bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC SO20 - Audit of the guidelines for staging laparoscopy in gastro-oesophageal cancers
Authors: Penny Nancy , Saunders John 
Published: November 2024

Abstract

Background
Staging laparoscopy and peritoneal washings form part of surgical work up of oesopheageal and gastric cancers. Peritoneal washings help to identify microscopic disease, the presence of which drastically alters prognosis. This audit looks at the adherence to staging laparoscopy guidelines introduced, and the intraoperative finding.

Method
Staging laparoscopy and peritoneal washings form part of surgical work up of oesophageal and gastric cancers. Peritoneal washings help to identify microscopic disease, the presence of which drastically alters prognosis. This audit looks at the adherence to staging laparoscopy guidelines introduced, and the intraoperative finding.

Results
Two hundred and twenty-seven patients were identified. Two patients did not have washings performed due to the extent of their disease, which was appropriate. The remaining patients had washings performed. Twelve patients had washings performed but not in line with policy. In all cases a clinical reason was found. Overall twelve patients had positive cytology from the washings. Of those that had washings, forty-one patient’s had T1/T2 disease and one hundred and eight-four patients had T3/T4 disease. All cytology positive patients had T3/T4 stage disease.

Conclusion
Two hundred and twenty-seven patients were identified. Two patients did not have washings performed due to the extent of their disease, which was appropriate. The remaining patients had washings performed. Twelve patients had washings performed but not in line with policy. In all cases a clinical reason was found. Overall twelve patients had positive cytology from the washings. Of those that had washings, forty-one patient’s had T1/T2 disease and one hundred and eight-four patients had T3/T4 disease. All cytology positive patients had T3/T4 stage disease
OGC SO44 - Robotic gastric resection is feasible and safe - the first 25 cases at a tertiary UK Oesophago-gastric unit
Authors: Cross Andrea , Brown Joshua , Phillips Alexander , Wahed Shajahan , Immanuel Arul 
Published: November 2024

Abstract

Background
Robotic approaches to upper GI surgery are being increasingly used due to purported benefits including improved vision and dexterity over conventional laparoscopy, and reduction in surgical trauma and wound-related morbidity over open surgery. Introduction of new technology and its implementation into practice comes with an inevitable learning curve and it is paramount that this does not occur at the expense of patient outcomes. This study looked at the surgical and oncological outcomes from the implementation of a robotic gastric resectional service at a tertiary centre in the UK.

Method
A prospectively maintained database was used to identify all patients undergoing robotic subtotal and total gastrectomy irrespective of indication. Patients having sleeve gastrectomy or gastric wedge resection were not included. Demographic, operative, pathological and complications data were included. Complications were graded using the Clavien-Dindo classification. Textbook outcomes for gastric cancer surgery were defined as complete resection, pathological R0, &gt;15 lymph nodes resected, no intraoperative complications, no reintervention, no ICU readmission, no prolonged hospital stay (defined as &gt; 21 days), no mortality or readmission at 30 days, and no severe complications (Clavien Dindo ≥ II).

Results
Twenty-five patients were identified, 13 (52%) were women and the median age was 73 (range: 40 – 88). Twenty-two (92%) had a subtotal gastrectomy and adenocarcinoma was the diagnosis in 15 (62.5%).
Median blood loss was 50ml (50 – 310 ml) and operative time 320 minutes (225 – 480 minutes). There were no conversions to open. Complications occurred in 6 (24%) with one leak, 2 theatre returns, one death and no readmissions. Median stay was 6 days (4-14 days). Of the 16 having cancer surgery, median nodal yield was 29.5 (16 – 66), R0 rate 100% and a textbook outcome achieved in 14 (87.5%).

Conclusion
Robotically-assisted gastric resection can be implemented with a low rate of complication. In those patients having surgery for cancer, pathological outcomes were good and 14/16 patients achieved a textbook outcome which is significantly higher than most published studies.
BN SO11 - Optimising Day Case Laparoscopic Cholecystectomy: A GIRFT-Based Audit and Efficiency Analysis
Authors: MacDonald-Nethercott Meiling , Jacob Preethi , Tanner Nicola , Finch Guy 
Published: November 2024

Abstract

Background
Laparoscopic cholecystectomy (LC) is the gold standard for managing symptomatic gallstone disease and is commonly performed as a day surgery procedure due to its safety and efficiency. Despite its established benefits, recent analyses at our local hospital revealed a decline in the day case rate for elective LC, falling below the national median as highlighted by the Get It Right First Time (GIRFT) data.

Method
We analysed patient data for elective LC performed between 1st October 2023 and 29th February 2024. The data included patient demographics, length of stay, and reasons for unplanned admissions. Procedures from the hot and emergency lists were excluded from the analysis. To enhance the day case rate, a business case was developed to extend recovery staffing levels and coverage hours in the DSU from 6pm to 9pm. Additionally, we requested the coding team to distinguish elective cases from hot list cases for more accurate future analyses. The impact of these changes will be evaluated in a subsequent audit cycle.

Results
During the observed period, 86 elective LC cases were performed, with a day case rate of 64% (55/86), exceeding the national median of 60%. The discrepancy with the GIRFT analysis was due to the inclusion of hot list cases in their data. The primary reasons for unplanned admissions included monitoring observations (46%), late afternoon extubations (29%), and intra-operative concerns (18%). The median length of stay for unsuccessful day cases was 1 day. Cost analysis estimated the unplanned admission costs at over £12,000 for LC alone during the observed period, based on the NHS National Tariff 2024/25.

Conclusion
This audit demonstrated that our day case rate for elective LC surpasses the national median. By identifying key factors leading to unplanned admissions, we implemented targeted interventions, such as extending recovery area hours. These measures aim to further improve the day case rate, enhance patient care, and achieve significant cost savings.
BN SO12 - Management Strategies for Complications in Common Bile Duct Exploration: A Single Unit Comprehensive Analysis
Authors: Salem Rola , Hale Emily , Poulton Theodore , Bush Alexander , Kostalas Marcos 
Published: November 2024

Abstract

Background
10-20% of individuals with systemic gallstones are estimated to have common bile duct stones (CBDS)(1). Laparoscopic common bile duct exploration (LCBDE) and two stage laparoscopic cholecystectomy (LC) with subsequent endoscopic retrograde cholangiopancreatography (ERCP) are clinically equivalent in their purpose but associated with different risks and require different skill sets, training and facilities. This study has retrospectively reviewed all LCBDE in our Benign Upper Gastrointestinal Surgery Unit, in particular analysing complications, the management strategies employed, and the impact associated with these interventions.

Method
A retrospective analysis was conducted on all patients (n=427) who underwent LCBDE between November 2013 and May 2024 at our benign Upper Gastrointestinal Surgery Department to evaluate complications. Comparison is made with British Benign Upper Gastrointestinal Surgical Society (BBUGSS) standards.

Results
16.6% (n=71) experienced complications; 3.28% (n=14) retained stone, 3.74% (n=16) bile leak, 9.6% (n=41) non-specific surgical complications.
Bile leak approaches were transcystic (n=2), transcystic converted to cholecdochotomy (n= 3), and choledochotomy n=11. Leaks were diagnosed on ERCP (50%), drains (n=3), CT (n=4) and clinical suspicion (n=1). 50% (n=8) were managed by ERCP, n=6 laparoscopic washout, and n=2 conservatively.
Of retained stones, n=5 were indicated intraoperatively, n=7 on readmission with pain, n=1 on tubogram, and n=1 due to increased drain output. 80% (n=12) managed via ERCP with sphincterotomy +/- stenting. Of the remainder n=1 underwent open exploration, and n=1 managed conservatively.

Conclusion
Bile duct complications can be life altering and thus early identification and management is paramount. BBUGSS’ recommended performance standards for LCBDE state that frequency of retained stones should be &lt;15%, bile leaks &lt;5% and return to theatre &lt;5% (2). In our trust rates are 3.51%, 3.74% and 1.64% respectively. Our stone clearance rate is 96.49%, higher than the BBUGSS standard of &gt;85% (2). Our findings conclude that a benign UGI unit in a District General Hospital can deliver a one stage approach with good management of complications from LCBDE.
BN SO13 - Re-Audit of Biliary Pancreatitis Management: Enhancing Compliance with Timely Laparoscopic Cholecystectomy
Authors: Sakr Mohamed , Methany Reda 
Published: November 2024

Abstract

Background
Biliary acute pancreatitis requires timely management to prevent complications. Guidelines recommend laparoscopic cholecystectomy within two weeks of admission. A previous audit in our surgery department showed only 32.6% compliance with this guideline. This re-audit aimed to evaluate improvements in compliance, identify barriers, and provide insights for enhancing patient care. By retrospectively analyzing patient data from January to November 2023, we assessed progress and highlighted areas needing further improvement to align with established guidelines and ensure better patient outcomes.

Method
A retrospective analysis was conducted on a cohort of 32 patients admitted to the general surgery department with a diagnosis of biliary acute pancreatitis between January 2023 and November 2023. Patient records were reviewed to gather data on the timing of laparoscopic cholecystectomy performed within two weeks of the index admission. The compliance rate from this period was compared to a previous audit to assess improvements. Key barriers to timely intervention, such as the availability of ultrasound slots, hot gallbladder lists, and pre-assessment clinics, were also identified and analyzed. Statistical methods were used to confirm the significance of observed changes.

Results
he re-audit revealed a significant improvement in compliance with guidelines for the management of biliary acute pancreatitis. The percentage of patients undergoing laparoscopic cholecystectomy within two weeks of admission increased from 32.6% in the initial audit to 64.5% in the re-audit. However, the analysis identified persistent barriers to timely intervention, including limited availability of ultrasound slots, insufficient "hot gallbladder" surgical lists, and fear of difficulty of acute laparoscopic cholecystectomy. These findings highlight both the progress made and the areas needing further attention to enhance compliance and patient care.

Conclusion
The re-audit demonstrated a notable improvement in adherence to guidelines for the management of biliary acute pancreatitis, with a significant increase in timely laparoscopic cholecystectomy. Despite this progress, persistent barriers such as limited ultrasound availability, insufficient "hot gallbladder" lists, and pre-assessment clinics need to be addressed. Continuous evaluation and targeted interventions are essential to further enhance compliance, reduce complications, and improve patient outcomes. Ongoing efforts to refine clinical practices will help achieve the highest standards of care for patients with biliary pancreatitis.
BN SO16 - Gastro-gastric intussusception without any lead point – a case report and review of literature
Authors: Ngo Vivien , D’Souza Joel , Scott Harriet , Howes Nathan 
Published: November 2024

Abstract

Background
Gastrogastric intussusception in a rare condition in adults. The underlying aetiologies include pathological lead points, anatomical abnormalities, previous foregut surgery or foreign body. The management of symptomatic gastrogastric intussusception in the absence of these aetiologies remains poorly defined and is highlighted by the paucity of evidence available for guidance. We present a case of idiopathic gastrogastric intussusception and a review of the literature.

Method
A 34-year-old male patient with a background of thrombocytopenia-absent radius (TAR) syndrome presented with recurrent episodes of upper abdominal pain and vomiting. Investigations with a CT abdomen revealed proximal gastrogastric intussusception. Subsequent endoscopy showed oedematous mucosa along the lesser curve and no pathological lead points or anatomical abnormalities. Histological findings were normal.

Results
The patient remained symptomatic despite a normal subsequent CT abdomen. A consensus decision was reached, and the patient was counselled for a laparoscopic gastropexy. Laparoscopic findings showed a central area of scar tissue circumferentially along the mid-body of the stomach highlighting the chronicity of the condition. No hiatal abnormalities were identified. A gastropexy was performed in two layers along the greater curvature of the stomach with non-absorbable interrupted sutures. The postoperative course was unremarkable. The patient remained asymptomatic on 6-week clinic follow up.

Conclusion
No previous case reports of idiopathic gastrogastric intussusception were identified on our literature search. It is our impression that this is the first such case-report to illustrate the diagnostic challenges of this rare, intermittently symptomatic condition and the successful management of it.
BN SO20 - Day-case laparoscopic cholecystectomy: Predictors of failure
Authors: Marks Bertram , Sow Karmen , Owen Lucy , Haddington-Ahmed Aysha , Carr William 
Published: November 2024

Abstract

Background
Laparoscopic Cholecystectomy (LC) is the main treatment option for symptomatic gallstone disease. It is commonly performed as a day case operation and Getting It Right First Time (GIRFT) have suggested that this should be the default position for all trusts. NHSE Model Hospital analyses hospital metrics and sets national benchmarks. They suggest that the day case rate for LC should be greater than 71.4%. The aim of our study is to analyse all elective LC’s over a two year period and identify factors that increase the likelihood of day-case failure and the common reasons for this.

Method
All patients who had LC between 1st July 2020 and 30th June 2022 were identified. All emergency cholecystectomies were excluded from analysis. Patient and operative details were retrieved from their electronic record and a Charlson co-morbidity index was calculated. Statistical analysis was performed using SPSS with Chi-squared tests performed for categorical data and ANOVA for continuous data. Odds ratios with 95% confidence intervals were calculated. Statistical significance was taken as p&lt;0.05.

Results
788 patients had elective cholecystectomies with 74.0% being successful day-case. Factors increasing day-case failure included: Admission with gallbladder disease within past year (OR 3.15 (2.26-4.37), CBD diameter&gt;8mm (OR 2.17(1.44-3.26), thick-walled gallbladder (OR 2.20(1.59-3.04), on-table cholangiogram (OR 4.16 (2.21-7.84), sub-total cholecystectomy (OR 30.6(9.19-102) and male sex (OR 1.55(1.11-2.18). Patients who failed day-case had higher mean age (59 vs 49) and higher co-morbidity index (2.16 vs 1.44). The most common reasons for day-case failure were complex procedure (41%), and symptom control (35%). Only 20% had planned admissions. 30-day morbidity and re-admission rate were higher for failed day-case patients.

Conclusion
Our hospital complies with the day case benchmark set out by Model Hospital. Furthermore, only 5.2% of patients undergoing elective cholecystectomy had a pre-operative decision for an inpatient stay demonstrating that day case is the default for the vast majority of patients. Despite this, improvement could still be made with post-operative symptom control to try and increase this number further.
BN SO28 - Dual Mesh Technique in Revisional Complex Laparoscopic Repair of Recurrent Paraesophageal Hernia (PEH)
Authors: Kwan Yi Xin , Pua Qiao Ying , Loh Danielle , Viswanath Y K S 
Published: November 2024

Abstract

Background
Mesh Augmentation in laparoscopic repair of complex PEH has been an ongoing debate with regards to its risk profile and success rate in reducing hernia recurrence.1 There have been concerns regarding the deployment of non-absorbable mesh around the hiatus resulting in erosion and stricture, which may lead to oesophagectomy or gastrectomy.2 Absorbable mesh has been introduced with appealing advantages of lower mesh-related morbidities, however its high cost and unclear long-term durability remains questionable for its role as an ideal mesh.2

Method
This is the case of a 65-year-old patient with chronic reflux symptoms undergoing revisional complex laparoscopic repair of recurrent type 4 PEH. The focus of this video is using a dual mesh technique involving fixation of a non-absorbable synthetic mesh at least 15mm from the oesophageal wall, reinforced with placement of an absorbable biosynthetic mesh which is in contact with the hiatus boundary.

Results
With regards to position of the permanent synthetic mesh, direct contact with the oesophagogastric wall should be avoided due to complications secondary to erosions and strictures. The deployment of a second mesh of absorbable material is preferred in this patient for hiatal reinforcement to reduce risk of recurrence due to friability of adjacent tissues.

Conclusion
The dual mesh technique aims to overcome the limitations of both types of mesh materials while preserving their individual benefits, expectantly reducing recurrence.
BN SO36 - Robotic versus laparoscopic giant hiatus hernia repair - is one superior in clinical outcomes?
Authors: Sinha Yashashwi , Howey Caitlin , Paz Betheliza Dela , Fernando Tyrrel , Akbari Khalid , Tan Lam Chin , Menon Vinod , McLaughlin Euan 
Published: November 2024

Abstract

Background
The number of robotic giant hiatal hernia repair (RGHHR) procedures is steadily increasing. RGHHR offers several potential advantages over traditional laparoscopy, including enhanced visualisation, superior ergonomics, and the use of articulating instruments, which can be particularly beneficial in the restrictive operating field of the diaphragmatic hiatus. However, the outcomes of RGHHR remain heterogeneous, both when reported alone and in comparison to laparoscopic giant hiatus hernia repair (LGHHR). This study aims to evaluate and compare the key clinical outcomes of RGHHR and LGHHR in adult patients.

Method
All patients undergoing primary giant hiatus hernia (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, hernia type, operative details. Use of mesh and gastropexy (as proxy measures to indicate difficulty of operation). Follow-up duration in weeks. Open cases within this cohort were excluded.
Outcomes were: length of stay (LOS), 30-day morbidity measured using Clavien-Dindo (CD) grading, RTT and 30-day mortality. 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 LGHHR RGHHR p n 56 29 Age (median) 71 (31-93) 66 (39-85) 0.1303 Female (%) 68.7 70 0.8988 BMI 31.8 (±6.4) 29.9 (±3.4) 0.1715 ASA grade (average) 2.4 2.2 0.0587 Hernia Types (median) 3 3 0.4411 Median follow-up (weeks) 8 (1-161) 12 (3-172) 0.5763 Table 2. Operative details LGHHR RGHHR p Mesh used (%) 9.1 0 0.0907 Gastropexy (%) 12.7 6.9 0.4175 Table 3. Outcomes LGHHR RGHHR p LOS (median) 1 (0-161) 2 (0-15) 0.4177 30-day morbidity (CD≥3, %) 3.6 6.9 0.9193 RTT (%) 9.1 6.9 0.5570 30-day mortality 0 0 NA

Conclusion
RGHHR approach has been successful in managing complex GHH, with low RTT, low co-morbidity and no mortality. In our institution RGHHR has demonstrated non-inferiority to LGHHR in respect to clinical outcomes. Patient factors and hernia types did not affect case selection.
Use of mesh and gastropexy showed no difference in outcomes between the two groups. Cost, operative time and surgeon strain/fatigue were not evaluated in this study, however, these would provide useful additional comparative markers for the future.
BN SO38 - Bile Duct Injuries Referrals and Management in a Tertiary Centre in UK– A 6-year study
Authors: Cardoso Swizel Ann , Neophytou Christodoulos , Mukadam Alifya , Kazi Saad , Bartlett David 
Published: November 2024

Abstract

Background
Laparoscopic Cholecystectomy (LC) is the standard treatment for symptomatic cholelithiasis. It has been associated with serious complications, such as vascular/biliary injuries (0.4-0.7% of cases) requiring surgical, endoscopic or radiological interventions.

Objective
To evaluate the management, intervention and outcomes post bile duct injuries (BDI)

Methods
We conducted a retrospective analysis on all patients referred with BDIs from regional centres, following a planned LC operation and treated at the HPB unit of Queen Elizabeth Hospital Birmingham between 2018 - 2023. Patients were followed up for at least one year.

Results
In our unit, 22 (12 male) patients, with a median age of 60 years (16-85) were treated, primarily for gallstone disease (n=14). Most sustained grade E injury (n=19) and were recognised and transferred on average in 4 days (0-43 days). 20 patients had a hepaticojejunostomy. Using the Clavien-Dindo classification, three patients had grade III complications requiring intervention, and one had grade IV complication with sepsis and cardiac failure, necessitating ITU transfer for inotropic support. Discharge occurred within 10 days (4-96), with follow-up over 18.8 months (5-65). Seven await further follow-up, six were discharged and two await PTC for anastomotic stricture.

Conclusion
Our cohort underscores the complexity and critical nature of these injuries. Most patients required hepaticojejunostomy, with a median recognition and transfer of four days. While the early discharge and follow-up outcomes are promising, ongoing monitoring is essential, as patients might commonly develop anastomotic strictures, requiring conservative, radiological or surgical management. These findings highlight the necessity for prompt recognition and referral to specialised HPB units to optimise patient outcomes and reduce the long-term complications associated with BDIs.