bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC SO42 - A comparison of body composition changes between neoadjuvant FLOT and MAGIC regimes in patients with locally advanced oesophageal cancer
Authors: Daley Andrew , Wong Enoch , Tan Benjamin 
Published: November 2024

Abstract

Background
Several studies have documented the changes in body composition that can occur between pre and post neoadjuvant chemotherapy for locally advanced OGA. However, none have compared the changes between different neoadjuvant regimes following the shift in practice from MAGIC to FLOT neoadjuvant chemotherapy. Specifically, given that the FLOT regimen has been thought to be more toxic than MAGIC regimen, it is unclear whether this toxicity is measurable and clinically significant with regards to body composition. This study aims to compare the changes in body composition between these two regimens in patients with locally advanced oesophageal cancer.

Method
We conducted a retrospective cohort study comparing changes in body composition between patients receiving either MAGIC or FLOT neoadjuvant chemotherapy. 115 patients treated with FLOT (n = 61) or MAGIC (n = 54) who underwent an oesophagectomy for OGA between 2008 and 2020 at Queen Elizabeth Hospital, Birmingham, UK were ultimately enrolled in the study. Changes in body composition between pre- and post-neo-adjuvant chemotherapy were determined by analysis of computed tomography (CT) imaging. Slice-O-Matic is a software tool allowing segmentation of body tissues into different classes Including skeletal muscle and fat based on the Hounsfield units.

Results
Our findings showed a statistically significant difference in the weight loss of participants enrolled the MAGIC group compared to FLOT (FLOT -0.6 ±6.9 vs MAGIC -3.4 ±1.2, p=0.034) which was therefore also reflected in BMI differential before and after neoadjuvant chemotherapy (FLOT -0.2 ± 2.2 vs MAGIC -1.2 ± 2.7, p=0.024). However, there was no statistically significant difference in the L3 skeletal muscle index in both regimes (FLOT -2.8 ± 4.1 vs MAGIC -2.9 ± 4.1; p=0.93). Finally, changes in L3 fat index between the two cohorts did not demonstrate statistically significant difference in our study (FLOT -0.9 ± 22.6 vs MAGIC -5.6 ± 24.8; p=0.29).

Conclusion
Our study suggests that a large proportion of patients with locally-advanced OGA were sarcopenic prior to starting chemotherapy and this proportion increased post treatment. There was no statistically significant loss of muscle mass or fat during treatment with either MAGIC or FLOT. Despite this, weight loss and decreases in BMI were greater in the MAGIC group compared to FLOT, suggesting FLOT may have a more favourable toxicity profile with regard to body composition. Overall, our findings support the safety profile of FLOT chemotherapy with regard to body composition changes and illustrates a superior pathological response to FLOT therapy for OGA.
BN SO01 - Fluorescent Precision: Advancing Laparoscopic Cholecystectomy with Indocyanine Green ( ICG )
Authors: Manasseh Mina , Bowling Kirk 
Published: November 2024

Abstract

Background
Laparoscopic cholecystectomy represents a significant advancement in surgical techniques for gallbladder disease. However, challenges persist in accurately identifying critical structures such as the bile ducts, leading to complications. Indocyanine Green (ICG), a fluorescent dye with unique properties, has emerged as a promising tool to enhance precision and safety in laparoscopic cholecystectomy. Originally developed for infrared photography, ICG's fluorescence capabilities have been harnessed in various medical applications, including ophthalmology and surgical procedures. Its ability to provide real-time visualization of the biliary anatomy facilitates better surgical navigation, reducing the risk of inadvertent injury and improving overall outcomes.

Method
Comprehensive review of existing literature and research on laparoscopic cholecystectomy, with a focus on the role of Indocyanine Green (ICG) in enhancing surgical precision and safety. Relevant articles, clinical trials, and meta-analyses were identified through databases such as PubMed, Google Scholar, and Scopus. Search terms included "laparoscopic cholecystectomy," "Indocyanine Green," "fluorescence imaging," and related terms.

Results
The results of this study highlight the significant role of Indocyanine Green (ICG) in laparoscopic cholecystectomy. Through a comprehensive review of existing literature and research, it was found that ICG integration enhances surgical precision and safety by providing real-time visualization of the biliary anatomy. The use of ICG reduces the risk of inadvertent injury and improves overall surgical outcomes. Despite challenges such as technical complexities and safety considerations, the evidence strongly supports the transformative potential of ICG in modern surgery.

Conclusion
In conclusion, the integration of Indocyanine Green (ICG) into laparoscopic cholecystectomy represents a pivotal advancement in surgical practice. The findings of this study underscore the importance of cautious navigation and collaboration in maximizing the benefits of ICG. By addressing challenges through innovation and evidence-based guidelines, ICG has the potential to revolutionize the landscape of minimally invasive surgery, offering patients safer procedures and better outcomes. As research continues to evolve, the journey of ICG in laparoscopic cholecystectomy holds promise for a future where precision and safety converge, ultimately shaping the standard of surgical excellence.
BN SO02 - Cholecystectomy HRG Coding Audit
Authors: Muscat Neil , Soxibova Firuza , Alam Imran , Kandil Ahmed , Rehman Urwah 
Published: November 2024

Abstract

Background
Incorrect coding practices for elective surgical procedures carry significant financial implications at Trust level. In this project, we aimed to audit the current coding practices pertaining to laparoscopic cholecystectomies performed within the NHS WWL Foundation Trust during November 2021-October 2022 and calculate the financial burden resulting from this.

Method
A list of 194 patients undergoing a cholecystectomy and their allocated HRG coding at time of discharge was compiled by the coding department. A comorbidity and complication index (CCI) for each of these patients was calculated using the operation note together with hospital and GP records. With this information, the correct HRG coding for each patient was calculated and compared to their allocated coding at discharge to calculate the difference in tariffs generated.

Results
69.23% of 194 procedures carried out during the reported time period were coded incorrectly.
This amounted to a financial burden of £72,232 lost in potential tariffs, equating to £372.33 per cholecystectomy performed.
Commonest CCI of 3 in 29% of patients with corresponding HRG code GA10J
Commonest incorrectly allocated coding GA10K denotes a presumed CCI of 0

Conclusion
High percentage of incorrectly coded procedures with significant financial implications at Trust level
Currenty coding practice often incorrectly presumes a CCI index of 0 with subsequent incorrect GA10K coding.
However, the appropriate coding for the vast majority of patients undergoing a laparoscopic cholecystectomy was GA10J.
Education and awareness is underway to make improvements at a Trust level before re-auditing of data can commence.
BN SO05 - Risk Factors associated with Complications Post-Laparoscopic Common Bile Duct Exploration: A Comprehensive Literature Review
Authors: Manasseh Mina , Elsmalouty Islam , San ChoNu , Kostalas Marcos 
Published: November 2024

Abstract

Background
Gallstone-related diseases, particularly common bile duct (CBD) stones, present a significant global health issue. The adoption of laparoscopic common bile duct exploration (LCBDE) has revolutionized the management of these conditions by providing a minimally invasive alternative to open surgery. This literature review aims to identify and analyze the risk factors associated with complications in LCBDE, thereby offering insights to improve patient care and outcomes.

Method
comprehensive search for primary research studies, systematic reviews, and meta-analyses pertaining to risk factors for complications following LCBDE. The search was conducted on PubMed, focusing on English-language articles published within the last 20 years and encompassing all age groups. Peer-reviewed journal articles were prioritized. All relevant studies reporting complications after LCBDE were eligible for inclusion if available as full texts, structured abstracts, or conference reports. The initial search yielded 826 articles. Exclusion criteria : open surgery, non-English articles, lacking full-text. A total of 29 records were identified by the literature search.

Results
Laparoscopic common bile duct exploration (LCBDE) is generally safe and effective, with complication rates influenced by patient and procedural factors. Older age, comorbidities, previous abdominal surgeries, high BMI, narrow common bile ducts, and difficult stones increase risks. Experienced surgeons and shorter operative times reduce complications. The transcystic approach and primary suture closure have fewer complications compared to the transductal route and T-tube drainage, respectively. Intraoperative imaging significantly reduces risks by ensuring complete stone clearance and identifying anatomical variations. Tailoring surgical approaches to patient-specific factors and leveraging surgical expertise are crucial for minimizing complications in LCBDE.

Conclusion
LCBDE emerges as a safe and effective therapeutic modality for addressing conditions impacting the bile ducts (31). The success and utility of LCBDE can be significantly enhanced through the meticulous optimization of patient-related, surgeon-related, and procedure-related factors. By addressing and fine-tuning these key elements, the occurrence of complications associated with LCBDE can be mitigated, thereby reinforcing its potential as a primary choice for managing various bile duct conditions. This strategic approach not only underscores the clinical efficacy of LCBDE but also advocates for its expanded utilization as a frontline intervention in the comprehensive management of bile duct disorders.
BN SO15 - Post Cholecystectomy Syndrome: Definition, Aetiology, Investigation & Management – A Systematic Review
Authors: Kobetic Matthew , Britton Emily , Rees Jonathan , Potter Shelley , Hinchliffe Robert 
Published: November 2024

Abstract

Background
Post-cholecystectomy syndrome (PCS) is a term commonly used to refer to the persistence of abdominal symptoms following cholecystectomy, or de-novo symptoms that develop post operatively. Despite the common use of the term, there is no widely agreed upon consensus definition. PCS is reported to affect between 5-40% of patients that undergo cholecystectomy representing a large populational burden. Despite this, there are no guidelines or protocols in place for the routine investigation and management of this large heterogenous patient group. In this study we systematically review the literature describing definition, aetiology, investigation and up-to-date management of PCS.

Method
An updated systematic search of the Medline, EMBASE and Cochrane databases was undertaken to identify studies where patients underwent cholecystectomy and subsequently were diagnosed with PCS. Included papers were published between 2016-2024, had a minimum of 10 cases of PCS following laparoscopic or open cholecystectomy. Excluded studies were case reports, narrative and systematic reviews, paediatric patient population or papers unavailable in the English language. Paper characteristics were extracted and where present, the definition of PCS, aetiology, investigations and management of these patients was both extracted and analysed.

Results
145 papers were identified of which 13 were included after title, abstract and full text screening. Definition of PCS, where present, was highly heterogenous between papers. Aetiology was often divided into biliary and non-biliary causes, with some papers claiming early-PCS and late-PCS as distinct clinical phenomena. In such papers, early-PCS was most commonly attributed to gastro-oesophageal pathologies and late-PCS to biliary pathologies. Investigation strategy is sparingly reported and without guideline or protocol. Most frequently used tests include LFTs, USS, MRCP, CT, ERCP and OGD. Some studies also used 99m Tc-Mebrofenin Hepatobiliary Scintigraphy, sphincter manometry and colonoscopy.

Conclusion
PCS has a widely reported prevalence in the published literature. This is potentially due to the heterogeneity of definitions used to cover the syndrome. The effective management of such patients depends on both the accurate diagnosis of the underlying cause, as well as exclusion of procedure related complications. There are currently no guidelines or protocols available for the investigation and management of patients presenting with symptoms post cholecystectomy despite the large populational burden. Further studies should aim to provide a consensus definition of PCS, and work towards guidelines for the investigation and management of this patient group.
BN SO18 - Considering Physiology Surveillance in Patients with Oesophageal Atresia
Authors: Miah Ismail , Wong Terry , Gossage James , Jafari Jafar 
Published: November 2024

Abstract

Background
Oesophageal atresia (OA) is a congenital malformation found between one in every 2,400 to 4,500 new-borns per year world-wide [1] who require immediate oesophageal surgery and lifelong endoscopic surveillance for complications of gastroesophageal reflux, oesophagitis, Barrett's oesophagus, anastomotic strictures, oesophageal dysmotility and dysphagia [2, 3].
This study investigates whether ad-hoc oesophageal physiology surveillance would be clinically beneficial for patients with post OA surgical history.

Method
Retrospective study was conducted on patients with surgical history for OA and undergone oesophageal physiology studies between 2010 and 2023. 11 patients were found (6 females) who had oesophageal physiology at mean age of 29 years (95% CI 26.7 to 35.3 years) or correspondingly post-surgery for OA.
Standard high-resolution manometry assessment was re-interpreted with reference Chicago Classification(version 4.0)[4]. This followed by stimulation with multiple water swallowing and solid bolus swallows as adjunctive testing [5, 6, 7].
This project was approved by the NHS institution and the local research ethics committee (REC 18/NW/0120)(IRAS 333800).

Results
Major dysmotility was observed in 7 patients (63.6%)(achalasia 3, absent contractility(AC) 4) and minor dysmotility was apparent in 4 patients (ineffective oesophageal motility [IOM]). Development of major dysmotility was at a later onset post-surgery to minor dysmotility (30.4 years vs 26.5 years, p=0.214). As was achalasia to AC (32.3 years vs 29.0 years, p=0.379).
Adjunctive testing augmented oesophageal smooth muscle contractility in all patients with IOM and invoked remaining neuromuscular functioning in 2 patients with AC. The achalasia diagnosis in the 3 patients remained unchanged during the adjunctive testing.

Conclusion
Oesophageal physiology surveillance in patients with post OA surgery would enable identifying the staging of the motility disorder and which may direct further surgical management. This study revealed patients were still suitable for partial fundoplication post OA surgery (54.5%) and surgical myotomy for achalasia (27.3%).
The prevalence of achalasia (27.3%) and absent contractility (36.4%) in post OA surgery observed this study are significantly higher compared to the non-OA treatment-naïve patients found in the general population living with achalasia and absent contractility disorders.
References
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564549/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093930/ (1)
[3] https://pubmed.ncbi.nlm.nih.gov/27579697/
[4] https://onlinelibrary.wiley.com/doi/10.1111/nmo.14058
[5] https://gut.bmj.com/content/66/Suppl_2/A270.2
[6] https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2982.2011.01682.x
[7] https://doi.org/10.1038/ajg.2013.289
BN SO26 - Predicting successful and safe day-case laparoscopic cholecystectomy: Validation of the Cholecystectomy as a Day Case (CAAD) score
Authors: Mamareli Christina , Craig Carol , Rajkomar Kheman 
Published: November 2024

Abstract

Background
Day case surgery is a major target for the NHS as it improves patient satisfaction and reduces financial costs. The CAAD score, using pre-operative variables from clinic letters and electronic sources, aids in selecting patients for day-case lists. This study assessed the validity of the CAAD score in predicting successful and safe day-case laparoscopic cholecystectomy (LC) at an isolated day unit.

Method
A retrospective analysis was performed on patients scheduled for elective LC between January 2020 and March 2022. Outcomes (same day discharge rate, length of stay, conversion to open, bile leak, mortality) were stratified by CAAD score (≤5, &gt;5). Statistical analyses included Chi square and independent t-tests using SPSS 28.0.

Results
58 patients were analysed.18/38 patients with CAAD ≤5 achieved same day discharge compared to 4/20 with CAAD &gt;5 (p&lt;0.05).
36 patients stayed for ≥1 day. The mean length of hospitalization was 1.38 days (range 1-2) for the 13 patients with CAAD ≤5. 15 patients with CAAD &gt;5 stayed significantly longer i.e. 2.53 days (range 1-10) (p &lt;0.05).
Longer stay for scores &gt;5 was due to difficult dissection (13%), conversion to open (13%) and drain insertion (7%). For scores ≤5, reasons were drain insertion, postoperative pain, nausea, and difficult dissection, each at 8%. No major complications were noted in either group.

Conclusion
The CAAD score is a predictive tool for successful and safe day-case LC, correlating lower scores with higher success rates and shorter hospital stays. Implementing the CAAD score can improve patient selection, potentially reduce unnecessary overnight stays, and support operational efficiency in isolated day units.
BN SO29 - Overinvestigation and unnecessary surgery for Gallbladder Polyps: An audit of compliance with ESGAR guidelines
Authors: Blackburn Jessie , Farksas Nicholas , Crotty Fiona , Miller Freya , Belgaumkar Ajay 
Published: November 2024

Abstract

Background
Incidental gallbladder polyps are increasingly reported on abdominal ultrasound and have a theoretical association with increased risk of gallbladder cancer. Most gallbladder polyps are actually gallstones and there is little evidence for any survival benefit or reduced rates of gallbladder cancer in patients under ultrasound surveillance. ESGAR guidelines attempt to standardize and rationalize surveillance protocols, balancing the risks of missed early cancers versus the costs of surveillance investigations. This audit aims to assess the investigation and management of gallbladder polyps as per ESGAR guidelines at a single NHS trust.

Method
An audit was conducted at a single NHS Trust in England. Searches were conducted on the electronic patient record for patients coded for K82.8 (Gallbladder pathology: other) from 01/01/2022 to 31/12/2023. Patient records were examined for radiological imaging confirming diagnosis of gallbladder polyp. Data was analysed using Microsoft excel and compared with the 2021 ESGAR guidance on management of gallbladder polyps.

Results
97 patients were included. All polyps were diagnosed with abdominal ultrasound. Patients had, on average, two ultrasounds. 51% were seen in outpatients clinic. 35 patients (36%) underwent laparoscopic cholecystectomy (including all patients with a polyp &gt;10mm). Histology confirmed diagnosis of cholecystitis (69%), pseudopolyp (9%), gallbladder polyp (6%) and IPMN (3%). 74% (26/35) of patients that underwent cholecystectomy had biliary symptoms and 77% (20/26) had cholecystitis confirmed by histology. Despite having biliary symptoms at first assessment, 47% of polyp patients went on to have two ultrasounds and two clinic appointments.

Conclusion
The study confirms that the majority of ultrasound detected polyps are not neoplastic, and patients undergo multiple hospital visits, incurring significant non-therapeutic costs. Adherence to ESGAR guidelines is inconsistent. In the symptomatic cohort, however, a low threshold for laparoscopic cholecystectomy should be considered given the high likelihood of underlying stones.
BN SO34 - Outcomes in giant versus non-giant hiatus hernia repair: Same payment different operative burden
Authors: Sinha Yashashwi , Howey Caitlin , Nandra Saroop , Thorne Thomas , Fernando Tyrrel , Akbari Khalid , Tan Lam Chin , Menon Vinod , McLaughlin Euan 
Published: November 2024

Abstract

Background
Hospital trust payment for operative procedures often rely on coding systems like the NHS's Office of Population Censuses and Surveys (OPCS) codes, which determine reimbursement rates. Both giant hiatus hernia (GHH) and non-giant hiatus hernia (NGHH) repairs often share the same code, as in our trust. This results in equal reimbursement to trusts for procedures with higher operative burden and resource needs. This study aims to assess differences in the patient population, their hiatal type, operative challenges and post-operative outcomes between GHH and NGHH repairs.

Method
All patients undergoing primary hiatus hernia surgery between March 2019 to March 2024 at a single institution were included. Retrospective review of electronic records were utilised to record: patient demographics, hernia type, operative details, length of stay (LOS), post-operative course and need for a return to theatre (RTT). Outcomes were comparison of surgical approach, use of mesh and gastropexy (as proxy measures to indicate difficulty of operation), 30-day morbidity measured using Clavien-Dindo (CD) grading and 30-day mortality and RTT. Analysis was undertaken using un-paired t-test and Chi2. A p-value of &lt;0.05 was considered statistically significant.

Results
Table 1. Patients GHH NGHH p n 91 135 Age (average) 69 (±10) 52 (±16) &lt;0.001 Female (%) 66.7 55.2 0.1100 BMI 30.8 (±5.4) 30.7 (±7.8) 0.2029 ASA grade (average) 2.2 1.9 &lt;0.001 Hernia Types (median) 3 1 &lt;0.001 Table 2. Operative details GHH NGHH p Open (%) 6.6 0 0.0020 Laparoscopic (%) 60.4 62.24 0.9840 Robotic (%) 33 33.3 0.9239 Mesh used (%) 8.8 0.7 &lt;0.041 Gastropexy (%) 12 0.7 &lt;0.001 Table 3. Outcomes GHH NGHH p LOS (median) 2 (0-161) 1 (0-8) 0.0179 RTT (%) 10.7 8 0.4747 30-day morbidity (CD≥3, %) 4.8 4.4 0.6519 30-day mortality 0 0 NA

Conclusion
This study highlights significant differences between giant hiatus hernia (GHH) and non-giant hiatus hernia (NGHH) repairs. GHH repairs have an increased likelihood of undergoing open procedures, use of mesh, and gastropexy, reflecting their greater complexity. GHH patients are older, have higher ASA grades, and present with more advanced hernia types compared to NGHH patients. Additionally, GHH repairs result in longer hospital stays.
The findings underscore the need for improved coding accuracy to reflect these disparities accurately in patient demographics, operative strategies, and recovery outcomes within hospital trusts, ensuring appropriate resource allocation and reimbursement based on procedural complexity.