bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGBN P03 Surgeons’ perceptions of elective laparoscopic cholecystectomy in the post-COVID era
Authors: Shivarajan Amber , Siddiqui Midhat 
Published: November 2023

Abstract

Background
The COVID-19 pandemic has significantly impacted healthcare systems worldwide, leading to modifications in surgical practices. Laparoscopic cholecystectomy (LC), a common elective procedure, has faced challenges in the post-COVID era, with increased waiting times and episodes of acute gallstone disease in patients awaiting their procedure. This poses the question as to whether modifications to routine practice should be made. This study aims to explore surgeons' perceptions on performing laparoscopic cholecystectomy in the current post-pandemic landscape.

Methods
An anonymous survey was conducted among general surgeons with expertise in LC across multiple healthcare institutions nationally. The survey included questions relating to surgeons’ speciality, and their experience with elective LCs, intraoperative cholangiograms (IOC) and laparoscopic common bile duct exploration (LCBDE) in post-COVID era. Further opinions were sought on complicated intraoperative findings, rate of aborting procedure, rate of conversion to open and number of elective LCs completed by trainees. The data obtained was analysed using descriptive statistics and Fisher’s exact test for statistical significance calculations.

Results
40 surgeons with varying levels of experience with LC completed the survey: 8 (20%) &lt;50, 16 (40%) 100-500 LCs,10 (25%) 500-&gt;1000. Overall, 21 (53%) perceived LC to be more challenging. Analysis between the different groups found no significant difference (p = 0.68) between those who performed &lt;50 LCs (6/8) and 500- &gt;1000 LCs (6/10). 8 (20%) respondents found no increase in complicated intraoperative findings. Of those not working in specialist centres, 11/36 perceived an increase in referral to a hepatobiliary unit. 14 (35%) perceived an increase in unplanned admission. 21 (53%) perceived a reduction in completion of LC by trainees.

Conclusions
This study demonstrates that a significant proportion of respondents believe that LC has become more technically challenging. In patients with increased time till surgery or episodes of acute gallstone disease, MRCP should be considered at pre-assessment. Furthermore, during challenging LCs, options to ‘bail-out’ or convert to open should be considered. This study also raises awareness on the reduction in training opportunities and the need to ensure trainees progress appropriately. Limitations include small sample size and subjective nature of responses. Further research on patient outcomes is required to provide strong recommendations to optimise surgical practice of LC in the post-pandemic era.
OGBN P04 Achalasia: A single-centre experience of surgical management over 14 years
Authors: Cheung Tiffany , Al-Ardah Mahmoud , Clarke Michael 
Published: November 2023

Abstract

Background
Achalasia is a rare motility disorder of the oesophagus with likely autoimmune aetiology, characterised by absent oesophageal peristalsis and impaired lower oesophageal sphincter relaxation. Typical symptoms include dysphagia, regurgitation and weight loss. Different treatment modalities are available, predominantly aimed at improving quality of life.
No UK guidelines currently exist for the management of achalasia; the US-based SAGES guidelines (2011) do however provide evidence-based recommendations, albeit of varying strength. A published survey of UK surgeons revealed variation in certain aspects. We sought to explore our institution's experience in management of achalasia, primarily focusing on surgery (laparoscopic Heller’s cardiomyotomy).

Methods
An electronic database search was performed to identify all patients either newly diagnosed with achalasia and / or who received treatment for achalasia at our institution between 2009 and 2022. Patients who had already received endoscopic, radiological or surgical treatment prior to 2000, or at another institution at any time were excluded. Demographics, diagnostic investigations, treatment (Botox injection, dilatation, cardiomyotomy) and surgical outcomes were retrospectively recorded in a database and analysed.

Results
128 patients met the inclusion criteria above; 127 were adults, 66 male.
70 patients (54.7%) underwent laparoscopic Heller’s cardiomyotomy with anterior fundoplication. All patients had OGD, 63 (90.0%) barium swallow and 54 (77.1%) high resolution manometry pre-operatively.
Major intra-operative bleeding occurred in one patient from lower oesophageal ulceration. 12 patients had mucosal breaches, repaired intra-operatively. Iatrogenic oesophageal perforations occurred in two patients requiring return to theatre. No mortalities occurred.
31 patients (44.3%) experienced long-term symptom resolution post-operatively. 8 patients (20.5%) with recurrent symptoms had laparoscopic re-do surgery, 11 Botox (28.2%) and 11 dilatation (28.2%) - several had combination of modalities.

Conclusions
Access to regional, then latterly local, high resolution manometry has facilitated full diagnostic assessment, as SAGES strongly recommends all patients undergo along with OGD and barium swallow.
Surgical management of achalasia at our institution over this 14-year period has been very standardised, owing to the operations being performed by two consultant surgeons only.
A good proportion of operated patients had a successful outcome with long-term resolution of symptoms. Serious complications in our cohort were rare; these patients required re-operation and ultimately recovered. Laparoscopic Heller’s cardiomyotomy with anterior fundoplication can be a safe and effective management option for achalasia.
OGBN P08 Increasing Cholecystostomies: Is this a reflection of COVID, change in indications, or an easy option?
Authors: Jindal Anushka , Ftaieh Fares , Shanti Hiba , Patel Ameet G 
Published: November 2023

Abstract

Background
Percutaneous cholecystostomy has been utilized in septic patients with non-malignant biliary pathology who are frail, where surgery is deemed too high risk or conservative management has failed (NICE guidance). The COVID-19 pandemic and the decreased access to surgery may have led to a rise in cholecystostomies. The aim of this study is to evaluate over the last decade, the changing trends, indications, and outcomes of cholecystostomies in our institution.

Methods
We retrospectively reviewed a prospective database of all patients who had cholecystostomy at our two sites; a Tertiary center and an associated district general hospital, between 2012 and 2022. Exclusion criteria included paediatric patients and biliary malignancies. Patients were grouped as Non-Septic (N-S: cholelithiasis, uncomplicated cholecystitis, choledocholithiasis), and Septic (S: complicated cholecystitis, empyema, systemic sepsis, MODS). Data collected for patient characteristics, co-morbidities using Charlson Co-morbidities Index (CCI), length of stay, duration of cholecystostomy, 90-day morbidity and mortality.

Results
Cholecystostomies were performed in 150 patients, median age 72 years, 52% female. There was an exponential rise of cholecystostomies over the decade. The overall mortality was 5% (8/150). Patients with CCI score &lt;5 & ³ 5, were compared for mortality (2/98 vs 6/52, p&lt;0.05). The cohort included two groups: N-S (n=105/150, 70%) and S (n=45/150, 30%). All mortalities were in the S group (n=8/45 p&lt;0.001). During COVID interval, there was a rise in non-septic patients getting cholecystostomies, which has persisted post pandemic (figure 1). Cholecystostomies stayed in situ for a median of 76 days (0-830), with subsequent cholecystectomies in 77%.

Conclusions
There is an exponential rise in the number of cholecystostomies in the last decade, this persisted during and post COVID. The ratio of S: N-S patients getting cholecystostomies was much greater pre-pandemic, then peri- or post-pandemic. The latter may reflect a change in practice. With the increasing pressure of waiting times, need to achieve “hot gallbladders” targets; has cholecystostomy indications changed or does this reflect an easy option and at what cost?
OGBN P10 Fenestrating versus reconstituting subtotal cholecystectomy for difficult gallbladder: A systematic review and meta-analysis
Authors: van Veelen Maria , Hajibandeh Shahab , Laing Richard , Athwal Tejinderjit , Sutcliffe Robert , Hajibandeh Shahin 
Published: November 2023

Abstract

Background
To evaluate comparative outcomes of fenestrating and reconstituting subtotal cholecystectomy (STC) in patients with difficult gallbladder.

Methods
A systematic search of electronic data sources and bibliographic reference lists were conducted. All comparative studies reporting outcomes of laparoscopic fenestrating and reconstituting STC were included and their risk of bias were assessed using ROBINS-I tool.

Results
Seven comparative studies were included enrolling 590 patients undergoing laparoscopic STC using either fenestrating (n=353) or reconstituting (n=237) approaches. Although fenestrating STC was associated with a significantly higher rate of bile leak (OR:2.47, p=0.007) compared to reconstituting STC, both approaches were comparable in terms of resolution of bile leak without (RD:-0.02, p=0.86) or with (OR:1.84, p=0.40) postoperative ERCP. Moreover, there was no significant difference in development of bile duct injury (RD:-0.02, p=0.16), need for postoperative ERCP (OR:1.36, p=0.49), wound infection (RD:0.03, p=0.27), re-operation (OR:0.95, p=0.95), gallbladder remnant cholecystitis (OR:0.21, p=0.09) or need for completion cholecystectomy (RD:0.01, p=0.59) between two groups.

Conclusions
Although fenestrating STC increases risk of bile leak compared with the reconstituting approach, this can be managed successfully with postoperative ERCP if not resolved spontaneously. We encourage low threshold for fenestrating approach in difficult situations, considering its relatively benign postoperative course and long-term outcomes.
OGBN P11 Robotic Benign Upper GI Surgery: A Systematic Review
Authors: Harris Matthew , Watton Leo , Peters Christopher 
Published: November 2023

Abstract

Background
Robotic surgery has gained popularity in General Surgical units for resectional procedures, however its use in ‘benign' operations is limited in the UK. We aim to review the current literature for common benign UGI operations.

Methods
Using PRISMA guidelines, we completed a literature search of MEDLINE and EMBASE including all evidence for Robotic Cholecystectomy (RC), Robotic Heller Cardiomyotomy (RH), Robotic Fundoplication (RF), Robotic Hiatus Hernia Repair (RHHR).
Data was extracted and synthesised by independent reviewers.
103 studies were included. 55 for RC, 12 for RH, 20 for RF and 14 for RHHR. The majority of these studies were cohort and case-control studies (53%). There were only 9 RCTs.

Results
Due to significant heterogeneity in patient population, study design and outcome reporting, meta analyses were not appropriate.
Trends observed for RC suggested that the robotic method can lead to improved post-operative pain and cosmesis, especially in single-incision robotic cholecystectomy (SIRC). However 2 cohort studies stated a small increased risk of CBD injury.
Evidence for RH show shorter operative time and reduced risk of oesophageal perforation, with other outcomes equivalent.
Studies for RF showed equivalence between laparoscopic and robotic methods. In more complex hiatus hernia repair or re-operative operations (RHHR), studies showed shorter operative time, reduced complication rate and equivalent recurrence.

Conclusions
This systematic review has highlighted the paucity of high quality evidence for robotic Upper GI procedures. Studies show at least equivalence between robotic and laparoscopy for less complex procedures, with some strong trends towards superiority for more complex procedures such as RH and RHHR.
OGBN P18 Surgical Intervention in Patient with Oesophageal Absent Contractility
Authors: Miah Ismail , Wong Terry , Gossage James , Zeki Sebastian , Jafari Jafar 
Published: November 2023

Abstract

Background
Absent contractility (AC) is a major motility disorder with poor prognosis. Surgical management for associated comorbidities of AC are often challenging such as in GORD patients where antireflux surgery may be contraindicated or undiagnosed achalasia manifesting with normotensive integrated relaxation pressure would be deprived of surgical myotomy. Thus, it’s crucial to explore potential surgical interventions for patients with AC from both ends of the spectrum. This study will investigate the two extremes of AC and seek to determine suitable strategies for patient selection and offer insights into the management of AC through surgical intervention.

Methods
This is a retrospective study of patients undergone high-resolution manometry (HRM) between January 2022 to June 2023 and were diagnosed with AC based on ten 5ml water swallows. Patients were followed-up with provocative multiple water swallowing (MWS) and solid bolus swallow (SBS) assessments. Peristalsis invoked by MWS with Distal Contractile Integral (DCI) &gt;100mmHgscm or SBS with DCI &gt;405mmHgscm are adequate peristaltic vigour for consideration of floppy Nissen fundoplication. Patients with absolute AC on provocative stimulation and without peristaltic remnants during the HRM recording underwent oesophageal transit testing in consideration for Heller’s myotomy.

Results
Total of 115 patients were included (female:male=59:56, mean age 56 years old) with 43 patients (37.4%) demonstrating peristalsis on adjunctive testing (SBS assessment provoking peristalsis was greater by 3.2 folds to MWS [p=0.0004]). In 72 patients with failed adjunctive testing, 6 patients (8.3%) invoked peristalsis (DCI&gt;100mmHgscm) from dry swallows (largest DCI observed: 1000) and 29 patients (40.2%) demonstrated peristaltic remnants (DCI&lt;100mmHgscm). 37 patients (32.2%) had absolute AC with 21/37 patients (56.7%) were diagnosed with achalasia on transit testing (7 patients are still pending tests). AC in 9 patients originate from aetiologies where surgery would not benefit the patients.

Conclusions
Approximately 37.4% of patients with AC were suitable for floppy Nissen fundoplication, while 32.2% required Heller's myotomy. Surgical intervention was postponed if peristaltic remnants was observed and pending complete diminishment or recovery with prokinetic therapy. Overall, surgical intervention may be considered in nearly 70% of patients with AC.
OGBN P19 Innovative use of Weerda diverticuloscope for removal of an impacted sharp foreign body mimicking malignancy in the cervical oesophagus
Authors: Peter Vaz Osborne , Rodrigues Rodney , Chaudhury Madhu , Stockwell Robert , Turner Paul D , Bruce Ward Jeremy , Pursnani Kishore G , Daya Shetty Vinutha 
Published: November 2023

Abstract

Background
Chronically impacted sharp foreign bodies (FB) of the cervical or upper thoracic oesophagus can present a diagnostic dilemma .Fifty percent of sharp objects tend to lodge in the upper oesophagus and frequently cause perforation.A multidisciplinary approach is warranted. Eventually, surgery by cervical oesophagotomy/thoracotomy may be required. The Weerda diverticuloscope offers excellent endoscopic visibility and access to the lumen of the upper oesophagus allowing for removal of FBs and mitigating risks of a major surgical procedure.

Methods
We report an interesting case of a 27 year old gentleman being investigated for dysphagia. The patient was radiologically diagnosed as having T4 malignancy but consecutive biopsies suggested Actinomycosis. Patient interestingly recollected having lost his dentures after a fist fight. This triggered the use of the Weerda diverticuloscope, a bivalved rigid diverticuloscope ( Karl Storz, Tuttlingen, Germany). It has a distal fibreoptic illumination that is designed for trans-oral stapling of pharyngeal pouches.The patient notes were obtained from the electronic patient records. The radiological images were sourced from the picture archiving and communication system (PACS) and endoscopy from stored images.

Results
Under general anaesthesia, the Weerda diverticuloscope was introduced into the cervical oesophagus .The tips of the jaws positioned just proximal to the embedded dental prosthesis. The diverticuloscope was suspended for stabilisation in the same manner as for endoscopic stapling of a pharyngeal pouch and the jaws were distracted to allow endoscopic access. A 5mm rigid telescope was passed alongside a pair of heavy endoscopic scissors and the prosthesis was divided into 3 parts. The central intraluminal component was removed first using endoscopic forceps, followed by gentle disimpaction and extraction of the remaining two components embedded in the oesophageal wall.

Conclusions
Chronically impacted FBs in the oesophagus can rarely mimic cancer or chronic granulomatous diseases. A multidisciplinary approach is occassionally recommended in their management. There have been a few published reports of the use of the Weerda diverticuloscope to remove upper oesophageal FBs successfully. It’s use, however,is not often considered routinely. We recommend the use of this technique at centres where expertise in endoscopic management of Zenker’s diverticula is available and when endoscopic retrieval has failed.
OGBN P20 A Clinician Delivered pH Manometry Service
Authors: Salem Rola , Wijesinghe Janaka , Atkins Rosa , Hale Emily , Poulton Theodore , Bowling Kirk 
Published: November 2023

Abstract

Background
Gastroesophageal reflux disease (GORD) has an influence on patients’ health related quality of life, affecting 20% of adults in high income countries (1)(2). Despite first line therapy, proton pump inhibitors, approximately 20-30% of patients have persistent symptoms (3). Anti-reflux surgery is by its very nature a lifestyle related procedure, thus there must be a robust and duplicatable method for assessment of the severity of symptoms to facilitate patient selection. We launched a clinician delivered high-resolution pH oesophageal manometry and ambulatory pH impedance service in January 2021 at our Specialist Anti-Reflux Centre. Here we present our preliminary data.

Methods
This is a retrospective analysis of patients who underwent ambulatory pH manometry within our department between January 2021 and June 2023. Analysis to date was undertaken of patient’s outcomes from their pH manometry. Patients with previous anti-reflux surgery were excluded. We reviewed those who were offered surgery versus those who were not. Each group had further analysis of the DeMeester score, Symptom Index (SI) and Symptom Association Probability (SAP). A two sample T-test was performed, with p&lt;0.05 considered statistically significant.

Results
Of the 141 patients that underwent ambulatory pH manometry, 62% (n=88) had sufficient data for analysis. 33% (n=29) of these were subsequently offered surgical intervention; 14 underwent fundoplication (48%) and 12 LINX procedures (41%); the remaining patients, 1 referred for POEM, 1 awaited surgical planning and 1 required Gastroenterology review. Those who progressed to surgery had a greater DeMeester score than those who were not offered surgery (45.2 vs 28.5). Patients in the surgical group also had a higher mean SI than those in the non-surgical group (57.0% vs 38.6%, p=0.01), and higher SAP (94.1% vs 80.3%, p=0.03).

Conclusions
This clinician-led in-house clinic has had significant impact upon our service. It has enabled collation of quantitative data to facilitate the decision-making process in the provision of anti-reflux surgery, thus aiding appropriate patient selection. Going forward, further work is being undertaken into quality of life questionnaires post anti-reflux surgery, both before and after introduction of our new service.
OGBN P25 A systematic review and clinical evaluation of Morphine Versus pethidine as a good drug choice to control for biliary colic before and after cholecystectomy
Authors: Khougali Mohamed Hussam , Di Rollo Domenic , Shahzad Khan Khurram 
Published: November 2023

Abstract

Background
The most commonly recommended pharmaceuticals for biliary and pancreatic pain are arguably morphine and pethidine, both of which can elicit varying effects at the gallbladder, common bile duct, and sphincter of Oddi levels. Morphine stimulates Oddi's sphincter motility, causing upper abdominal pain and biliary distress symptoms in certain patients. Pethidine is thought to have less consequences on the sphincter of Oddi than morphine. This analysis aims to evaluate the comparative outcomes and effect of morphine versus pethidine on the sphincter of Oddi and biliary colic control.

Methods
A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library and Science Direct. Comparative studies comparing effect of morphine versus pethidine on sphincter of Oddi pressure were included. Revman 5.4 (Cochrane, London, United Kingdom) was used for the data analysis.

Results
The results show four studies were eligible to be included in this review with a total number of 151 patients divided between morphine group (n=111) and pethidine group (n=40). Two prospective studies and two clinical trials were included in this review. The rate of sphincter of Oddi pressure was significantly higher in morphine group compared to pethidine group: odds ratio (OR)=1.39, and (OR) =7.82, p=0.005, respectively.

Conclusions
The analysis shows significant difference in sphincter of Oddi pressure when morphine used as analgesic drug to control the biliary colic compared to pethidine which seems to provide low pressure at the level of sphincter of Oddi and good control of biliary colic than morphine, however more studies and clinical trials are needed.