bluuebunny/crossref_metadata_2025_split huggingface dataset:
FA08.04: RELATIONSHIP BETWEEN PROGNOSTIC NUTRITIONAL INDEX AND PERITUMORAL IMMUNE SYSTEM DYNAMICS IN ESOPHAGEAL CANCER
Authors: Okadome Kazuo , Baba Yoshifumi , Yagi Taisuke , Kiyozumi Yuki , Daisuke Kuroda , Sawayama Hiroshi , Hiyoshi Yukiharu , Iwatsuki Masaaki , Miyamoto Yuji , Yoshida Naoya , Baba Hideo 
Published: September 2018

Abstract

Background
There have been reported that nutritional status and tumor-infiltrating lymphocytes (TILs) are prognostic factor for esophageal cancer. Prognostic Nutritional Index (PNI) is one of the most widely used indicators for nutritional status and also shows systemic immune competence. Because TILs is related to peritumoral immune system, there may be relation between PNI and TILs.

Methods
Using a database of 300 curatively resected esophageal cancer from April 2005 to Jun 2013, we evaluated the relationship between PNI and TILs. PNI was calculated using serum albumin and total lymphocyte count. TILs were histologically estimated using postoperative samples. Studying the expression of CD8 and Foxp3 by immunohistochemical staining, we tried to reveal which subsets of lymphocyte were relevant to PNI.

Results
PNI high group (N = 198) experienced better overall survival (P < 0.001) and cancer specific survival (P < 0.001) compared with PNI low group (N = 102). PNI was significantly related to the TILs status (P < 0.01). CD8 positive lymphocyte was also significantly related to the PNI (P = 0.013) but Foxp3 wasn’t (P = 0.62). CD8 positive lymphocyte high group (N = 224) was significantly better in overall survival (P = 0.028) and cancer specific survival (P = 0.012) than low group (N = 76). There was no significant difference between Foxp3 high group (N = 225) and Foxp3 low group (N = 75) about overall survival (P = 0.87) and cancer specific survival (P = 0.90).

Conclusion
PNI was predictive prognostic marker for esophageal cancer and had relation to TILs status. It means systemic immune competence maybe affects peritumoral immune system. Among subsets of lymphocyte, CD8 positive lymphocyte had relation to PNI and was prognostic factor. In this study, Foxp3 didn’t have any relation to PNI and prognosis.

Disclosure
All authors have declared no conflicts of interest.
PS01.025: CONSEQUENCES OF MUCOSAL PERFORATION FROM LAPAROSCOPIC HELLER MYOTOMY: A SYSTEMATIC REVIEW
Authors: Maurice Andrew , Malik Hassan , Pearson Thomas , Dodd Benjamin 
Published: September 2018

Abstract

Background
Mucosal perforation is a common complication of Laparoscopic Heller Myotomy (LHM) for achalasia. Perforations discovered intra-operatively are usually treated with laparoscopic suturing. Perforations not identified at the time of operation generally present with sepsis and a leak. We aimed to document every reported case of mucosal perforation in the literature following this procedure and define the prognostic significance of this complication.

Methods
A systematic literature search was performed using the PubMed database with the key-phrases ‘achalasia’ and ‘laparoscopy’ or ‘laparoscopic’. All English-language case series and trials were included that reported at least one mucosal perforation from 1997 to 2017. Two researchers appraised the literature for inclusion. For centers with multiple publications, the largest series was chosen for inclusion.

Results
Of 901 articles retrieved, 100 studies were included after duplicates were excluded. 672 mucosal perforations were reported in 8705 LHM procedures (7.7%, range 0.5–30%).
635 perforations were identified intra-operatively. 609 (96%) were repaired with laparoscopic suturing with or without fundoplication and no clinical sequelae. 22 (3.5%) were converted to open procedures. No deaths or long-term morbidity was reported in procedures where perforations were identified intra-operatively.
There were 37 definitive missed mucosal perforations that were identified post-operatively. 3 patients died. For those that survived, 22 returned to theatre, 2 were treated with radiological drainage and 10 were managed conservatively with long-term antibiotics. Due to differences in reporting nomenclature and definitions, the actual rate of missed mucosal perforations may be higher.

Conclusion
Mucosal perforation during LHM is rarely of prognostic significance if it is repaired with laparoscopic suturing at the time. Mucosal perforations identified post-operatively can result in re-operation, sepsis, prolonged hospital stay and death. Care should be taken to ensure any mucosal perforation is detected and repaired intra-operatively.

Disclosure
All authors have declared no conflicts of interest.
PS01.028: REOPERATIONS AFTER FAILED HELLER´S MYOTOMY FOR ESOPHAGEAL ACHALASIA
Authors: Roque González Rosalba , Angel Martínez Miguel , Gerardo Pereira Jorge , Jiménez Raul , Anido Vivianne , Neri Pinol Felipe 
Published: September 2018

Abstract

Background
Heller's cardiomyotomy associated with the anti-reflux procedure described by Dor is the treatment of choice in patients with esophageal achalasia. However, the causes of treatment failure are still controversial. The primary aim of this study is to describe the causes of failure of Heller's myotomy in patients operated on due to esophageal achalasia and the clinical progress of patients who required another surgery.

Methods
A descriptive, retrospective and longitudinal study of a series of patients who required another surgery due to failure of Heller's myotomy from January 2010 to December 2016.

Results
Heller's myotomy was performed in 253 patients diagnosed with esophageal achalasia. Of these patients, 7 (2.7%) required another surgery due to recurrence of symptoms, 4 (1.5%) were initially operated on at the institution and the rest were referred from other institutions in the country. Laparoscopic approach was utilized in 5 patients and 2 were treated thoracoscopically. The mean age was 41 ± 15 years (range 20–59). The most frequent symptoms were postoperative dysphagia and weight loss (100%). The time of recurrence of symptoms after the first operation was 6–12 months in 4 patients (57%), 12 to 18 months in 1 (16%) and 18 to 24 in 2 (33%) patients.

Conclusion
Incomplete myotomy was the main cause of reoperation, with laparoscopic re-myotomy with or without fundoplication being the surgical technique of choice for these patients, who had an excellent or good postoperative clinical progress.

Disclosure
All authors have declared no conflicts of interest.
PS01.035: ILEOCOLONIC INTERPOSITION GRAFT: A SAFE AND FEASIBLE CONDUIT AFTER ESOPHAGOGASTRECTOMY
Authors: Voon Kelvin , How Teoh Keat , Subramaniam Karthikeashvaren , Yee Lim Shyang , Nagalingam Premnath 
Published: September 2018

Abstract

Background
Restoration of gastrointestinal tract continuity with a suitable conduit is a vital step in esophagectomy. An adequate length of conduit, preservation of a good blood supply and functionality are keys to a successful outcome

Methods
We report two cases of successful ileocolonic interposition graft after esophagogastrectomy for caustic injury.

Results
Both patients were female with mean age of 45. They presented with progressive dysphagia and weight loss after alleged corrosive ingestion. Both had good functional status with no significant comorbidities. OGDS revealed long complex esophageal stricture and biopsy showed acute on chronic esophagitis. CT scan showed diffuse thickening of mid-distal esophagus and gastric stenosis. Both patients had refractory strictures with unsuccessful serial endoscopic dilatation. One patient had endoscopic nasoenteric tube insertion for enteral feeding while the other had laparoscopic feeding jejunostomy placed due to tight strictures. A 3-stage esophagogastrectomy with ileocolonic interposition graft was performed after optimization. Intra-operatively findings were dense fibrotic esophagus with diffuse gastric strictures. Ileocolonic graft comprising of the distal 15cm of terminal ileum, ascending colon and transverse colon was constructed based on middle colic arterial supply via marginal artery of Drummond. Vascularity and length of graft were confirmed before transection. Graft pull through was done via orthotopic posterior mediastinal route and isoperistaltic end-to-side esophago-ileocolonic anastomosis was performed at the neck. Contrast studies showed no anastomotic leak and both patients were discharged well on postoperative day 10. They had good oral intake with satisfactory weight gain with no functional disorders during follow up.

Conclusion
Ileocolonic interposition graft is a safe and feasible option if a gastric conduit is not available. In addition to the advantages of long length, reflux resistance and good blood supply, the smaller caliber of the ileum eases the pull through and the anastomosis due to a smaller size discrepancy.

Disclosure
All authors have declared no conflicts of interest.
PS01.038: MANAGING POST STENT LARGE TEF FOR BOERHAAVE SYNDROME: A THERAPEUTIC CHALLENGE
Authors: Chandramohan Servarayan , Varadharajan Visvarath , Chinnathambi Madeshwaran , Manickavasagam Kanagavel , Chandramohan Apsara 
Published: September 2018

Abstract

Background
Stenting of Boerhaave syndrome is accepted as a modality of therapy but may not be successful at all times. We report a case of failed stenting, restenting and TEF due to stent.

Methods
This patient was managed at a different center and has undergone multiple procedures before. We have listed the procedures in chronological order. 24 FEB 2017: Endoscopy for acute retrosternal pain 28 FEB 2017: Left ICD for pyothorax 4 MARCH 2017: 15cm PTFE covered stent for large oesophageal rent at 28 cm 3 APRIL 2017: Stent removal 4 APRIL 2017: Check CT scan oesophago pleural fistula with 3mm rent on lelft lateral wall 8 APRIL 2017: Fistula closure with APC and fibrin sealant. 12 APRIL 2017: Fistula closure done with Thermal coagulation glue and covered SEMS. 27 MAY 2017: Stent removal and check ct showed supracarinal TEF admitting the scope. REFERED TO OUR UNIT AT THIS STAGE.

Results
Procedure done at our center: Right thoracotomy, layered fistula closure and vascularised intercostal muscle flap, subtotal esophagectomy, retrosternal gastric pullup, oesophago gastric anastamosis with feeding enteral access.

Conclusion
Post operative period was uneventful. Tracheostomy was done on 4th POD as there was drop in oxygen saturation. He improved gradually. Oral fuid started on day 7. Discharged on day 16. He is on regular followup.Tracheostomy and jejunostomy tubes removed. He was eating and speaking normally. This case is presented to high light the pertinent issues and limitations of SEMS placement for oeosphageal perforation. Diligent approach is to be followed in cases presenting with large diameter perforations. Caution should be exercised in SEMS exchange procedures when primary stenting has not produced optimal results. Surgery in select situations can be an optimal solution in these patients.

Disclosure
All authors have declared no conflicts of interest.
PS01.052: OUR STANDARD PROCEDURE IN LAPAROSCOPIC NISSEN FUNDOPLICATION FOR GERD PATIENTS
Authors: Suwa Tatsushi , Kitamura Kenta , Matsumura Tomonori , Karikomi Kazuhiro , Koyama Motoi , Okada Keigo , Suzuki Hiroyuki , Masamura Shigeru 
Published: September 2018

Abstract

Background
Laparoscopic techniques in anti-reflux surgery for GERD patients are still considered complicated by many surgeons. We have established our simple procedure.

Methods: SURGICAL PROCEDURE
Setting Our 5-trocar setting with patients is as follows: 12 mm trocar just below the navel (A), 5 mm trocar at the upper right abdomen for pulling up lateral segment of the liver, 5 mm trocar at the upper right abdomen, 12 mm trocar at the upper left abdomen (B), 5 mm trocar at the middle left abdomen (C). Step 1 Under laparoscopic view, left part of the lesser omentum was cut with preserving the hepatic branch of vagus nerve. The right crus of the diaphragma has been dissected free from the soft tissue around the stomach. In this step the fascia of the right crus should be preserved and the soft tissue should not been damaged to avoid unnecessary bleeding. After cutting the peritoneum just inside the right crus, the soft tissue was dissected bluntly to left side. Then the inside margin of the left crus of the diaphragma was recognized from right side. In this part, laparoscope: trocar (A), the assistant: trocar (B), the operator's right hand: trocar (C). Step 2 The branches of left gastroepiploic vessels and the short gastric vessels were divided. The left crus of the diaphragma was exposed and the window at the posterior side of the abdominal esophagus was widely opened. In this part, laparoscope: trocar (A) at the beginning of dividing left gastroepiploic vessels, trocar (B) when dividing short gastric vessels. Step 3 The both crus are sutured with interrupted stitches to reduce the hiatus. From the right side, the fundus of the stomach is grasped through the widely opened window behind the abdominal esophagus. Then the fundus of the stomach is pulled to obtain a 360 degree ‘stomach-wrap’ around the abdominal esophagus. Using 2–0 non-absorbable braided suture, stitches are placed between both gastric flaps.

Results
We have performed this procedure in 90 cases. The mean operation time of recent 20 cases was 90 min.

Conclusion
We have established our standard anti-reflux surgery procedure with less bleeding and less operative time.

Disclosure
All authors have declared no conflicts of interest.
PS01.053: GASTRO-ESOPHAGEAL REFLUX TEST DECIDING SURGICAL INDICATION AND RESULTS OF LAPAROSCOPIC NISSEN FUNDOPLICATION FOR GERD PATIENTS
Authors: Suwa Tatsushi , Kitamura Kenta , Matsumura Tomonori , Karikomi Kazuhiro , Koyama Motoi , Okada Keigo , Suzuki Hiroyuki , Masamura Shigeru 
Published: September 2018

Abstract

Background
The indication of laparoscopic anti-reflux surgery for GERD patients is difficult to be judged fairly. We have established ‘Reflux Test‘ as the tool for the decision in the surgical indication for GERD patients.

Methods
Reflux Test At the standing position a patient swallows 300 ml barium solution. After total solution goes into stomach, a patient lies down at the flat position. Then a patient changes the position to left lateral decubitus position, flat position, right lateral decubitus position and flat position again every 10 seconds in the order. During this procedure, gastro-esophageal reflux was evaluated and assigned to severe, moderate and slight category. If the reflux was observed slightly up to cervical esophagus, the case was assigned to moderate category. If the reflux was observed intensely up to cervical esophagus, the position was returned to head high position for the safety and the case was assigned to severe category. The anti-reflux surgery was considered in the moderate and severe categories.

Results
We have performed laparoscopic Nissen procedure in 90 cases. The mean operation time of recent 20 cases was 90 min. The outcome was assessed by Reflux Test performed on 4–5 postoperative day, and the results showed no reflux in every cases. Median follow-up period of this study was 48 months (0–99 months). In 11 cases (12.6%) PPI was restarted before 6 months after the anti-reflux surgery. In 23 cases (25.6%) PPI was restarted after the anti-reflux surgery during the whole follow-up period of this study. The BMI of the patients had no relationship to the needed PPI restart. To evaluate the degree of esophagitis objectively before and after the anti-reflux surgery we designed ‘the esophagitis score’. In this scoring method, a number from 0–5 was assigned according to the degree of esophagitis along with the LA classification. The results of the study have shown that the reflux esophagitis was improved obviously after the anti-reflux surgery even in the PPI restarted group (P < 0.001).

Conclusion
Reflux Test is feasible because of its convenience and visual effects for the patients. The results of the laparoscopic Nissen fundoplication were good and satisfied by the patients mostly.

Disclosure
All authors have declared no conflicts of interest.
PS01.062: REFLUX ASPIRATION SURGICAL OUTCOMES: DOES LAPAROSCOPIC FUNDOPLICATION SIGNIFICANTLY DECREASE QUANTITATIVE AND SYMPTOMATIC PULMONARY ASPIRATION?
Authors: Khoma Oleksandr , Falk Susanna , Burton Leticia , Van Der Wall Hans , Falk Gregory 
Published: September 2018

Abstract

Background
Pulmonary aspiration of gastric refluxate is one of the indications for anti-reflux surgery. Effectiveness of surgery in preventing pulmonary aspiration post-operatively has not been previously tested.

Methods
Retrospective analysis of prospectively populated database of patients with confirmed aspiration of gastric refluxate on scintigraphy. Patients that have undergone anti-reflux surgery between 01/01/2014 and 31/12/2015 and had scintigraphy post-operatively were included. Objective data such as resolution of aspiration, degree of proximal aero-digestive contamination, surgical complications and oesophageal dysmotility as well as patient quality of life data was analysed.

Results
Inclusion criteria were satisfied by 39 patients (11 male and 28 female). Pulmonary aspiration was prevented in 24 out of 39 patients (61.5%) post operatively. Significant reduction of isotope contamination of upper oesophagus supine and upright (P = 0.002) and pharynx supine and upright (P = 0.027) was confirmed on scintigraphy post operatively. Severe oesophageal dysmotility was strongly associated with continued aspiration post-operatively OR 15.3 (95% CI 2.459–95.194; P = 0.02). Majority (24/31, 77%) of patients were satisfied or very satisfied with surgery, whilst 7/31 (23%) were dissatisfied. Pre-operative GIQLI scores were low (mean 90.5, SD 18.8), modest improvements at 6 months (mean 92.8, SD 23.9) and 12 months (mean 92.2, SD 27), were not significant (P = 0.07).

Conclusion
Surgery is partially effective in reversing pulmonary aspiration of gastric refluxate on short-term follow up. Severe oesophageal dysmotility is a predictor of inferior control of aspiration with surgery. Overall satisfaction with surgery in patients with pulmonary aspiration is inferior compared to other patients undergoing anti-reflux surgery.

Disclosure
All authors have declared no conflicts of interest.
PS01.063: THE EFFECT OF DISEASE DURATION ON SURGICAL OUTCOMES FOR PATIENTS WITH EROSIVE GERD TREATED BY LAPAROSCOPIC SURGERY
Authors: Tsuboi Kazuto , Omura Nobuo , Yano Fumiaki , Hoshino Masato , Yamamoto Se-Ryung , Akimoto Shunsuke , Masuda Takahiro , Kashiwagi Hideyuki , Mitsumori Norio , Yanaga Katsuhiko 
Published: September 2018

Abstract

Background
Erosive gastro-esophageal reflux disease (e-GERD) is associated with various symptoms caused by reflux of acid and gastric contents from the stomach to the esophagus. In general, it seems that as the duration of the disease is longer, surgical outcomes are inferior because of disease progression. The aim of this study is to evaluate the relationship between the disease duration and surgical outcomes of laparoscopic fundoplication (LF).

Methods
Two hundred and fifty-one (mean age was 53.4 years, male in 166) patients with e-GERD who underwent LF as an initial operation at our institution were extracted from the database. E-GERD was defined as equal to or more than grade A esophagitis by Los Angeles classification. These patients were divided into three groups by the length of disease duration: less than two years in Group A (n = 104), two to 5 years in Group B (n = 68) and equal to or more than 5 years in Group C (n = 79). We analyzed patients’ background, pre-operative symptoms, surgical outcomes, patients’ satisfaction and post-operative course. Before surgery, a standardized questionnaire was used to assess the degree of frequency and severity of symptoms (heartburn, regurgitation, dysphagia, vomiting and chest pain). Moreover, satisfaction with the operation was evaluated using the standardized questionnaire.

Results
Age and degree of acid reflux by pH-metry were significantly different among the three groups (P = 0.0054 and 0.0345, respectively). As to the pre-operative symptom score, the severity score of heartburn and the frequency score of regurgitation were significantly lower in Group A (P = 0.0225 and 0.031, respectively). Although operation time was significantly difference among the three groups (P = 0.0423), there were no differences in intraoperative blood loss, occurrence of peri-operative complications, post-operative course and patients’ satisfaction.

Conclusion
Although the patients who suffered equal to or over two years had more severe heartburn and regurgitation because of prolonged acid reflux, the duration of the disease does not seem to affect the surgical outcomes.

Disclosure
All authors have declared no conflicts of interest.
PS01.067: SHLYAKHOVSKIY I.A., ERMOLOVA I.V., SELINA I. E., P. O., BURCHULADZE/PERFORATED APPENDICITES IN DIAPHRAGMAL HERNIA
Authors: Shlyakhovskiy Igor 
Published: September 2018

Abstract

Background
We present a clinical case of a patient with acute perforated appendicitis complicated by empyema in a false left-sided diaphragmatic hernia.

Methods
Patient K. 21 L. taken by ambulance to the intensive care unit. X-ray conclusion—the rupture of the left dome of the diaphragm to the infringement of the colon. The patient urgently operated. The defect of the diaphragm size 10,0х6,5cm. There is a lack in the abdominal cavity of small and large intestine, and spleen. The diagnosis—gangrenous perforated appendicitis in the left pleural cavity, empyema. Performed appendectomy, diaphragm was sutured. 5 days after surgery performed videothoracoscopy

Results
The patient is in satisfactory condition was discharged from hospital 32 days after admission.

Conclusion
Polypositional x-ray examination of the chest and abdominal cavity and active surgical tactics has allowed to establish the correct diagnosis and resulted in a favorable outcome.

Disclosure
All authors have declared no conflicts of interest.
PS01.082: ESOPHAGEAL PERFORATIONS: WHAT TO DO?
Authors: Caballero Albert , Viciano Marta , Garsot Elisenda , Arnau Marta , Francesc Julian Joan 
Published: September 2018

Abstract

Background
Esophagus perforations are one of the most severe lesions of the digestive tract. Until now the treatment continues to be controversial, with mortality greater than 30% of cases, mainly with a thoracic location. Severity is determinate by the progression of infection due to anatomical characteristics of the mediastinum. The location, size of the perforation and the evolution time determine the treatment to follow. In order to assess the results obtained and the different management options we present a series of 9 patients, with benign esophageal perforations, treated in our center during the last 5 years.

Methods
We designed an observational study in which we identify retrospectively the results of our series during the last five years (From 2013 to 2018). We analysed the following variables: Characteristics of patients, medical and surgical management, morbidity and mortality

Results
In all series, 5 of 9 patients received surgical treatment (55,5%), In the remaining three cases, simple suture and placement of drainages was performed. Conservative treatment was the first management attempt in the last four cases (44,5%), all of them due to impaction of food bolus or foreign body. Of all series evolved favourably with a non-negligible morbidity and continued ambulatory follow up. There was no mortality.

Conclusion
It is difficult to establish a protocol of action in patients with esophageal perforation. We have obtained good results by individualizing each case and adjusting the type of treatment to the needs of each patient, from a conservative attitude to radical surgery.

Disclosure
All authors have declared no conflicts of interest.