bluuebunny/crossref_metadata_2025_split huggingface dataset:
O17 A PROPENSITY SCORE-MATCHED CASE-CONTROL STUDY TO COMPARE POEM AND LAPAROSCOPIC HELLER MYOTOMY IN THE TREATMENT OF ESOPHAGEAL ACHALASIA
Authors: Andrea Costantini , Pietro Familiari , Mario Costantini , Renato Salvador , Michele Valmasoni , Giovanni Capovilla , Rosario Landi , Francesca Mangiola , Luca Provenzano , Stefano Merigliano , Guido Costamagna 
Published: November 2019

Abstract

Background
We designed this study with the aim of comparing POEM and laparoscopic Heller myotomy+Dor fundoplication (LHD) by matching 2 groups of consecutive patients, treated in 2 high-volume Centers, with the propensity score (PS).

Methods
Patients undergoing treatment for achalasia from 2014 to 2017 were selected: by applying the PS, 140 patients in both centers were matched. LHD and POEM were performed following established techniques. Patients were followed with clinical, endoscopic and pH-manometry evaluations.

Results
POEM required a shorter operation time (47 min [35-57]) and postoperative stay (2 days [2-2]) compared to LHD (95 min [85-105] and 3 days [3-3], respectively, p<0.001). No mortality was recorded in either group. Seven complications were recorded in the POEM group (5 mucosal perforations) and 3 in the LHD group (3 mucosal perforations)(p=0.33). At a median follow up of 24 mos. [15-30] for POEM and 31 mos. [15-41] for LHD (p<0.05), the median Eckardt score did not differ: moreover, 99.3% of the POEM patients and 97.7% of the LHD patients showed an Eckardt score ≤ 3 (p <0.12). Four years after the treatment, the probability to be symptom free was > 90% for both groups (98.2% for POEM and 93.9% for LHD, p=0.2, Log-rank test). HR-Manometry showed a similar reduction in the LES pressure and 4sIRP; however, 24-h pH-monitoring showed an abnormal exposure to acid in 38.4% of POEM patients, as compared to 17.1% of LHD patients (p<0.01) and esophagitis was found in 37.4% of the POEM and 15.2% of LHD patients (p<0.05). Finally, the need for PPI therapy was higher in the POEM group (38.8%) compared to the LHD group (15.1%), p<0.001.
P171 LAPAROSCOPIC REPAIR OF A GIANT MORGAGNI’S HERNIA PRESENTING WITH RESPIRATORY DISTRESS
Authors: Davakis Spyridon , Syllaios Athanasios , Karydakis Lysandros , Hasemaki Natasha , Skotsimara Antonia , Mylonas Konstantinos , Tsiboukelis Antonios , Papalampros Alexandros , Charalabopoulos Alexandros 
Published: November 2019

Abstract

Background
Morgagni hernias are a rare entity among diaphragmatic hernias, representing 2% of all cases. Although uncommon, it can be fatal if the diagnosis is missed. Foramen of Morgagni is a triangular space located between the muscular fibers of the xiphisternum and the costal margin fibers that insert on the central tendon of the hemidiaphragm. They usually present in childhood with respiratory symptomatology, and a majority of cases in adults are detected incidentally on chest radiographs.

Aims/Scope
To present an extremely rare case of acute dyspnea caused by a giant congenital Morgagni’s hernia, together with review the diagnostic algorithm and the role of surgical treatment.

Results
A 48-year-old caucasian male, previously healthy, was referred to our department with acute onset dyspnea and vague right-sided chest pain for the past 4 months. No history of chest or abdominal trauma was mentioned. Chest examination revealed bowel sounds and decreased air-entry in the right chest. The patient was offered a laparoscopic repair; at operation, jejunum, ileum, appendix, ascending and transverse colon to its distal two thirds with the associated omentum were found within the hernia sac. Hernia’s neck was bridged with a dynamesh IPOM mesh in a tension free manner. The patient is well and symptoms free at 1 year follow up.

Conclusion
Majority of Morgagni hernias are diagnosed late because patients are either asymptomatic or present with nonspecific gastrointestinal or respiratory symptoms. Controversy exists regarding operative approaches via either transabdominal route or transthoracic route. In our case, laparoscopic repair was offered with favorable outcome.
P173 HIGH-RESOLUTION MANOMETRIC FINDINGS AFTER MAGNETIC SPHINCTER AUGMENTATION
Authors: Riva Carlo Galdino , Siboni Stefano , Lazzari Veronica , Sozzi Marco , Asti Emanuele , Bonavina Luigi 
Published: November 2019

Abstract

Aim
The aim of this study was to evaluate esophageal motility before and after Magnetic Sphincter Augmentation (MSA) for medically refractory Gastro-Esophageal Reflux Disease (GERD).

Background and Methods
MSA (LINX® Reflux Management System) is intended for patients with chronic GERD with incomplete symptom relief from proton-pump inhibitors (PPI) and abnormal acid exposure. A prospectively collected database of patients who underwent MSA between 2007 and 2019 was queried. All patients who completed pre- and post-operative high-resolution manometry (HRM) were included in the study. Additional investigations included Health-Related Quality of Life (GERD-HRQL) questionnaire, Functional Outcome Swallowing Scale (FOSS), upper gastrointestinal endoscopy, barium swallow, and 24-96 hours pH-study. Data were analyzed using Wilcoxon signed rank test and McNemar test.

Results
Forty-five patients met the inclusion criteria. The median follow-up was 10 months (IQR 6). Compared to baseline, there was a statistically significant reduction in PPI use (p=0.000), rate of heartburn (p=0.000), regurgitation (p=0.008), and extra-esophageal symptoms (p=0.000). Only three (6.7%) patients required dietary changes. The GERD-HRQL score significantly improved (p=0.000). There was a significant increase in the Lower Esophageal Sphincter (LES) competency, including LES length (p=0.004) and Esophago-gastric Contractile Integral ((EGJ-CI) (p=0.000). A significant increase in integrated relaxation pressure (IRP) (p=0.000), mean Distal Contractile Integral (DCI) (p=0.008) and intrabolus pressure (p=0.000) was also found. Thirteen (28.9%) patients presented pre-operative Ineffective Esophageal Motility (IEM) and five of them resolved postoperatively. Two patients (4.4%) developed IEM after surgery: both had IRP and DCI values within normal limits, and one of them complained of dysphagia. However, the GERD-HRQL score recovered in both patients.

Conclusion
MSA was clinically effective in relieving both typical and atypical GERD symptoms. LES competency increased after MSA. EGJ outflow obstruction was uncommon and not associated with symptoms. Finally, ineffective esophageal motility may reverse to normal after MSA.
P176 MICRONUTRIENT DEFICIENCIES FOLLOWING MINIMAL INVASIVE ESOPHAGECTOMY FOR CANCER
Authors: Thijs H J B Janssen , Laura F C Fransen , Jeroen E H Ponten , Grard A P Nieuwenhuijzen , Misha D P Luyer 
Published: November 2019

Abstract

Aim
To investigate the role of micronutrient deficiencies in patients undergoing an esophagectomy for cancer.

Background & Methods
Over the past decades survival rates for patients with resectable esophageal cancer have improved significantly. Consequently, the sequelae of having a gastric conduit such as development of micronutrient deficiencies become increasingly important. For this study, a systematic search of the literature was conducted, and postoperative hematological and nutritional parameters in the follow-up of patients that participated in the NUTRIENT II trial between October 2015 and May 2018 at the Catharina Hospital were investigated. Patients were included if they had at least one postoperative value for either iron, ferritin, vitamins B1, B6, B12, D, folic acid or methylmalonic acid.

Results
Data was available in 83 of 95 patients. Of these, 78.3% (65/83) had at least one and 37.3% (31/83) had more than one micronutrient deficiency at a median of 6.1 months (interquartile range 5.4-7.5) after surgery. Similar to the results found in previous studies, deficiencies included iron (including ferritin) in 42.2% (27/64), vitamin B12 (including methylmalonic acid) in 18.3% (15/82) and vitamin D in 50.6% (41/81) of patients, respectively. Moreover, folic acid deficiency was present in 28.8% (23/80) of patients. Anemia was present in 32% (16/50) of patients. At 24.8 months (interquartile range 19.4-33.1) after surgery, most micronutrient deficiencies normalized following supplementation.

Conclusion
Micronutrient deficiencies are common in patients as early as six months following an esophagectomy. Therefore, these patients should be routinely checked and supplementation provided when needed.
P178 SYNCHRONOUS TRIPLE CANCER OF THE ESOPHAGUS, GASTRIC CARDIA AND GIST OF THE STOMACH: A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Czubba M , Riepl R L , Theisen J 
Published: November 2019

Abstract

Background
A 82-year old man was admitted to our hospital in February 2019 for a thorough investigation to determine an incidential finding of a tumor of the stomach in a CT-Scan. He had no history of previous abdominal surgery or of serious illness. The initial symptoms were slight dysphagia, deterioriation in general condition and weight loss in the last months.
Endoscopy of the stomach confirmed a poorly differentiated adenocarcinoma of the gastric cardia (intestinal type, Siewert Type II AEG) with the suspicion of paragastric lymph node metastasis.
The consensus of our Comprehensive Cancer Center was a neoadjuvant FLOT-chemotherapy followed by radical resection.
The Patient presented again during chemotherapy in April 2019 complaining of discomfort and epigastric pain. Endoscopy showed a partial regress of the primary tumor and on CT scan a progress of the potential lymph node metastases. Due to the symptoms and findings early resection was recommended.
On surgery extensive tumor masses were found around the lesser curve and around the peritoneal cavity not like lymph node metastases. An radical resection with intrathoracic anastomoses with gastric pull up was performed. The patient was discharged 4 weeks postoperatively.
The histopathological findings showed 2 other synchronous cancers besides the adenocarcinoma of the gastric cardia (ypT1b, L0;V1,G3,R0, HER2-negative, no microsatellite instability). It showed an early stage of squamous cell carcinoma of the esophagus (pT1a (m3-Type), Gn0 (0/21), L0, V0, G1, R0) and the potential paragastric lymphnode metastasis revealed to be a rare high-risk wild-type GIST of the stomach which showed a high mitotic index (> 120 mitoses/15 high-power fields).
The patient was readmitted to our hospital because of severe epigastric pain. A CT-Scan showed a massive progress and local recurrence of the GIST with a diameter of 7cm and infiltration into the portal vein and ascites with suspicion on peritoneal carcinomatosis. Despite the attempt of a sunitinib therapy the patient died in the beginning of May 2019 in a palliative setting .

Conclusion
There have only been few reports in the literature of synchronous triple cancer of gastric GIST, esophageal squamous cell carcinoma, and gastric adenocarcinoma.
In our case we considered the gastric adenocarcinoma to be a middle stage cancer and the squamous cell carcinoma an early stage esophageal cancer. The incidental finding of the high-grade gastric GIST with a high mitotic index and unfavorable histopathological features as the wild-type confirmation was probably the cause of death of the patient.
P180 OPTIMIZING UPPER MEDIASTINAL LYMPHADENECTOMY DURING MINIMALLY INVASIVE OESOPHAGECTOMY IN PRONE POSITION: FROM 2D THORACOSCOPY AND DOUBLE LUMEN (DL) ENDOTRACHEAL TUBE VENTILATION TO 3D THORACOSCOPY AND SINGLE LUMEN (SL) TUBE VENTILATION
Authors: Bruno Lorenzi , David O’Hara , Gabriele Corsi , Parameswaran Pragatheswaran , Thusyanthan Vinayagamoorthi , Daniela Zanotti , Alexandros Charalabopoulos 
Published: November 2019

Abstract

Aim
Upper mediastinal lymphadenectomy is a fundamental step of a radical oesophagectomy. Nodal dissection around the recurrent laryngeal nerves may be difficult and different approaches have been described in minimally invasive surgery. We describe our experience including recent technological advancements leading to improved outcomes.

Background & Methods
A retrospective analysis was performed among patients who underwent minimally invasive oesophageal resection for cancer including upper mediastinal lymphadenectomy between January 2016 and October 2018 at our Regional Centre for Oesophago-gastric Surgery (Broomfield Hospital, Chelmsford). A comparison between the initial cases performed using 2D thoracoscopy and DL endotracheal tube ventilation vs the more recent ones adopting 3D technology and SL tube ventilation was carried out.
Length of operative time for this part of the operation, number of nodes removed and related peri-operative complications were among the data collected.

Results
A total of 14 patients were included in the study. 2D thoracoscopy and DL endotracheal tube ventilation was used in 10 patients whilst 3D technology and SL tube ventilation was adopted in 4 cases. Operative time was reduced in the 3D group. Complications related to upper mediastinal lymphadenectomy were noted in 5 patients (all of the 2D group) and included 5 recurrent laryngeal nerve palsies and 2 temporary tracheostomies for glottis oedema. There was no significant difference in the number of nodes retrieved.

Conclusion
Lymphadenectomy of the upper mediastinal nodes can be challenging and is associated with significant morbidity. In our experience, the use of SL tube ventilation facilitates the retraction of the trachea and the exposure of the area, and 3D thoracoscopy gives optimal magnified visualization of the recurrent nerves reducing the risk of damage.
P182 3D TECHNOLOGY IN MINIMALLY INVASIVE UPPER GI SURGERY: COMPARISON BETWEEN DIFFERENT SYSTEMS
Authors: Bruno Lorenzi , Ali Kordzadeh , Krashna Patel , Attila Jonas , Priyantha Siriwardana , Naga Venkatesh Jayanthi , Cheuk-Bong Tang , Sritharan Kadirkamanathan , Daniela Zanotti , Alexandros Charalabopoulos 
Published: November 2019

Abstract

Aim
Three-dimensional laparoscopy improves the depth of perception during minimally invasive surgery, leading to better visibility and more precise dissection, and providing better clinical and surgical outcomes in complex surgical procedures. The aim of this study was to compare the pros and cons of the 3D technological systems available in our Unit for UGI surgery.

Background & Methods
In our Unit, we have two different 3D systems for abdominal and thoracic surgery. B Braun has the EinsteinVision 3D system with 0 and 30 degree fixed camera. Olympus produces an Endoeye Flex with an articulating tip 0 degree 3D camera as well as an Endoeye 3D 0 and 30 degree rotating camera. Advantages and disadvantages of the different 3D systems were evaluated on the basis of the experience of our senior surgeons performing routinely 3D operations.

Results
All surgeons agreed of the superiority of 3D vision compared to conventional 2D laparoscopy or thoracoscopy. The B Braun system is not available in an integrated operating theatre system and does not allow image rotation, but provides a full HD sharp resolution and has the advantage of a reusable camera with single use warming cover which could be used for unlimited procedures every day. The Olympus Endoeye Flex does not provide HD resolution and can be more difficult to manoeuvre, but has the advantage of the articulating tip. The Olympus Endoeye 30 degree rotating camera has a better HD resolution and the advantage of image rotation while maintaining the horizon.

Conclusion
Technology beyond 3D laparoscopic system has been evolving rapidly. Different products have their own strengths and weaknesses, and surgeons should be familiar with the system used.
P183 NEW METHOD OF ESOPHAGO-GASTRO ANASTOMOSIS WITHIN MINIMALLY INVASIVE HYBRID IVOR LEWIS PROCEDURE
Authors: Oleksandr Usenko , Andrii Sydiuk , Andrii Klimas , Olena Sydiuk , Savenko Georgii 
Published: November 2019

Abstract

Aim
Improve the results of surgical treatment of esophageal cancer by developing and implementing a new method for the formation of invagination mechanical esophagogastoanastomosis.

Material and methods
Reconstruction after esophagectomy together with the reliability of the esophagus-gastric anastomosis (EGA) constitute some of the most important problems in the surgery of the esophagus, because anastomosis leakage is one of the main reasons of lethal surgery.
The research included 60 patients who anderwent the minimally invasive hybrid Ivor Lewis procedure for malignant tumors of esophagus in Shalimov National Institute of Surgery and Transplantation (1 group comprised 30 patients with mechanical EGA end-to-side; 2 group comprised 30 patients with invaginated mechanical EGA).
The objects for estimation included post-operative mortality as well as the number of post-operative anastomosis complications: the number of EGA leakages in the early post-operative period and the number of post operative strictures in the EGA area three, six and twelve months after the surgery.
All patients underwent a course of neoadjuvant chemo/RT in accordance with NCCN guidelines.
Data processing was done by means of Statistic - licensed application programs for Windows.

Results and discussion
Patients belonging to both groups were comparable according to their age, sex, weight, height and surgery duration.
Research group did not register a single case of EGA leakage while 2 patients in control group (р<0,05). had the leakage which was stopped by means of “Endovac” system. There were 2 cases of esophagus post-operative strictures which developed 3 months after the surgery in the research group which was less than in the control group which saw 6 cases of strictures of EGA (р<0,05). 6 months after surgery, the number of post-operative strictures increased in both groups, but was lower in the research group and amounted to 4 cases in the research group and 11 cases in the control group (р<0,05). There were 5 cases of esophagus post-operative strictures which developed 12 months after the surgery in the research group which was less than in the control group which saw 13 cases of strictures of EGA (р<0,05). Neither of the groups had any cases of post-operative mortality.

Conclusion
The study found that invaginated mechanical EGA within minimally invasive hybrid Ivor Lewis procedure reduces EGA leakages as well as EGA benign strictures.
P186 CAROTID-GASTROPLASTY FISTULA: AN UNCOMMON CAUSE OF HEMATEMESIS IN THE DELAYED POSTOPERATIVE PERIOD AFTER ESOPHAGECTOMY
Authors: Hurtado-Pardo L , Mingol Navarro F , Menéndez Jiménez de Zadava Lissón M , Pérez Alonso C , Bruna Esteban M , Álvarez Sarrado E , Vaqué Urbaneja J , García-Granero Ximénez E 
Published: November 2019

Abstract

Aim
To describe a case report of a carotid-gastroplasty fistula post esophagectomy with a successful result.

Background & Methods
Upper gastrointestinal bleeding due to a fistula between esophagus or gastroplasty and carotid vessels is infrequent. It is usually due to malignant tumors, penetrating trauma, foreign bodies or radiotherapy.

Results
A 55-year-old man, with background of laryngeal squamous cell carcinoma that was treated with total laryngectomy and tracheostomy followed by radiotherapy, and posterior recurrence of squamous cell carcinoma at the upper esophagus required total esophagectomy with pharynguectomy and lymphadenectomy, and reconstruction with gastroplasty with anastomosis to the floor of the mouth and pectoralis muscle flap. During this second postoperative period, patient developed a left hemiplegia secondary to thrombosis of the right common carotid artery.
After recovery, the patient had repeated episodes of hematemesis that required hospital admission and blood transfusion. After several episodes with conservative management, upper endoscopy revealed blood oozing close to the anastomosis with no other findings. Once again, the patient returned to the emergency department with massive hematemesis, being visualized by endoscopy a high-flow arterial bleeding close to the anastomosis of the floor of the mouth. Arteriography showed the already known thrombosis of the right common carotid artery and the origin of the bleeding distal to that occlusion, where it was repermeabilized by a branch of the right vertebral artery. Given the inability of selective embolization by interventional radiology, urgent surgical approach was decided, performing a right lateral cervicotomy and identifying a fistula that communicated the common carotid artery with gastroplasty. It proceeded to close the fistulous orifice of the arteria and the gastroplasty with a continuous suture. A partial sternocleidomastoid muscle flap was interposed between the two sutures.
The postoperative evolution was satisfactory. Patient was discharged 16 days after surgery and being currently stable without signs of hemorrhagic neither oncological recurrence.

Conclusion
Carotid-gastroplasty fistula is a rare complication with high mortality rate due to its more frequent presentation: the massive hematemesis. Gastrointestinal endoscopy and angiography allow us to diagnose and treat this complication, however in massive and uncontrollable bleeding, surgical approach is indicated. Prognosis will depend on the early diagnosis and a therapeutic individualization is required.
P188 QUALITY ASSURANCE OF SURGICAL INTERVENTION WITHIN RANDOMIZED CONTROLLED TRIALS FOR GASTRO-ESOPHAGEAL REFLUX DISEASE
Authors: Sheraz R Markar , Sara Jamel* , Tom Wiggins , George B Hanna 
Published: November 2019

Abstract

Aim
Randomized controlled trials provide level 1 evidence for surgical intervention in the treatment of gastro-esophageal reflux disease (GERD). This systematic review aimed to investigate the practice of surgical quality assurance in RCTs concerning surgical interventions in GERD.

Background & Methods
A systematic literature search for articles was performed in Medline, Embase, Web of Science and Cochrane library for randomized controlled trials (RCT) evaluating surgical intervention in the management of GERD. Each RCT was assesses for surgical quality assurance (SQA) using an eight-point checklist in three main areas and given a SQA score out of 8. Clinical outcomes from each trial including reoperation rates were then compared against the SQA score.

Results
Thirty-one publications were included compromising 5803 patients.
The assurance of surgical quality was poor with the randomized controlled trials included, ranging from 3% to 68% for the factors examined:
Credentialing surgeon experience before entry into the trial by;
1. Case volume – 26% (8/31)
2. Operative reports – 6% (2/31)
3. Video assessment – 6% (2/31)
4. Live operating room evaluation – 3% (1/31)
Pre-trial standardization by;
5. Education of surgeons – 13% (13%)
6. Consensus for standardization – 68% (21/31)
Monitoring surgical performance during the trial by;
7. Video assessment – 10% (3/31)
8. Monitoring of data – 3% (1/31)
RCTs with a high SQA score had a reduced average rate of reoperation (SQA score 4 to 8 vs. 0 to 3; 0% vs. 3.19%; P<0.05). Credentialing surgeons by case volume before entry into the trial was also associated with a reduced rate of reoperation (0.04% vs. 3%; P<0.05).

Conclusion
Surgical quality assurance has been largely lacking in randomized controlled trials for GERD previously. High surgical quality assurance was associated with reduced reoperation rates within RCTs, highlighting the need for good SQA within these types of trials. Future RCTs in benign UGI conditions with surgical interventions should ensure SQA in three main areas:
(i) Credentialing surgeon experience before trial; to ensure they are past learning curve.
(ii) Standardizing the surgical technique; to ensure less heterogeneity in operative performance.
(iii) Monitoring performance during trial; to ensure standard of surgical quality is maintained within the trial.