bluuebunny/crossref_metadata_2025_split huggingface dataset:
BN SO27 - Articulative Minimally Invasive Surgery and Placement of Anti-reflux Magnetic Surgical Appliance (LINX)
Authors: Pua Qiao Ying , Loh Danielle , Kwan Yi Xin , Viswanath Y K S 
Published: November 2024

Abstract

Background
Gastro-oesophageal reflux disease (GORD) is a condition of prolonged retrograde flow of gastric contents into the oesophagus or structures beyond, causing symptoms such as heartburn and regurgitation.1 Laparoscopic Nissen Fundoplication (LNF) has been the surgical gold standard, however its side effects and technical challenges has limited its use to 1% of the GERD population.2 The use of a magnetic surgical appliance (LINX) has recently emerged as a promising treatment in overcoming the limitations of conventional LNF.3 Literature has shown patients aged less than 45 with satisfactory mean contraction amplitude (MAP) of 30mmHg and typical symptoms have favourable outcomes with LINX.3

Method
This is a case of a 35-year-old patient presenting with typical reflux symptoms, with satisfactory MAP and high DeMeester score, patulous gastro-oesophageal junction and no hiatus hernia endoscopically. Steps for LINX placement are described in the video and we demonstrate the use of ArtiSential, an articulating laparoscopic instrument that provides better range of motion and angulation comparable to that of a robotic instrument.

Results
Using a magnetic surgical appliance (LINX) is superior to LNF through preservation of physiological belching and vomiting, reducing surgical time and duration of hospital stay while also scoring highly on quality of life and patient satisfaction.4

Conclusion
We would recommend considering the placement of a LINX device in suitable patients as it provides good outcomes on par with LNF and to consider the use of an articulating instrument (ArtiSential) as it provides the surgeon better control and ease in placing a small device laparoscopically.
BN SO31 - Pedicle First; a Paved Laparoscopic Approach for Huge Splenomegaly
Authors: Shaaban Mohamed , Farag Mohamed 
Published: November 2024

Abstract

Background
Since its introduction for the first time by Delaitre et al1 in 1991, laparoscopic splenectomy (LS) has become the minimal invasive approach of choice for the management of the hematological splenic disorders2. Many agreed benefits have been achieved with this approach regarding the hospital stay, blood loss, duration of recovery, aesthetic results and quality of life; however, massive spleens remain a real technical challenge in front of achieving those benefits. The complex and non-typical variable configurations of the vascular system for the pancreatic body and tail which come from the splenic artery represents another faced point of anatomical complications3.

Method
From March 2020 to February 2024, a prospective study has included 30 patients presented with benign hematological disorders and massive splenomegaly (more than 20 cm longitudinal axis) who underwent laparoscopic splenectomy in our institution. Detailed data regarding their demographics, splenic size, operative time, blood loss, conversion rate, postoperative serum amylase and hospital stay were collected. Standardized anterior approach operative steps were adopted by the same surgeon for all patients with early control of the arterial system of the splenic circulation before mobilization (short gastric vessels and splenic artery 2 to 4 cm away from hilum).

Results
Thirty patients presented with huge splenomegaly have underwent laparoscopic splenectomy with a conversion rate of 6.6% (2 patients due to extensive perisplenic adhesions). The mean longitudinal splenic dimension was 24 ± 1.5 cm (range from 20 to 27 cm), mean operative time was 110 ± 16 minutes, mean operative blood loss was 160 ± 20 ml, mean hospital stay was 4 ± 1.5 days, postoperative rate of hyperamylasemia in 20% (asymptomatic 6 patients with no operative evidence of pancreatic injury), respiratory complications in 16.6 % (5 patients), and reactive thrombocytosis in 6.6% (2 patients).

Conclusion
Early laparoscopic control of the arterial system away from the splenic hilum can enable us to lessen the conversion rate for massive splenomegaly patients and achieve successfully the benefits of laparoscopy for those patients on the expense of the elevated postoperative hyperamylasemia rate.
BN SO35 - A Novel Ambulatory Pathway in the Management of Acute Pancreatitis
Authors: Gopalan Vignesh , Fox Benjamin , Baker Daniel , Walters Mary , Blencowe Natalie , Peckham-Cooper Adam , Pathak Samir , Hollyman Marianne 
Published: November 2024

Abstract

Background
Acute Pancreatitis (AP) accounts for 20000 admissions per year, resulting in an average hospital stay of 5 days. Over 90% of patient have mild or moderate disease severity. Validated risk stratification tools such as the Harmless Acute Pancreatitis (HAP) score utilised alongside biochemical markers and clinical acumen can predict up to 97% of patients with a mild disease course.
A pathway was introduced at two NHS centres to enable diagnosis and ambulatory management of patients with predicted mild AP with the aim of improving patient experience by preventing unnecessary admission, reducing pressure on surgical departments and providing safe outpatient management.

Method
The study took place at two sites: a district general hospital (DGH) and a tertiary referral centre. Pathway development occurred in parallel to pilot. Ambulation was defined as no overnight stay in a hospital bed. An initial retrospective review of all AP admissions was undertaken to understand current burden of disease and severity in our centres.
Suitable patients were identified prospectively and data (demographics, biochemical markers, modified HAP score, severity of disease, complications, re-admission rate, surgical or endoscopic intervention) were collected for up to 30 days after discharge. AP ‘proforma’ were created to understand surgeons decision-making surrounding ambulation versus admission.

Results
Between November 2023 and May 2024, 99 patients with AP presented to the DGH surgical unit. Causes of AP included gallstones (n=55), idiopathic (n=21), alcohol (n=17), and post-ERCP (n=2). 38 patients (38%) were ambulated, with 23/38 (61%) returning for planned review within 72 hours.
There were no mortalities in the ambulatory group. Three (7%) ambulated patients were re-admitted within 30 days for pain control (n=2) and post-cholecystectomy complications (n=1).
Reasons for non-ambulation included: pain (n=30), inpatient cholecystectomy (n=4), poor oral intake (n=4), social reasons (n=3).
In 4-week tertiary data collection, 5/17 (29%) eligible patients were ambulated, with 1 (20%) re-admission.

Conclusion
Pilot of a novel pathway to identify and ambulate patients with a predicted mild course of AP has been successful across two NHS centres. Use of validated risk scores alongside biochemical markers and clinical acumen produces a safe, sustainable and effective pathway that reduces burden on inpatient surgical resources.
It is safe and feasible to ambulate patients with AP whilst undertaking diagnostic imaging, managing symptoms, facilitating expedited cholecystectomy and arranging specialist review in the outpatient setting.
Further work is required with stakeholders to refine the pathway and replicate these results in other surgical units.
BN SO37 - Upper GI surgical training in the UK: Are there enough training opportunities? 10-year trends in Benign Upper GI index procedures and the impact of COVID-19
Authors: Brown Oliver D , Aroori Somaiah 
Published: November 2024

Abstract

Background
Surgical training was adversely impacted during the COVID pandemic, with reports of reduced logbook numbers and challenges in meeting training competencies. Despite a national elective care recovery plan, and interventions aimed at maintaining training opportunities, waiting list expansion has continued and has particularly impacted benign procedures. Upper GI trainees are all required to achieve “Level 4” (independent) competence in Cholecystectomy and Antireflux surgery, however there are anecdotally. fewer opportunities in the post-COVID era to train in these procedures. This study aimed to evaluate trends in these index procedures and to compare the pre- and post- COVID eras.

Method
The annual Admitted Patient Care (APC) publications draw on Hospital Episode Statistics and summarise activity for each financial year by OPCS4 codes. Codes pertaining to cholecystectomy and antireflux surgery (the “Benign Upper GI” competences on the Joint Committee of Surgical Training New Curriculum Checklist) were screened for inclusion. Data were extracted from APC publications between 2013 and 2023. These data were summarised in a Microsoft Excel Spreadsheet, categorised by index procedure and divided into pre-covid (2013-2019) and post-covid (2019-2023). Trends were evaluated using a Mann-Kendal Non-Seasonal Trend Test. Comparisons were undertaken using a two tailed unpaired t-test.

Results
Between 2013 and 2023 there was a statistically significant negative annual trend in the number of cholecystectomies from 75934 to 68182 (p=0.02), with a minimum of 47803 in the 2020-2021 financial year and a non-significant positive trend in the subsequent years. There were significantly fewer cholecystectomies in the 4 years following COVID (mean 77357 vs 63882, p=0.015). Antireflux procedures also underwent a significant negative trend from 5467 to 4745 (p=0.02), with a minimum of 2565 in the 2020-2021 financial year and a non-significant positive trend in subsequent years. Mean post-COVID antireflux procedures were also significantly lower (5548 vs 4256, p=0.03).

Conclusion
The procedures required for training in Benign Upper GI surgery in the UK are occurring with lower frequency than before the COVID pandemic. Whilst this may reflect ongoing operational pressures, or changes in clinical practice, this evidence suggests that training opportunities are now less frequent. This highlights the importance of focussed training and an awareness of training needs amongst both trainees and their mentors.
BN SO49 - An early experience in robotic Upper GI surgery at a busy District General Hospital
Authors: Patel Maitreyi , Mukherjee Dipankar , Mukherjee Samrat 
Published: November 2024

Abstract

Background
Robotic surgery is being adopted in performing Upper GI surgery due to the added advantage of precision and safety. Current literature suggests that robotic surgery may be associated with improved patient outcomes, such as blood loss, length of stay and perioperative complications, with majority of evidence stemming from colorectal, urological or thoracic surgical domains. Our UGI unit started robotic surgery in November 2021, initially one surgeon trained, and from June 2022, a second consultant surgeon began robotic surgery. This study describes the early outcomes of robotic Upper GI surgery at our UGI surgery Unit in a busy District General Hospital.

Method
We retrospectively assessed data of patients undergoing Robotic UGI surgery from a prospectively maintained database. Patient demographics, surgical procedure and duration of surgery was recorded. Conversion rates, post-operative complications and length of stay were recorded.

Results
Between November 2021 and January 2024, 125patients underwent robotic UGI surgery at our Hospital. The surgeries included cholecystectomy (n=80), Anti-reflux surgery (n=22), Hellers cardiomyotomy (n=4), Gastrectomy (n=6) and oesophagectomy (n=1). The median length of stay was 2 days. Morbidity as per Clavein-Dindo classification 3 and 4 was 3%. There were no mortalities.

Conclusion
Our preliminary experience suggests that robotic surgery is feasible and safe. It has low complication rate and reduced critical care stay. A structured training of surgeons ensures a safe introduction of robotic services.
BN SO56 - Post-ERCP clearance of bile duct stones: Should the gallbladder be left in-situ?
Authors: Lin Cindy Wong Siaw , Tanner Nicola 
Published: November 2024

Abstract

Background
Laparoscopic cholecystectomy (LC) has become the gold standard treatment for patients with cholelithiasis and co-existing common bile duct stones (CBSD) with the ultimate goal to prevent further biliary complications. Despite the procurement of ERCP and LC skills, there still remain a significant proportion of patients who are treated non-operatively. There has been debate on the safety of a ‘watch-and-wait’ policy post ERCP for clearance of CBDS alone. The objective of our study was to review our current practice and compare the outcomes of expectant management (EM) versus LC with an aim to evaluate the necessity of LC after ERCP.

Method
A retrospective review of patients who underwent ERCP for choledocholithiasis from 1st January 2017 to 31st December 2019 was performed. Exclusion criteria applied to patients with previous cholecystectomy, absence of CBDS, gallbladder/pancreatic malignancy, biliary stricture and patients lost to follow-up. Patient characteristics, details of ERCP, initial plan for EM or LC, details of LC and further changes in treatment plan were extracted from the prospectively maintained database of a single institution. Age 70 years is used as cut-off to define elderly group. Primary outcomes measured were biliary-related morbidity and mortality. Secondary outcomes included all-cause mortality, operation-related morbidity and mortality.

Results
265 patients were identified, with 136 patients primarily planned for EM and 129 patients initially booked for LC. The median age of patients in the EM group was greater than LC group (80 vs 62 years). 20.6% patients in the EM group re-presented with biliary events compared to 3.9% in the LC group. The median time from first ERCP to recurrence of biliary events in the EM group was 14 months. There was no significant correlation between age and complications from LC. However, 51.4% of our EM group died during follow up with a median survival of 29.5 months.

Conclusion
Prophylactic cholecystectomy should be performed for patients with concomitant cholelithiasis and choledocholithiasis. A conservative approach should be reserved for the elderly population who are not ideal surgical candidates. A follow-up of up to 2 years is recommended for patients who opt for a ‘watch-and-wait’ approach. Early LC is preferrable due to the risk of recurrence of biliary events and the higher risks of surgery if patients require emergency surgery. Further study is warranted to determine the optimal timing for LC. Patients should be informed about the potential recurrence of symptoms if the waiting time to surgery is longer than expected.
BN SO57 - Transversus Abdominis Plane (TAP) Block in Laparoscopic and Robot-Assisted Cholecystectomy: Is it worth the effort?
Authors: Sira Sukhbir , Suresh Reena , Choudhry Mariam , Tongo Folashade , Koo Huifen , Simoadefreitas Sabrina , Mukherjee Samrat 
Published: November 2024

Abstract

Background
Minimal access cholecystectomy is a common procedure undertaken worldwide. These are usually performed on an ambulatory basis and given the short timeline, strategies to optimize pain control and reduce nausea or vomiting are key factors to facilitate early hospital discharge. There has been studies showing that both TAP block and wound infiltration deliver superior pain relief after laparoscopic cholecystectomy, but TAP blocks are not used routinely after cholecystectomy in the U.K.
This study aims to assess the efficacy of post-operative subcostal TAP block in laparoscopic and robot-assisted cholecystectomy in reducing post-operative opioid requirements and facilitating same day discharge.

Method
A retrospective cohort analysis was performed at a single centre (January 2022 – July 2023). Patients undergoing laparoscopic or robot assisted cholecystectomy under a single surgeon who performs cholecystectomy with additional use of postoperative TAP block were included. The primary outcome of post-operative opioid requirements was assessed. Secondary outcomes included length of post-operative stay and individual morphine/fentanyl requirements.

Results
Among 87 patients, 22(25.3%) underwent TAP block and 65(74.7%) had local anaesthetic infiltration of the port sites. Of the two cohorts, there were no significant differences in the age, M:F ratio or ASA grade. There were more obese patients (BMI &gt; 30kg/m2) in the TAP block cohort (63.6% vs 47.7%; p= 0.012).
Of the patients in the TAP block, 88.2% were discharged the same day. 95.5% of these patients had no post-operative morphine or fentanyl requirements.The difference in outcomes were not statistically significant. There were no post-procedural complications from use of the TAP block in any patient.

Conclusion
These results demonstrate that use of TAP block can provide a safe alternative approach for post-operative analgesia, with low post-operative opioid requirements and facilitation of same-day discharge.
BN SO63 - A systematic review of Hiatus Hernia classifications
Authors: Barratt Owain , Badenoch Thomas , Findlay John 
Published: November 2024

Abstract

Background
Hiatus hernias (HH) are common, an important cause of symptoms, and a strong risk factor for complications and oesophageal dysplasia and adenocarcinoma. However, there is a lack of consensus as to how they should be classified. This has significant implications for benchmarking and standardising practice, as well as generating and answering research questions. The aim of this review was to systematically identify and appraise what classification systems have been described, and to identify any novel approaches to HH classifications and their association with treatment outcomes.

Method
We undertook a systematic review of the PubMed and EMBASE databases on the 17th January 2023. Inclusion criteria were any studies containing a HH classification described within adults. Exclusion criteria were studies not in English, animal studies and case reports.

Results
847 articles were identified. 245 were included, with a further 9 studies identified that tested a novel approach to classifying HH against surgical outcomes. Most classification systems (64.9%) were anatomical, but with significant variation as regards stratification of size of the hernia, and its contents (primarily the proportion of herniated stomach). A small number of classifications described endoscopic, manometry, symptomatic and intra-operative classifications. There was considerable heterogeneity in the definitions used for larger HH. The quality of studies comparing classifications with outcomes was limited; however, some possible associations were reported based on anatomical and physiological parameters.

Conclusion
We found a wide range of HH classification systems. These were mainly anatomical and based on the traditional type I-IV system. Whilst the evidence is limited, it seems likely that other components (anatomical and physiological) may have utility in better classifying HH and guiding treatment, standardisation and research.
HPB SO11 - Dropped Gallstones After Laparoscopic Cholecystectomy: An Umbrella Review
Authors: Abu Abdulrahim , Almoshantaf Mohammad Badr 
Published: November 2024

Abstract

Background
Gallstones (cholelithiasis) are solid formations in the gallbladder or biliary tract due to high cholesterol or bilirubin levels, affecting 10-20% of adults. Over 20% of those affected show symptoms like biliary colic. Gallstones can be cholesterol, black pigment, or brown pigment, with cholesterol stones being the most common. The persistence of gallstones following laparoscopic cholecystectomy (LC) poses a significant clinical challenge, potentially leading to morbidity and diagnostic complexities, often with delayed recognition. These complications can present as various intraabdominal conditions such as abscesses (intraabdominal or abdominal wall), fistula formation, peritonitis, bowel perforation, or ileus.

Method
We performed an extensive search of the academic literature spanning several databases, namely PubMed, Embase, Scopus, Web of Science, and Google Scholar. Inclusion criteria for this research encompassed systematic reviews, with or without meta-analysis, focusing on the examination of spilled gallstones in terms of signs, symptoms, diagnosis, imaging, and management. The assessment of potential bias in the final study selection was undertaken utilizing the R-AMSTAR and Risk of Bias in Systematic Reviews (ROBIS) assessment tools.

Results
The most prevalent sites for lost gallstones were identified as the right subhepatic, perihepatic, retroperitoneal, right flank, and pelvic regions. Multiple stones were found to be more common than single stones. Clinical presentations included the presence of abdominal masses simulating malignancy, intestinal obstruction, and pelvic pain or fistula formation. Surgical intervention emerged as the primary treatment approach. Pain localized to the right upper quadrant was reported by 24% of participants. Computed tomography (CT) was the most frequently employed diagnostic modality for stone identification (70.2%), followed by ultrasonography (US) (63.2%) and X-ray (42.9%).

Conclusion
Our research underscores a significant area that has received limited attention in existing literature. The occurrence of spilled gallstones presents challenges in diagnosis and carries the potential for severe post-laparoscopic cholecystectomy complications. A notable gap exists in the education of both surgeons and patients regarding this complication, emphasizing the need for heightened awareness among surgeons. Given the considerable variability observed between laparoscopic cholecystectomy procedures and the onset of associated symptoms, comprehensive studies with larger cohorts are imperative for elucidating pertinent risk factors and devising effective interventions.