bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB O02 - On-site hepatobiliary surgery capability independently predicts treatment pathway completion in metastatic rectal cancer: A nationwide observational study of 15,727 patients
Authors: Lakha Adil S , Chammas Lara , Morris Eva , Gordon-Weeks Alex 
Published: November 2024

Abstract

Background
Stage IV rectal cancer carries a 10% 5-year survival rate (Jemal et al., 2005). Curative-intent management requires treatment of both the primary and metastatic disease. This study aimed to identify patterns in stage IV rectal cancer treatment pathway at population level across the UK, and to identify predictors of treatment pathway completion.

Method
Patient demographics and treatment data were extracted from the UK Colorectal Cancer Intelligence Hub’s CORECT-R repository, national chemotherapy (SACT), radiotherapy datasets (RTDS), and Hospital Episode Statistics (HES) data. Treatment pathway completion was defined as receipt of intervention to the primary tumour, in addition to metastasis-directed therapy, or the combination alongside chemotherapy. Multivariable logistic regression analysis was performed to identify independent predictors of treatment completion.

Results
A total of 15,727 patients with stage IV rectal cancer diagnosed between 2010-19 were identified. There was significant variation in proportion of patients with complete treatment between MDTs. Multivariable analyses showed that lack of on-site HPB surgery capability was the only predictor of failure to complete treatment (OR 1.22, 95%CI:1.07-1.38, p&lt;0.01).

Conclusion
Across the UK, there is variation in Stage IV rectal cancer patients completing treatment for both their primary and metastatic disease. Further work is needed to determine whether differences in treatment pathways stem from variation in access to specialist services between cancer alliances or whether they are due to differences in MDT decision making.
MS O09 - OGC Long-term oncological outcomes following totally minimally invasive, hybrid and open oesophagectomy for cancer
Authors: Sadik Wafia , Waheed Unaiza , Alkhaffaf Bilal 
Published: November 2024

Abstract

Background
There has been a significant shift in the surgical management of oesophageal cancer, with increased popularity of minimally invasive oesophagectomy in comparison to open approaches. Data thus far has largely focused on the peri-operative and short-term benefits with limited study on long-term oncological outcomes. This study aims to explore patterns of oesophageal cancer recurrence and survival following minimally invasive and open oesophagectomy.

Method
This was a retrospective review of consecutive patients who underwent open (OO), hybrid (HO) and minimally invasive (MIO) oesophagectomy for cancer at a regional oesophago-gastric centre in the UK between 2014-2023. Follow-up data was obtained from the centre’s established surgical database, in addition to the regional radiology, MDT and electronic patient records to record survival, recurrence, and patterns of recurrence (locoregional, haematological, distal nodal, peritoneal and number of recurrence sites).

Results
437 patients (170 OO; 132 HO; 135 MIO) were included. There was no difference in baseline data between the groups. Overall survival rates at 1-, 3-, and 5-year were 88%, 64% and 54%. Recurrence rates at 1-, 3-, and 5-year were 17%, 35% and 41%. Haematological and locoregional recurrence made up 37% and 33% of all recurrence types. 52% of patients had one type of recurrence at diagnosis. After adjusting for disease stage, there was no significant difference between operative approaches with respect to survival and recurrence rates (at 1,3 and 5 years), time to recurrence, or patterns of recurrence.

Conclusion
This study found no significant difference in long-term oncological outcomes when comparing different minimally invasive and open surgical approaches to oesophagectomy. MIO can continue to be offered to patients as a safe alternative to open surgery. Further multi-centre prospective research is required to validate these results.
VS 02 - HPB Inter-fascial Catheter with Local Anaesthetic Infusion in Hepato-biliary Surgery (HILA) – A Video Guide to Catheter Placement
Authors: Sellappan Hari , Charles Nina , Adiamah Alfred , Eastwood Joanne , Sanyal Sudip 
Published: November 2024

Abstract

Background
Thoracic epidural analgesia (TEA) offers effective pain control after open hepato-biliary surgery, however it is associated with several limitations that delay post-operative recovery. Inter-fascial catheter with local anaesthetic infusion (IF) is an effective, safe and cost-saving alternative to thoracic epidural analgesia (TEA) following open liver and biliary surgery, with significant decrease in post-operative vasopressor requirements, and length of critical care and hospital stay.

Method
This video presentation outlines current clinical evidence with local data from Nottingham University Hospital, relevant clinical anatomy of the inter-fascial plane, intra-operative placement techniques, tips and tricks as well as troubleshooting in the event of a catheter related complication.

Results
The inter-fascial catheters can be placed in the transversus abdominis or posterior rectus plane based on the type of skin incision to achieve optimal post-operative pain control. It is associated with a low technical failure rate.

Conclusion
Inter-fascial catheter with local anaesthetic infusion is an effective, safe and cost-saving technique associated with significant decrease in post-operative vasopressor requirement, and length of critical care and hospital stay.
VS 04 - HPB Laparoscopic trans-vesical approach is safe management for cholecystoduodenal fistula
Authors: Bakewell Zoe , Thiagarajah Viswan , Bright Euan , Zino Samer 
Published: November 2024

Abstract

Background
A 71 year old female initially presented cholangitis. Her MRCP showed a distal common bile duct (CBD) stone. An ERCP was then performed which was not successful due to anatomical challenge in the form of a large diaphragmatic hernia. An elective laparoscopic cholecystectomy with IOC was performed. An incidental cholecystoduodenal fistula was found therefore the clinical decision was made to perform a trans-vesical approach to fistulogram. This showed a fistula was present and that it was not complicated further. This case shows that this approach avoided iatrogenic injury by confirming presence of the fistula and aided further surgical planning.

Method
Standard four-port technique with 10mm, 30-degree laparoscope. Blunt, sharp, energised and hydro-dissection were employed. The duodenum was adherent to the gallbladder body therefore a trans-vesical enterotomy was performed. Fistulogram confirmed presence of a cholecystoduodenal fistula but nil further pathology. The fistula was dissected from the gallbladder and stapled with the GIA endo- tri-staple 45 Purple. Further dissection to gallbladder to ensure clear visualisation of calot’s triangle. Basket trawl of the CBD was performed and repeat cholangiogram was clear. The gallbladder was dissected from gallbladder fossa, all gallstones were removed and 3L of wash was used to irrigate the intra-abdominal cavity.

Results
The patient was admitted following the procedure and was discharged on day two with PPI. She was reviewed post-operatively at 12 weeks and had no further issues. She remains well and has had no further episodes of cholangitis or hospital admissions in almost four years since the procedure.

Conclusion
This case shows an unexpected finding of cholecystoduodenal fistula in a planned laparoscopic cholecystectomy with IOC. It is important to note that some gas was seen in the gallbladder on initial imaging therefore indicating a possible cholecystoduodenal fistula. This trans-vesical approach with fistulogram confirmed a simple fistula and no further pathology and aided safe surgical planning. This improved patient outcomes and avoided iatrogenic injury thus providing a safer way to manage cholecystoenteric fistula. This novel approach to cholecystoduodenal fistula repair improves patient safety, length of stay and by aiding intra-operative planning and avoiding iatrogenic injury.
AHP SO02 - A Quality improvement project to improve the Nutritional teaching within the General Surgery Department
Authors: Walton Chelsea , Finn Megan , Hill Anna 
Published: November 2024

Abstract

Background
Malnourished patients have greater incidences of post operative complications which can prolong hospital stay. Dietitians improve the nutritional status peri-operatively to reduce complications and accelerate recovery in hospital. Given that the doctors working in surgery are junior doctors who work on a rotational basis, means that they have little time to get to know the roles of the MDT, hence they are faced with the challenge of having little knowledge of complex nutritional needs of the surgical patient.
The aim of the quality improvement project is to improve the nutritional teaching within the General surgery department to improve clinical practice.

Method
Using Plan-do-study-act (PDSA) Methodology, a Multi-disciplinary-team was created to identify ways to improve our nutritional knowledge. An initial survey was collated and distributed throughout the department to establish the current knowledge of nutritional challenges. From the initial survey, a need to improve the teaching of nutrition to the department was highlighted.
The plan implemented itself in the form of informal teaching and educational resources to provide teaching to the department. Further questionnaires were used to assess the value of the teaching sessions. Pre/Post-teaching session surveys were used to assess the participant progress and satisfaction of the teaching session.

Results
The initial survey showed that on average the individuals sampled had a neutral/basic knowledge of the nutritional topics.
In addition the survey addressed a need for surgical nutritional teaching to which 100% of respondents answered ‘Yes’. 100% of the respondents gave a 7/10 above or higher rating for how much they would benefit from the teaching and 100% of the cohort either requested teaching sessions alone or both a teaching session and information booklet.
Following these interventions; a Pre/ Post-teaching survey was conducted to provide insight of how the department responded to the teaching, which was overall well received.

Conclusion
The role of nutrition is an important factor that affects surgical outcome and having clinical knowledge of nutritional needs and complications allows us to improve our clinical practice and patient care. The project identified a need for educational improvement and the project has allowed the department to establish regular quarterly nutritional teaching for rotational training and provided educational resources that have been demonstrated to be an effective intervention within the department. The project provided an overall positive engagement to improve our nutritional knowledge and will undoubtedly have a marked impact on quality of care, patient outcomes and their experience.
AHP SO07 - Dietetic Outpatient Service to Patients undergoing Oesophagogastric (OG) Surgery for Cancer
Authors: White Cathy , Arumugasamy Mayilone , Robb William 
Published: November 2024

Abstract

Background
Nutrition is a modifiable risk factor impacting surgical outcomes in OG cancer. Its key role influencing health related quality of life is emerging with improved survivorship. Guidelines depicting optimal timing and type of dietetic intervention for this patient group are unclear. In order to best direct dietetic care, optimise timing of nutritional interventions and understand demand for service it is important to reflect on current provision. This audit aimed to describe the dietetic outpatient service to patients undergoing OG Surgery for cancer in a national centre for treatment of oesophageal cancer.

Method
A retrospective review of dietetic records and statistics. Patients who underwent oesophagectomy (O), gastrectomy (G) or subtotal gastrectomy (STG) for cancer between May 2022- May 2023 were included.

Results
63 patients were included: 38 O, 17 TG, 8 STG. 11 were seen by the dietitian at first visit to OG Clinic (9 O, 1 TG, 1 STG) – 6 had an elective feeding tube (FT) inserted for neoadjuvant treatment (5 O, 1 STG). 83% attended a surgical pre-assessment dietetic appointment (36 O, 14 TG, 2 STG). 86% were reviewed within 1 month post O or TG, 75% post STG. 258 dietetic interventions occurred in the first year post-op (median 3.5, range 0-14). 64% in the first 3 months(m) post op, 16% at 3-6m, 10% at 6-9m, 10% at 9-12m.

Conclusion
In this high nutritional risk group only 18% are assessed by a dietitian at first visit to UGI MDT clinic. There is a successful pathway for immediate peri-operative dietetic care in patients post O and TG. The pathway for STG is less well established. Dietetic interventions are concentrated in the first 3 months after surgery. There is no established protocol to support longer term nutritional needs into survivorship. To inform practice a measure of patient experience and needs would be useful, to explore best delivery format and access routes to future services.
AHP SO10 - A review of preoperative dietetic outcomes in patients with oesophagogastric (OG) cancer undergoing surgery
Authors: Hegarty Jane , Mak HiuKei , O' Neill Aoife , Henggeler Cordula , Evans Orla 
Published: November 2024

Abstract

Background
In line with NICE guidance (2018), all patients undergoing OG surgery at GSTT are offered a dietetic assessment by a specialist dietitian before their surgery. There is emerging evidence and interest in prehabilitation programmes to improve clinical and patient-centred outcomes. Nutritional optimisation is a key component of such programmes, although the optimal nutrition interventions are not fully elucidated, particularly within the preoperative period (Casey et al., 23). There is large national variation in dietetic interventions and minimal guidance on best practice to support this patient group.

Method
A retrospective review was undertaken to assess whether preoperative dietetic goals for patients with OG cancer undergoing surgery between August 2022 to January 2023 were achieved. Outcomes based on weight were reviewed given its routine use and availability. Dietetic goals were categorised according to the following aims: weight gain, weight stability and weight loss. Data was collected on 44 patients and excluded from analysis were those who were not assessed by a dietitian preoperatively. The length of intervention was defined in days.

Results
Table 1.0 Goal Weight Gain (n=11) (all ONS) Intervention length Achieved (&gt;1kg weight gain) 7 (64%) 19-46 Not achieved (&lt;1kg weight gain/ weight loss) 4 (36%) 26-40

Conclusion
Overall, 52% patients did not achieve their weight goal before surgery. At present in our centre, patients receive one appointment with the specialist dietitian before their surgery due to limited resource. There is a recognition that additional support is required for many patients to prepare for surgery. Prehabilitation would address this and have the potential to improve dietetic outcomes. Weight is a readily available outcome measure but does not reflect body composition or other parameters of nutritional status. More comprehensive assessment of nutritional status would support further evaluation of dietetic outcomes and their impact on clinical and patient centred outcomes.
BS SO03 - Revisional bariatric surgery following sleeve gastrectomy, a meta-analysis comparing RYGB and OAGB
Authors: Santoro Giovanni 
Published: November 2024

Abstract

Background
The number of bariatric operations is on the rise each year. Sleeve gastrectomy is the most popular procedure however often requires a revision surgery because of insufficient weight loss, weight regain or GERD. The most popular procedures are RYGB and OAGB. Our primary outcome was to look at the effect on weight loss in patients undergoing revision surgery and the secondary outcomes were gastro-oesophageal reflux, BMI difference, operative time, bleeding and anastomotic leak

Method
A systematic electronic search was undertaken using PubMed, MEDLINE®, Ovid®, Cochrane Library and Google Scholar™ according to PRISMA. Initial search identified 2,546 articles, after screening seven papers met the inclusions criteria, six retrospective studies and one RCT.

Results
There were a total of 802 patients that fit the inclusion criteria. 390 patients had a OAGB and another 412 had a RYBG. All patients previously had sleeve gastrectomy for weight loss. The length of follow-up was 12 months for our primary outcome. We found no statistically significant difference in %EWL between OAGB and RYGB (p=0.11). The incidence of post-operative reflux was statistically significantly higher in the OAGB group (16% vs 10.1%, p&lt;0.003). Operative time was statistically significantly lower in the OAGB group (p=0.04).

Conclusion
Our meta-analysis showed no statistically significant difference between the two revision bariatric surgery procedure for %EWL. RYGB was superior to OAGB in reducing the incidence of symptomatic GERD while OAGB had a significant shorter operative time.
BS SO09 - Use of ursodeoxycholic acid in preventing gallstone formation after bariatric surgery – introduction of a new clinical pathway
Authors: Cromwell Paul , Gopalan Vignesh , Ayliffe-Daly Lucie , Welbourn Richard 
Published: November 2024

Abstract

Background
Rapid weight loss is a risk factor for symptomatic gallstone formation. Managing gallstone disease such as choledocholithiasis can be more challenging after Bariatric Surgery (BS) due to altered anatomy. Ursodeoxycholic acid (UDCA) is a low-cost and low-risk method of reducing the risk of symptomatic gallstone disease and cholecystectomy by almost a third in patients who have had BS. However, it is not yet included in national guidelines for bariatric surgery. We audited prescription rates of UDCA in patients who underwent BS with a view to introducing it into our standard post BS care bundle.

Method
Data was collected from 30 consecutive patients who underwent a sleeve gastrectomy or Gastric bypass in November and December 2023. The results informed our practice and a UDCA prescribing pathway was developed using evidence from randomized trials. The pathway was circulated to all members of the bariatric service on 17/1/2024 and discussed at the departmental meeting. The audit loop was closed by collecting data from a further 30 consecutive patients. Demographic data, type of operation, BMI, history of gallstone disease, prescribing data and reasons for non-compliance were collected. The compliance rate to the UCDA pathway was expected to be 100%.

Results
Data was collected from 60 patients (85% female; median BMI 49; median age 45). No patient who could have benefited received UDCA prior to the intervention. After the intervention, 15/30 (50%) of patients were correctly prescribed UDCA. Therefore, correct prescription of UDCA did not meet target compliance rates. No patient was incorrectly prescribed UCDA. Reasons for non-compliance include human error, concern about the size of the tablet, inadequate knowledge about how to administer (e.g. crushing in liquid) and misconceptions of oral intake after BS.

Conclusion
UCDA can reduce incidence of symptomatic gallstones following BS, yet use of UDCA in bariatric centres in the UK is thought to be low. We discovered that more time should be dedicated to educating the team about administration methods and how it interacts with the current postoperative diet plan. A UCDA pathway and education of bariatric teams can improve compliance with appropriate UDCA prescribing. Further intervention is required and planned in our centre such as utilising e-prescribing as a prompt to include UDCA in the discharge prescription and considering the use of the drug's liquid form in the short term.
BS SO13 - Reversal of OAGB- Audit and steps of surgery
Authors: Kaur Mandeep , Haider Ijlal 
Published: November 2024

Abstract

Background
OAGB is a well-established procedure that gives good outcomes in terms of benefits from obesity related morbidity and weight loss. The nutritional complications of OAGB are not common. The most common complication for OAGB is bile reflux which can be controlled with medical or surgical management.
The need to convert OAGB to normal anatomy or sleeve does not arise frequently. It is needed in a few patients. It is a technically challenging procedure and should be done in expert centers

Method
We would like to present a video on the steps of reversal surgery. We recorded our procedure and used imovies software to edit it demonstrating each step of surgery with a written commentary for ease of understanding
We would also take this opportunity to present an audit of our series of patients. We gathered our operative sheets from December 2016- Jan 2024. There were 12 patients who needed conversion or reversal. 10 needed conversion to RYGB for bile reflux. 2 needed reversal to normal anatomy.

Results
High quality video presentation with narration talking about steps of surgery and results from our audit

Conclusion
Reversal surgery is a technically challenging procedure. It should be done in expert center. Also, since this surgery is not needed frequently, it needs expert surgeons.
EGS SO03 - Audit of wound complications after Emergency laparotomies in A University Teaching Hospital: 2-cycle Prospective Audit
Authors: Awad Philobater , Hassan Basma 
Published: November 2024

Abstract

Background
Wound infections and incisional hernias are frequent complications that can occur after an emergency laparotomy. The surgical technique used plays a crucial role in determining the likelihood of complications. The objective of this audit was to evaluate our technique in performing emergency midline incision closure and to compare our complication rates with those of established guidelines.

Method
A two-year prospective audit, comprising two cycles, was conducted at a teaching university hospital to evaluate the incidence of wound infections following emergency laparotomy. During each cycle, which lasted for one year, 1423 patients underwent an emergency laparotomy.

Results
The initial outcomes showed that wound infection rate was 123 out of 621, which translates to 19.8%, the overall rate of acute fascial rupture was 66 out of 621, amounting to 10.6%, while overall incisional hernia rate was 87 out of 621, which equals 14%.
In the subsequent cycle, wound infection rate was 49 out of 802, corresponding to a percentage of 6.2%. The overall rate of acute fascial rupture was 34 out of 802, which is equivalent to a percentage of 4.3%, while the overall incisional hernia rate was 42 out of 802, which translates to 5.2%.

Conclusion
In conclusion, the audit revealed several areas of improvement to address in order to enhance its overall performance and achieve its goals of decreasing our rate of wound complications after urgent laparotomy which needs our adherence to this closure technique