bluuebunny/crossref_metadata_2025_split huggingface dataset:
468. CALCULATING THE MINIMAL CLINICALLY IMPORTANT DIFFERENCE FOR THE FACT-E FROM ESOPHAGECTOMY TO RECOVERY USING DISTRIBUTION-BASED METHODS
Authors: Crump Trafford , Dehghani Mehrnoush , Mueller Carmen , Ferri Lorenzo 
Published: September 2024

Abstract

Background
The Functional Assessment of Cancer Therapy-Esophageal (FACT-E) is a validated patient-reported outcome instrument that measures four subscales of general cancer health and one subscale specific to esophageal cancer. To make the instrument more clinically useful, therapeutic thresholds known as minimal clinically important differences (MCID) are needed. The purpose of this study was to calculate the MCID for the FACT-E and its subscales for patients undergoing an esophagectomy.

Methods
The study was based on a retrospective analysis of a registry maintained by a high volume North American tertiary care referral centre, which includes the FACT-E collected between August 2004 and September 2023. The FACT-E was administered at nine time points over the course of a patient’s care, ranging from the time of first presentation to 5 years post-esophagectomy. This study used two distribution-based approaches – the standard error (SE) and the standard deviation (SD) – to calculate the MCID for the FACT-E’s total score and its five subscales. Nonparametric bootstrapping was used to generate 95% confidence intervals for each MCID.

Results
There were 731 participants included in this study but not all of those completed each subscale at each time point. The MCID for physical well-being ranged from 2.2-3.1 using SE and 2.3-3.4 using SD, from 2.1-3.6 using SE and 2.2-3.6 using SD for social well-being, 1.2-1.7 using SE and from 1.4-2.0 using SD for emotional well-being, 2.1-2.4 using SE and 3.2-3.6 using SD for functional well-being, and from 3.2-4.3 using SE and from 4.3-6.4 using SD for the esophagus cancer subscale. The MCID for the total score ranged from 6.7-8.3 using SE and from 8.9-11.2 using SD.

Conclusion
The MCID thresholds for the FACT-E subscales vary depending on when they are collected and how they are measured. In general, smaller thresholds of change are needed in the social and emotional well-being subscales, while larger ones are needed for the esophagus cancer subscale. Overall, the MCID for the FACT-E total score ranged from 6 to 11. Clinicians should consider these MCID if using the FACT-E to assess changes in patients’ symptom severity before and after esophagectomy.
482. REFLUXSTOP PROCEDURE IN THE LAPAROSCOPIC REPAIR OF HIATAL HERNIA
Authors: Zehetner Joerg 
Published: September 2024

Abstract
The video demonstrates laparoscopic anti-reflux surgery with the RefluxStop procedure, first introduced in 2016 and now offered in multiple centers across Europe. As this tertiary level hospital was among the first to offer this treatment to patients in clinical practice, this video provides unique insight to the lessons learned from the early experience of this surgery, with regard to optimizing effectiveness and safety. In light of the promising clinical outcomes that are emerging as follow-up data become available, the number of surgeons performing this this technique is likely to continue to increase.
The RefluxStop procedure addresses all 3 components of the anti-reflux barrier as follows: 1) laparoscopic hiatal hernia repair, 2) high mediastinal dissection to achieve 4-6 cm intraabdominal length of esophagus, allowing the LES to be brought into an optimal intraabdominal position, and 3) recreation of the flap valve at the angle of His though creation of a 90-degree esophago-gastric plication. The 22mm round silicone RefluxStop device is then positioned high-up and close to the esophagus in a fundic pocket, to maintain the correct position of the repair.
https://drive.google.com/file/d/1hlXXRUUMkDPmheW_mgPM_g1wWCu2R_Y3/view
491. STEP BY STEP INTRATHORACIC HAND-SEWN ESOPHAGOGASTRIC ANASTOMOSIS DURING TOTALLY ROBOTIC MINIMALLY INVASIVE TWO-STAGE ESOPHAGECTOMY
Authors: Farguell Jordi , Turrado Victor , Nuñez Hemberly Dereck , Gil Ignacio , Cardin Dra Verena , Curell Dra Anna , Ibarzabal Dra Ainitze , Pera Miguel , Momblan Dra Dulce 
Published: September 2024

Abstract

Background
In every esophagectomy, regardless of the approach, the creation of the anastomosis is a critical step. In minimally invasive esophagectomy, to avoid challenges of thoracoscopic suturing in the upper mediastinum most surgeons use stapling devices or even decide to do a cervical anastomosis. However, in robot-assisted minimally invasive esophagectomy, the surgeon benefits from increased dexterity that facilitates to perform a hand-sewn intrathoracic anastomosis.

Methods
A 67-year-old man with esophageal adenocarcinoma, staged as a T3N1 underwent neoadjuvant chemotherapy, followed by a fully robotic minimally invasive Ivor-Lewis esophagectomy (robotic surgery during both the abdominal and thoracic phase). For the thoracic phase, the patient was placed in left sided semi-prone position. An 8 mm robotic trocar is inserted in the 6th intercostal space for the camera. Two other 8mm robotic trocars were inserted in the 4th, 8th and a 12mm 10th intercostal space. The anastomosis was constructed at the level, just above the azygos vein.

Results
The esophagogastric anastomosis was performed with an end-to-end construction. A barbed 3.0 suture was used to close the posterior wall by a single-layer running hand-sewn technique. The esophagostomy and the gastrostomy were performed using vascular scissors. A 36Fr Faucher was placed to expose de inner layer during the esophagostomy. A second posterior continuous full-thickness layer was performed using barbed 3.0 suture. Finally, an anterior wall full-thickness layer was performed using the same suture. To protect the anastomosis an omental wrap was applied.

Conclusions
Totally robotic minimally invasive esophagectomy for the treatment of esophageal cancer is on the rise. It offers all the advances of minimally invasive techniques, like reduced rates of pulmonary and cardiac complications associated with open thoracotomy and shorter length of stay. Intrathoracic esophagogastric anastomosis still remains challenging and it is considered as the most difficult step of the procedure. Robotic transthoracic manual anastomosis has appeared to overcome this difficulties.
https://www.dropbox.com/scl/fi/km4oo66hhnb00k45e7ecq/Stepbystepmanual.mp4?rlkey=eb074cf3sj796byijqza0zoq6&dl=0
495. LAPAROSCOPIC FUNDOPLICATION IMPROVES ESOPHAGEAL MOTILITY IN PATIENTS WITH GERD A HIGH VOLUME SINGLE CENTER CONTROLLED STUDY IN HIGH-RESOLUTION MANOMETRY ERA
Authors: Santangelo Matteo , Vittori Arianna , Capovilla Giovanni , Provenzano Luca , Nicoletti Loredana , Costantini Andrea , Pittacolo Matteo , Forattini Francesca , Moletta Lucia , Valmasoni Michele , Savarino Edoardo V , Salvador Renato 
Published: September 2024

Abstract

Background
Pathophysiology of GERD is complex and esophageal motility disorders are frequently contributing to the disease. Most of the existing literature demonstrates that Laparoscopic Fundoplication (LF) is safe in the setting of ineffective or weak peristalsis, however the effect of the wrap on esophageal motility is still debated. This study aimed to assess how a functioning and effective fundoplication could impact the esophageal motility in patients with GERD.

Methods
We analyzed prospectively collected data on patients who underwent laparoscopic Nissen (LN) or Toupet (LT) fundoplication for GERD between 2010-2022. We selected patients who have been treated with LF according to the GERD international guidelines. The exclusion criteria were: patients with a giant hiatal hernia and patients with a proof of a too-tight LF.
Patients were evaluated with the GerdQ questionnaire, barium-swallow, endoscopy and HRM and 24-hour pH-Impedance before and after surgery. The HRM were reviewed by 2 experts (Chicago Classification v4.0). LF failure was recorded in case of an abnormal postoperative pH-MII using the Lyon 2.0 criteria.

Results
We recruited 124 patients (M:F=89:35). Fifty-eight LN and 66 LT were recorded. A good outcome at the 24-hour pH-Impedance was registered in 103 patients (GLF) and a failure in 21 patients (FLF).
As shown in Figure 1, in GLF patients, 29 had a preoperative motility disorder (24 IEM and 5 DES), and postoperatively 22 (76%) of these patients had a normalization of the esophageal motility. Ten FLF patients had a preoperative motility disorder (9 IEM and one DES); 4 (40%) of them showed normal motility after LF. There was a significant association between GLF and normalization of esophageal motility (p&lt;0.05).

Conclusion
This study demonstrates that LF is an effective and functioning treatment in patients with GERD associated with an esophageal motility disorder. Moreover, our results indicate that LF could determine a normalization of the disordered esophageal motor function in patients with GERD.
496. OESOPHAGEAL STENTING IN BOERHAAVE SYNDROME: OUR EXPERIENCE
Authors: Vos Gigi , Martijnse Ingrid , Heisterkamp Joos , Laheij Robert , Matthijsen Robert 
Published: September 2024

Abstract

Introduction
Boerhaave syndrome is the spontaneous rupture of the oesophagus. This rare condition is associated with a high mortality. Its treatment remains controversial, with an aggressive surgical approach being most described.
In striving for the safest and most minimally invasive treatment for our patients, we opt for a multidisciplinary intervention: prompt endoscopic stenting of the esophageal defect in combination with optimal drainage of the pleural cavities. We reviewed our recent experience.

Methods
In our referral hospital, between October 2018 and October 2023, we treated nine patients with Boerhaave syndrome by prompt endoscopic stenting of the esophageal defect combined with drainage of either one or both pleural cavities, preferentially by thoracoscopy.
Retrospectively the data from these patients was analysed to provide an overview of our experience with this multidisciplinary approach.

Results
In total we have treated six men and three women with a median age of 61 years (53-82years). All patients received an endoscopy and pleural catheter drainage at presentation, combined with stenting of the 1-4cm esophageal defect.
In six patients (67%) the minimally invasive treatment was successful, with a median hospitalisation period of 33 days (17-77days) and median stent removal after 47 days (40-73days). All these patients reported a good oral intake.
Thoracoscopic debridement of the pleural cavity was performed in seven patients. In one patient endoscopic stenting failed with the need for an oesophagostomy. Two patients have deceased, resulting in 22% overall mortality.

Conclusion
Boerhaave syndrome is known to be a surgical emergency. From our experience we conclude that prompt endoscopic stenting of the oesophageal defect in combination with drainage of the pleural cavities is a safe and minimal invasive approach, even for cases with larger defects and extensive contamination of the thorax. Due to the rarity of the condition, data is limited. We advocate for a registration study to obtain the current golden standard.
507. LONG BARRETT´S ESOPHAGUS IN MONOZYGOTIC TWINS WITH ADENOCARCINOMA DEVELOPMENT
Authors: De Tomas Jorge , Tudela Ms Maria , Monturiol Jose Maria 
Published: September 2024

Abstract

Background
Familial aggregation of Barrett's esophagus (BE) and esophageal adenocarcinoma (EA) suggests a genetic pattern in fewer than 10% of patients with the former diseases. In 1983, BE was described in identical twins, underlining the hereditary influence on the development of mucosal dysplasia in some patients with this epithelial alteration. At present, some studies have attempted to identify chromosomal alterations among patients with familial aggregation of BE or EA, but there is not a clear pattern.

Methods
Description of the case report of a male patient who underwent esophagectomy due to EA on a long BE, who had a monozygotic twin without gastroesophageal reflux symptoms and no upper GI endoscopies before.

Results
A 53-year-old man was diagnosed with EA and a long BE (8 cm length) in 2017. He underwent CROSS neoadjuvant treatment and minimally invasive Ivor-Lewis esophagectomy. The pathological report indicated a GI T3N1M0 adenocarcinoma. Unfortunately, the patient developed lung metastases and passed away in 2019. Before that, the patient recalled that he had an identical twin brother with no gastroesophageal reflux symptoms, but we decided to scope him in 2017. The gastroscopy report revealed a 2 cm hiatal hernia with a long BE (C4M6 Prague Classification) but with no dysplasia. Nowadays, the twin patient is under close follow-up with proton pump inhibitors (PPI) and has not developed dysplasia.

Conclusion
Monozygotic twins provide a perfect model to study the possible influence of genetic predisposition to develop BE and EA. The development of EA in a patient guided us to diagnose and treat a long BE in his asymptomatic identical twin. More studies should be done to find the possible genetic alterations linked to familial aggregation of BE and EA.
510. INNOVATIVE ROBOTIC-ASSISTED ESOPHAGECTOMY WITH THREE-FIELD LYMPHADENECTOMY: A NOVEL APPROACH TO ESOPHAGEAL CANCER SURGERY
Authors: Patraithikul Premkamol , Swangsri Jirawat , Suwatthanarak Tharathorn , Nampoolsuksan Chawisa 
Published: September 2024

Abstract

Background
Esophageal squamous cell carcinoma, the predominant form of esophageal cancer in Thailand, often presents at advanced stages (III - IV), necessitating surgical intervention. Radical esophagectomy, including three-field lymphadenectomy, stands as one of the most invasive gastrointestinal surgeries. However, in the era of minimally invasive surgery (MIS), robotic systems have emerged as a formidable approach to achieve radical treatment goals while minimizing surgical invasiveness. This video showcases a novel surgical technique and its challenges.

Methods
A case of mid-thoracic esophageal squamous cell carcinoma, clinically staged III, treated via robotic-assisted esophagectomy and three-field lymphadenectomy using the Da Vinci Xi system. The operation encompassed three phases: Initially, the thoracic phase with patient in semi-prone position with three robotic and one assistant trocars for complete esophageal mobilization and mediastinal lymph node retrieval. The abdominal phase, followed by the cervical phase, utilized four robotic trocars and one assistant trocar in supine position with hyperextended neck, facilitating perigastric lymph node retrieval, gastric tube reconstruction via the posterior mediastinal route, and cervical esophago-gastric tube anastomosis using a circular stapler.

Results
The patient experienced an uneventful recovery. Postoperative esophagogastroduodenoscopy on day 1 revealed the integrity of the anastomosis and normal vocal cord function. Imaging conducted on day 7 confirmed that the anastomosis was patent without any leakage. Surgical outcomes included an operative time of 615 minutes, estimated blood loss of 150 ml, a 14-day hospital stay, and recovery without complications. This video highlights the intricacies of the procedure and the robotic system's ability to access anatomically challenging spaces, thereby minimizing surgical invasiveness and enhancing recovery.

Conclusion
The robotic system is capable of performing radical procedures in anatomically challenging areas, such as narrow spaces and areas requiring precise maneuverability among vital structures. It enables a comprehensive approach spanning from the upper to the lower thoracic regions and diversity of surgery in thoracic and abdominal cavity. Additionally, this presentation highlights unique surgical tips and techniques that enhance the safety and feasibility of robotic-assisted esophagectomy. By significantly reducing surgical errors and optimizing outcomes for both oncologic and minimally invasive surgeries, it thereby marks a significant leap forward in the field of esophageal surgery.
https://drive.google.com/file/d/1vrmu2D8TGoetnplcREPWQocXJle4PrOX/view?usp=share_link
511. IS IT SAFE TO USE NONABSORBABLE MESH IMPLANTATION FOR HIATAL REINFORCEMENT DURING PRIMARY ANTIREFLUX PROCEDURES?
Authors: Haidarzhi Yevhen 
Published: September 2024

Abstract

Background
Laparoscopic Fundoplication (LF) is highly effective in surgical treatment of GERD and the prevention of disease progression. Currently it is the gold standard of treatment and allows to achieve good and excellent postoperative results in majority patients. However, despite the gained experience, failures of primary LF and hiatus repair like hiatal hernia recurrence demonstrate that current surgical techniques are not optimal. One of the decisions is mesh implantation for hiatal reinforcement in GERD. However, due to the different types of complications (mesh erosion, scarring, dysphagia) safety use of mesh are still controversial.

Method
Laparoscopic Total Fundoplication (LTF) with nonabsorbable and composite light mesh implantation for hiatal reinforcement during 2022 – 2023 years were performed in 71 patients. We use macroporous nonabsorbable polypropylene or composite (polypropylene/monocryl) light mesh repair routinely by own proposed surgical technique. Our decision did not depend on size of hiatal hernia and hiatal surface area. We use U-shaped mesh posteriorly on the approximated crura by previous interrupted suturing not around the esophagus (Fig. 1). The mesh fixes with staples to the muscular and ligamentous structures of crura. We compared our results with the group of LTF without mesh implantation.

Result
All patients underwent completed validated questionnaires, esophagogasroduodenoscopy, contrast video esophagram, 24-hour impedance-pH monitoring after surgery. Some patients underwent computed tomography. Along with the disappearance of GERD symptoms, no mesh erosion and long (&gt;3 month) postoperative follow-up dysphagia were marked in any patient with mesh repair. There are no significant difference in comparison with these results of LTF without mesh implantation. During the early postoperative period (&lt; 12 months) no recurrence of hiatal hernia was diagnosed in the group with mesh implantation.

Conclusion
According to our study, in comparison with no-mesh repair, the proposed surgical technique is safe. Nonabsorbable and composite light mesh implantation for hiatal enforcement during primary antireflux procedures may be used routinely to prevent hiatal hernia recurrence effectively. Further, longer-term follow-up will be continued to confirm this position.
515. LAPAROSCOPIC PHARYNGO-COLOPLASTY WITH RIGHT COLON FOR A CASE OF COROSSIVE INJURY
Authors: Vijaya Kumar K , Ramesh N , Parthasarathi Ramakrishnan , Chinnusamy Palanivelu 
Published: September 2024

Abstract

Introduction
Corrosive stricture of esophagus and stomach is more common in Acid poisoning. Management these cases requires good surgical planning, technical expertise in doing these complex procedures

Case report
A34 year gentleman consumed small quantity of sulphuric acid. Feeding jejunostomy was done for improving the nutrition. After 9 months of initial insult Upper GI scopy and CT NECK, CHEST, ABDOMEN was done which confirmed complete esophageal stricture from cricopharyx, thickened entire stomach.
We Did LAPAROSCOPIC PHARYNGO-COLOPLASTY WITH RIGHT COLON. Intraoperatively thickened stomach, total gastrectomy done, Right colon used for Coloplasty.Post procedure patient recovered well, Drins removed on 4th post op day, patient was discharged on 6 th day.
https://drive.google.com/file/d/15OkPYKjsoQ-NVceBUzUArFAqMzcnA02S/view?usp=drive_web
516. HELLER MYOTOMY FOR SYMPTOMATIC ACHALASIA: TRADITIONAL LAPAROSCOPY OR ROBOTICS? A SYSTEMATIC REVIEW WITH META-ANALYSIS
Authors: Cuce Federica , Sacco Michele , Bencivenga Maria , Zenzaro Matteo , de Manzoni Giovanni , Giacopuzzi Simone 
Published: September 2024

Abstract

Background
Laparoscopic Heller myotomy (LH) has been established as the gold standard for symptomatic achalasia; robotic-assisted laparoscopic myotomy (RH) has shown promising outcomes regarding safety and effectiveness. We aim to meta-analyse data comparing LH and RH surgical outcomes and complications.

Methods
A systematic search was conducted in February 2024 without restrictions according to PRISMA guidelines in PubMed, Web of Science, Scopus, and Cochrane Register. Studies comparing laparoscopic and robotic approach for Heller myotomy in adults with symptomatic achalasia were included for systematic review. Meta-analysis was performed trough generalized linear mixed model in R 4.3.2.

Results
16 observational studies, out of 273, were included; reporting on 15076 patients. No statistically differences in preop characteristics were noted.
RH had significantly fewer intraoperative esophageal perforations (OR=7.29, p&lt; 0.0001, 95%), fewer subsequent myotomies and endoscopic treatments for recurrence (OR= 3.64, p=0.01 and OR= 3.38, p=0.03) and better symptom score improvement (OR=0.507, p=0.04). Although not clinically significant, RH had shorter hospital stays (MD=0.45 days, p= 0.005,) and reduced intraoperative blood loss (MD=10.46 ml, p=0.0002).
Although not statistically significant, RH had fewer bleeding episodes, lower conversion, reintervention and mortality rates, comparable morbidity and postoperative GERD and higher operative time.

Conclusion
This updated meta-analysis suggests that RH is associated with lower regarding perforations, recurrence rates and symptom improvement compared to LH, with negligible lengthening of operative times.
RH for symptomatic achalasia represents a feasible treatment for symptomatic achalasia, with a satisfying safety and effectiveness profile.
RCTs on the topic and about cost-effectiveness evaluations are necessary to support the reported data.