bluuebunny/crossref_metadata_2025_split huggingface dataset:
MS O07 - OGC ‘Textbook Outcome’ for Gastrectomy: Redefining a Valid Composite Measure Assessment Tool for Surgical Performance in a Specialist Unit within the United Kingdom
Authors: Gan Tze Yi , Brown Leo R , McGregor Richard J 
Published: November 2024

Abstract

Background
A ten-item composite measure defining ‘textbook outcome’ (TBO) following oesophagogastric cancer surgery was proposed to benchmark surgical quality. While subsequent studies have demonstrated an association between TBO and improved survival, the reported proportion of patients who meet all the required criteria remained consistently low. Postoperative complications of Clavien-Dindo grade ≥2 (CD≥2) commonly preclude TBO, despite evidence that minor complications are unlikely to influence long-term outcomes. This study aimed to assess whether modification of TBO parameters to Clavien-Dindo grade ≥3 (CD≥3) is associated with improved overall survival in patients undergoing gastric cancer surgery within an UK specialist unit.

Method
Consecutive patients who underwent a surgical resection for gastric cancer, at a single tertiary centre between January 2016 and December 2019, were identified from a prospectively maintained regional database. Patients were included irrespective of (neo)adjuvant treatments. Data collected included clinicopathological characteristics, treatment modalities and postoperative outcomes. Comparisons were drawn between patients who met all the parameters defining TBO and those who did not, using both CD≥2 and CD≥3 classifications for ‘major’ complications. The primary outcome of interest was overall survival.

Results
Sixty-seven patients (median 70 years, 61.2% male) underwent resection for gastric cancer during this study. Of these, 27 patients (40.3%) achieved TBO based on a CD≥2 complication grading and 38 patients (56.7%) when CD≥3 was used. Clinicopathological characteristics were all comparable between TBO groups based on both cut-offs. Improved overall survival was evident with a CD≥3 TBO (p=0.026), however not with CD≥2 TBO (p=0.430). Following adjustment for confounding variables, CD≥3 TBO remained associated with improved overall survival (HR: 0.30 (95% CI: 0.10-0.93), p=0.037) while CD≥2 TBO was not (HR: 0.64 (95% CI: 0.21-1.93), p=0.428).

Conclusion
Textbook outcome is a multi-parameter metric for benchmarking quality in gastric cancer surgery. Modification of the complications parameter required for TBO to CD≥3 in our patient population resulted in a stronger association with overall survival amongst patients undergoing surgical resection for gastric cancer.
AHP SO09 - Introduction of Registered Advanced Nurse Practitioner into Upper Gastrointestinal Cancer Surgical Service
Authors: Hickey Wendy 
Published: November 2024

Abstract

Background
The author whom is a nurse, works in a large University teaching hospital with a mission to deliver best quality care to patients, where its nursing philosophy ensures continued and consistent commitment in the provision of holistic patient centred care to the highest possible standard. The introduction of the new Registered Advanced Nurse Practitioner (RANP) role within the Upper GI Surgical Department is part of the expansion of the Upper Gastrointestinal cancer service within the hospital.

Method
At the nurse-led cancer surveillance clinic the RANP is authorised to assess, review and initiate diagnostic interventions for a specific agreed cohort of patients with Upper GI cancer.

Results
An Upper GI RANP has recently been recruited into the Upper Gastrointestinal cancer surgical service in the hospital and commenced reviewing patients on 11.09.23. The overall aim of the post is to deliver an advanced level of clinical nursing practice within the field of gastrointestinal cancer with the quality improvement objective to enhance patient experience within the hospitals Upper GI cancer service.

Conclusion
Cancer survivorship begins at the time of diagnosis and continues until the end of life (DOH; 2017). Optimising these patients’ quality of life is now a primary focus of the Irish Healthcare system. Focus has now shifted to living well with, through and beyond a cancer diagnosis (DOH; 2017).
The National Cancer Strategy 2017- 2026 (DOH;2017) has highlighted that there is significant scope and need to expand the number of ANP’s in our cancer services particularly to run nurse-led clinics for follow-up and survivorship. This new ANP role within the Upper GI service will seek to address this need.
EDI&S SO06 Do All Patients with Biliary Problems Need Surgery? Applying C-Gall Study Results to Long Waiters for Laparoscopic Cholecystectomy
Authors: Mahendran Ashuvini , Hollyman Marianne 
Published: November 2024

Abstract

Background
The recent C-GALL study, a multi-centre randomised trial, found no significant difference in quality of life at two years between operative and non-operative management of uncomplicated gallstone disease.
This suggests some patients may not benefit from elective laparoscopic cholecystectomy (LC), potentially leading to over-listing for surgery. By identifying patients who may no longer need surgery, we could reduce waiting lists and improve resource allocation.
This study aims to reassess patients with an enforced period of observation on an elective waiting list for LC, to determine if they wish to make a different decision about proceeding with surgery.

Method
Patients listed for an elective LC who had been waiting longer than 11 months from referral were reviewed. Patients were contacted through telephone clinics by a surgeon. Data was collected on type of gallstone disease, history of abdominal surgery, biliary pain since last seen by a clinician, pain radiation to the back, pain reduction with simple analgesia, nausea, and heartburn. Identified patients were contacted and, if exhibiting minimal or no symptoms, were offered the option to be removed from the waiting list with 12 months of patient-initiated follow-up and high priority relisting if their clinical condition worsened.

Results
We contacted 59 patients awaiting elective LC Most were female (49, 83%), had biliary colic (43, 73%), and were under 60 years old (38, 64%).
Seventeen patients (29%) were happy to opt out due to lack of symptoms. Of these, 13 (76%) were female, 11 (65%) had biliary colic, and 7 (41%) were under 60.
Chi-squared analysis identified age as the only predictive factor, with those under 60 being less likely to opt out (p=0.038).
We will continue to monitor representation and the need for reoperation to ensure safety and the findings remain consistent overtime.

Conclusion
The study demonstrates that a significant proportion of patients awaiting elective LC can be safely managed without planned cholecystectomy, potentially reducing waiting lists, cost and utilisation of healthcare resources. We would advise considering review of long waiters to re-evaluate their clinical need for cholecystectomy in order to improve sustainability within surgery. These findings support a more personalised approach to managing biliary pain, prioritising patients for surgery based on symptom severity.
EDI&S SO09 Tracking Waste in Surgical Theatres (TWIST) - a snapshot of waste production in a large teaching hospital
Authors: Yao Lu , Amar Hoda , Aroori Somaiah 
Published: November 2024

Abstract

Background
The NHS contributes up to 5% of the UK’s greenhouse gas emissions. Thirty percent is generated by operating theatres, of which a significant proportion comes from single-use consumables. The aim of this project was to evaluate the amount and cost of disposable material that was opened but unused in theatres. By identifying areas for improvement, this can help to reduce the environmental impact of our work.

Method
This was a trainee lead collaborative study taking place over a period of two weeks at a tertiary teaching hospital, between Monday 19th and Friday 30th June. We prospectively collected information on the number of consumables that were opened but unused across various surgical specialties. The number and type of materials wasted at the end of each list were recorded and a cost analysis performed. A questionnaire was sent to staff to assess factors influencing theatre waste.

Results
A total of 238 operating lists were covered during the study period. A total of 636 procedures took place, and 544 items were wasted, coming to a cost of £1993.56. The mean number of items wasted per list was 2.3 and the mean cost per list was £8.38. The most common item wasted was sutures. The most common factors staff felt contributed to waste production were the surgeon’s preferences and lack of experience among staff.

Conclusion
Unnecessary waste production in theatres has significant environmental and financial consequences. We can hope to reduce this by educating staff, including surgeons and the wider theatre team.
BS SO05 - A Comparative Study Between Laparoscopic Sleeve Gastrectomy with omentopexy Versus conventional Laparoscopic Sleeve Gastrectomy: A Prospective Cohort Study
Authors: Hassan Basma , Awad Philobater 
Published: November 2024

Abstract

Background
Sleeve Gastrectomy, is a widely used procedure globally. However, omentopexy is a newly added variation, which involves reattachment of the omental to the stomach. Currently, there is not enough data regarding this technique

Method
A prospective cohort study, was conducted from June 2021 to June 2023 in University Hospitals and other non-governmental hospitals, which included 174 for a one-year follow-up.

Results
Group (I) with omentopexy while Group (II) without omentopexy. Regarding intra-operative time, the mean time in minutes in the group (I) is 115.45 minutes with a standard deviation ±11.19. While in group (II) is 79.8 minutes with a standard deviation of ±13.3 (p=O.001). Regarding complications rate . leakage occurred in 1(1.14%) patient in group (I). While, in 3(3.4%) patients in group (II) (p=0.62). Bleeding was found in 1 (1.1%) patient in group(I) and 2(2.3%) patients in group (II) (p=1). GERD was found in 10(11.49%) patients in group(I) and 12(13.7%) patients in group (II) (p=0.82).

Conclusion
Although there was no significant superiority in the group of patients with omentopexy, less bleeding, leakage, and GERD were detected compared to the traditional group, so we recommend further studies comparing both groups to be able to do meta-analysis comparing both groups and we also should emphasize that further refinement of the learning curve is possible in the future to further reduce the operative time required to execute this essential technique.
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 &gt;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 &gt;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.