bluuebunny/crossref_metadata_2025_split huggingface dataset:
AHP SO06 - A case report of the nutritional and multi-disciplinary team (MDT) management of an emergency oesophageal perforation associated with Eosinophilic Oesophagitis (EOE)
Authors: Ribalta Rachel , Owen Kellie , Saunders John , Grimshaw Kate 
Published: November 2024

Abstract

Background
EOE once considered rare, is a chronic inflammatory condition of the oesophagus presenting as dysphagia and food impaction in children and adults. Awareness and management of EOE is variable despite an increasing prevalence and the condition deemed the most common cause of oesophageal perforation in adults and children by the British Society of Gastroenterology (BSG). This case review aims to increase the awareness of EOE, highlight the clinical presentation of EOE, discuss considerations for the nutritional management and the importance of an MDT approach to the care of this condition in relation to the BSG consensus guidelines.

Method
The patient was admitted to a specialist oesophago-gastric surgical centre in the Northwest of England. A retrospective review of the patient’s case notes was completed. This included exploration of all inpatient and outpatient contacts stored in the electronic patient records system.

Results
18-year-old underweight male with IgE-mediated nut allergy and odynophagia, developed complex multi-site oesophageal perforations following OGD. Management included 40-day endoluminal vacuum therapy and extensive nutritional support. Although initial biopsies lacked diagnostic quality and conclusive results, EOE was subsequently confirmed. Dietetic evaluation included nutritional status, atopic history, symptoms, and dietary intolerances. MDT discussions influenced care continuity and patient compliance. Feeding delays attributable to frequent theatre visits impacted continued weight loss; addressed with allergen-free enteral and parenteral feeding, and dietary reintroduction, following six-food elimination once perforations had healed. Healthy BMI was achieved through patient’s preferred long-term management of normal diet and Budesonide.

Conclusion
Increased awareness of EOE is paramount for patients presenting with unexplained oesophageal perforation. Obtaining biopsy samples as per BSG guidance supports earlier diagnosis and management plan. A thorough clinical history including childhood eating behaviours, atopic history, dietary intolerances and symptom presentation from the patient and relatives gathers collateral information to support diagnosis and treatment planning. Joint discussions regarding pharmaceutical management, dietary elimination and reintroduction are important to achieve remission. The case highlights the importance of collaborative MDT working with the surgical, medical and dietetics whilst empowering the patient to make informed decisions regarding the nutritional and medical management of condition.
EDI&S SO08 A novel approach to environmentally sustainable surgical theatre by rationalising surgical instrument set – a qualitative analysis
Authors: Warner Jennifer , Singh Gautam , Dronamraju Shridhar , Fawole Adeshina 
Published: November 2024

Abstract

Background
The surgical theatres are a major source of hospital waste generation. The NHS has set a net zero supply chain target by 2045. This aim is supported by the RCS intercollegiate green theatre checklist to reduce the environmental impact of operating theatres. One key area identified in this process, that will support the net-zero target is surgical instrument tray rationalisation. Laparoscopic cholecystectomy was identified as one of the most common surgical procedures performed in England. The purpose of this study was to demonstrate the impact of rationalising the number of surgical instruments, enabling surgeons to drive towards net zero surgery.

Method
Our Trust participated in this study, in collaboration with NHS England sustainable procurement team and the innovation agency.
Total 58 cholecystectomies performed across two sites, Pinderfields and Dewsbury were included in this prospective audit undertaken from January – March 2023. The surgical tray checklists were used to record the actual instrument usage and noted the redundant and supplementary instruments. This data presented to a surgical advisory group, who agreed on routine instruments and proposed removal of redundant.
A green pilot tray was approved and used for cholecystectomy. Qualitative questionnaire feedback was collected from surgeons and operation theatre staff from both sites.

Results
The instrument use matrix revealed almost 50% instruments from the previously used major tray were never used in any of the 58 cholecystectomy surgeries performed.
Subsequently, based on the use matrix data, we switched from using major tray containing 84 instruments, to a reduced size tray containing 46 instruments including re-usable metal ports.
Survey results revealed tray rationalisation led to easier and faster surgery preparation, improved efficiency and a reduction in waste, thereby reducing the cost to the Trust.
It was also noted that having a smaller tray means less time to count instruments during the surgical pause.

Conclusion
The results of tray rationalisation are very positive and have demonstrated cost savings, carbon reduction and time saved preparing for surgery and the post-operative instrument count.
This pilot study has shown that by making the surgical set smaller, savings have been achieved from a reduction of slots required per machine cycle for decontamination.
Tray rationalisation goes some way towards the net goal of zero carbon surgery and delivering a sustainable future.
BS SO06 - Bariatric Surgery is a Safe, Effective and Feasible Option in Super-Super Obese Patients
Authors: Haider Ijlal , Kaur Mandeep 
Published: November 2024

Abstract

Background
Bariatric surgery is proven to be feasible and safe in obese and super obese patients (BMI &lt; 60). SSO patients pose greater challenges from technical and medical standpoints. This cohort study aims to assess the safety and feasibility of bariatric surgery in SSO individuals.

Method
A retrospective analysis of a prospective database was conducted, encompassing 4471 bariatric procedures performed over seven years (January 2016 to December 2023). Fifty patients were classified as SSO (BMI &gt; 65). Key outcome variables examined included length of stay (LOS), intra-operative complications, and 30-day morbidity and mortality rates. We evaluated the Resolution of Obesity Related Morbidity (RORM).

Results
Sleeve gastrectomy most common procedure (24, 48%), followed by One Anastomosis Gastric Bypass (17, 34%). Six patients underwent Roux-en-Y Bypass (12%), and six others received SADIs (12%).
Among these, [24 (48%)] had obstructive sleep apnea (OSA), [14 (28%)] had diabetes mellitus (DM) and [9 (18%)] had hypertension.
Average LOS was 2.5 days. No mortality was reported within 30 days with no intra-operative complications. One patient required readmission to the hospital within 30 days after discharge due to vomiting.
The report at 6 months was positive. OSA, DM and Hypertension were resolved in [11 (46%), 13 (92%) and 7 (77%)]

Conclusion
Bariatric surgery should not be dismissed for SSO patients solely due to perceived increased risk based on BMI. Evidence suggests that it can be safely performed on SSO individuals, yielding significant benefits particularly for obesity-related morbidity.
BS SO10 - Predictive Factors in the Development of Dumping Syndrome After Bariatric Surgery
Authors: Tase Arkeliana , Niaz Osamah , Askar Lina , Askari Alan , Musendeki Debbie , Jambulingam Periyathambi , Rashid Farhan , Whitelaw Douglas , Jain Vigyan , Adil Tanveer , Al-Taan Omer , Munasinghe Aruna 
Published: November 2024

Abstract

Background
Dumping syndrome (DS) is a recognised complication of Roux En-Y Gastric Bypass (RYGB) and rarely Sleeve Gastrectomy (SG). The prevalence of DS is unclear, with current literature ranging from 10-50%. The condition is characterised by gastrointestinal and vasomotor symptoms resulting in a significant impact on quality of life. This study aimed to prospectively utilise Sigstad scoring to evaluate post-operative patients, investigating the timing of symptom onset and its correlation with pre-existing diabetes, revision surgery, and percentage of Total Body Weight Loss (TBWL).

Method
We used the Sigstad scoring questionnaire, administered by our bariatric Clinical Nurse Specialists (CNS) at outpatient clinics to assess patients for DS between January to May 2024. Data collected included patient demographics, surgery type and date, TBWL, Body Mass Index (BMI), and whether the patient had a diagnosis of Diabetes Mellitus type II (DMII). A diagnosis of DS was confirmed if a patients score ³7 points on the Sigstad questionnaire. We explored factors influencing the development of DS.

Results
In total, 64 patients were evaluated for DS of whom 86% were female and the median age was 44 years (IQR: 35-45). Most patients (67%) had undergone primary RYGB, 19% SG, 11% conversion from SG to RYGB and 70% were assessed within one year of surgery. DS symptoms emerged in 25% of patients, predominantly within the first-year post-operation (60%). The median TBWL was 12% (IQR: 9-22%), showing no correlation to DS onset. Patients with DMII exhibited a higher propensity for DS (66% vs 20%, p=0.029). Patients undergoing revisional surgery also had a higher incidence of DS (33% vs 6%, p=0.117).

Conclusion
A quarter of patients undergoing bariatric surgery will develop DS, most of whom within the first-year post-surgery. Revisional surgery and pre-existing DMII are the primary predictors in developing DS. There was no observed association between TBWL and DS onset. Further extensive studies are needed to confirm these observations.
BS SO11 - Impact of various biliopancreatic limb lengths on EBWL, Nutritional deficiencies and resolution of ORMs -MGB/OAGB
Authors: Kaur Mandeep , Haider Ijlal 
Published: November 2024

Abstract

Background
OAGB was first described by Robert Rutledge. There have been a few modifications of MGS since its first introduction. There have been modifications in the limb length, pouch side, type, and location of anastomosis.
Concerns have been raised about nutritional deficiencies by various authors about the longer limb length. Few other authors have published promising results from their studies regarding good outcomes on longer limb length.

Method
We follow BMI based guidelines at our center to decide on OAGB limb length.BMI &lt; 50- BP limb length – 150 cmBMI &gt;50 BP limb length- 200 cmBMI &gt; 60 BP limb length- 250 cm.
We analysed our results from BP limb lengths &gt;/=200 cm in terms of EBWL, ORM resolutions, Nutritional deficiencies and compared it to similar outcomes in BP limb lengths of 150 cm

Results
Our data is currently under review. Initial assessment suggests promising results of longer limb lengths with no major complications highlighted. All the longer limb length patients are under 3 monthly follow up with 2 years follow up data now being analysed.
Literature review suggests inadequate weight loss with shorter limb lengths. The longer limb lengths are associated with nutritional deficiencies. We are excited to take this opportunity to discuss our results

Conclusion
Limb length should be tailored as per patient factors and available support. One standard limb length doesn't apply to all the patients.
BS SO17 - Large Bowel Occlusion as a Manifestation of Gastric Adenocarcinoma in a Patient with Previous Gastric Bypass
Authors: Araújo Bruna , Damas Carlos , Dionísio Daniela , Sousa Rui , Marques Hugo Pinto 
Published: November 2024

Abstract

Background
Gastric bypass surgery has become one of the hallmarks of the treatment of obesity and metabolic syndrome. Over the last decade, an increasing number of gastric cancer cases have been reported following gastric bypass, particularly in the excluded stomach. The anatomical changes and the difficult access to the excluded stomach via endoscopy hinder the diagnosis and treatment of this cancer.

Method
Literature review and clinical case analysis through clinical records and exam results.

Results
A 59-year-old male with a history of gastric bypass 15 years prior was admitted to the emergency department with bowel occlusion. A CT scan revealed colonic obstruction due to invasion by a neoplastic/inflammatory process. Consequently, a right hemicolectomy was performed. Histopathological analysis revealed infiltration of the colonic wall by poorly cohesive gastric carcinoma cells. A follow-up CT scan confirmed a lesion in the excluded stomach. A LAMS (lumen-apposing metal stent) was placed to repermeabilize the excluded stomach, and biopsies confirmed gastric mixed adenocarcinoma. A gastroduodenal stent was placed for antropyloric stenosis. A multidisciplinary team opted for palliative chemotherapy.

Conclusion
The association between bariatric surgery and gastric cancer remains controversial. As described in previous studies, this clinical case demonstrates that gastric adenocarcinoma in patients who underwent gastric bypass often presents as an aggressive and advanced-stage disease. Given the mortality associated with gastric cancer and the increasing number of bariatric surgeries, this case report highlights the important need to develop patient selection protocols for gastric bypass and respective appropriate follow-up.
BS SO20 - The impact of Ethnicity and Social Deprivation on Weight Loss following Roux-En-Y Gastric Bypass Surgery
Authors: Karim Seiver , Askar Lina , Al-Fagih Othman , Niaz Osamah , Loh Alex , Razzaq Ahsen , Ahmar Moaz , Sesby-Banjoh Oluwatofunmi , Adil Md Tanveer , Munasinghe Aruna , Rashid Farhan , Jambulingam Periyathambi , Whitelaw Douglas , Jain Vigyan , Al-Taan Omer , Askari Alan 
Published: November 2024

Abstract

Background
Long-term weight loss and weight regain are markers of success following bariatric surgery. The aim of this study was to determine whether there are differences amongst various ethnic and social deprivation groups in terms of weight loss following Roux-En-Y Gastric Bypass (RYGB) at 24 months post-surgery.

Method
Data from a single high-volume UK Bariatric centre (Luton & Dunstable Hospital) were analysed. Relevant variables such as patient demographics, weight and Body Mass Index (BMI) at surgery, were included. Failure to lose sufficient weight was defined as failure to lose ³20% TBWL at 24 months post-surgery.

Results
A total of 1,427 patients underwent RYGB during this time, of whom 80.2% were female. The median age was 48 years old (IQR: 39-55) and the median BMI was 44.7Kg/m2 (IQR: 40.6-50.1). At 24 months post-surgery, 39.3% of patients had failed to lose 20% TBWL. Multivariable analyses demonstrated that the most socially deprived patients were less likely to achieve a TBWL of ³20% at 24 months post-surgery (OR: 0.71 95% CI: 0.56-0.89, p=0.023) as were those from Black (OR: 0.69, 95% CI: 0.50-0.83, p=0.019) and Asian backgrounds (OR: 0.73, 95% CI: 0.61-0.88, p=0.013) compared to patients from a White background.

Conclusion
Ethnicity and social deprivation serve as key indicators of predicting weight loss at 24 months following bariatric surgery. These findings suggest the possible need for tailored care and treatment strategies to optimise long-term outcomes for diverse populations. Understanding these differences is crucial for developing personalized treatment plans and improving the efficacy of bariatric surgery across various ethnic groups. Future research should focus on identifying the underlying causes of these disparities and evaluating interventions to mitigate them.
EGS SO01 - A retrospective study on understanding the dangers of delaying emergency laparoscopic cholecystectomies in patients with acute cholecystitis
Authors: Ragunathan Ragshna , Raza Mehdi 
Published: November 2024

Abstract

Background
Gallstone related diseases account for approximately one-third of emergency general surgery admissions and referrals. Acute cholecystitis (AC), a major complication of gallstones, is typically treated with laparoscopic cholecystectomies (LC), the gold standard for treating symptomatic gallstone disease. According to NICE guidelines patients with AC should preferably undergo a LC within 72 hours. Similarly, SAGES recommends that patients who can tolerate the procedure should have a LC within 24-72 hours of diagnosis. This study aimed to determine if surgical outcomes differ among patients managed within 24 hours, between 25-72 hours, and more than 72 hours from onset of symptoms.

Method
This retrospective analysis evaluates wait times between onset of symptoms and surgery, as well as subsequent surgical outcomes for patients booked for emergency LC over a twelve-month period from September 2022 to September 2023. The data assessed included demographics, indications, imaging results, alkaline phosphate (ALP) levels, alanine transaminase (ALT) levels, total bilirubin levels, C-reactive protein (CRP) levels, white cell count levels, american society of anaesthesiologists (ASA) grade, type of intraoperative complications, time of day operated, length of hospital stay, duration of symptoms prior to decision for surgery and wait until surgery. This data was compared against NICE and SAGES standards.

Results
Sixty-one patients underwent emergency LC in the twelve-month period reviewed, mean age was 49.7 years. The sample was approximately 70% (n=43) female and 28% (n=17) male. 62% (n=38) of patients were booked for a LC within 72 hours of symptom onset. 5% (n=3) of patients had their surgery within 24 hours of presenting to hospital with symptoms, 41% (n=25) had their surgery within 24-72 hours and 54% (n=33) waited more than 72 hours for their LC. 84% (n=51) of the total patients had no adverse intraoperative findings. The 16% (n=10) patients who had complications were part of all three groups.

Conclusion
This study found that 46% of the patients presenting with symptoms of AC undergo emergency LC within 72 hours as per NICE and SAGES guidelines. Intraoperative complications were found in all groups of patients, waiting from 0 to 72 hours for their surgery. 80% of the complications seen were in patients waiting more than 24 hours for their LC. Increasing local awareness on the importance of not delaying emergency LC by creating pathways, such as dedicated LC lists, to allow same-admission LC will enable us to adhere more closely to current guidelines and reduce morbidity from gallstone disease.
EGS SO06 - Emergency provision for Oesophago-Gastric Surgery in the United Kingdom: A National Survey
Authors: Sivarajan Sri , Penney Nicholas , Sreedharan Loveena , Lewis Michael , Kumar Bhaskar 
Published: November 2024

Abstract

Background
Oesophagogastric (OG) emergency conditions may require specialised intervention in centralised OG cancer surgery units. Recently published AUGIS OG commissioning guidance recommends OG units provide 24/7 on-call cover for internal and external OG emergency referrals with a formalised rota. However, there may be widespread inconsistent provision of OG emergency services across United Kingdom (UK) regions with significant workforce, capacity, and funding challenges. This may lead to barriers to provision of on-call OG services. Currently there is no research that establishes current OG on-call coverage or explores OG surgeons’ perceptions and attitudes towards providing this service.

Method
An 11-item electronic questionnaire was developed at an OG cancer unit to identify OG consultant emergency on-call coverage at NHS OG cancer units in the UK. The questionnaire was initially piloted among OG surgeons for refinement and subsequently disseminated through professional networks (AUGIS), direct contact, and snowballing. It was active for three weeks in January 2024. Secondary outcomes included: identifying barriers to providing an emergency OG service; defining the scope of conditions acceptable for transfer; understanding current referral mechanisms and examining OG consultant attitudes and perceptions towards providing an on-call OG service.

Results
71 consultant OG surgeons from 26 UK OG cancer units responded (Figure 1). 61% (n=43) report participating in a 24/7 formalised emergency OG on-call rota, staffed by a median of 5 (range 3-8) surgeons. Among the nine respondents from three centres without a formal OG emergency service, all cited limited funding as the primary barrier. Only 31% (n=19) used auditable referral mechanisms like email or online systems. 97% percent (n=69) of respondents perceive an OG emergency service to be beneficial for patients, and 86% (n=61) agreed it should be nationally mandated for OG cancer units to provide a 24/7 service.

Conclusion
Consultant OG surgeons recognize the importance of delivering high-quality OG emergency services. However, the data indicates inconsistent delivery across the UK. Given the seriousness of OG emergencies, mandatory provision of this service with appropriate funding and remuneration is essential. Several workforce challenges, including potential impacts on OG cancer resection volume and provision of General Surgical on-call, need to be addressed. Ultimately, patients require timely and specialised intervention. As one respondent emphasized: "A situation where surgeons in non-OG centres can spend a whole night ringing around various OG centres looking for help with a Boerhaave perforation is unacceptable."
EGS SO10 - Restructuring of emergency surgical service in DGH leads to significant reduction in time to cholecystectomy for gallstone pancreatitis in line with international guidance
Authors: Ainley Paul , Kerr Barry , Davis Helen , Gallagher Charles , Byrnes Colman , McAree Barry 
Published: November 2024

Abstract

Background
The International Association of Pancreatology guidelines suggest that patients with mild biliary pancreatitis undergo cholecystectomy during their initial hospital admission. A single-center retrospective study was conducted to examine adherence to this guideline following a significant overhaul of emergency surgical services. Our team, with support from the surgical ambulatory emergency care network, revolutionized care through an Emergency Surgery Unit (EmSU) system. This included surgical assessments with ambulation, coordinated radiology appointments, semi-emergency theatre lists twice a week in addition to NCEPOD theatre sessions, and an emergency roster split by patient gender, ensuring a balanced caseload for the surgeons on duty each week.

Method
A retrospective study of patients with mild biliary pancreatitis for three years before (n = 107) and after (n=108) the EmSU system. Cholecystectomy on index admission was recorded, as was overall time to surgery (days). Data was analysed using GraphPad Prism Version 9.5.1. Data is expressed as Mean ± SEM. Percentages underwent Arcsine transformation prior to inferential analysis. Groups of data were analysed using Students T-Tests.

Results
The percentage of patients operated on index admission increased 13.1-fold (4.8% to 62.9%; P &lt; 0.01).
Days to surgery saw a 10.1-fold reduction (332.5 ± 41.1 to 32.9 ± 6.3 days; P &lt; 0.0001).

Conclusion
The adoption of our EmSU system has drastically improved care for patients with gallstone pancreatitis, bringing it much closer to best practice guidance. Further improvement is likely with increased buy-in from all members of staff.