bluuebunny/crossref_metadata_2025_split huggingface dataset:
BS P05 The Return to Bariatric Surgery Following the COVID Pandemic 2020- A Single Center Prospective Study
Authors: Ibrar Hussain Muhammad , Ghoneima Ahmed , Khawgali Mohamed , Farooq Rahy , Bonner Clare , Hammett Felix , Saha Arin , Peter Mark , Dobbins Brian , Adair Robert , Ainslie William , Salih Tamir 
Published: November 2023

Abstract

Background
Elective surgical practice was paused in March 2020 to cope with the Covid pandemic. Bariatric surgery was amongst the first specialities to be stopped as resource allocation prioritised lifesaving service for Covid positive patients over what is considered quality of life improving procedures. It was also one of the last to be restarted due to fears of Covid infection in obese patients undergoing surgery both of which are known risk factors of mortality in Covid cases. This study describes outcomes after bariatric surgery since the weight-loss program restarted and the measures to ensure service provision and maintenance of patient safety.

Methods
Elective bariatric surgery restarted in June 2021; patients were managed within a ‘green’ elective pathway in a new ring-fenced elective surgical hub. All patients who had surgery from June 2021 to January 2023 in a single centre were identified from a prospectively-maintained database of operations. The outcomes were patient safety measured by Covid infection and complication rates post operatively, impacts on hospital resources measured by length of stay in hospital and HDU/ITU bed occupation, impacts on the Bariatric Surgery service measured by waiting time for surgery and cancellations, and benefits to patients measured by remission of diabetes and hypertension.

Results
124 patients were included; 42 (34%) had sleeve gastrectomy and 82 (64%) had gastric bypass.
There were no Covid infections/complications in this series.
Median length of stay after surgery was two days with no admissions to HDU/ICU.
Waiting time for surgery was &gt;52 weeks at the start of the study period which has fallen to 15 weeks after listing and no operations were cancelled due to lack of beds.
Post-operative outcomes were favorable and in line with national data; 87% of patients had remission of diabetes and 60% of patients were off anti-hypertensive medications one year after surgery.

Conclusions
The creation of dedicated ring-fenced elective surgical hub allowed the rapid restart of bariatric surgery despite the effects of the Covid-19 pandemic. This model separated elective and acute patients reducing exposure of high-risk patients. This allowed the resumption of weight-loss surgery safely as evident by the zero Covid-related complications, no additional pressure to hospital resources such as beds and intensive care unit capacity, a high-quality service with short waiting times and favorable long term outcomes. This are all signs of good practice in a resilient service and can very easily be replicated in the future whenever required.
OGBN P09 Management of acute gastric volvulus: a systematic review and practical guide to management
Authors: Butterworth James , Dawas Khaled , Ramdin Ashling 
Published: November 2023

Abstract

Background
Gastric volvulus can result in a life-threatening clinical course resulting in gastric ischemia. The optimal treatment strategy for gastric volvulus has not been established, hence we performed a systematic review and developed a practical guide to management.

Methods
A systematic on-line literature search of Embase and Medline identified 1435 articles of which 49 relevant studies were selected, including 32 retrospective studies, 17 case series. Selected articles were assessed by two reviewers to extract data.

Results
731 patients with gastric volvulus (76.8% organoaxial, 22.2% mesentericoaxial)were identified with a median age of 40 years, 50% were female. 233 (32%) of patients underwent a laparotomy, 255 (35%) a laparoscopy and 148 (20%) were managed conservatively. Endoscopic decompression was trialled initially in 81 patients and successful in 20 (26.3%) patients. A higher proportion of complications (22.4% versus 4.7%) and recurrence (33% versus 0%) was seen in those who had laparoscopic rather than open repair. A lower 30-day mortality (0% versus 4.7%) and length of stay (3.3 versus 12 days) was noted in the laparoscopic cohort.

Conclusions
A multimodal approach using endoscopic decompression and placement of an NG tube is vital followed by a prompt decision on definitive surgical intervention. Laparoscopic and open procedures are both possible however lower morbidity and recurrence rates are evident following an open-approach but with a higher associated mortality risk.
OGBN P13 Laparoscopic splenectomy for massive splenomegaly: Is it feasible?
Authors: Elshaer Ahmed , Kaur Mandeep 
Published: November 2023

Abstract

Background
Laparoscopy has high credibility in the treatment of normal sized and mildly enlarged spleens. However, there is lack of evidence for its safety for cases with massive splenomegaly. EAES defined massive splenomegaly by maximum splenic diameter exceeding 20 cm. It recommended hand assisted laparoscopic splenectomy (HALS) or open surgery as a treatment for such cases. In this video, we demonstrated the feasibility of the use of laparoscopy in cases with massive splenomegaly with favourable outcomes.

Methods
We describe a video for a 36 years old female patient who is known Kikuchi syndrome. She had massive splenomegaly which reached 25 cm in its maximum length. Patient was in right lateral position. Camera port was located left to the umbilicus, another 10 mm port at left midclavicular line and two 5 mm ports were used (one at epigastrium and assistant port at left anterior axillary line). The video demonstrates the steps of laparoscopic splenectomy with the challenges of the huge size of the spleen. Specimen was taken through patient’s old caesarean scar (Pfannenstiel incision).

Results
Patient had CT scan on day 2 for raised inflammatory markers, which showed small collection at splenic bed which was treated conservatively. Patient was discharged on day 5 postoperatively after removal of surgical drain. Clinical review after 4 weeks post discharge didn’t show any clinical concerns.

Conclusions
Using a stepwise laparoscopic approach is feasible and safe for massive splenomegaly cases. Refining the selection criteria for laparoscopic versus open or HALS splenectomy should be revised with less consideration to the size of spleen as a limiting factor.
OGBN P15 The cost-effectiveness of a novel implantable device for treating gastro-oesophageal reflux disease in the United Kingdom
Authors: Mealing Stuart , Harper Sam , Grodzicki Lukasz , Gemmill Liz , Goldsmith Paul , Ahmed Ahmed 
Published: November 2023

Abstract

Background
Gastro-oesophageal reflux disease (GORD) is a common gastrointestinal condition characterized by heartburn, chest pain, and regurgitation. Chronic treatment with proton pump inhibitor (PPI)-based medical management is the current standard of care, with antireflux surgery considered in selected patients. RefluxStop is a novel implantable device indicated for patients eligible for laparoscopic anti-reflux surgery. The purpose of this analysis was to assess the cost-effectiveness of RefluxStop against other GORD treatment options in the UK.

Methods
A Markov model was developed to assess the cost-effectiveness of RefluxStop compared with PPI-based medical management, laparoscopic Nissen fundoplication, and magnetic sphincter augmentation (MSA) for management of GORD. The UK National Health Service perspective was adopted, with clinical outcomes and costs estimated over a lifetime horizon and an annual discount rate of 3.5% applied. Clinical efficacy data for RefluxStop was obtained from its CE mark study, and comparator treatments were based on published literature.

Results
RefluxStop demonstrated favorable surgical outcomes compared to both laparoscopic Nissen fundoplication and MSA. The base case incremental cost-effectiveness ratios (ICERs) compared with PPIs, laparoscopic Nissen fundoplication, and MSA were £4,156, £6,517, and £249 per quality-adjusted life-year (QALY) gained, respectively. With a UK cost-effectiveness threshold of £20,000 per QALY gained, the probabilities that RefluxStop was cost-effective compared with PPIs, laparoscopic Nissen fundoplication, and MSA were 100%, 93%, and 100%, respectively.

Conclusions
Based on this analysis, RefluxStop was estimated to improve quality of life and extend life expectancy in GORD patients when compared to PPIs, laparoscopic Nissen fundoplication, and MSA. Furthermore, this analysis demonstrated that RefluxStop is highly likely to be a cost-effective option for treating GORD in the UK.
OGBN P16 Endoscopic surveillance allows prediction of burden of early signet ring cell carcinoma in Hereditary Diffuse Gastric Cancer syndrome
Authors: Jun Lim Hui , YC Lee Colin , Karthik Nandini , O’Donovan Maria , Fitzgerald Rebecca C , O’Neill J Robert , di Pietro Massimiliano 
Published: November 2023

Abstract

Background
Hereditary diffuse gastric cancer (HDGC) syndrome is commonly linked to CDH1 germline pathogenic variants (PV) and carries a high lifetime risk of diffuse gastric cancer (DGC). Definitive treatment remains prophylactic total gastrectomy (PTG). However, endoscopic surveillance can be offered to inform decision-making around surgery, although the optimal time for treatment escalation remains unclear. This study aims to establish whether histopathological assessment of endoscopic biopsies can predict burden of early signet ring cell (SRC) carcinoma on PTG specimens.

Methods
We performed a retrospective review of prospectively collected data on endoscopic and surgical histopathologic results from CDH1 PV carriers who underwent PTG at Addenbrooke’s Hospital between January 2006 and May 2023. Targeted and systematic Cambridge protocol biopsies were performed. Patients with confirmed DGC (stage 2 or higher) at baseline endoscopy were excluded. Pearson correlation was performed to assess the relationship between number of SRC foci on endoscopy and surgical specimens.

Results
46 patients underwent PTG with median of 3 pre-operative surveillance endoscopies over 22 months. Final stage was pT1aN0M0 in 41 patients and pT0N0M0 in 5 patients. The number of SRC foci on PTG specimens ranged from 0 to 273. There was a strong correlation between number of SRC foci on gastrectomy specimens and from targeted and random biopsies when evaluated separately and together for last 2 and all endoscopies. The strongest correlation was seen with total number of SRC foci on random biopsies for last 2 endoscopies (r=0.738, p-value&lt;0.001). Random biopsies outperformed targeted biopsies in prediction of early SRC burden.

Conclusions
Endoscopic surveillance with systematic targeted and random biopsies by expert endoscopists within a dedicated specialist service provides useful information to estimate the burden of early SRCC. Low number of SRC foci at last two endoscopies indicate scarce gastric neoplastic involvement.
OGBN P21 Improving patient satisfaction with discharge information after laparoscopic cholecystectomy: a quality improvement project
Authors: Fardanesh Armin , Refaat Daniel , Stavropoulou-Tatla Stavroula , Atiyah Ayah , Cullinan Bridget , Jones Liam , Rohatgi Ashish 
Published: November 2023

Abstract

Background
With the rise in day case surgery, there has been an increase in both nurse-led discharge and patient turnover. Patients recovering from anaesthesia frequently retain less, therefore information delivered to patients regarding post-operative recovery is sometimes lost or forgotten.
The aim of this quality improvement project was to improve both the quality of information and the patient satisfaction with the information provided to them upon discharge following laparoscopic cholecystectomy.

Methods
Patient satisfaction was assessed using questionnaires at baseline and following each Plan- Do-Study-Act (PDSA) cycle. In PDSA 1, a generic discharge summary delivering standard post-operative instructions, was distributed to patients on discharge. For PDSA 2, a detailed leaflet, encompassing information requested by previously surveyed patients, entitled “going home after your gall-bladder surgery” was provided in addition to the discharge summaries.

Results
At baseline we found all patients were receiving some sort of discharge information after laparoscopic cholecystectomy. Key information such as wound care, dietary advice and expected pain, was frequently missed. We found that patients were not satisfied, with an average reported satisfaction of 55%. After PDSA 1 patient satisfaction rose to 66%. However,the generic discharge summary missed advice for patients going home with drains and driving advice. With introduction of the detailed leaflet, patient reported satisfaction reached 100%.

Conclusions
Introducing detailed discharge leaflets improved the patient satisfaction with the information they received on discharge. We anticipate this will in turn reduce patient concerns and need to seek further medical attention. Similar leaflets can be distributed for day case operations such as hernias. This serves as a useful measure to aid patient recovery at home and supports a high turnover day case surgery list.
OGBN P22 The safety and efficacy of the Gastric Electrical Stimulator (GES) for gastroparesis in pregnancy
Authors: Archer Matthew , Askari Alan , Kadirkamanathan Sritharan 
Published: November 2023

Abstract

Background
Gastroparesis, a severe illness, can considerably complicate pregnancies. A large proportion of patients suffering from gastroparesis are female and often of child bearing age. This study explored the Gastric Electrical Stimulator's (GES) safety during pregnancy and evaluated outcomes such as symptom control and Quality of Life (QoL).

Methods
We examined our gastroparesis patient database to identify pregnant women with in-situ GES. The key outcomes included GES safety and efficacy during pregnancy. Metrics such as QoL SF36 scores, nausea, vomiting, pain, satiety, bloating, hospital stay, admissions, and feeding support were evaluated pre- and post-operatively.

Results
Twelve women with in-situ GES became pregnant. Median age at surgery was 29 years (IQR: 26-31 years), with 58% having diabetes as their gastroparesis cause. A majority (67%) underwent robotic GES insertion. Post-operative improvement was seen across several metrics, including nausea score (from 4 to 1), vomiting score (from 4 to 0), pain score (from 4 to 1), satiety score (from 4 to 0), and bloating score (from 4 to 0). SF36 scores significantly increased from a median pre-operative score of 261 (IQR: 178-65) to 1,783 (IQR: 765-3,527, p&lt;0.001). Also, 58% transitioned from assisted feeding to no feeding support.

Conclusions
For pregnant patients, GES implantation safely improved gastroparesis symptoms, enhanced QoL as per SF36 scores, and reduced feeding support reliance. More extensive research is required to confirm these findings and understand GES's implications in pregnancy-related gastroparesis.
OGBN P29 Short term outcomes after anti-reflux surgery for Gastro-Oesophageal Reflux disease
Authors: Patel Maitreyi , Suresh Reena , Woods-orugboh James , Shetty Jeevith , Amalesh Thangadorai , Mukherjee Samrat , Mukherjee Dipankar 
Published: November 2023

Abstract

Background
Laparoscopic fundoplication is the standard surgical practice for management of Gastro-oesophageal reflux Disease (GORD). However, post operative complications and recurrence can be problematic. We conducted this study to assess short-term post operative outcomes following anti-reflux surgery (ARS) for GORD at our UGI surgery unit at a busy District General Hospital (DGH).

Methods
All patients above 18 years of age undergoing ARS between January 2016 and December 2021 were included. We excluded patients who underwent fundoplication as part of treatment of achalasia or large hiatus hernia repairs. Data was collected retrospectively from a prospectively maintained database. Pre –operative investigations and surgical procedure was recorded. Primary outcome assessed were post-operative complications recorded as per Clavien-Dindo grade and re-operation rates. Secondary outcomes assessed were symptomatic relief and proton pump inhibitor (PPI) discontinuation.

Results
86 patients were included. The median age at surgery was 52 years. 98% patients had typical symptoms of GORD at presentation. On pre-operative OGD, 29% patients had oesophagitis and 77.91% had hiatus hernia. 79 (91.86%) patients underwent pH manometry. 97.67% patients underwent Nissen fundoplication. All cases were successfully completed laparoscopically with no conversions to open. The median post-operative length of stay was 1 day. 93.02% had no post operative complications, and none had 30 day re-operation. At 1-year follow up, 97.67% patients reported improvement in symptoms and 94.19% patients were able to stop PPI use.

Conclusions
Laparoscopic fundoplication provides excellent relief of GORD symptoms with low incidence of post operative complications and re-operation rates.
OGBN P30 Post-operative and symptomatic outcomes following Laparoscopic Hellers Cardiomyotomy- single centre experience
Authors: Patel Maitreyi , Suresh Reena , Woods-orugboh James , Shetty Jeevith , Amalesh Thangadorai , Mukherjee Samrat , Mukherjee Dipankar 
Published: November 2023

Abstract

Background
Esophageal achalasia represents a uncommon primary oesophageal motility disorder secondary to loss of inhibitory neurons in the oesophageal myenteric plexus level. The main goal of treating oesophageal achalasia is to relieve dysphagia secondary to the functional obstruction of the distal oesophagus by the inability of the Lower Oesophageal Sphincter (LOS) to relax appropriately after deglutition. The Eckardt score (ES) was developed to objectively assess the symptom severity and continues to be widely used. Aim of this study was to assess the post-operative outcomes and symptomatic improvement using ES in consecutive patients undergoing laparoscopic Hellers cardiomyotomy for achalasia in our unit.

Methods
Data of consecutive patients who underwent LHCM between January 2016 and December 2021 was collected. Patient demographics, surgical details, perioperative course, ES, and manometric data including Integrated Relaxation Pressure (IRP), were retrieved from a prospectively maintained database. Primary outcomes assessed were peri-operative morbidity assessed using Clavien-Dindo grade. Secondary outcomes assessed were improvement in symptoms using ES (pre- and post-operative). ES of ≤3 was considered as symptomatic improvement. Data was analysed using Microsoft Excel. Comparison of pre-operative and post-operative means was performed using paired t test. Fishers exact test was used for categorical variables. A p-value &lt;0.05 was considered statistically significant.

Results
41 patients underwent LHCM. Twenty-one were males. Median age was 56 years (20-77). 95.12% patients had dysphagia for a median duration of 24 months (2-180). Type II achalasia was most common in 87.80%. Median IRP was 22.3 mm Hg (11-78). Oesophageal dilation was performed in 2 while, 10 patients received botulin injection pre-operatively. Median hospital stay was 1 day (1-12). 92.68% had no post operative complications. None of the patients had significant complications (Clavien-Dindo &gt;grade 2). At a median follow-up of 60 months, there was significant improvement in ES 8±1.97 to 1.82±1.16, p&lt;0.001 and dysphagia score (p&lt;0.001).

Conclusions
LHCM with fundoplication leads to significant symptomatic improvement with excellent short and medium term outcomes with low morbidity and complication rates. A detailed pre-operative discussion with patients is essential to provide tailored treatment as per individual patient symptoms.
OGBN P31 Laparoscopic versus open repair of giant paraoesophageal herniae: a 4-year retrospective study
Authors: Butterworth James , Dawas Khaled , Silver Amy 
Published: November 2023

Abstract

Background
Although laparoscopic repair of giant paraoesophageal hernia (PEH) has known advantages over open repair including a reduced post-operative length of stay (LOS) and reduced post-operative pain, there has been concern amongst surgeons regarding the recurrence rate. We sought to further analyse differences in outcomes in a retrospective series of patients with giant hiatus hernia in a single tertiary centre.

Methods
All giant PEH receiving operative repair at a tertiary referral centre (UCLH) were reviewed retrospectively over a one-year period from July 2019-July 2022. Diagnosis was made on gastroscopy and computer tomography (CT). A giant PEH was defined as one in which the hernia contained at least 50% of the stomach. If the patient was symptomatic post-operatively they were investigated for recurrence with gastroscopy and CT.

Results
The laparoscopic cohort (n=14, median age of 72 years, ASA 2) had similar demographics to those receiving open repair (n=21, median age of 68 years, ASA 2.5). Median length of stay was shorter in the laparoscopic cohort compared to the open cohort (3.5 days (1-7) versus 7 days (5-9)). The laparoscopic and open cohorts had similar rates of minor complications (42.8% (6=2, Clavien Dindo 2) versus 47.6% (n=10, Clavien Dindo 2))respectively. Recurrence of reflux or dysphagia symptoms was higher in those who had a laparoscopic repair (28.6% versus 14.3%). One radiologically confirmed recurrence occurred in the open group (4.7%).

Conclusions
Although the benefits of a faster post-operative recovery with a shorter LOS were clear in the cohort following laparoscopic repair, a higher rate of recurrence of symptoms was evident within those receiving a laparoscopic repair. Large, controlled, prospective studies with long-term follow-up are required in order to further establish differences in outcomes between laparoscopic and open repair of giant PEH.
OGBN P35 The effect of social deprivation in patient outcomes following cholecystectomy
Authors: Yee Kuan Jen , Peter Vaz Osborne , Fitzpatrick Stephanie , Khan Rehan , Rajendran Ilayaraja 
Published: November 2023

Abstract

Background
Socio economic status (SES) has shown to impact patient outcomes in different types of cancer. Socio economically deprived populations experience severe as well as complicated gall stone diseases more frequently in comparison with their affluent counterparts (doi: 10.1089/heq.2022.0063). However, the impact of SES on the presentation and outcomes of gallstone disease(GSD) in deprived population is not well studied. Therefore, a study was set up to assess the impact of deprivation in patients presenting with GSD.

Methods
A retrospective observational study of cholecystectomies in adults in our trust from August 2022 to December 2022 was performed. Patients were assigned into Affluent(AF) and Non-Affluent(NA) groups based on the Index of Multiple Deprivation (https://data-communities.opendata.arcgis.com/datasets/communities::indices-of-multiple-deprivation-imd-2019-1/explore). Data was collected using MS Excel and analysed using IBM SPSS statistics ver 27.

Results
100 patients were included from August to December 2022. Male female ratio was 1:3. The five most deprived deciles (NA) had 46 and the five least deprived deciles (AF) had 54 patients. Median age in years was 48 and 52.5 respectively (p = 0.10). The NA deciles had 37 patients referred via the emergency department (ED) and 9 via GP. AF deciles had 34 referrals via ED and 20 via GP (p=0.05). No statistically significant difference was observed in Charlson’s index (p=0.53), operative time (p=0.58) and length of stay (p=0.74) between the groups. There were no conversions to open.

Conclusions
A higher ratio of patients came via GP referrals in the affluent deciles whereas more patients were referred via the ED in the non affluent deciles. However, there was no statistically significant difference in time to surgery and outcomes between these two groups.