bluuebunny/crossref_metadata_2025_split huggingface dataset:
EGS SO07 - Laparoscopic retrieval of endoscopic lithotripsy basket aided by laser fragmentation: Case presentation and literature review
Authors: Nip Lawrence , Lynch Mark , Philipose Zinu , Ceraldi Serena Sabato 
Published: November 2024

Abstract

Background
Large or impacted common bile duct (CBD) stones that cannot be removed by conventional endoscopic methods sometimes require endoscopic mechanical lithotripsy. A rare but feared technical complication related to this is basket entrapment, where the stone-basket complex cannot be separated from each other due to mechanical failure and becomes impacted within the CBD. We present a novel case of laparoscopic CBD exploration and antegrade laser fragmentation of impacted stone-basket complex, and perform a literature review pertaining to this topic.

Method
This is a case report from a single district general hospital with laparoscopic capabilities but no access to Spyglass. The operation began with fundus first subtotal cholecystectomy and the cystic duct was ligated with PDS endoloops. A choledochotomy was made and dilated to allow insertion of a 7.5 Fr cholangioscope. Through this, laser lithotripsy was undertaken which reduced the stone size and permitted disengagement of the stone from basket. The stone was retrieved via enlargement of the choledochotomy, while the basket and wire retrieved orally. We subsequently performed a literature review of Pubmed, Google Scholar, and Embase.

Results
Laparoscopic retrieval of an impacted basket was first described in 1993, with the basket found lodged in the gallbladder. The technique involved a large cholecystotomy, followed by removal of the basket, closure of the gallbladder, and then cholecystectomy. Our literature review yielded 5 case reports of laparoscopic retrieval of basket from the CBD. Three authors describe manual disengagement of the basket by laparoscopic manipulation of the wires, one describes capturing an impacted Dormia basket with a second Dormia basket, and one describes direct mechanical fragmentation and subsequent balloon trawl of the remaining debris.

Conclusion
To our knowledge, this is the first case report describing laparoscopic CBD exploration with concurrent laser fragmentation to facilitate retrieval of impacted stone-basket complex following mechanical lithotripsy failure. We propose that this is a viable option in centres without Spyglass or electrohydraulic lithotripsy, but where expertise for emergency laparoscopic CBD exploration exists.
EGS SO13 - Evaluation of Different Surgical Risk Prediction Models in Predicting Morbidity and Mortality in Giant Hiatus and Diaphragmatic Hernia Repairs
Authors: AlAsmar Mohamed , Al Aaraj Mahmoud , Alwani Omneya , Embaby Abdalrahman , Moore Eleanor , McKechnie Iona , Chaparala Ram 
Published: November 2024

Abstract

Background
Emergency giant hiatus hernia and diaphragmatic hernia repairs are associated with high rates of mortality and morbidity; different studies reported variable outcomes. Accurate risk assessment empowers patients to provide informed consent and also serves as a valuable tool for identifying individuals who may require enhanced postoperative care, such as respiratory support and critical care admission. Various risk prediction tools have been developed to assist clinicians in making decisions to aid in stratifying the risk of surgical management. We aimed to assess the effectiveness of different risk prediction models in predicting mortality and morbidity in this patient cohort.

Method
Retrospective analysis performed on cases between May, 2010 and January, 2021 in a tertiary adult upper gastro-intestinal centre. The outcomes from the operations were assessed and compared with the predicted morbidity and mortality for different risk prediction models. Including the Surgical Outcome Risk Tool (SORT), the National Emergency Laparotomy Audit (NELA), parsimonious NELA and the American College of Surgeons National Surgical Quality Improvement Programme (ACS-NSQIP). The models were compared using the area under the curve (AUC). Morbidity models included Portsmouth Physiological and Operative Severity Score (P-POSSUM) and the ACS-NSQIP. Morbidity was evaluated by calculating the comprehensive complication index (CCI).

Results
A total of 108 patients met the criteria and were included in the analysis. Among these 50.9% were females. The median age was 69 (IQR 59-78). The 30-day mortality rate was 6.93% (7 patients), six patients died during the same admission, and one patient died during a re-admission. ACS-NQSIP had the highest predictive power for mortality (AUC = 0.6344), in comparison to NELA (AUC=0.5665), parsimonious NELA (AUC=0.4866) and SORT (AUC = 0.4342). Both ACS-NSQIP and P-POSSUM showed moderate correlation to CCI (rho = 0.489, p&lt;0.001 and 0.446, p&lt;0.001 respectively).

Conclusion
ACS-NSQIP is a better predictor of both mortality and morbidity in emergency giant hiatus and diaphragmatic hernia repairs when compared to NELA, parsimonious NELA, P-POSSUM and SORT. Interestingly, parsimonious NELA had a lower prediction rate when compared with the older NELA model. ACS-NSQIP may have a role in pre-assessment and consenting of emergency hiatus and diaphragmatic hernia repairs. Multi-centre prospective studies could be used to validate these findings.
EGS SO21 - The undifferentiated general surgical take over 10 years: Emergency imaging
Authors: Hale Emily , Dean Lydia , Bowling Kirk 
Published: November 2024

Abstract

Background
The undifferentiated emergency general surgical take in July 2013 and July 2023, at a District General Hospital, was reviewed with the aim of understanding increasing pressures on the surgical and radiology departments, and subsequently identifying areas in which we could adapt to facilitate these demands.

Method
Patients were identified retrospectively if they had been cared for by the emergency general surgical team in July 2013 or July 2023. Further information was collected from electronic notes, with a focus on admission and initial imaging modalities. Patients were excluded if information was not available electronically.

Results
Of the 395 patients in July 2013, and 594 in July 2023, 55% and 61% respectively had imaging studies within 7 days of admission. 11% (n=44/395) of patients in 2013 had abdominal X-ray without further imaging, compared to 6% (n=33/594) in 2023. Computed Tomography (CT) use increased by 35%, whilst ultrasound scanning (USS) increased only by 11%. Time from admission to scans of all types has reduced from 0.79 days (+/-0.16, p=0.02) in 2013 to 0.60 (+/-0.1, p=0.02) days in 2023.

Conclusion
Overall volume of imaging has increased slightly, although the proportion of patients being scanned is largely unchanged, with subtle variation in preferred imaging modalities. CT is marginally more common, whilst USS remains mostly unchanged. The use of abdominal x-ray without subsequent imaging has decreased, demonstrating its reducing use in clinical judgement and reliance on alternative imaging techniques. Time from admission to scan of all kinds has reduced, despite increasing demands on radiology departments.
EGS SO31 - Does in-hospital delay in appendicectomy lead to complicated appendicitis and affect post operative outcome - a single centre study
Authors: Singh Gautam , Sonde Sarah , Guest Megan , Astbury Lauren , Gupta Ankit , Hamson George , Brown Daniel , Raheel Muhammad , Morrison Charles , Sarkar Rupa 
Published: November 2024

Abstract

Background
Acute appendicitis is one of the most common reasons for emergency general surgical admissions in the U.K. The standard treatment for acute appendicitis is emergency appendicectomy. However, the urgency to operate on patients admitted to hospital with acute appendicitis has been widely debated, with no current standard guideline to follow.
The aim of this study was to identify the effect of in-hospital delay in appendicectomy on intra operative findings of complicated appendicitis. The secondary outcome measures were the requirement of a surgical drain, overall length of stay, post-operative complications and re-admission rates.

Method
This was a single centre retrospective study. All patients who underwent an emergency appendicectomy, between 01/09/2023 and 30/11/2023 were included in this study. Hospital electronic patient records were screened to record the time of decision to operate, surgical start time, the delay between decision to operate and surgical start, intra-operative findings, and post-operative course.
A total of 105 patients were included. These were divided into two sub-groups based on the delay between decision to operate and surgical start time; patients who had surgery within 12-hours (early) and those who had surgery after 12-hours (delayed) from the decision to operate time.

Results
Surgery was performed within 12-hours in 42% cases. The remaining 68% had more than a 12-hour delay, with almost 1 in 4 cases (26 /105) delayed over 24 hours.
15% cases (16) with uncomplicated appearance on pre-op imaging and delayed more than 12-hours progressed to complicated appendicitis intra-operatively.
Surgical drains were required in 10% delayed cases and 6% early cases.
The median length of stay was 2-days in delayed, compared to 1 day in cases performed early.
Post-operative complications were higher in cases early. Although majority of these had complicated appearance in pre-op imaging.
Both groups had same readmission rate.

Conclusion
Our study found that in-hospital delay in appendicectomy can potentially result in increased length of stay, higher rate of requirement of surgical drains and progression from imaging severity. This needs better prioritisation and theatre allocation.
OGC SO04 - Impact of COVID-19 on Decision-making and Survival in Esophago-Gastric Cancer Treatment: Insights from a Multidisciplinary Approach
Authors: Alasmar Mohamed , Matias Nadia , Alhamed Norah Ali M , Alwani Omneya , Rudge Brogan , Moti Terngu David , Yassin Abdelwahab Mohamed Ossama , Stockton Jennifer , Raslan Charef , Cairney-Hill Jess , Altarawni Mohamed , Alkhaffaf Bilal 
Published: November 2024

Abstract

Background
The COVID-19 pandemic necessitated rapid adaptation in healthcare delivery, affecting cancer care pathways. This study assesses the impact of these changes on multidisciplinary team (MDT) decision-making and survival outcomes in esophago-gastric cancer patients across pre-pandemic, peak pandemic, and post-pandemic periods.

Method
A retrospective cohort study involving patients referred to a UK tertiary EG cancer center during distinct six-month intervals mirroring the pandemic's evolution. Analysis focused on MDT recommendations, treatment pathways, and two-year survival rates, comparing deviations from standard care across periods.

Results
The study revealed a significant reduction in patient referrals and expedited treatment decisions during the pandemic peak, with a shift towards palliative care in post-pandemic cases. Although no statistically significant difference in two-year survival rates was observed, the post-pandemic period showed an increase in tumor aggressiveness and positive resection margins, suggesting potential long-term impacts of delayed diagnosis and treatment.

Conclusion
COVID-19 has significantly influenced MDT decision-making and patient pathways in esophago-gastric cancer care, underlining the necessity of resilient healthcare systems. Despite maintaining survival rates, the observed increase in tumor aggressiveness post-pandemic highlights the critical need for uninterrupted cancer diagnosis and treatment services during global health emergencies.
OGC SO06 - Novel Non-metallic Fiducial marker for Radiotherapy in Oesophageal Cancer
Authors: Robinson Alexander , Abdul-Kader Nayaab , Ullah Faizan , Farhangmehr Neda , Jayanthi Venkatesh 
Published: November 2024

Abstract

Background
Early oesophageal tumours are technically difficult to delineate on the planning computed tomography (pCT) for Image Guided Radiotherapy (IGRT). We describe the use of a novel non-metallic fiducial marker for this purpose.

Method
Non-metallic fiducial marker (NFM) (BioXmark) was used in 17 patients from April 2021 to November 2022 for marking tumour site prior to radical or palliative radiotherapy. NFM was injected in the sub-mucosal plane using fluoroscopy under general anaesthesia, with the patient supine and using regular injection catheter and syringes. After the initial series, further modifications to the technique improved the injection and shortened operative time. These include left lateral positioning, an ultra-fine injection catheters and micro-dosing syringes. Feedback from the treating radiation oncologists was sought for all the patients.

Results
Injection was successful in all the patients. In the initial series before the modifications to the technique, often the marker was a larger than anticipated due to a combination of poor visibility when the patients were supine and use of larger bore injection catheters. Once the patient position was changed along with the changes in the injection catheters and the syringes, marking was very precise.

Conclusion
Previously used fiducial markers are gold based. While these were visible on pCTs, they are known to cause distortion along with being expensive and cumbersome to inject. In comparison, NFM is easy to inject without the artefacts seen with metallic markers. We refined the technique further by changing the patient’s position to left lateral which afforded a improved fluoroscopic visibility. Introducing finer injection catheters and micro-dosing syringes further led to usage of lesser volume and precise marking respectively. In summary we present a series of patients whose early oesophageal tumours were marked with a NFM aiding precise delivery of radiotherapy.
OGC SO12 - Extended Venous Thromboembolism Prophylaxis in Postoperative Oesophagogastric Cancer Patients: A Completed Audit
Authors: Kuan Jen Yee , Turner Paul , Pursnani Kishore , Ward Jeremy , Shetty Vinutha Daya 
Published: November 2024

Abstract

Background
Venous thromboembolism (VTE) is a life-threatening complication for cancer patients undergoing oesophagogastric surgery. The NICE recommends extending pharmacological VTE prophylaxis to 28 days for patients undergoing major abdominal cancer surgery. While the effectiveness of in-hospital VTE prophylaxis is well-documented, the optimal duration for postoperative VTE prophylaxis remains a subject of debate. This study aims to evaluate the prescribing compliance, effectiveness, and safety of extending VTE prophylaxis to 28 days following hospital discharge (HD), a policy adopted trust-wide since 2014.

Method
This is an 11-year retrospective study from July 2012-2022, followed by a complete audit cycle conducted between January 2023-2024. The study included all patients who underwent cardio-esophagectomy or gastrectomy for oesophagogastric cancers. Exclusion criteria comprised patients who died during the index admission, those who underwent benign oesophagogastric surgery or local excision of gastrointestinal stromal tumours (GIST), and patients with peripherally inserted central catheter (PICC) line-associated VTE. The primary outcome measured was the prescribing compliance of 28-day VTE prophylaxis post-hospital discharge. Secondary endpoints included the incidence of VTE and bleeding complications necessitating hospital readmission within 28 days of discharge.

Results
Our study included 582 patients, showing that post-2014, 423 out of 490 patients (86.3%) were discharged with 28-day VTE prophylaxis, compared to 13 out of 92 patients (14.1%) pre-2014, indicating a significant improvement (p&lt;0.05). Only one patient (0.17%) developed VTE more than 28 days post-discharge, and no readmissions due to bleeding complications. In the subsequent audit, 63 out of 68 patients (92.6%) received the prophylaxis, further increasing prescribing compliance. Comparing the two periods, compliance improved from 86.3% to 92.6%, though not statistically significant (p=0.145). Overall, VTE incidence was minimised from 0.17% to 0%, with no readmissions due to bleeding complications.

Conclusion
Routine extended VTE prophylaxis for 28 days post-hospital discharge should be recommended for cancer patients undergoing oesophagogastric surgery. This practice has significantly improved prescribing compliance rates, reduced post-hospital discharge VTE incidence, and demonstrated safety, with no hospital readmissions due to bleeding complications.
OGC SO23 - Audit on Enhanced Recovery After Surgery (ERAS) in Oesophago-gastric Resections for Cancers
Authors: Merkouris Christos , Tokhi Ashraf , Barnes Simone , Parsons Simon L 
Published: November 2024

Abstract

Background
Enhanced Recovery After Surgery (ERAS) protocols, have been designed to guide clinicians in managing patients post-operatively, reducing hospital stay, complications and readmissions. Our trust’s ERAS protocol includes guidance on oral intake initiation, drain, catheter and epidural removal, investigation frequency, medications required on discharge and early mobilization. However, implementation of ERAS protocols in complex oncological surgery can be challenging, due to the multiple factors included and increasing complexity. We aimed to assess the compliance of ERAS implementation in a high volume resectional oesophago-gastric unit, and subsequent impact on morbidity.

Method
A retrospective review of all patients who underwent oesophago-gastric resections during March-April 2024 was performed. Patients were included if they completed an oesophagectomy, or subtotal/total gastrectomy resection for cancer. Electronic records and medical notes were reviewed and compared to all aspects of the trust’s ERAS protocol. The adherence percentage to the protocol was calculated.

Results
20 patients underwent surgery. 85% started their oral diet on time per ERAS protocol. Adherence to ERAS was lowest for epidural (52.6%, 95% within 24-hours of target), catheter (55%, 90% within 24-hours of target), apical (55.6%, 100% within 24-hours of target), basal (53.8%, 85.7% within 24-hours of target), and abdominal drain removals (81.8%, 90.9% within 24-hours of target). All patients mobilized within four days post-op, with 65% achieving daily mobilization. VTE prophylaxis was prescribed for all, and discharge medication adherence ranged from 86.7% to 100%. The mean hospital stay was 9 days post-oesophagectomy, with a 3.2% emergency department return rate.

Conclusion
Implementation of an ERAS protocol is feasible in complex oesophago-gastric cancer surgery. Effective involvement and training of allied health, specialist pain services and the whole surgical team can decrease morbidity and length of stay in oesophagectomy, while avoiding excess emergency department presentations. Ongoing training and feedback of allied health, pain services, and surgical team at all levels is important to ensure adequate compliance.
OGC SO28 - Predictors of Pulmonary Complications Following Thoracoscopic Oesophagectomy
Authors: Ng Jessica Yan-Seen , Chmelo Jakub , Immanuel Arul 
Published: November 2024

Abstract

Background
Thoracoscopic oesophagectomy, a minimally invasive technique, is associated with less postoperative pain and reduced pulmonary dysfunction. There is a correlation between preoperative cardiopulmonary fitness and postoperative outcomes, with certain variables linked to a higher risk of complications following oesophagogastric cancer surgery. This review aims to identify variables that correlate with pulmonary complications after oesophagectomy.

Method
A retrospective review of patients undergoing thoracoscopic oesophagectomy between 2014 -2022 at a single oesophagogastric unit was performed. 96 patients were identified and separated into two groups (19 with serious complications (SC) (greater than Clavien Dindo 3b), and 77 without serious complications (Clavien Dindo 3a and below)(NC). The primary outcomes measured included FEV1, FVC, VE/VCO2, VO2 Peak, anaerobic threshold, Estimated Met Score (EMS). Secondary outcomes measured preexisting pulmonary complications, smoking status and operating (chest time, one lung ventilation time (OLVT)).

Results
Groups were similar in age, gender, BMI, ASA, and clinical stage. SC had a significantly less number of smokers (p=0.004) and less individuals with pulmonary disease (p=0.019). AT was higher in NC (14.15 vs 13.50, p=0.355) and VE/VCO2 was significantly greater in SC (28 vs 32, p=0.018). SC had a significantly lower FEV1 and FVC (2.12 vs 2.81, p=0.009 and 3.11 vs 3.80, p=0.010) and a trend towards a lower EMS (6.95 vs 7.25, p=0.245). There was no significant difference in chest time between NC and SC (295min vs 265min, p=0.151) and OLVT (270min vs 245min, p=0.381) in both groups.

Conclusion
VE/VCO2 ratio in thoracoscopic oesophagectomy patients is a significant predictor of postoperative complications and has increasing links to adverse outcomes. Smoking status and pulmonary history do not significantly correlate with pulmonary complications in our cohort. Lower EMS, FEV1, and FVC are significantly associated with complications. Although preoperative inspiratory muscle training has not broadly impacted postoperative outcomes, it may benefit specific groups. These variables are crucial for clinicians to consider when counselling patients and planning prehabilitation.
OGC SO38 - Laparoscopic repair of para-conduit hernia post minimally invasive esophagectomy using anterior hiatal suture repair and mobilisation of left liver lobe as reinforcement
Authors: Habib Helai , Newbold Ryan , Knight William , Gossage James 
Published: November 2024

Abstract

Background
Para-conduit hernia (PCH) formation is a rare and late complication of oesophagectomy that is associated with high risk morbidity. Minimally invasive oesophagectomy is associated with increased incidence of PCHs when compared to open or trans-hiatal oesophagectomies. Various techniques to repair PCHs including mesh repair, anterior/posterior hiatal suture repairs or even careful 360 degree repairs have been described in the literature1,2. But the risk of recurrence of PCH still remains high. We describe a unique laparoscopic technique which we believe to be associated with reduced risk of recurrence of PCH post-surgical repair.

Method
We present 4 cases of symptomatic PCH repairs performed laparoscopically. In this unique technique the contents of the sac is reduced and the hiatus is repaired anteriorly with interrupted ethibond sutures. The left lobe of the liver is mobilised and glued to the greater curve omentum along the conduit and the hiatus. This latter step is an additional way of preventing intraabdominal contents from entering the mediastinum.
Data was collected retrospectively to include: patient demographics, details of original MIO surgery, pre-op imaging and details of the presenting symptoms with PCH including imaging, operative details and all available follow up.

Results
Between January 2022 and July 2024, 4 patients underwent laparoscopic repair of paraconduit hernia within 1-2 years post MIO. 3 were male and 1 female aged between 56-71 years. 3 of the procedures were performed electively and one as an emergency. All presented with symptomatic paraconduit hernias and managed with surgery using the technique described above. We present a video of laparoscopic repair as described.

Conclusion
We report a case series of 4 patients presenting with symptomatic PCH that were managed safely with a unique laparoscopic technique using suture repair and left liver lobe mobilisation to prevent recurrence of PCH.
References
1. Watkins et. al. Repair of para-conduit hernia. Thoracic.| Vol 26, Issue 2, P324-340, June 2021. A.A.
2. H.Hietaniemi et. al. Paraconduit hernia after minimally invasive esophagectomy – incidence and risk factors. Scandinavian Journal of Gastroenterology, Vol. 58, No. 7, 764–770
3. J. Sutherland et. al. Postoperative incidence of incarcerated hiatal hernia and its prevention after robotic transhiatal esophagectomy. Surg Endosc. 2011 May;25(5):1526-30.