bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC SO46 - Gastric Cancer: A Comprehensive Literature Review
Authors: Manasseh Mina , Mithany Reda 
Published: November 2024

Abstract

Background
Gastric cancer stands as a significant global health concern with high mortality rates urging urgent attention. This article comprehensively explores the epidemiology, anatomy, risk factors, pathophysiology, clinical presentation, diagnosis, staging, treatment modalities, prevention strategies, and survival rates associated with gastric cancer. Notably, Helicobacter pylori infection, dietary choices, and intricate stomach anatomy play pivotal roles in disease development. Early detection, utilizing staging, grading, and genetic testing for personalized treatment approaches is emphasized. Treatment modalities encompass surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Prevention strategies involve lifestyle changes, and genetic counseling. Survival rates vary by stage, highlighting the need for individualized care.

Method
This comprehensive review was conducted by systematically analyzing a wide range of published literature on gastric cancer. The search strategy involved utilizing electronic databases such as PubMed, Google Scholar, and Scopus, with specific keywords including "gastric cancer," "stomach cancer," "epidemiology," "anatomy," "risk factors," "pathophysiology," "diagnosis," "treatment modalities," "prevention," and "survival rates."

Results
Risk Factors: Factors such as Helicobacter pylori infection, dietary choices, tobacco use, and genetic predispositions contribute to gastric cancer risk. Pathophysiology: Genetic alterations, chronic inflammation, and dysregulated signaling pathways drive the development of gastric cancer. Clinical Presentation: Symptoms vary & diagnosis involves a combination of methods, including endoscopy and molecular profiling. Treatment Modalities: Treatment options include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Prevention Strategies: Prevention efforts focus on minimizing risk factors through lifestyle changes, screening, and genetic counseling. Survival Rates: Survival rates vary significantly by stage, ranging from 90-95% for stage 0 to less than 5% for stage IV

Conclusion
The intricate anatomy of the stomach plays a crucial role in disease localization, staging, and treatment planning, with genetic mutations and inflammation central to the pathophysiology. Early detection is underscored through clinical presentation and diagnosis processes, utilizing staging, grading, and genetic testing for personalized treatment approaches, including surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Prevention strategies emphasize lifestyle changes and screening, while survival rates vary by stage, underscoring the need for individualized care. In conclusion, addressing gastric cancer requires a collaborative effort to reduce its impact and enhance outcomes on a global scale.
BN SO06 - Comparison of local infiltration of tramadol versus bupivacaine for Post-operative pain relief
Authors: Dawach Adil , Talib Vikash , Kundnani Rakesh , Dawani Surrendar , Rasul Shahid 
Published: November 2024

Abstract

Background
To compare the mean pain score of local infiltration of tramadol and bupivacaine among patients undergoing hernioplasty, a Tertiary Care Hospital, Karachi.

Method
Quantitative and qualitative data was collected, presented and analyzed. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification independent t test was applied taking p-value of ≤0.05 as significant.

Results
Mean postoperative pain at 24 hours in tramadol versus bupivacaine group was 1.65±0.58 and 1.72±0.82 respectively. P-value was 0.001.

Conclusion
Locally infiltrated tramadol prior to herniorrhaphy wound closure provides better pain relief compared to bupivacaine in adult patients
BN SO10 - Virtual Reality in Acute Pain Management of Adult Surgical Patients: Literature Review
Authors: Yershov Danylo , Esfahani Mona Seyed , Khajehpour Salman Heydari 
Published: November 2024

Abstract

Background
Pain is an unavoidable side effect of medical procedures. British Pain Society (BPS) reports almost 10 million people in UK suffer from pain everyday. BPS reported an estimated €5 million per year is spent on managing back pain alone. Pharmaceutical pain management is costly and can cause side effects. Virtual Reality (VR) is a novel technology used to alleviate pain. We performed a literature review to assess the current advances in the pain management using VR.

Method
A literature search was done on the use of VR for pain management across 4 databases (Pubmed, Medline, Embase and Cinahl) using key words virtual reality, acute pain, adult, surgery. 144 non-duplicated studies were found. 66 studies were excluded: 41 were non-acute pain related, 16 involved chronic pain, 9 involved paediatric population. 78 studies with the total number of 1514 patients (n=1514) were included. All studies used VR to relieve acute pain symptoms experienced while undergoing a procedure. The data included sample size, gender, age, specialty, VR type, pain scale, pain score before and after, interventions, key findings and limitation.

Results
VR was tested to control pain in general surgery, plastics, obstetrics and gynaecology, cardiothoracics, orthopaedics, urology, and dentistry. In benign UGI surgery, including fundoplication, paraesophageal hernia repair, esophageal myotomy, and pyloroplasty requiring an overnight stay, the use of VR reduced pain, anxiety and nausea. Overall, no adverse outcomes were reported. No difference in nausea and dizziness between VR and control groups was observed. Active software has been shown to be superior to the passive one. Complete immersion with visual and audio stimulation replaced by VR environment is important. The results were similar in different age groups.

Conclusion
There is a good body of evidence to support the use of VR in pain management in clinical practice. It acts as a good distraction tool. The use of VR was demonstrated to be beneficial in reducing postoperative pain in benign UGI surgery. However, the main areas of application would be in short procedures where it not only delivers better pain management but also increases patient satisfaction and decreases the need for pharmaceutical analgesia, thus bringing down the overall cost.
BN SO17 - When cholecystectomies go wrong: A single-centre review of post-operative complications over a two year period
Authors: Marks Bertram , Sow Karmen , Owen Lucy , Haddington-Ahmed Aysha , Carr William 
Published: November 2024

Abstract

Background
Laparoscopic cholecystectomy (LC) is the main treatment for symptomatic gallstone disease with around 70,000 performed in the UK each year. The majority of these are day case procedures and patients recover well, however, there will always be a risk of more serious complication which can have serious negative effects on patients. The Clavien-Dindo classification of surgical complications is the most recognised method of grading post-operative complications by severity. The aim of our study was to identify our rates and severity of post-operative complication and their management.

Method
All patients who had LC between 1st July 2020 and 30th June 2022 were identified. Patient and operative details were retrieved from their electronic record. A complication was defined as any deviation from the standard post-operative course and was graded according to the Clavien-Dindo classification. 30-day readmission data was collected via hospital episode statistics and outcomes were reviewed on the patient record.

Results
974 patients underwent LC. 30-day morbidity = 8.9%, 30-day readmission = 4.8% and 30-day mortality = 0.31%. Clavien-Dindo grade of complication: Grade 1= 44.7%, Grade 2 = 22.4%, Grade 3A = 12.9%, Grade 3B = 11.8%, Grade 4A = 1.2%, Grade 4B = 1.2%; and Grade 5 = 3.5%. 11 patients (1.1%) returned to theatre; bile leak was the most common indication (73%). Two intra-operative bile duct injuries were observed (0.21%) with one managed locally and the other transferred to the regional HPB centre. 7 patients required post-operative ERCP (0.72%), 57% for CBD stones and 43% for persistent bile leak.

Conclusion
Our study showed that the majority of post-operative morbidity following LC is related to post-operative pain (2.9%) or simple wound infection (1.8%). 2.6% of patients who underwent LC during had a significant complication requiring surgical, endoscopic or radiological intervention or admission to intensive care (Clavien-Dindo &gt; 2). We report a 0.21% risk of bile duct injury and a 0.92% risk of post-operative bile leak. Overall our findings are in keeping with other studies but provide an insight into our local practice and that an area of potential improvement would be better management of post-operative pain.
BN SO19 - Evaluating Wrap Pressure Augmentation Ratio and Physiological Transit Time for Post-Fundoplication Dysphagia
Authors: Miah Ismail , Wong Terry , Gossage James , Zeki Sebastian , Jafari Jafar 
Published: November 2024

Abstract

Background
Post-fundoplication dysphagia affects many patients that can often lead to significant weight loss and reduced quality of life, and prompt some to seek surgical reversal. Current diagnostic methods may not fully explain the dysphagia which may necessitate repeat oesophageal physiology testing. This study retrospectively evaluates two novel markers, Wrap Pressure Augmentation Ratio (WPAR) and Physiological Transit Time (PTT), to better understand and manage the post-fundoplication dysphagia.

Method
The study retrospectively reviewed 54 post-Nissen’s fundoplication patients from January 2020 to May 2024. WPAR was calculated as the ratio of the augmented wrap basal pressure to the median integrated relaxation pressure found during high-resolution manometry following the Chicago Classification guideline [1]. PTT was measured from controlled measurements of antegrade bolus movement [2] during multichannel impedance-pH studies [3]. Patients completed HODQ forms to assess dysphagia [4]. Optimal WPAR and PTT thresholds were determined using Youden’s J index from receiver operating characteristic curves. This study was ethically approved (REC 18/NW/0120, IRAS 333800).

Results
Out of 54 cases (female=28:26, mean age 50.6), 75.9% reported clinical dysphagia post-fundoplication. Significant correlations were found with WPAR (&lt;1.49, p=0.017) and PTT (&gt;0.83 minutes, p=0.028)(see Table 1). These findings suggest WPAR and PTT as effective markers for post-fundoplication dysphagia. The analysis revealed a moderate correlation between WPAR and PTT (r =-0.45, p&lt;0.05), suggesting that lower WPAR values tend to be associated with longer PTT. SensitivityPositive Predictive Valueχ2p-valueWPAR &lt;1.490.610.895.680.017PTT &gt;0.83 minutes0.780.844.820.028
Table 1 showing predictive DR and PTT values for clinical dysphasia post fundoplication.

Conclusion
This pilot study identifies PAR and PTT as promising physiological markers for diagnosing post-fundoplication dysphagia. The moderate correlation between PAR and PTT suggests a potential link, indicating that lower pressure augmentation might be associated with slower oesophageal transit times. These markers could enhance management strategies for affected patients. However, the study's small sample size and lack of a control group limit generalizability. Larger, controlled studies are necessary to validate these findings and further explore the relationship between PAR and PTT.
References
[1] https://onlinelibrary.wiley.com/doi/10.1111/nmo.14058
[2] https://gut.bmj.com/content/70/Suppl_1/A215.1
[3] https://gut.bmj.com/content/68/10/1731
[4] https://www.gastrojournal.org/article/S0016-5085(09)62439-2/fulltext
BN SO23 - From referral to resolution, impact of acute biliary pathway on patients care
Authors: Elmaradny Ahmed , Robinson Steven John , Perry Anthony , Wadley Martin 
Published: November 2024

Abstract

Background
At our trust, we introduced acute biliary pathway to efficiently manage patients presenting with acute biliary pathology. This pathway begins with a referral form containing relevant patient information for triage. A triage team reviews these forms and classifies patients into three categories based on specific criteria.

Method
Patients are triaged into three categories:Red: Patients needing emergency surgery during the same admission.Amber: Patients requiring urgent but non-emergency care, scheduled for an outpatient (OP) appointment for consent, followed by a laparoscopic cholecystectomy within 2-3 weeks or 6-8 weeks, based on the pathology.Green: Patients who do not meet the criteria for red or amber are referred for further outpatient assessment before definitive management.

Results
Over four months , 202 referrals were received. Approximately 50% (102 patients) were referred to the outpatient department. Of the remainder, 45% were categorised as red and had IP cholecystectomy, with a mean length of stay of 1.5 days post-surgery across 30 operations. The remaining patients were managed as amber, resulting in 22 operations. The total complication rate was low, with only 2 cases managed conservatively, and 4 patients required re-admission before definitive treatment. The average wait time for a clinic appointment was 2 weeks, while the average wait time for surgery was 8 weeks, with a total of 6 cancellations.

Conclusion
The acute biliary pathway demonstrates effectiveness through a low complication rate and timely management of patients. This approach improves the efficiency of patient care and reduces the need for emergency re-admissions. More importantly, this model is straightforward enough to be implemented in any high-volume centre with a sufficient level of expertise in treating biliary patients.
BN SO24 - Predicting incidental gallbladder cancer: A protocol for identifying predictive factors of incidentally detected gallbladder cancer and prospective validation of a scoring system to allow selective histological analysis of the gallbladder
Authors: Brown Oliver D , Sorrell Lexy , Latour Jos M , Aroori Somaiah 
Published: November 2024

Abstract

Background
Incidental Gallbladder Cancer (iGBC) is a rare complication of cholecystectomy, with a UK incidence of 0.14-0.3%. Despite its rarity, most gallbladder specimens are analysed histologically. Some comparable countries undertake Selective Histological Analysis (SHA), selecting high-risk specimens for histology based on clinical judgement or postoperative inspection. However, evidence suggests a third of diagnoses can be missed with these approaches. Swedish and Dutch diagnostic scores incorporate few risk factors and are not generalisable to the UK. We present a protocol for a UK study aiming to develop a detailed diagnostic score for iGBC to reliably stratify patients by their risk of iGBC.

Method
This UK multicentre, cross-sectional, trainee-led study includes adult patients undergoing cholecystectomy for benign indications. It incorporates a feasibility study and an adaptive design, and has been submitted for ethical review. A parallel qualitative study will explore attitudes towards the risk of iGBC and the acceptability of SHA among patients and healthcare professionals. The feasibility phase will include 500 patients over six months, collecting data on patient risk factors for iGBC, preoperative investigations, operative findings, and histology results. Exclusion criteria include cholecystectomy as a secondary procedure, polyps over 5mm, and conditions known to increase the risk of biliary tract cancers.

Results
Following the feasibility phase, the recruitment rate and data completeness will be evaluated. Outcomes will be assessed against anticipated values, and collaborators will be surveyed to identify challenges with data collection. Necessary adjustments to the electronic case record form or overall protocol will be made, and the recruitment target will be recalculated based on an updated sample size calculation. When the study meets specified progression criteria, additional sites will be recruited, and data collection will continue to meet the required sample size. A detailed statistical analysis plan will be provided at a later date.

Conclusion
This protocol describes a UK diagnostic modelling study aimed at developing a risk-stratification score for iGBC in patients undergoing routine cholecystectomy, identifying high-risk patients and facilitating SHA.
BN SO30 - One hundred consecutive Laparoscopic Heller's Cardiomyotomy & Fundoplication – a personal series
Authors: Sinha Yashashwi , Howey Caitlin , Jerome Ellen , Fernando Tyrrel , Menon Vinod 
Published: November 2024

Abstract

Background
Oesophageal Achalasia (OA) is an uncommon primary oesophageal motility disorder, characterised by the loss of inhibitory neurons in the oesophageal myenteric plexus. The primary goal of treating OA is to alleviate dysphagia caused by the functional obstruction of the distal oesophagus due to the inability of the lower oesophageal sphincter (LOS) to relax appropriately after swallowing. Heller's cardiomyotomy (HCM) remains a standard treatment for OA.
The aim of this study was to assess the symptomatic improvement and post-operative outcomes following HCM with fundoplication at our centre.

Method
All patients underwent HCM through laparoscopic blunt muscle separation technique, between January 2005 and March 2024, by a single surgeon. Retrospective review of electronic and compiled paper patient records were analysed to assess patient demographics, preoperative symptoms, operative details, length of stay (LOS), complications, post-operative symptoms, gastroscopy and pneumatic dilation (PD) as well as revisional surgery.
Primary outcomes assessed were binary changes in key symptoms of weight loss, dysphagia, retrosternal pain and regurgitation. Comparison of pre and post-operative outcomes were performed using paired t-test. A p-value of &lt;0.05 was considered statistically significant.

Results
100 procedures involving 99 patients (average age 50 years, 43% female), 1 conversion to open and 1 revision at 3 years. ASA grades were 1 (27%), 2 (58%), and 3 (15%).
Median LOS was one day, median follow-up 99 months.
Post-operatively; weight loss persisted in 11% of patients from 48%, dysphagia reduced from 98% to 42%, retrosternal chest pain from 39% to 20% and regurgitation from 57% to 24% (all p&lt;0.05).
2 patients required (PD) ≤30 days (CD≥3). 36 patients underwent PD at median of 13 months, 20 needed repeat PD. None of the patients developed cancer.

Conclusion
As demonstrated in this large series of 100 consecutive patients, HCM remains one of the best treatment modalities for OA. Key symptoms of OA significantly reduced following HCM.
Our technique avoided the use of energy devices, ensured a short hospital stay and durable symptom improvement, lends support to its continued application in managing this condition.
BN SO32 - Operative techniques and outcomes following giant hiatus hernia repair: 5 years of tertiary centre experience
Authors: Sinha Yashashwi , Howey Caitlin , Nandra Saroop , Fernando Tyrrel , Akbari Khalid , Tan Lam Chin , Menon Vinod , McLaughlin Euan 
Published: November 2024

Abstract

Background
Giant hiatus hernia (GHH) repair is a complex surgical challenge, often requiring advanced techniques and specialised expertise. Whilst the repair of small hiatus hernias is well-documented, the optimal strategy for giant hernias remains debated.
This study reviews five years of experience at a tertiary centre, focusing on operative techniques and outcomes. The aim is to identify trends and best practices that enhance patient outcomes and minimise complications in the repair of GHH.

Method
All patients undergoing primary GHH surgery between March 2019 and March 2024 at a tertiary institution and a five surgeon upper GI service.
Retrospective review of electronic records were utilised to document patient demographics, type of hernia, operative details including surgical approach (open/laparoscopic/robotic), use of fundoplication, use of mesh and gastropexy.
Outcomes measured included 30-day morbidity (Clavien-Dindo (CD) grading), 30-day mortality, binary symptom recurrence, length of stay (LOS), need for return to theatre (RTT) and RTT versus mesh use. Analysis undertaken using paired t-test. Statistical significance was set as p&lt;0.05.

Results
91 patients underwent GHH repair with median age 70 (31-93) years, 66.7% female, average BMI 30.8(±5.4). ASA: ≤2 (72.4%), 3 (25.5%), 4 (2.1%). Hernia types: 2 (15.7%), 3 (55.4%), 4 (28.9%).
Approach: open 6.6%, laparoscopic 61.5%, robotic 31.9%.
Fundoplication in 88%, gastropexy in 13%, 2 cases utilised both.
Mesh: 91.2% without, 8.8% biologic, nil prosthetic.
Median LOS 2 days (0-161). Median follow-up 8 weeks (1-172).
Symptoms recurred in 25.6%. 94.5% had no significant complications (CD≤2). 5.5% had RTT≤30 days. 4.4% RTT&gt;30 days. No mortalities.
No significant difference in RTT and mesh use (p=0.7832).

Conclusion
This five-year review confirms that GHH repair using open, laparoscopic, and robotic techniques is effective and safe, even in an older population with high ASA scores. The study highlights minimal complications (94.5% with CD≤2). Only 4.8% required a RTT within 30 days. RTT was not significantly impacted by the use of mesh however this may represent a type two error given the limited use of mesh and low number of patients that RTT. These findings support the tailored use of advanced surgical techniques, mesh, and gastropexy as effective strategies for managing GHH in a tertiary care setting.
BN SO40 - Increasing incidence of medicolegal claims in the NHS for bile duct injury in spite of 30 years of experience and training
Authors: Ingley Paul , Hajibandeh Shahin , Yap Ye Theng , Athwal Terjinderjit , Cheruvu Chandra 
Published: November 2024

Abstract

Background
Bile duct injury (BDI) in cholecystectomy is the most commonly recognised complication occurring in 0.5-1.4% of cases and is associated with significant morbidity and mortality. Despite the increasing number of cholecystectomies and falling number of bile duct injuries due to both surgical experience and recognition of the issue, there appears to be increasing number of payouts by NHS England. We investigated the trend in claims, their underlying cause, stage in procedure where they occurred in the past 20 years to identify areas where improvements could be made, for better patient outcomes and to reduce the medicolegal burden to the NHS.

Method
Data was obtained following a freedom of information request from NHS Resolution UK for cases of bile duct injury. Data analysis was performed on years 2001-2021 to examine the number of claims, their underlying cause and stage in procedure where they occurred as well as average damages awarded and cost to the NHS.

Results
In 2001 there were 11 claims made (costing £644,000) which rose to 28 in 2021 (costing £7,424,000). 400 claims were successful out if 508. The commonest being intraoperative error (49%) followed by operator error (11%) and delay in treatment (8%). The most expensive type of claim arose from intraoperative complications costing a total of £42,836,000 over the period. Pre-operative delays and inadequate patient consent cost the NHS £7,236,000, whilst delays in recognition of BDI cost £8,000,000 between 2001 and 2021.

Conclusion
Although settled cases of BDI have risen in the last 20 years despite improvement in training and techniques of cholecystectomy, they remain significantly below the anticipated numbers. Prompt recognition of anatomy and intraoperative complication as well as effective post-op management are essential for better patient outcomes and maintaining this low claim rate.
Surgeon training within the NHS is crucial but appropriate case selection is the key to patient safety. Laparoscopic cholecystectomy can be a complex operation, worsened by delays in treatment , requires an experienced UGI surgeon or supervision by a consultant and never considered simple or routine operation.