bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGBN P26 Institutional initial experience and outcomes for the first 100 Upper gastrointestinal Cases: A single tertiary center results
Authors: Brooks Benjamin , Harrington Bertram , Elshaer Ahmed , Athanasiou Antonios 
Published: November 2023

Abstract

Background
Robotic surgery is widely spreading in many centers across the United Kingdom. Potential benefits include shorter admissions, fewer complications as well as better surgeon ergonomics and dexterity. Evidence suggests that robotic surgery has a rapid learning curve when first implemented with the number of cases linked to operative time. In this study, we report our preliminary results after implementation of robotic surgery at our upper gastrointestinal unit.

Methods
This retrospective study included all robotic elective upper gastrointestinal cases since the introduction of robotic surgery at our unit. All cases were performed by two surgeons using Da Vinci XI starting in August 2022. The first 100 cases were completed in 10 months. Both surgeons completed Intuitive training prior to initiating their independent operating lists. Cholecystectomy and anti-reflux surgeries were the main surgeries performed during the study period. Demographics, number of cases per list, console timing and postoperative complications were collected and analysed. Console timing was obtained by Intuitive software. Postoperative complications were graded using the Clavien-Dindo scale.

Results
100 UGI robotic surgery cases were analysed consisting of 86 cholecystectomies and 14 anti-reflux operations. Females represented the majority of cases (68%). Mean age was 53.0 years (18-78) while mean ASA and BMI were 2 and 30.3 kg/m2 respectively. Mean console time was 53.3 minutes. Cholecystectomies required 43.0 minutes and anti-reflux surgeries required 119.3 minutes on average. The mean length of stay was 0.90 days for cholecystectomies, and 1.46 days for anti-reflux surgery. There were two readmissions post cholecystectomy for pneumonia and liver bed collection. One cholecystectomy patient developed a Clavien-Dindo grade &gt;3 complication for port site hernia repair.

Conclusions
Our initial experience has shown favourable outcomes of robotic surgery. There was a noticeable rapid learning curve, encountering only one major post-operative complication. This high effectiveness should stimulate the swift introduction of robotic surgery to other hospitals.
OGBN P27 Outcome of specialist-led urgent laparoscopic cholecystectomy for gallstone disease at a London District General Hospital
Authors: Ahuja Manish , Soggiu Fiammetta , Goutham Meera , Drymousis Panagiotis , Pore Naresh , Raje Durgesh , Jawad Zaynab , Abdalla Sala , Sheth Hemant 
Published: November 2023

Abstract

Background
Laparoscopic cholecystectomy is the mainstay for treatment of symptomatic gallstones and its associated complications. Emergency cholecystectomy rates in the United Kingdom (UK) remain low despite NICE guidelines recommendations to offer surgery within 7 days for acute cholecystitis and index cholecystectomy for mild gallstone pancreatitis. We analysed our data over last 10 years to assess the safety and feasibility of providing an emergency cholecystectomy service in a London District general Hospital with a specialist Upper Gastrointestinal / hepatobiliary consultant workforce in line with NICE guidelines.

Methods
Data of 663 consecutive patients undergoing index admission emergency cholecystectomy during 2013-2023 from a prospectively maintained database was reviewed. Patient demographics, duration of hospital stay, complications, need for further interventions and re-admission rates were collected and analysed.

Results
Six hundred and sixty-three consecutive patients underwent emergency cholecystectomy gallstone disease and associated complications. The conversion rate was 5.2% (n=35). The median time from presentation to surgery was 2 days (Range 0-63), overall length of stay was 6 days (Range 1-91), and post-procedure stay was 2 days (Range 1-89). Overall complication rate was 7% (n=45), bile leak was observed in 8 patients (1.2%) with no evidence of major biliary injury. One patient had postoperative haemorrhage requiring laparotomy (No bleeder identified) (grade IVa) and 1 patient died within 90 days for reasons unrelated to the operation. The re-admission rate was 10.2%.

Conclusions
Index admission emergency laparoscopic cholecystectomy in district general hospitals is feasible and safe when performed by a specialist consultant workforce, leading to compliance to guidelines and a low rate of complications and readmissions to hospital.
OGBN P32 Outcomes of patient with Biliary Dyskinesia undergoing laparoscopic cholecystectomy - A multicentre cohort study
Authors: Ali Kiren , Shahzad Khan Khurram 
Published: November 2023

Abstract

Background
Biliary dyskinesia (BD) is a benign disorder characterized by recurrent episodes of biliary pain in the absence of gallstones on ultrasound, normal liver function tests and an ejection fraction (EF) of &lt;35% on hepatobiliary iminodiacetic acid (HIDA) scan. Laparoscopic cholecystectomy (LC) remains the only known effective treatment for BD. However, many surgeons are reluctant to offer LC in such patients due to the fear of non-resolution of symptoms. Our aim was to analyse the outcome of patients who underwent LC for BD in terms of resolution of the biliary symptoms.

Methods
Multicentre retrospective cohort study of patients who have BD proven on HIDA scan from January 2015 to December 2022. BD was defined as EF ≤35% on HIDA scan. Those with EF ≤35% but had evidence of gallstones, microlithiasis or post op leak were excluded from the study.
Electronic case notes were reviewed for demographic details, duration of symptoms, body mass index (BMI), liver function test (LFT), radiological investigations, endoscopy report and histopathology results of cholecystectomy. Rome IV criteria of functional gastrointestinal (GI) disorders was used to confirm symptoms were biliary in origin.

Results
Of the 222 patients who had HIDA scan, 35 (15.7%) patients had BD. 26 (74.2%) were female and median age was 42 years (IQR 33-55). Median time from the onset of symptoms and HIDA scan was 18 months.
19 (54.2%) patients had LC preformed, 9 (25.7%) were discharged with decision of LC not required, 4 (11.4 %) had no further review and 2 (5.7%) still having LC under consideration. Histopathology of LC was, chronic inflammation in 10 (52.6%), cholesterosis in 3 (15.8%) and 4 (20.1%) had normal gallbladder. 13 (68.4%) patients who underwent LC were symptom free 12 months post-surgery.

Conclusions
BD although painful and potentially lifestyle limiting, does not progress to more serious consequences if untreated. Diagnosis is usually difficult, and patients go through extensive investigations before they have HIDA scan. LC improves the symptoms in two thirds of patients and should be offered to all patients with BD with appropriate counselling.
OGBN P33 The Missing LINX® - Reconstituting the Hill Valve
Authors: Clements Caterina , Bezzaa Sabrina , Dunstan Matthew , Stroud Lauren , Nehra Dhiren 
Published: November 2023

Abstract

Background
Magnetic sphincter augmentation (MSA) with LINX® is an increasingly utilised procedure as an effective and safe alternative for fundoplication in the management of gastro oesophageal reflux disease (GORD). Our aim was to evaluate the post-operative LINX® endoscopic appearances in maintaining the competence of the Hills valve. Here we present a retrospective review of endoscopic assessment post insertion of LINX® Reflux Management System.

Methods
Patients who underwent magnetic sphincter augmentation with LINX® between December 2012 and December 2022 at a single district general hospital were recruited for a retrospective case analysis. Photographs taken at the time of endoscopy were assessed to evaluate the gastroesophageal flap valve using the Hill classification.

Results
Of 186 patients who underwent MSA, 40 underwent endoscopy post-operatively and of these 35 had photographs suitable for evaluation. There were various indications for endoscopy including dysphagia (13), dyspepsia (9), abdominal pain (7), laryngopharyngeal reflux (2), odynophagia (2), Barrett’s surveillance (1) and food bolus (1). Median time from LINX® to endoscopy was 2.5 years. 33 out of 35 patients (94.2%) were found to have Hills Grade I. One patient (2.8%) had Hills Grade II and one patient (2.8%) had a recurrence of their hiatus hernia, Hills Grade IV.

Conclusions
Endoscopy is a useful modality to assess symptomatic patients after MSA with LINX®. This study has confirmed reconstitution of the Hills valve on endoscopic assessment in 94.2% of patients. This supports LINX® as an effective and robust solution in the management of GORD.
OGBN P37 Improving the Accuracy of Endoscopic Measurements of the Size of Gastrointestinal Lesions by a Guidewire Scale
Authors: Talalak Nanthawat , Orrapin Saritphat , Wattanarochanaporn Sittichock , Sotananan Teerawat , Likidkarnchanakornkij Thanakorn , Mahawongkajit Prasit 
Published: November 2023

Abstract

Background
Endoscopic measurement of lesion size is important for the assessment of the healing process, treatment strategies, and cancer staging. Consequently, accurate measurement of the size of the lesion is critical for proper candidate selection for endoscopic resection of early gastric cancer. A visual estimation of the size of the lesion has been widely used, but inaccuracy has been found. Hence, several endoscopic measurement methods have been proposed, but no reliable method has been used thus far. Therefore, we developed a guidewire scale for measuring the size of the lesion. This study focused on improving the accuracy on a practical level.

Methods
The guidewire scale consisted of green and yellow bands alternating on the wire, which were 5 mm for each band and a total of 30 mm in length. To assess the procedure’s validity and reliability, endoscopists estimated the size of the artificial lesions in the model by visually comparing them with the guidewire measurements. We found measurement error of the guidewire by 0.036±0.25 mm. The endoscopists determined the size of the lesion by the guidewire scale and used a numeral rating scale (NRS) to assess the satisfaction after the procedure.

Results
We enrolled 52 patients who were evaluated for the size of the lesion by the guidewire scale. The rate of completion of the procedure was 100% without any complications. Overall, the endoscopists’ satisfaction was good (NRS ≥ 8), but satisfaction was significantly higher in the dyspepsia group (P = 0.03). The mean of the size of the lesion was 10.7±8.9 mm, and small ulcer size (size ≤ 1 cm) displayed more satisfaction. The average time of measuring the lesion was 39.4±13.6 seconds, and the procedure time ≤ 30 seconds was highly satisfactory.

Conclusions
Our guidewire scale enhanced the accuracy of the endoscopic measurement of the size of the lesion. Thus, this guidewire scale could be used to estimate the sizes easily and safely in a clinical study.
OGBN P40 Laparoscopic Cholecystectomy waiting list: morbidities and cost
Authors: Salih Ahmed K A , Tayo Oluwasegun , Jiwani Zaneen , Elnagar Mohamed 
Published: November 2023

Abstract

Background
Gallstone Disease refers to the presence of stones in the gallbladder or common bile duct, which can lead to symptoms and complications. Around 15% of adults are affected by this condition, but only 20% of them experience symptoms. The severity of symptoms can range from mild and nonspecific to intense pain and complications. Treatment options vary and can include conservative or medical approaches, endoscopic procedures, or surgical interventions. Cholecystectomy is considered the gold standard for managing symptomatic gallstones. In the UK, Approximately 66,660 surgeries conducted annually in the UK (61,220 laparoscopically), which cost around £111.6 million per year.

Methods
A retrospective analysis was conducted on the patients listed for Laparoscopic Cholecystectomy in the General Surgery department of Aberdeen Royal Infirmary. The study covered the period from January 1, 2019, to June 30, 2022, focusing on the occurrence of morbidities or complications, such as re-admissions and visits to the emergency department (ED), as well as the associated costs. Trakcare documentation was utilized for data collection. The data was collected in November 2022. The analysis involved identifying patients and their demographics from the Master Waitlist. Complications, hospital readmissions, and emergency surgeries were analyzed using SPSS.

Results
Out of 857 patients on the waitlist, the average age was 54.8 years, with females comprising 69.2%. The mean wait time was 15.8 months (maximum: 45 months). Around 8.2% re-presented to the ED, mostly due to biliary colic, with a mean of 3.7 visits (maximum: 8). SAC clinic visits were needed for 4.8% of patients. Hospital readmission occurred for 4.3% with an average stay of 17 days. Complications affected 11.4% of patients, including colic, cholecystitis, Choledocolithiasis, pancreatitis, Cholangitis, perforated gallbladder, Mirrizi Syndrome, and Fistula. Interventions were required for 7.2% of patients. Only 7% underwent cholecystectomy, with 8 being emergency cases.

Conclusions
The prevalence of gallstone disease is high, and patients who experience a delay in their surgical operation often suffer from various morbidities. These complications not only impact the well-being of the individuals but also create a financial burden for healthcare providers. To address this issue, the implementation of an urgent or hot Gallbladder list could potentially offer a solution. By prioritizing patients requiring immediate attention, this approach aims to reduce the adverse effects associated with prolonged waiting times and improve both patient outcomes and the overall efficiency of the healthcare system.
OGBN P43 Mucosal injury following Laparoscopic Heller’s Cardio myotomy: Experience at a tertiary referral centre
Authors: Khan Rehan , Rajendran Ilayaraja , Shetty Vinutha , Ahmed Salman , Paul Turner , Singh Mohan , Date Ravindra 
Published: November 2023

Abstract

Background
Heller’s cardio myotomy is a standard surgical procedure to treat patients with Achalasia Cardia. Mucosal injury is the most common serious complication of this procedure. The study was carried out to assess the impact of this serious complication on the patients who had surgery performed in this trust.

Methods
All patients who underwent Laparoscopic or Laparoscopic converted to open Heller’s myotomy for Achalasia Cardia mentioned in Flex Prod online patient record software were included in the study. Data of 57 patients who underwent the procedure was collected prospectively and analysed retrospectively.

Results
The data of total 57 patients was analysed for mucosal injuries in the perioperative period. 2 out of 3 patients suffered mucosal injuries were identified intraoperatively, subjected to laparoscopic converted to open exploratory laparotomy and repair. Both these patients recovered and were discharged home. Third patient presented day 6 postoperative period with symptoms of mucosal injury was subjected to laparotomy with repair of perforation over T-tube, had a prolonged admission and recovery leading to significant morbidity.

Conclusions
Iatrogenic mucosal perforation is the most important potentially serious perioperative complication of Hellers myotomy which can be avoided with careful and meticulous dissection. This procedure should ideally be performed at tertiary care centre where high volume of such cases is expected. Early intraoperative identification is key to good postoperative outcomes with late detection in postoperative period could lead to serious morbidities.
OGBN P44 Does laparoscopic fundoplication have a role in non-erosive reflux disease?
Authors: Halliday Laura , Donald Neil , Dighe Shwetal 
Published: November 2023

Abstract

Background
Non-erosive reflux disease (NERD) is a sub-group of gastro-oesophageal reflux disease (GORD) characterised by reflux related symptoms without endoscopic evidence of oesophageal mucosal erosion. Management can be challenging as the prevalence of functional dyspepsia and IBS-related symptoms is often high. This study was undertaken to examine symptom control after laparoscopic fundoplication in patients with NERD compared to those with oesophagitis associated GORD.

Methods
Patients who underwent laparoscopic fundoplication for NERD or GORD with oesophagitis between January 2017 and January 2022 were included in this study. Patients were asked to score their current symptoms using the modified DeMeester Clinical Symptom Score (CSS) and Gastrointestinal Symptom Rating Scale (GSRS), and then rate their satisfaction with the procedure.

Results
14 patients who underwent surgery for NERD and 31 with oesophagitis associated GORD were included in this study, with a mean follow up of 3.4 years and 2.7 years respectively after surgery. 86% of NERD patients and 94% of oesophagitis patients reported an improvement in symptoms after surgery. There was a trend for higher symptom scores in NERD patients (NERD patients CSS 4.57±1.95, oesophagitis patients CSS 3.45±1.79, p=0.065; NERD patients GSRS 1.99±0.37, oesophagitis patients GSRS 1.72±0.49, p=0.069). NERD patients with higher pre-operative DeMeester scores from pH testing had lower GSRS scores (r=-0.616, p=0.043).

Conclusions
With careful patient selection and detailed pre-operative counselling, surgery can play a role in the management of NERD patients. Whilst post-operative symptom control may not be as good as that achieved with classical oesophagitis associated GORD, these findings suggest that NERD patients do achieve symptom improvement after laparoscopic fundoplication. Further research is needed to help identify other factors that predict response to surgery in NERD to optimise patient selection and improve shared decision making.
OGBN P46 Megaoesophagus in a patient with achalasia treated with laparoscopic Heller cardiomyotomy
Authors: Abu Suleiman Amro , James Daniel , Wilkins Alex , Lo Terrence 
Published: November 2023

Abstract

Background
Achalasia is an oesophageal motility disorder that is a rare but important differential diagnosis in patients with dysphagia. Surgical treatment with laparoscopic Heller myotomy (LHM) and fundoplication is the gold standard; other options include peroral endoscopic myotomy (POEM), dilatation in cases that are unsuitable for surgery, and esophagectomy as a last resort.

Methods
We describe a case reported at our institution and the relevant workup, findings and management.

Results
A 41-year-old woman presented with persistent cough and shortness of breath on exertion. Chest x-ray showed right basal consolidation and a dense structure along the right mediastinum. CT revealed megaoesophagus with an oesophageal diameter of 7cm. Detailed history revealed long-standing history of progressive dysphagia and acid reflux and more recent history of weight loss, retrosternal pain and shortness of breath when eating solid foods. Workup included gastroscopy, oesophageal manometry and Chagas disease testing due to potential exposure to T. cruzi. A diagnosis of idiopathic achalasia was made, and she underwent laparoscopic Heller’s cardiomyotomy and Dor fundoplication.

Conclusions
Achalasia is an important differential in patients presenting with symptoms of dysphagia. This case reveals an atypical presentation of the disorder, suggesting a need to consider it in a wider range of presentations. Successful treatment of achalasia depends on timely diagnosis prior to oesophageal failure when it is still possible to intervene effectively.
OGBN P47 Isolated Pneumoperitoneum following ERCP
Authors: Bandyopadhyay Samik , Fadipe Adetokunbo , Satyadas Thomas 
Published: November 2023

Abstract

Background
An 84-year-old man underwent a difficult ERCP following biliary leak after laparoscopic converted to open cholecystectomy for acute cholecystitis. Postoperative scan was suggestive of bile leak from Cystic Duct stump and an ERCP-stenting had been requested to treat the problem. He needed urgent decompression for extensive pneumoperitoneum causing acute ventilatory dysfunction during the procedure. Post procedure CT showed pneumoperitoneum and pneumobilia suggesting air leak through Cystic Duct Stump.

Methods
The patient had been admitted for acute cholecystitis and had undergone treatment as an inpatient. An urgent abdominal decompression with a Veress needle after completing the procedure had resolved the acute respiratory distress. He needed a short stay in the intensive care after the ERCP before being safely stepped down to the wards. Records of the rare event was collected retrospectively from the hospital electronic patient record system.

Results
The patient recovered after continued monitoring and support in the Intensive Care. He needed transient respiratory support and treatment for lung collapse. The CT scan ruled out any duodenal injury - the initial suspected reason for the acute deterioration. The presumed cause of the pneumoperitoneum was air leak from an open Cystic Duct stump following canulation of the common bile duct.

Conclusions
Pneumoperitoneum after ERCP is usually secondary to duodenal injury. Our patient had no evidence of Free pneumoperitoneum causing respiratory compromise at ERCP - this is extremely rare. The patient was monitored till discharge for any sign of hollow viscus re-perforation Pneumoperitoneum due to air leak from Cystic Duct stump has not been reported before.
OGBN P48 Comparison of Acute Pancreatitis Management: Local Hospital Policy versus Current Practice
Authors: Alwani Omneya , Moti Terngu , Baltatzis Minas , Alasmar Mohamed 
Published: November 2023

Abstract

Background
This study aims to compare acute pancreatitis management between our current practice in NHS hospital in the northwest and the local hospital policy, which combines national and international guidelines in Emergency Department settings and acute surgical admissions.

Methods
In this retrospective study, we analysed data from fifty-three patients. The study focused on assessing the usage of diagnostic criteria, severity scoring, and investigations, evaluating whether they were performed or ordered. Data were collected from medical records covering the period from October 2022 to March 2023.

Results
Among 53 acute pancreatitis patients, 27 (50.9%) were male, 26 (49.1%) were female, with a mean age of 52.72 years. Gallstones were the leading aetiology in 29 (54.7%) patients. Clinical pancreatitis was diagnosed in 34 (64.2%), Only 12 (22.6%) had documented severity scoring. Amylase and lactate tests were conducted in 37 (69.8%) and 35 (66%) of cases, respectively. 15 (28.3%) had an erect X-ray, and 22 (41.5%) had an abdominal ultrasound. CT scans were performed in 42 (79.2%), Antibiotics were administered in 8 (15.1%) for suspected other pathology.

Conclusions
The study underscores the importance of standardized protocols and guidelines to optimize patient care and resource utilization. In the Emergency Department, necessary laboratory investigations like lactate and amylase tests for suspected pancreatitis are crucial. Severity scoring aids in accurate patient care assessment. Additionally, optimizing the usage of Erect X-ray and CT scans enhances diagnosis and management. Addressing these areas improves healthcare outcomes and resource allocation.