bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGBN P36 Surgical Consideration in Patients with Ineffective Oesophagus: Implications for Low Risk of Dysphagia and Suitability for Antireflux Operation
Authors: Miah Ismail , Wong Terry , Gossage James , Zeki Sebastian , Jafari Jafar 
Published: November 2023

Abstract

Background
Ineffective oesophageal motility (IOM) is a minor motility disorder that is commonly found in patients. The IOM diagnosis is based on heterogenous combination of failed peristalsis, weak peristalsis activity and peristaltic defects that are observed during the stimulation to 5mL standard water swallows. IOM is implicated to post-surgical dysphagia and therefore influences the surgical decision making. This paper will address this topic.

Methods
A retrospective review was conducted on patients who underwent oesophageal high-resolution manometry (HRM) between March and May 2023. The diagnosis of IOM was based on the international Chicago Classification guideline (version 4.0). Patients' oesophageal motility profiles were assessed for peristaltic reservation (PR) and oesophageal contractile mean wave amplitude (MWA). PR &gt;100% in IOM patients indicates low risk of dysphagia after laparoscopic Nissen fundoplication (LNF). Similarly, normal MWA indicate a low risk of dysphagia in considering patients for Magnetic Sphincter Augmentation (MSA).

Results
120/270 patients (44.4%) were diagnosed with IOM (female:male=86:34, median age 52 years old). Mean PR in IOM patients was 217.8% [95%CI:181.2%-254.4%] with 60.8% demonstrating PR &gt;100%. Average MWA found in IOM patients was 40.8mmHg (95%CI:38.5mmHg-43.1mmHg) with 38.3% demonstrating normal MWA. 13.3% (16/120) of patients did not invoke peristalsis on MWS, but 6 of the 16 patients showed normal MWA. 24.2% (29/120) patients demonstrated PR &gt;100% and normal MWA. 14.2% (17/120) of patients showed adequate PR and weak MWA and pose risk of postsurgical dysphagia. 75% (90/120) of patients with IOM were suitable for at least one antireflux operation.

Conclusions
Approximately half of the oesophageal physiology patients have IOM and three-quarters of these patients are suitable for at least one form surgical intervention with low risk postsurgical dysphagia. Only 14.2% of patients with IOM pose a risk of post-surgical dysphagia. The overall findings suggests that surgical intervention may be a viable option for patients with IOM that could potentially improve their quality of life and prevent reflux oesophagitis/pre-cancerous Barrett’s oesophagus. This study was limited by not investigating the relationship between IOM pathophysiology and the reflux oesophagitis severity grade.
OGBN P38 Adherence to AUGIS Guidelines in Index Admission Cholecystectomy: Impact on Hospital Recurrences
Authors: Alwani Omneya , Nasim Mazhar , Hassanein Mohamed , Patel Anish V , Patel Aminah , Baltatzis Minas , Alasmar Mohamed 
Published: November 2023

Abstract

Background
This study aims to assess adherence to AUGIS guidelines for index admission cholecystectomy and investigate the effects of non-compliance on hospital readmissions and cost implications.

Methods
A retrospective analysis was conducted on 105 patients admitted to the surgical department at Salford Royal Hospital between October 2022 and January 2023. Unfit patients and those who refused surgery were excluded, resulting in 96 eligible patients fit and approved for index admission cholecystectomy.

Results
Out of 105 patients, 96 were eligible for surgery, with 15 (15.62%) undergoing index admission laparoscopic cholecystectomy, 9 (9.37%) having laparoscopic cholecystectomy during readmissions, and 42 (43.75%) receiving elective surgeries. Thirty patients (31.25%) had no operation. The average number of hospital admissions was 1.96, and the average stay for index admission laparoscopic cholecystectomy was 7.07 days. Eligible readmissions had an estimated average stay of 11.14 days. Based on these numbers, the estimated extra days of hospital stay during the study period and up until July 1st, 2023, were 329.5 days.

Conclusions
Non-compliance with AUGIS guidelines led to hospital readmissions and prolonged stays. Conversely, adherence to the guidelines significantly reduced recurrence rates and healthcare expenses. Emphasizing a Gallbladder pathway is critical for achieving optimal surgical outcomes and cost-effective patient care.
OGBN P39 Feasibility and Safety of Laparoscopic Anti-Reflux Surgery at a District General Hospital: Matching National Standards and Improving Patient Quality of Life
Authors: Livingstone James , Nanda Akriti , DiMaggio Francesco , Thomas Rhys , Rock Caitlin , Kyrtsonis Georgios , Rothnie Alex 
Published: November 2023

Abstract

Background
Gastro-oesophageal Reflux Disease (GORD) affects a substantial proportion of adults in the UK, with surgery offering superior short-to-medium term benefits compared to medical management alone. However, there is significant variation in surgical practice nationwide. This study aimed to assess the feasibility and safety of laparoscopic anti-reflux surgery (LARS) at a District General Hospital (DGH) by aligning outcomes with the national standards set by AUGIS (Association of Upper Gastrointestinal Surgeons).

Methods
Prospective data from patients who underwent LARS between May 2022 and May 2023 were collected and recorded locally as well as on the National Hiatal Surgery Register (NHSR). Pre-operative symptoms and investigations, intraoperative findings, post-operative short and medium-term outcomes, and patient-reported outcome measures (PROMs) were analyzed. Quality of life (QoL) questionnaires, administered by the NHSR, were collected at 6 months to 1 year post-surgery. AUGIS standards, including a minimum of 5 procedures per year by 2 surgeons, conversion rate below 5%, 30-day return to theatre below 5%, and 30-day readmission rate below 10%, were utilized for comparison.

Results
In one year, two surgeons performed 41 LARS procedures: 31 Nissen, 4 Toupet, and 2 Dor wraps, with 2 redo surgeries. Minor complications occurred in 3 patients, requiring no intervention. One surgery was converted to open due to bleeding, and hiatal repair performed. Wrap migration led to re-do after 10 months. The 30-day return to theatre rate was 0%, readmission rate 2% (n=1, unremarkable CT scan). One patient discharged as a day case, average stay 4 days. Out of 23 eligible patients, 15 completed post-op questionnaires, showing significant QoL improvement. Additionally, 55% no longer needed anti-reflux meds at 6-month follow-up.

Conclusions
We significantly increased the number of LARS procedures performed while meeting the national standards set by AUGIS and we observed a significant improvement in our patients' quality of life following surgery. Experienced laparoscopic Upper GI surgeons can safely and effectively offer anti-reflux surgery in a DGH setting. Our commitment to prospective data collection for audit and research purposes has been a major strength. Future objectives include further consolidation of our work and expanding the range of procedures, such as magnetic sphincter augmentation (LINX), to improve day-case rates.
OGBN P41 Cholecystostomy drain for Acute Cholecystitis and its further management: A retrospective observational study from a University Hospital
Authors: Shams Ola , Alexiadis Aris , Kanchustambam Subba , Reece-Smith Alex 
Published: November 2023

Abstract

Background
Acute Cholecystitis (AC) is one of the most common surgical pathologies. The gold standard treatment of AC is cholecystectomy which can be high-risk in those with poor physiological reserve or sepsis with haemodynamic instability. Therefore, percutaneous cholecystostomy (PC) can be considered as an alternative management strategy. PC has long been used with no definitive protocol for delivery or management of patient recovery. This single center study of patients who had cholecystostomy in our trust aims to create an efficient protocol for PC drains.

Methods
We conducted a retrospective observational study of patients who had cholecystostomy in the Royal Devon and Exeter Hospital between 2019 and 2023. Data from 20 patients was obtained from patient records. Severity and duration of symptoms on presentation, frailty, co-morbidities, cholecystostomy technical approach, length of stay and complications were recorded and analysed. Regarding the post-insertion period, investigations, post-cholecystostomy management plan and discharge were assessed. We conducted a literature review to compare our results to the usual practice. Data are expressed as median and results were considered to be statistically significant where p≤0.05.

Results
PC patients were high-risk candidates (median frailty score 4) with 90% being elderly (Age &gt; 65, median age 77). The majority were septic (median WCC 17.9 and CRP 255). Upon drain insertion, median CCI (Charlson Co-morbidity Index) was 4.5. Four cholecystostomies were transhepatic ,three were transperitoneal with the rest unrecorded.Complications included displacement, leakage, and infection (Clavien Dindo 3,2).Old age was associated with more complications (p&lt;0.006) and drain dislocation (p&lt;0.022). Seventeen patients were discharged with drains in, one dislodged. Two patients died. Post-insertion investigations, drain duration and follow-up differed for all patients with no protocol followed. Six patients subsequently underwent cholecystectomy.

Conclusions
The management of PC and the follow-up differs from one patient to another, as there is currently no definite protocol. Old age is associated with a higher rate of complications related related to cholecystostomy. Further studies should investigate the optimal duration of the drain, timing of the tubogram, subsequent removal of the cholecystostomy drain or cholecystectomy.
HPB P03 Stereoractic ablative radiotherapy provides a safe and feasible treatment alternative for non-surgical candidates with primary hepatocellular carcinoma
Authors: Wagner Boris , Falk Stephen , Callaway Mark , Abbadi Reyad , Appanna Gautham , Rees Jonathan , Skipworth James , van Laarhoven Stijn 
Published: November 2023

Abstract

Background
Stereotactic ablative radiotherapy (SABR) is a highly focused radiation treatment that delivers an intense dose of radiation to a tumour whilst limiting exposure of surrounding tissues. SABR has been associated with improvement in overall survival and local control in non-surgical candidates with primary hepatocellular carcinoma (HCC). The aim of this study was to evaluate the outcomes of HCC patients treated with SABR in a tertiary referral hepatobiliary centre.

Methods
A total of 33 patients (median age 72 years {range 47-85}, 79% male) who received SABR for primary HCC liver lesions over a 2-year period between July 2020 and August 2022 were retrospectively analysed. Patient, treatment and follow-up details were obtained from online patient records and imaging.
Patients underwent SABR either due to co-morbidity precluding surgery (23/33), lack of suitable treatment alternatives (9/33) or due to patient choice (1/33). Five patients had previously undergone liver resection, eight transarterial chemoembolisation (TACE) and three microwave ablation (MWA).

Results
Table 1 shows patient demographics and treatment details of the study cohort.
Overall survival was 79% at a median follow-up of 12 months (range 3-25). A total of seven patients died at a median of 8 months post SABR (range 4-18). Only 10/33 (30%) reported toxicity including gastrointestinal upset (n=5), fatigue (n=4) and localised rib discomfort (n=3). No Grade 3/4 toxicities were reported. Of those where radiological outcomes were available, two thirds (20/30) achieved local control at the treatment site while local disease progression occurred in 10/30 (33%). Overall, 6/20 (20%) of patients developed metastatic disease.

Conclusions
These data suggest SABR is a viable, well-tolerated and potentially effective treatment for HCC in patients unsuitable for surgical therapy. Longer-term follow-up data and prospective studies, including randomised trials, are required to assess survival benefit, and optimise patient selection and dose-fractionation regimens.
HPB P07 HIDA scan utilisation and its influence on the management of patients with Gallbladder Dysmotility Disorders – A Retrospective Multicentre Cohort Study
Authors: Ali Kiren , Qazalbash Zeeshan , Nadeem Junaid , Shahzad Khan Khurram 
Published: November 2023

Abstract

Background
Hepatobiliary Iminodiacetic Acid (HIDA) - Cholecystokinin (CCK) and fatty meal scan is widely used in the investigation of patients with acalculour biliary-like pain as they present a significant diagnostic and management challenge to the healthcare system. This scan detects functional capacity of gallbladder in the form of gallbladder ejection fraction (GBEF). GBEF of &lt;35% is consistent with biliary dyskinesia and &gt;80% with hyperkinesia, a recently postulated pathology. Laparoscopic cholecystectomy (LC) remains the treatment of choice of for both the entities. We performed audit of utility of HIDA scan and interpretation of its results across three sites.

Methods
A retrospective cohort study of patents undergoing HIDA scan across three hospitals between January 2015 and December 2022. Patients with biliary pain according to ROME IV criteria of functional GI disorders were included. Electronic case notes were reviewed and demographics, laboratory results of bilirubin and ALP, radiological investigations, endoscopy result and HIDA scan result.

Results
A total of 225 patients underwent HIDA scan; median age was 42 years (IQR 34-53) and 194 (86.2%) were female. Median time form the onset of symptoms to HIDA scan was 19 months (IQR 6-24). 35 (15.5%) had GBEF &lt;35%, 157 (69.7%) with GBEF 36-79%, and 33 (14.6 %) had GBEF ≥80. 36 patients had LC after HIDA scan: 19 (52.7%) for biliary dyskinesia, 12 (33.3%) for microlithiasis and/or biliary sludge on EUS and 5 (13.8%) had it for symptoms but normal GBEF. Histopathology of 4 patients had normal gallbladder, while 27 had chronic cholecystitis and/or cholesterosis.

Conclusions
HIDA scan is vital investigation for recurrent biliary-like pain without presence of gallstones and gallbladder dysmotility is not uncommon in this group of patients. HIDA scan should be more liberally utilised to rule out gallbladder dysmotility. Reporting method of HIDA scan should also be standardised to help interpret the results accurately.
HPB P09 A systematic review of pancreaticoduodenectomy for pancreatic cancer in randomised control trials to examine variations in operative technique
Authors: Malik Abdullah , Karki Bishow , Mahendran Balaji , Shrikhande Shailesh , Moir John , Smith Andrew , Blencowe Natalie 
Published: November 2023

Abstract

Background
Pancreatoduodenectomy (PD) is a complex surgical intervention comprising multiple components which, when delivered differently, can impact outcomes, introduce bias into randomised controlled trials (RCTs) and impair accurate interpretation of results. This study aimed to systematically explore and summarise variation in PD description and standardisation amongst contemporary RCTs in pancreas surgery.

Methods
Systematic literature searches for RCTs of PD were undertaken from 2020 to 2023. RCTs including robotic PD, or other types of pancreas resection (e.g. total, distal), were excluded. The technical aspects of PD were deconstructed into constituent components and steps (pre-operative considerations, before skin incision, incision, dissection, resection, haemostasis, reconstruction, insertion of adjuncts, closure and after closure) using a methodological framework. Trial reports and protocols were scrutinised to examine whether the components/steps were described, and whether (and how) adherence was assessed.

Results
Of 83 screened articles, 29 RCTs were included, reporting on 3440 patients across 16 countries (1 trial compared pre-operative interventions, 18 trials compared intra-operative interventions, and 10 trials compared post-operative interventions). Forty-one PD steps were identified. No studies described all steps and five did not describe any. Fifteen component parts were described in one RCT. Only three RCTs reported that delivery of PD was recorded and assessed, using intra-operative photographs in all cases.

Conclusions
In a contemporary series of RCTs evaluating PD, descriptions of the procedure were inadequate. Clear descriptions of PD using pre-existing methodological frameworks in future trials are warranted to improve outcomes, decrease bias and facilitate cross-RCT comparisons in systematic reviews.
HPB P11 Hepatic vein reconstruction during hepatectomy – a feasible and underused technique?
Authors: Ahuja Manish , Joshi Kunal , Coldham Chris , Dasari Bobby , Marudanayagam Ravi , Mirza Darius , Issac John , Bartlett David , Chatzizacharias Nikolaos , Sutcliffe Robert , John Roberts Keith 
Published: November 2023

Abstract

Background
Hepatic vein involvement can be a contraindication to resection of liver tumours. This study aimed to assess the feasibility, long term outcomes and vein patency among patients who underwent hepatic vein reconstruction during liver resections for liver tumour(s).

Methods
Retrospective analysis of patients who underwent circumferential hepatic venous reconstruction identified from a prospectively maintained database. Standard volumetric analysis was performed using software to estimate volumetry with and without hepatic venous reconstruction. Long term vein patency was established using review of available radiology.

Results
15 patients underwent 17 venous reconstructions for colorectal liver metastases (n=13), cholangiocarcinoma (n=1) and hepatocellular carcinoma (n=1). The median FLR without and with venous reconstruction were 32 (range 18.0-74.5) and 96% (range 26.9-97.7) respectively; the median increase in FLR was 34% per patient. Venous patency was 89% at a median follow-up of 25 months (Range 1-53) with 2 graft thrombosis. No patient developed PHLF.

Conclusions
Hepatic venous reconstruction during liver resection is safe and feasible. It has the potential to expand the scope of liver resection and preserve liver and venous drainage if needed in the future.
HPB P13 A Systematic Review of the Methodology Used in Nutritional Effectiveness Trials for Pancreatoduodenectomy Patients
Authors: Halle-Smith James , Krishnan Keshav , Kirupananthan Jasmin , Pathak Samir 
Published: November 2023

Abstract

Background
Malnutrition is highly prevalent amongst pancreatoduodenectomy (PD) patients and remains a major modifiable risk factor for postoperative morbidity and mortality. As a result, there is a need to identify optimal nutritional therapies but this has typically been difficult due to multiple methodological issues including lack of suitable control group and outcome. Therefore, the aim of this review is to report and compare the administration of different nutritional therapies as well as reporting of nutritional outcomes in randomised controlled trials (RCTs) of PD patients.

Methods
A systematic review of randomised controlled trials (RCTs) studies reporting the effect of different nutritional interventions after PD was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase and Medline databases were searched. The search identified 21 suitable studies for inclusion.

Results
There were 5 different feeding routes reported, with oral diet (14 studies, 67%) and parenteral nutrition (9 studies, 43%) being the most common. There was widespread variation in when oral diet was started, ranging between postoperative day (POD) 1 and 7. Regarding enteral tube feeding, multiple different feed types were used and feed administration was highly variable, for both rate and duration. In terms of outcome types, 17 (81%) studies reported biochemical outcomes with serum albumin being the most common (12 studies, 57%) and 12 (57%) reported anthropometric outcomes with body mass index the most common (7 studies, 33%).

Conclusions
Amongst the published RCTs investigating the effect of different nutritional routes after PD, widespread variation in the methodology was evident. This has implications for both interpretation of results and for design of future nutritional trials. Multiple biochemical and anthropometric outcomes were reported but quality of life measures, such as the SF-36 recommended by a recently published core outcome set, were not used.
HPB P15 Diagnosis of Choledocholithiasis in Risk-Stratified patients: the benefits of Magnetic Resonance Cholangiopancreatography. - A single centre retrospective cohort study
Authors: Stevenson Carla , Kee Ng Shou , Stewart Brian , Di Rollo Domenic , Mahmud Sajid , Shahzad Khan Khurram 
Published: November 2023

Abstract

Background
Association of Upper Gastrointestinal Surgeons (AUGIS) guidelines recommend that magnetic resonance cholangiopancreatography (MRCP) should be performed in patients with suspected gallstone disease who have deranged liver function tests (LFTs) and dilated bile ducts on ultrasound scan (USS). Early laparoscopic cholecystectomy (LC) is recommended to reduce complications of gallstone disease. Confirmation of choledocholithiasis helps guide acute management as well as operative planning. The aim of this study was to determine the probability of choledocholithiasis on MRCP of risk stratified patients.

Methods
A retrospective cohort study of adult patients who underwent MRCP in a single centre was conducted from September 2020 to September 2022. Patients being investigated for non-biliary indications (e.g. hepato-pancreato-biliary malignancies) were excluded.
Patient demographics, pre-MRCP peak LFTs, clinical indications and all radiology imaging results were analysed. Patients were risk-stratified based on modified AUGIS guidelines using hyperbilirubinemia and the presence of biliary duct dilation on USS and CT-scans as risk factors. Patients with MRCP proven choledocholithiasis were compared to those without. P value was calculated using chi-square testing. This study was registered with Clinical Quality Project (LanQIP: 14737).

Results
1,107 MRCP were identified; 97 were excluded. Median age was 65 years (IQR 50.3-75) and 625 (61.9%) were female. 677 (67%) were inpatient scans and 432 (42. 8%) were urgent. Median time for inpatient scans was 1.1 days (IQR 0.8-2.1). 739 (73.2%) patients had known gallstones. 157 (15.5%) were post-cholecystectomy. 596 (59%) had hyperbilirubinemia and 726 (71.9%) had elevated alkaline phosphatase (ALP). 38.5% of USS and 48.2% of CT scans showed dilated ducts. Overall, 276 (27.3%) MRCPs showed choledocholithiasis. Raised ALP, hyperbilirubinemia, and dilated ducts on preceding imaging were strongly predictive for choledocholithiasis on MRCP (p&lt;0.001).

Conclusions
Our result are consistent with previously published data. We suggest that AUGIS guidelines should be used to risk stratify patients to maximise the utility of MRCP. If early LC cannot be performed, careful assessment of patient risk factors can guide the need for MRCP to determine the need for interval endoscopic retrograde cholangiopancreatography and aid pre-operative surgical planning. In centres where expertise is available, intra-operative cholangiogram can replace the need for MRCP in low-risk group.