (11), and others. All surgeries were laparoscopic, with 2 subtotal cholecystectomies. Complications included bile or stone spillage (12) and bleeding (7). Postoperative follow-up showed 16 patients discharged within 24 hours, 3 readmissions, and a 37% complication rate. No bile leaks or CBD injuries were reported.

Conclusion

Emergency and hot cholecystectomy services not only cut down waiting lists but also reduce costs of reoccurring admissions and treatments, with no significant associated complications. Selective gall bladder histological examination may help cost reduction with no significant recognised risks in the literature.
BN SO22 - Magnetic sphincter augmentation in the management of gastro-esophageal reflux disease: A systematic review and meta-analysis
Authors: Krahelski Oliver , Fadel Michael , Tarazi Munir , Dave Madhav , Ashrafian Hutan , Fehervari Matyas
Published: November 2024

Background

Magnetic sphincter augmentation (MSA) through placement of the LINX device is an alternative to fundoplication in the management of gastro-esophageal reflux disease (GERD). This systematic review and meta-analysis aimed to assess efficacy, quality of life and safety in patients that underwent MSA, with a comparison to fundoplication.

Method

A literature search of MEDLINE, Embase, Emcare, Scopus, Web of Science and Cochrane library databases was performed for studies that reported data on outcomes of MSA, with or without a comparison group undergoing fundoplication, for GERD from January 2000 to January 2023. Meta-analysis was performed using random-effect models and between-study

Results

Thirty-nine studies with 8,075 patients were included: 6,983 patients underwent MSA and 1,092 a fundoplication procedure. More individuals discontinued proton-pump inhibitors (P<0.001; WMD 0.83) and had higher rates of satisfaction (P<0.001; WMD 0.85) following MSA compared to fundoplication. Functional outcomes including ability to belch (P<0.001; WMD 0.96) and emesis (P<0.001; WMD 0.92), and bloating (P=0.003; WMD 0.20) were better after MSA than after fundoplication, although MSA had higher rates of dysphagia (P=0.001; WMD 0.41). The overall erosion and removal rate following MSA was 0.24% and 3.9% respectively, indicating no difference in re-intervention rates between MSA and fundoplication (P=0.446; WMD 0.001).

Conclusion

MSA is a safe and effective procedure at reducing symptom burden of GERD and can potentially improve patient satisfaction and functional outcomes. However, randomized controlled trials directly comparing MSA with fundoplication are necessary to determine where MSA precisely fits in the management pathway of GERD.
BN SO41 - A systematic search and evaluation of patient information quality on Anti-reflux surgery using modified EQIP Score
Authors: Bibi Ayesha , Jayakrishnan Anushka , Bano Zaubaria Shehar , Khan Muhammad Usman , Nijjar Rajwinder , Tucker Olga , Hossain Tanvir
Published: November 2024

Background

GORD affects 20% of western populations and internet searches are a key resource for patients considering surgery. An assessment of the quality of public intended electronic information can highlight a need for improved material to aide patient education. This study assesses the quality of internet information on anti-reflux surgery using the validated Modified Ensuring Quality Information for Patients (EQIP) tool.

Method

A systematic analysis of the top 200 results for the search engine query “Anti-reflux surgery” was conducted. Google (UK) was used. Search results aimed solely for healthcare professionals were excluded. Results were evaluated using the modified (EQIP) tool (score 0-36) and evaluation performed on information on surgery benefits, risks and complications.

Results

107 of 200 websites were included in the main study. The majority (43%) originated from UK, while 40% were from USA. Median EQIP score for all websites was 16. Median EQIP scores for the 3 domains were 7/18, 1/6 and 8/12 for content, identification data and structure respectively. Benefits of surgery was described on 71%, surgery risks on 66%, and complications on 11%. However, only 16% of websites described the quantitative risks of surgery. Information on postoperative recovery was included on 63%, emergency advice on 22%, and mortality rates on 7% of websites.

Conclusion

We observed most public intended internet searches lacked information on the quantitative risks and complications of anti-reflux surgery. Moreover, the information provided was insufficient on morbidity and mortality to adequately assist patients make informed decisions. This study supports the need for improved quality of patient intended publicly available information accessible online on Anti-reflux surgery.
BN SO45 - Reported criteria and safety for day case management of acute appendicitis
Authors: Tase Arkeliana , Askari Alan , Karim Seiver , Jambulingam Periyathambi , Whitelaw Douglas , Jain Vigyan , Al-Taan Omer , Munasinghe Aruna , Adil Tanveer
Published: November 2024

Background

Acute appendicitis has an incidence of 7-8%. About 45,000 appendicectomies are performed in UK/year. Whilst day case surgery (DCS) is standard for cholecystectomies, hernia repair and even gastric bypass, reluctance exists in application of day care pathway for acute appendicitis. We aimed to review published literature on patient selection criteria, rates of day case discharge, readmission and re-intervention rates and patient satisfaction.

Method

A literature search was conducted in Embase, Pubmed and Medline for day case appendicectomy, Patient safety, selection criteria. A total of 116 papers were found. Once duplicates were removed, 75 studies underwent abstract screening from which 41 were full text screened. 29 publications were included in this review study. Data was collected on criteria for patient selection, length of stay, rate of DCS, rates of re-admission and re-intervention and patient/ relative satisfaction.

Results

Studies assessed DCS in children and/or adults. All authors included patients with uncomplicated appendicitis, well managed pain without opioid analgesia and adequate social support. Other authors additionally, only included patients under 65yrs old. The rates of DCS varied between 36.9% - 87%. Factors affecting DCS were time of admission and operation, female patients, symptom control and social factors.

Rates of readmission ranged between 0-2.5% with no difference between DCS and admitted patients. Rates of re-intervention were low (0-2.5%) with a high patient satisfaction (87-91%). Late evening finishing of operation led to patient admission (77%) with no complications occurring within 48hrs.

Conclusion

Day case surgery for appendicectomy is reported to be safe provided adequate patient education and clear criteria for patient selection. No significant difference was found between the rates of re-intervention and re-admission between day case and admitted patients. We suggest standardising care pathways and provision of adequate education to both patients and staff as a method of safe day care discharge.
BN SO47 - Can Peroral Endoscopic Myotomy (POEM) be the new gold standard for Achalasia? – as it is safe and effective
Authors: Yap Ye Theng , Gollapinni Uday , Ingley Paul , Hajibandeh Shahin , Cheruvu Chandra , Rajkumar Sarveson
Published: November 2024

Background

Laparoscopic Heller’s cardiomyotomy is the gold standard for treatment of achalasia. POEM has emerged as a revolutionary minimal invasive procedure in the management of achalasia and related oesophageal motility disorders. POEM effectively utilises an endoscopic approach by creating a submucosal tunnel to perform a myotomy at the lower oesophageal sphincter (LES) , achieving symptomatic relief. Being firstly introduced in 2008, POEM offers an excellent alternative option to surgical intervention and conservative approaches. The aim of this study is to evaluate the clinical efficacy and safety of POEM since its introduction in our unit.

Method

POEM procedures performed in adult patients are recruited prospectively from May 2020 to January 2024 and data are collected using electronic trust records. Eckardt score (a commonly used scoring system to characterise severity of achalasia) is recorded before and after the procedure. A total of 46 patients are identified however three patients are excluded in this study due to unavailable clinical information. This study presents a cohort of patients with median age of 60 and an equal gender distribution.

Results

Out of 43 patients, 69.8% were treatment naïve and 30.2% had previous treatments. Mean Eckardt score pre-procedure was 8.2. The average length of hospital stay was 1.7 days and immediate post treatment complications were 6.9% (2.3% mucosotomy, 2.3% oesophageal leak, 2.3% infection). No mortality was recorded within 30 days post-procedure. A 93% clinical success rate (Eckardt score ≤3) was achieved in the initial follow-up period (three to six months) with a mean Eckardt score of 1.1. 41.9% of patients experienced reflux symptoms which require proton pump inhibitor use within four weeks post-procedure. 18.4% of patients had recurrent achalasia symptoms over their follow-up period.

Conclusion

The clinical success rate (Eckardt score ≤3) and recurrence rate post POEM in this study are comparable with the international cohort quoted in literature. Post POEM reflux rate is prevalent, which is a well-known complication. The substantial improvement in clinical outcomes, evidenced by the Eckardt score reduction and the low incidence of post-operative complications, underscores the procedure’s efficacy and safety. Overall, POEM represents a significant advancement in the treatment of oesophageal motility disorders, especially achalasia. This study presents POEM as a safer and less invasive treatment alternative compared to Heller’s cardiomyotomy.