bluuebunny/crossref_metadata_2025_split huggingface dataset:
BN O01 - Hiatus hernia and gastro-oesophageal reflux disease. Does size matter?
Authors: Barghash Mohammed , Obayi Emmanuel , Itaman Usifoh , Furber Zoe , Caul Amy , Othman Ahmad , Mansour Moustafa 
Published: November 2024

Abstract

Background
Hiatus hernia occurs when part of the stomach bulges into the thoracic cavity through the hiatal opening of the diaphragm. In our study, we aimed to assess the impact of the hiatal hernia size on DeMeester score, symptom correlation, and presence of pathological reflux on PH studies. The study also looked at the impact of various characteristics including age, smoking, alcohol consumption, body mass index (BMI), and presence of oesophagitis and/or dysmotility on DeMeester score, symptom correlation, and presence of pathological reflux on PH studies.

Method
The study was conducted in an Upper Gastrointestinal surgery unit located in the North West of England. All patients aged over 18 who underwent laparoscopic fundoplication for gastro-oesophageal reflux disease between January 2017 and June 2023 were included. Patients who underwent fundoplication for para-oesophageal hiatus hernia, those who had fundoplication as a complementary step to Heller’s cardio-myotomy, or those who underwent revisional surgery were excluded.

Results
A total of 115 patients with a median age of 54 were included. Patients’ age was found to have a statistically significant association with hiatus hernia size above 2 cm, DeMeester score, and Symptom Association Probability with a P value of 0.011, 0.021, and 0.030 respectively. Hiatus hernia size above 2 cm was found to have a statistically significant association with pathological reflux (P=0.017). Smoking association with DeMeester score was found to be significant (P=0.027). Hiatus hernia size was not found to have a statistically significant association with DeMeester score, Symptom Index, or Symptom Association Probability (P=0.115, 0.315, 0.904) respectively.

Conclusion
Hiatus hernia size above 2 cm was found to have a statistically significant association with pathological reflux on PH studies but not statistically associated with elevated DeMeester score above 14.72 or symptom correlation indices. Thorough endoscopic assessment in addition to detailed oesophageal physiological studies are mandatory to evaluate patients with gastro-oesophageal reflux disease prior to considering surgery.
BN O02 - Introducing the Cholecystectomy Urgency Index (CUI) – A novel way to visualise and optimise the waiting list for laparoscopic cholecystectomy at a large district general hospital
Authors: Allan Charlotte , Whitehead-Clarke Thomas , Nadeem Tehmina , Muthukumaru Yogeswaran , Yaqub Haseeb , Nehra Dhiren 
Published: November 2024

Abstract

Background
Gallstone disease effects approximately 10-15% of the adult population, and laparoscopic cholecystectomy is one of the most common surgical procedures in the UK, with over 60,000 performed each year. Delays to surgery from diagnosis has been found to increase patient morbidity and readmission rate. Waiting lists in the UK have been struck with a significant backlog from the COVID-19 pandemic, and navigating this ever-expanding patient population to determine priority for booking cases is complex. We propose a new system to prioritise and visualise this cohort of patients in real time – the Cholecystectomy Urgency Index.

Method
At one large district general hospital, we had a waiting list of 148 patients for laparoscopic cholecystectomy. We identified the individual underlying pathology and established the waiting time since diagnosis to allocation of operative date.
We used excel to formulate a pairwise scatter plot of the waiting list patients based upon the time waiting. We were able then to colour code them based on pathology (biliary colic/cholecystitis/cholangitis/pancreatitis/obstructive jaundice). We were then able to link this directly to our scheduling to create a live, visual representation of our waiting list, by both days waited and causative pathology.

Results
We found our median wait times for patients varied based on pathology: Biliary Colic = 185 days, Cholecystitis = 57 days, Pancreatitis, Cholangitis and Obstructive Jaundice (OJ) = 65 days.
We found that the pairwise scatter plot provided a rapidly accessible, easily identifiable visual representation of our patient cohort by both days waited and diagnosis.
This allows relevant staff, surgeons and schedulers to plan elective cases according to both urgency and time waited. Long waiters are easily identified as outliers on the graph and can therefore be flagged for last minute cancellation slots.

Conclusion
By using this system, we can optimise our waiting lists, improve productivity and patient outcomes. We propose a system to enable this further when booking patients: to give them a colour coded CUI number of 1-3. 1 being biliary colic, 2 – cholecystitis, 3 – pancreatitis/cholangitis/OJ.
This will be directly linked to our scatter graph and in doing so, provides us with a readily available, live snapshot in time of the current wait list. This system allows for both clinical urgency prioritisation and easy visualisation of patient cohorts, thus catalysing the elimination of long waiters by means of clear identification.
BN O04 - Trends in the management of bile duct stones in the United Kingdom: Are we following the evidence?
Authors: Brown Oliver D , Aroori Somaiah 
Published: November 2024

Abstract

Background
Common bile duct stones (CBDS) are typically managed in two stages: Endoscopic Retrograde Cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). However, access to ERCP can be limited or require referral, has a high failure rate, often necessitates additional imaging, and may involve multiple procedures. Increasing evidence suggests that single-stage management, involving LC with intraoperative imaging and bile duct exploration when indicated, is cheaper, more effective, and reduces overall length of stay. British Society of Gastroenterology guidance states that it is a valid alternative to ERCP. This study aimed to determine whether clinical practice aligns with this evidence.

Method
National Health Service (NHS) Admitted Patient Care publications summarise Hospital Episode Statistics by financial year and are openly accessible. OPCS4 Procedure Codes were screened by two authors and categorised as “operative” or “endoscopic.” Codes detailing the management of CBDS or bile duct exploration were included, while ambiguous codes or those for non-stone indications were excluded. Data pertaining to these codes were extracted from the Admitted Patient Care publications for 2012 to 2022 and summarised in a Microsoft Excel spreadsheet. Trends were analysed using a Non-Seasonal Mann-Kendall Trend Test

Results
A total of 249,475 procedures for CBDS were performed over the ten-year period, with a mean patient age of 67. Annually, the total number of procedures increased from 21,365 to 27,668 (p=0.002). Endoscopic procedures increased from 19,716 to 25,976 (p=0.002), while operative procedures remained stable (1,649 to 1,692, p=0.431). Consequently, the proportion of endoscopic management rose from 92.3% to 93.9% (p&lt;0.001). The mean age of patients undergoing operative procedures was ten years younger than those undergoing endoscopic procedures (57 vs. 67 years)

Conclusion
Despite evidence and guidance supporting single-stage procedures, there is a trend towards endoscopic management of CBDS in the UK. This may be due to operational pressures on the NHS, including the sequelae of the COVID-19 pandemic, or reflect challenges within hospital culture, skill mix, or equipment availability.
HPB O03 - Snapshot Audit of RELEVANCE: REal worLd outcomEs of adjuVant therapy in pANcreatic CancEr
Authors: Alfarah Jameel , Halle-Smith James , Roberts Keith 
Published: November 2024

Abstract

Background
Evidence-based medicine plays a critical role in shaping clinical practices and setting patient expectations. While randomized controlled trials (RCTs) of adjuvant chemotherapy in pancreatic cancer have demonstrated improved survival rates with newer regimens, their selective inclusion criteria often favor patients with better prognoses. This study aims to compare real-world outcomes with those from RCTs to evaluate the effectiveness of adjuvant therapies in typical clinical settings.

Method
In this retrospective study, we examined overall survival (OS) among patients who received adjuvant chemotherapy (gemcitabine, gemcitabine-capecitabine, or FOLFIRINOX) following the resection of pancreatic ductal adenocarcinoma. We compared survival curves from RCTs (ESPAC 4, PRODIGE-24) with those from real-world cohorts selected based on RCT criteria. Data were collected retrospectively from medical records and institutional databases, covering OS, disease-free survival (DFS), and adverse events.

Results
From July 2014 to December 2019, 303 pancreatic ductal adenocarcinoma patients underwent resections, with 209 (69%) receiving adjuvant chemotherapy: 91 (44%) received gemcitabine, 69 (34%) gemcitabine-capecitabine, and 37 (18%) FOLFIRINOX. The median OS for gemcitabine was 21.6 months, close to ESPAC 4’s 25.5 months. Gemcitabine-capecitabine had a median OS of 25.2 months versus ESPAC 4’s 28 months. FOLFIRINOX had a lower median OS in our cohort (19.9 months) compared to PRODIGE 24’s 54.4 months. Additionally, gemcitabine OS in PRODIGE 24 was higher (35 months) than in our data. FOLFIRINOX had a 17% completion rate.

Conclusion
The real-world outcomes for gemcitabine-based adjuvant therapy align closely with RCT results, while FOLFIRINOX appears less effective in typical clinical settings, possibly due to tolerance issues. These findings highlight the importance of incorporating real-world data in clinical decision-making to better predict patient outcomes and improve treatment strategies for pancreatic cancer. Further research is needed to bridge the gap between RCTs and real-world practices, especially concerning patient selection and treatment tolerability.
MS O04 - OGC Outcomes following gastrectomy for cancer: A 15-Year Retrospective Study examining the impact of regional service centralisation, benchmarking against international standards
Authors: Worthington Lucy , Waheed Unazia , Thirunavaya Kalathil Mohamed Abdullatheef , Al-Daghri Khalid , Alkhaffaf Bilal 
Published: November 2024

Abstract

Background
Gastrectomy remains the cornerstone of curative treatment for gastric cancer but is associated with significant risks of complications. This study aimed to explore the impact of service centralisation in Greater Manchester on outcomes following gastrectomy for cancer. Outcomes were compared against international benchmarks to evaluate impact of centralisation and identify areas for improvement.

Method
This was a retrospective study of all patients undergoing gastrectomy (total gastrectomy TG; partial gastrectomy PG) for cancer at a tertiary OG cancer centre between 2007-2022. Patients were allocated to three time periods (2007-2012; 2013-2018; 2018-2022). Regional centralisation took place in August 2018. Outcome selection was guided by a core outcome set for gastrectomy and international benchmarks including the GastroData consortium and the Dutch Upper Gastrointestinal Cancer Audit (DUCA).

Results
379 patients undergoing gastrectomy (TG; 201, PG; 172) were included. Median length of stay shortened (p=0.023) and median lymph node yield improved (p&lt;0.001) following centralisation. This was consistent with findings from the DUCA audit. There was no difference in R0 resection rates (p=0.668), surgical reinterventions (p=0.717) or readmissions within 90-days (p=0.428) after centralisation. Whilst post-operative mortality improved (30-day 4.5% versus 0%; 90-day 5.4% versus 1.2%), this was not statistically significant (p=0.09).

Conclusion
Centralisation of surgical OG cancer services in our region resulted in improved short-term outcomes for patients undergoing gastrectomy. This may reflect a greater emphasis on standardised peri-operative surgical and pathology protocols. These findings were partly consistent with international benchmarks. Further evaluation of the impact on longer-term outcomes is required.
MS O05 - HPB The ORDEAL Study: A Multi-Centre Retrospective Cohort Study Assessing the Optimal Resection for Proximal and Distal Duodenal Adenocarcinoma
Authors: Horne Sophie , Kowsik Mukunth , Pandé Rupaly , Chatzizacharias Nikolaos 
Published: November 2024

Abstract

Background
Duodenal adenocarcinoma (DA) accounts for over 50% of all small bowel adenocarcinomas, however there is a paucity of cases and outcome data, no UK guidelines for surgical management, and a lack of contemporaneous UK patient data. There is debate as to whether oncological and perioperative outcomes differ between pylorus-preserving pancreaticoduodenectomy (PPPD) and classical PD (cPD) in proximal DA (D1/D2), and between PD (cPD or PPPD) and limited resection (LR) in distal DA (D3/D4). This study aimed to determine the optimal type of resection for proximal and distal DA through investigating differences in long-term survival and perioperative outcomes.

Method
A national retrospective audit of consecutive patients from 2008-2023 undergoing curative resection for DA was conducted, with data collected anonymously via REDCap. Baseline demographics, radiological, operative, pathological and short and long-term outcomes were collated. Analysis was performed using SPSS with standard descriptive statistical methods. Chi-Square, Mann-Whitney and ANOVA were used as appropriate to compare variables and outcomes between two groups, with statistical significance set at p&lt;0.05. Survival analysis (overall survival (OS) and disease-free survival (DFS)) was performed using the Kaplan–Meier method and the log-rank test to compare differences between survival curves. Time-to-event analysis was calculated with Cox regression.

Results
The study cohort (median age 68 years, 54.4% males) had a mean follow-up of 35.6 months. For proximal DA, 56 underwent PPPD and 87 underwent cPD; for distal DA, 26 underwent PD and 37 underwent LR. For proximal DA, survival and lymph node clearance were similar, with severe complications and no adjuvant chemotherapy independently decreasing survival. For distal DA, survival was similar despite greater lymph node clearance with PD, with age and no adjuvant chemotherapy independently decreasing survival. Complications including pancreatic fistula, delayed gastric emptying, and post-pancreatectomy haemorrhage, were comparable for proximal DA but greater with PD in distal DA.

Conclusion
Preliminary findings suggest adequate lymphadenectomy and comparable long-term survival for cPD and PPPD in proximal DA. For distal DA, LR is associated with similar long-term survival but lower morbidity despite greater lymph node clearance with PD. Additional records will validate these findings further.
MS O10 - BN Case Report: Aberrant Right Subclavian Artery As A Rare Differential For Dysphagia
Authors: Howey Caitlin , Sinha Yashashwi , Akbari Khalid 
Published: November 2024

Abstract

Background
Dysphagia lusoria (DL) is characterised by swallowing difficulty due to external oesophageal compression from congenital aortic arch malformations. It is clinically rare and affects less than 2.5% of the population.
The most prevalent form of DL is the aberrant right subclavian artery (ARSA) where approximately 10% of patients experience dysphagia.
Despite AL being congenital, dysphagia often manifests later in life, likely due to age-related atherosclerotic changes in the vasculature and decreased oesophageal flexibility.

Method
Presented is a case report of a female in her seventies where, despite repeat hiatal hernia repair and maximal medical management, her index symptoms of dyspepsia and retrosternal discomfort persisted when reviewed in specialist upper gastrointestinal clinic.
She underwent extensive investigation; however, her symptoms were unremitting, manifesting in numerous emergency department presentations to exclude acute coronary syndrome.
This case report details the anatomical differences via diagrams and documents the comprehensive investigation and multi-disciplinary approach to the management of dysphagia in ARSA.

Results
Prior to referral to our team, the patient had a laparoscopic hiatus hernia repair and Nissen fundoplication undertaken. Oesophageal manometry revealed weak oesophageal motility and 24-hour pH monitoring did not demonstrate pathological acid-reflux. Recurrence of hiatus hernia was observed on oral contrast swallow and gastroscopy.
Subsequently, the patient underwent laparoscopic revision of hiatus hernia and conversion of Nissen to a Dor. Post-operatively her symptoms required complete fundoplication reversal. Following reversal, assessment demonstrated improved distal oesophageal emptying.
Her CT emphasised an ARSA causing significant compression and deviation of the proximal oesophagus. The patient was referred onwards to vascular surgery.

Conclusion
Initial diagnostic workup for patients presenting with dysphagia in the upper gastrointestinal clinic seeks to encompass several common aetiologies including oesophageal motility disorders, malignant compression and benign strictures.
Clinicians must consider less common causes of extrinsic compression, such as ARSA, particularly in patients with unrelenting and persistent symptoms despite appropriate implementation of both medical and surgical interventions.
Treatment approaches for ARSA reflect symptom severity, with both conservative and surgical options considered.
VS 06 - HPB Laparoscopic Caudate lobectomy and resection of exophytic cyst
Authors: Kadamapuzha Jacob , Lambert Joel , Satyadas Thomas 
Published: November 2024

Abstract

Background
A 64 year old lady with no comorbidities presented with early satiety and upper abdominal discomfort. Imaging (CT abdomen and MR Liver) revealed multiple cystic lesions in liver including 9cm X 8cm X 6 cm cyst in segment 2 and 10cm X 8 cm X 8cm cyst in caudate lobe suspicious of Simple cyst/biliary cystadenoma.

Method
A laparoscopic caudate lobectomy and resection of exophytic cyst was done.

Results
Post operative period was uneventful and patient was discharged on post operative day 5. Patient is on follow up.

Conclusion
A video of a successful laparoscopic caudate lobectomy and resection of exophytic cyst is presented.
VS 07 - OGC Visualisation of variant thoracic duct anatomy using mesenteric injection of Indocyanine Green (ICG) and early ligation of the high thoracic duct can decrease the occurrence of chyle leaks after robotic oesophagectomies: Insights from a single-centre case series
Authors: Salem Riadh , Mastoridis Sotiris , Sgromo Bruno 
Published: November 2024

Abstract

Background
Chyle leak (CL) remains a relatively common complication following oesophagectomy, with reported incidence up to 9%, and is associated with significant clinical and financial consequences. We assess the feasibility and utility of fluorescence to visualise the thoracic duct (TD), using an easy-to perform intraoperative technique. This involves injecting ICG into the small bowel mesentery during robotic Ivor-Lewis oesophagectomy (RAMIO) and early ligation of the thoracic duct above azygos arch.

Method
Between 2022-2024, 36 patients undergoing RAMIO received ICG (2ml of 2.5mg/mL solution) injected in the root of jejunal mesentery by endoscopic needle injector via laparoscopic port during the abdominal phase. A minimum of 60min following injection, fluoroscopic visualisation of TD anatomy was performed with Firefly® system.
During the initial phase of the thoracic stage, the thoracic duct was located in the upper mediastinum, just above azygos arch, and was securely clipped using the Hem-o-Lok® system.

Results
Successful TD imaging using ICG-fluorescence was achieved in all 36 patients undergoing RAMIO. Variations from the standard single duct structure were observed in 4 (11%) of patients. Specifically, two cases exhibited duct bifurcation at the level of the azygos arch, one case had branching in the lower mediastinum, and another case demonstrated branching from the main duct over the thoracic aorta. All observed branches were individually clipped with Hem-o-Lok® system. Two individuals (5.5%) experienced low-volume chyle-leak post-operatively, which was successfully managed conservatively. No chyle leaks were detected at the end of the surgery in any of the cases.

Conclusion
In our single-centre experience, fluorescence visualisation of the thoracic duct during RAMIO by intraoperative mesenteric injection of ICG is an easily performed, reproducible technique which can assist in the visualisation of variant TD anatomy and reduce the incidence of CL. In addition to its impact on clinical outcomes and healthcare costs, the approach can also support a better appreciation of TD anatomy among surgeons.
VS 09 - HPB Laparoscopic Trans-Cystic Bile Duct Exploration is Safe and Feasible even after previous Cholecystectomy
Authors: Bakewell Zoe , Thiagarajah Viswan , Zino Samer , Gemenetzis Georgios 
Published: November 2024

Abstract

Background
Laparoscopic trans-cystic bile duct exploration is well know to have less comorbidity that conventional trans-ductal approach. A 56-year-old female underwent emergency laparoscopic cholecystectomy in 2019 for cholecystitis. Subsequently treated conservatively for ascending cholangitis due to large stone in the bile duct on MRCP. She underwent two unsuccessful ERCPs due to anatomical challenges; large hiatus hernia and duodenal diverticulum. The MDT determined bile duct exploration was necessary as no endoscopic options remained. After assessing previous imaging, laparoscopic trans-cystic exploration was chosen to minimise complications. This video highlights the feasibility of laparoscopic trans-cystic CBD post-cholecystectomy.

Method
Standard four-port technique with 10mm, 30-degree laparoscope. Blunt, sharp, energised and hydro-dissection were employed. Indocyanaine green(ICG) helped identify the bile duct(CBD) and the cystic duct(CD) stump. CD was dissected from the gallbladder bed and opened for a cholangiogram; confirming a large stone in the distal bile duct. A 3.5 mm choledochoscope with electrohydraulic lithotripsy(EHL) was used to explore the bile duct and fragment the stone for extraction. Remaining small fragments were flushed into the duodenum after 20mg buscopan intravenously. Final cholangioscopy and cholangiogram through the choledochoscope showed clear ducts with good flow into the duodenum.

Results
The patient was started on IV antibiotics due to pyrexia on the first night of admission. The abdominal drain was removed after 48 hours, and the patient was discharged on day three to complete a five-day course of antibiotics. Nine months post-operatively, she presented with a 3x5x7.5 cm sub-hepatic abscess, requiring interventional radiology (IR) drainage and a six-week course of antibiotics. The drain was removed after a follow-up CT scan three weeks post-drainage showed resolution. There have been no further episodes of cholangitis, and she has returned to her baseline quality of life.

Conclusion
This case shows laparoscopic trans-cystic approach remains viable post-cholecystectomy. Advanced imaging and tools including 3.5mm choledochoscope and EHL aid safer surgery with reduced morbidity, shorter stays and faster recovery. Antibiotics may be necessary for cases with longstanding bile duct stones. Furthermore, this case highlights the importance of intraoperative cholangiography and bile duct exploration. The patient had an MRCP in 2019 that showed no bile duct stones but a dilated CBD associated with deranged LFTs. This suggests that her journey might have been less complicated if a cholangiogram had been performed during the initial laparoscopic cholecystectomy.