bluuebunny/crossref_metadata_2025_split huggingface dataset:
BN SO09 - Same day discharge after laparoscopic cholecystectomy: Getting It Right First Time (GIRFT)
Authors: Hammett Felix , Foley Sinead , Saha Arin 
Published: November 2024

Abstract

Background
A key component of elective recovery strategy is to increase day-case provision. GIRFT standards recommend that at least 85% of elective laparoscopic cholecystectomies (LC) should day-cases; most hospitals struggle to achieve this and we aimed to identify barriers to same day discharge after LC.

Method
Consecutive patients who had LC between December 2022 and March 2023 were identified. Electronic patient records were interrogated to analyse outcomes, length of stay and in-patient treatment.

Results
138 patients included, 93 (67%) had elective surgery: ConditionNumber of patients (%)Proportion of elective:acuteBiliary Colic66 (47.5%)60:6 (91.0%:9.0%)Pancreatitis17 (12.2%)4:13 (23.5%:76.5%)Cholecystitis40 (30.0%)19:21 (47.5%:52.5%)CBD stones11 (7.9%)8:3 (72.7%:27.3%)Gallbladder polyp2 (1.4%)2:0 (100%:0%)Cholecystitis and CBD stones2 (1.4%)2:0 (100%:0%)
66 elective patients (70%) were discharged on the same day. Common reasons for staying overnight were late finish (11, 15%), drain or antibiotics (10, 14%) and anaesthetic reasons (10, 14%). Of admitted patients, 15 (21%) did not have any post-operative investigations and 21 (30%) had no in-patient treatment.

Conclusion
Most patients were managed on a day-case basis, though not to national GIRFT standards. Of admitted patients, 30% did not need in-patient treatment; these patients could have safely been sent home and had they been, the unit would have met national standards. These results highlight the potential for an extended stay area or a post-operative next-day treatment area to increase day-case activity.
BN SO14 - Evaluation of local cholecystectomy service and outcomes (Local Data for GECKO study)
Authors: Sakr Mohamed , Albendary Mohamed , Elarian Mohamed , Abbasova Aisel , Jacob Preethi 
Published: November 2024

Abstract

Background
Cholecystectomy is a common procedure performed for different biliary pathologies. Patients have their procedure as elective, emergency, or prioritised bases (Hot Gall bladder service).

Method
GECKO is a prospective, international, observational collaborative cohort study
Consecutive patients undergoing cholecystectomy, between 23rd Oct – 19th Nov 2023 with follow-up at 30-day and one-year postoperatively

Results
Over a 4-week period , 38 cholecystectomies were performed, with 47.5% of patients having prior cholecystitis or cholangitis and multiple admissions. Half of the surgeries occurred within 6 months, and the longest wait was 13 months. Procedures were split equally between elective and emergency cases. Indications included acute cholecystitis (13), biliary colic (11), and others. All surgeries were laparoscopic, with 2 subtotal cholecystectomies. Complications included bile or stone spillage (12) and bleeding (7). Postoperative follow-up showed 16 patients discharged within 24 hours, 3 readmissions, and a 37% complication rate. No bile leaks or CBD injuries were reported.

Conclusion
Emergency and hot cholecystectomy services not only cut down waiting lists but also reduce costs of reoccurring admissions and treatments, with no significant associated complications. Selective gall bladder histological examination may help cost reduction with no significant recognised risks in the literature.
BN SO22 - Magnetic sphincter augmentation in the management of gastro-esophageal reflux disease: A systematic review and meta-analysis
Authors: Krahelski Oliver , Fadel Michael , Tarazi Munir , Dave Madhav , Ashrafian Hutan , Fehervari Matyas 
Published: November 2024

Abstract

Background
Magnetic sphincter augmentation (MSA) through placement of the LINX device is an alternative to fundoplication in the management of gastro-esophageal reflux disease (GERD). This systematic review and meta-analysis aimed to assess efficacy, quality of life and safety in patients that underwent MSA, with a comparison to fundoplication.

Method
A literature search of MEDLINE, Embase, Emcare, Scopus, Web of Science and Cochrane library databases was performed for studies that reported data on outcomes of MSA, with or without a comparison group undergoing fundoplication, for GERD from January 2000 to January 2023. Meta-analysis was performed using random-effect models and between-study

Results
Thirty-nine studies with 8,075 patients were included: 6,983 patients underwent MSA and 1,092 a fundoplication procedure. More individuals discontinued proton-pump inhibitors (P&lt;0.001; WMD 0.83) and had higher rates of satisfaction (P&lt;0.001; WMD 0.85) following MSA compared to fundoplication. Functional outcomes including ability to belch (P&lt;0.001; WMD 0.96) and emesis (P&lt;0.001; WMD 0.92), and bloating (P=0.003; WMD 0.20) were better after MSA than after fundoplication, although MSA had higher rates of dysphagia (P=0.001; WMD 0.41). The overall erosion and removal rate following MSA was 0.24% and 3.9% respectively, indicating no difference in re-intervention rates between MSA and fundoplication (P=0.446; WMD 0.001).

Conclusion
MSA is a safe and effective procedure at reducing symptom burden of GERD and can potentially improve patient satisfaction and functional outcomes. However, randomized controlled trials directly comparing MSA with fundoplication are necessary to determine where MSA precisely fits in the management pathway of GERD.
BN SO41 - A systematic search and evaluation of patient information quality on Anti-reflux surgery using modified EQIP Score
Authors: Bibi Ayesha , Jayakrishnan Anushka , Bano Zaubaria Shehar , Khan Muhammad Usman , Nijjar Rajwinder , Tucker Olga , Hossain Tanvir 
Published: November 2024

Abstract

Background
GORD affects 20% of western populations and internet searches are a key resource for patients considering surgery. An assessment of the quality of public intended electronic information can highlight a need for improved material to aide patient education. This study assesses the quality of internet information on anti-reflux surgery using the validated Modified Ensuring Quality Information for Patients (EQIP) tool.

Method
A systematic analysis of the top 200 results for the search engine query “Anti-reflux surgery” was conducted. Google (UK) was used. Search results aimed solely for healthcare professionals were excluded. Results were evaluated using the modified (EQIP) tool (score 0-36) and evaluation performed on information on surgery benefits, risks and complications.

Results
107 of 200 websites were included in the main study. The majority (43%) originated from UK, while 40% were from USA. Median EQIP score for all websites was 16. Median EQIP scores for the 3 domains were 7/18, 1/6 and 8/12 for content, identification data and structure respectively. Benefits of surgery was described on 71%, surgery risks on 66%, and complications on 11%. However, only 16% of websites described the quantitative risks of surgery. Information on postoperative recovery was included on 63%, emergency advice on 22%, and mortality rates on 7% of websites.

Conclusion
We observed most public intended internet searches lacked information on the quantitative risks and complications of anti-reflux surgery. Moreover, the information provided was insufficient on morbidity and mortality to adequately assist patients make informed decisions. This study supports the need for improved quality of patient intended publicly available information accessible online on Anti-reflux surgery.
BN SO45 - Reported criteria and safety for day case management of acute appendicitis
Authors: Tase Arkeliana , Askari Alan , Karim Seiver , Jambulingam Periyathambi , Whitelaw Douglas , Jain Vigyan , Al-Taan Omer , Munasinghe Aruna , Adil Tanveer 
Published: November 2024

Abstract

Background
Acute appendicitis has an incidence of 7-8%. About 45,000 appendicectomies are performed in UK/year. Whilst day case surgery (DCS) is standard for cholecystectomies, hernia repair and even gastric bypass, reluctance exists in application of day care pathway for acute appendicitis. We aimed to review published literature on patient selection criteria, rates of day case discharge, readmission and re-intervention rates and patient satisfaction.

Method
A literature search was conducted in Embase, Pubmed and Medline for day case appendicectomy, Patient safety, selection criteria. A total of 116 papers were found. Once duplicates were removed, 75 studies underwent abstract screening from which 41 were full text screened. 29 publications were included in this review study. Data was collected on criteria for patient selection, length of stay, rate of DCS, rates of re-admission and re-intervention and patient/ relative satisfaction.

Results
Studies assessed DCS in children and/or adults. All authors included patients with uncomplicated appendicitis, well managed pain without opioid analgesia and adequate social support. Other authors additionally, only included patients under 65yrs old. The rates of DCS varied between 36.9% - 87%. Factors affecting DCS were time of admission and operation, female patients, symptom control and social factors.
Rates of readmission ranged between 0-2.5% with no difference between DCS and admitted patients. Rates of re-intervention were low (0-2.5%) with a high patient satisfaction (87-91%). Late evening finishing of operation led to patient admission (77%) with no complications occurring within 48hrs.

Conclusion
Day case surgery for appendicectomy is reported to be safe provided adequate patient education and clear criteria for patient selection. No significant difference was found between the rates of re-intervention and re-admission between day case and admitted patients. We suggest standardising care pathways and provision of adequate education to both patients and staff as a method of safe day care discharge.
BN SO47 - Can Peroral Endoscopic Myotomy (POEM) be the new gold standard for Achalasia? – as it is safe and effective
Authors: Yap Ye Theng , Gollapinni Uday , Ingley Paul , Hajibandeh Shahin , Cheruvu Chandra , Rajkumar Sarveson 
Published: November 2024

Abstract

Background
Laparoscopic Heller’s cardiomyotomy is the gold standard for treatment of achalasia. POEM has emerged as a revolutionary minimal invasive procedure in the management of achalasia and related oesophageal motility disorders. POEM effectively utilises an endoscopic approach by creating a submucosal tunnel to perform a myotomy at the lower oesophageal sphincter (LES) , achieving symptomatic relief. Being firstly introduced in 2008, POEM offers an excellent alternative option to surgical intervention and conservative approaches. The aim of this study is to evaluate the clinical efficacy and safety of POEM since its introduction in our unit.

Method
POEM procedures performed in adult patients are recruited prospectively from May 2020 to January 2024 and data are collected using electronic trust records. Eckardt score (a commonly used scoring system to characterise severity of achalasia) is recorded before and after the procedure. A total of 46 patients are identified however three patients are excluded in this study due to unavailable clinical information. This study presents a cohort of patients with median age of 60 and an equal gender distribution.

Results
Out of 43 patients, 69.8% were treatment naïve and 30.2% had previous treatments. Mean Eckardt score pre-procedure was 8.2. The average length of hospital stay was 1.7 days and immediate post treatment complications were 6.9% (2.3% mucosotomy, 2.3% oesophageal leak, 2.3% infection). No mortality was recorded within 30 days post-procedure. A 93% clinical success rate (Eckardt score ≤3) was achieved in the initial follow-up period (three to six months) with a mean Eckardt score of 1.1. 41.9% of patients experienced reflux symptoms which require proton pump inhibitor use within four weeks post-procedure. 18.4% of patients had recurrent achalasia symptoms over their follow-up period.

Conclusion
The clinical success rate (Eckardt score ≤3) and recurrence rate post POEM in this study are comparable with the international cohort quoted in literature. Post POEM reflux rate is prevalent, which is a well-known complication. The substantial improvement in clinical outcomes, evidenced by the Eckardt score reduction and the low incidence of post-operative complications, underscores the procedure’s efficacy and safety. Overall, POEM represents a significant advancement in the treatment of oesophageal motility disorders, especially achalasia. This study presents POEM as a safer and less invasive treatment alternative compared to Heller’s cardiomyotomy.
BN SO51 - Complications from operative cholangiogram during emergency laparoscopic cholecystectomy: A retrospective, observational cohort study in a UK single centre
Authors: Moscalu Andrei , Dipti Joshi , Bahadur Kathayat Lok , Sabu Jerin , Liao Christopher , Sinclair Martin , Bence Atkari 
Published: November 2024

Abstract

Background
Laparoscopic cholecystectomy (LC) is a common surgical procedure, with &gt;60,000 undertaken annually in the UK. One serious complication of cholecystectomy is bile-duct-injury (BDI), with an incidence of 0.28–1.5%. The use of intraoperative-cholangiogram (OTC) has been shown to aid in earlier diagnosis and treatment of BDI. Although advocated as routine by many, no studies have assessed the morbidity caused by OTC. With newer modalities available, such as indocyanine-green-fluorescent-cholangiography (ICGC) and three-dimensional laparoscopy, it is important to consider each method's risks and benefits, including OTC. We decided to investigate the morbidity caused by OTC with an emphasis on post-OTC acute pancreatitis.

Method
We conducted a retrospective cohort study of a prospectively collected cohort of patients aged 18 and over who have undergone emergency LC, defined as LC within seven days from admission with acute cholecystitis, over three years in a UK district general hospital. The primary outcome studied was the incidence of complications following OTC, including acute pancreatitis (AP), acute cholangitis, extra-hepatic biliary tree injury and hepatic abscess. The STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist was utilised. We used GraphPad Prism 10.2.3. for statistical analysis.

Results
472 cases were analysed. Median age was 54(A), BMI 31(C), ASA grade 2(D), clinical frailty score 2(E), Charlson Comorbidity Index 1(F), Tokyo severity grade 1(K) and female-to-male ratio 0.83(B). 14.31% of cases had pre-op CBD dilatation, 0.42% CBD stones and 6.19% both, with most having ultrasound pre-op (J-I). The median Nassar score was 3(L). 24.57 % of cases had an OTC done, with a median volume of contrast-media used of 11(6;24.5) mls, with 17 cases having CBD stones diagnosed(M-O). Four cases, or 3.44% of the total OTCs, developed acute pancreatitis (P).

Conclusion
Emergency laparoscopic cholecystectomy with intraoperative cholangiogram may increase the risk of postoperative acute pancreatitis.
BN SO58 - Patient Reported Outcome Measures in Hiatal Surgery: A Feasibility Study
Authors: Atkins Rosa , Davis Heather , Platt Timothy , Christopoulos Petros , Kostalas Marcos , Sinha Surajit , Andrews Stuart , Bowling Kirk 
Published: November 2024

Abstract

Background
Hiatal surgery is predominantly a quality-of-life procedure rather than a lifesaving intervention. Whilst procedural complications are well understood, they do not necessarily reflect the patient experience. Traditional indicators of patient care are insufficient. Patient Reported Outcome Measures (PROM) are robust indicators of care quality (1) and are being used across surgical specialities to benchmark success and identify areas for improvement (2). We present a three-year review of our PROM data to demonstrate feasibility of data collection.

Method
Patient reported outcome measure data were collected from the National Hiatal Surgery Registry (3) for our benign centre over a three-year period (November 2021-January 2024). Consent was obtained from all patients for research purposes. Surgical procedures included: anti-reflux surgery, hiatus hernia repair and cardiomyotomy. All patients were asked to complete pre-operative quality of life surveys. Patients are automatically contacted through the registry at 6months, 1 year and then annually for five years and prompted to complete quality of life surveys. Ekhardt score is used in achalasia. GORD-QoL score was used for anti-reflux procedures, with the Hernia-QoL score for hiatal hernia.

Results
Data were collected for 20 patients. Mean BMI was 28.2. All completed preoperative surveys. At six months there was attrition of one patient, who has since completed 1-year and 2-year data. At the time of writing, six patients have completed 6month data, 5 patients have completed 1-year data and 3 patients have completed 2-year data.
Mean Ekhardt score was 9.25 preoperatively; at six months mean score was 0.
Five patients underwent LINX, eleven underwent fundoplication; one Dor, ten Toupet. Mean pre-operative quality of life score was 31.1; at six months mean score was 15.5. At one year this was 4.

Conclusion
The National Hiatal Surgery Registry facilitates easy acquisition of surgeon specific PROM data over a short- and long-term period. Patient attrition is low, demonstrating acceptability. Our data demonstrate significantly improved patient reported quality of life postoperatively for all hiatal surgery.
BN SO59 - Learning Curve for Robotic-Assisted Cholecystectomy
Authors: Mitchell Benjamin , De Rosa Antonella , Alqudah Abdallah , Lasheen Omar , Dwerryhouse Simon , Upchurch Emma , Hornby Steve , Vipond Mark , Higgs Simon 
Published: November 2024

Abstract

Background
Assessment of learning curves following the introduction of robotic-assisted technology has shown that improvement in surgical outcomes can be seen with increasing robotic experience.

Method
All robotic-assisted cholecystectomies performed by a single consultant upper gastrointestinal surgeon as primary operator were analysed between 6/8/21 - 6/6/24 at a UK specialist centre using the Versius robotic system (CMR surgical). We recorded set up time during cases over this period.

Results
38 robotic-assisted cholecystectomies were performed within the study period. In the first 10 cases, average set up time was 8 minutes and 18 seconds. In the second 10 cases this reduced to 5 minutes and 36 seconds. No further improvement was seen after case 20.

Conclusion
Our results demonstrate that set up time for robotic-assisted cholecystectomy improves over the first 20 cases. This data suggests 20 cases are adequate for acquiring the skillset required to set up the Versius robotic system efficiently in real life practice.
HPB SO02 - Cutting surgical site infection rates in perihilar cholangiocarcinoma with informed changes to perioperative antibiotic prophylaxis: A quality improvement project in a UK hepatopancreatobiliary tertiary centre
Authors: O’Leary Lawrence , Lal Pankaj , Gilbert Timothy , Quinn Marc , Díaz-Nieto Rafael , Jones Robert , Fenwick Stephen , Malik Hassan 
Published: November 2024

Abstract

Background
Perihilar cholangiocarcinoma (pCCA) is the most common cancer of biliary epithelia. While potentially curative, surgical resection is associated with high morbidity and mortality. Surgical site infections (SSIs) are common and pernicious.
Preoperative biliary instrumentation is universal: to confirm histological diagnosis and deploy stents to relieve jaundice. Patients receive multiple antibiotic courses as periprocedural prophylaxis and to treat cholangitis. They are at high risk of harbouring bacteria not quelled by perioperative prophylactic antibiotics given for other general surgical procedures.
Studying the biliary microbiome, this quality improvement project sought to reduce SSIs through informed changes to local guidelines on perioperative antibiotic prophylaxis.

Method
Health records of all patients undergoing resection for pCCA in a UK hepatopancreatobiliary centre from February 2009 to January 2024 were analysed retrospectively (n=118). For all patients, we routinely sent intraoperative bile swabs for culture and sensitivity.
Informed by these microbiology results, multidisciplinary discussion led to changes to local guidelines in March 2019. Formerly, cefuroxime and metronidazole were given on anaesthetic induction, with subsequent antibiotic choice and duration according to surgeon preference. New guidance stipulated teicoplanin and piperacillin/tazobactam be given on induction and for 72 hours postoperatively.
We studied the impact of these changes on SSIs within 30 days.

Results
75 patients received cefuroxime and metronidazole; 43 patients were given teicoplanin and piperacillin/tazobactam after the policy change.
Proportions of patients who developed any SSI substantially fell following the guideline change (55% v 28%; p=0.0049), primarily owing to reductions in intraperitoneal collections (39% v 21%; p=0.047). Rates of deep (8% v 2%; p=0.21) and superficial incisional infections (8% v 5%; p=0.49) were not significantly affected.
Associated secondary outcomes were drops in post-hepatectomy liver failure (17% v 5%; p=0.047), and 90-day mortality (16% v 5%; p=0.067), albeit the latter was not statistically significant.

Conclusion
Invasive investigative work-up, disease complications and exposure to multiple courses of antibiotics prior to resection of pCCA subject patients’ biliary systems to colonisation with antimicrobial-resistant bacteria. We urge centres that undertake these operations to introduce intraoperative bile cultures as a part of routine practice to inform local guidance on perioperative antimicrobial prophylaxis. We demonstrated effective antibiotics in the perioperative period can have enormous benefits to patient outcomes.