bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB O01 HemopatchTM – A Viable Means of Preventing Post-Operative Pancreatic Fistula, A Multi-Institutional Review
Authors: Daoud Mohammed , Devine Michael , Naraine Urvashi , Abdelmoeti Mahmoud , O’Suilleabhain Criostoir , O’Sullivan Adrian 
Published: November 2023

Abstract

Background
Perioperative complications post distal pancreatectomy can be myriad. One of the most common is pancreatic fistula (POPF), with an incidence that can range widely. Many techniques are employed to prevent POPF but these are mainly equivocal.

Methods
We conducted a retrospective review of a prospectively maintained multi-institutional pancreatic resection database of patients who underwent surgery between 01/01/2018 and 31/12/2022. Cohorts were divided into those who had a HemopatchTM applied to the pancreatic stump and those without. Demographics, POPF Grade A and Grade B/C, peak drain amylase after day 3, complications, and 30-day mortality were analyzed. Statistical analysis was conducted using SPSS. Chi-squared and T-tests were employed with a p-value of &lt;0.05 deemed significant.

Results
Demographics between the two groups were similar. Mucinous cystic neoplasms and pancreatic adenocarcinoma accounted for the majority of indications for resection. Through the use of HemopatchTM a statistically significant reduction in Grade A POPF was seen (39% vs 63%, p-value 0.04). Grade B/C POPF approached but did not reach statistical significance in difference (6% vs 18%, p-value 0.07). Peak drain amylase was 7989 IU/L in the cohort who did not have a Hemopatch applied while in the cohort who did there was a mean of 1818 IU/L (p-value 0.05).

Conclusions
The routine use of HemopatchTM is a safe adjunct in distal pancreatectomies. It renders a statistically significant reduction in Grade A POPF. For Grade B/C POPF it approaches but does not meet the threshold for significance. Routine use is advocated while larger prospective trials are undertaken.
OGBN O02 Ergonomics in laparoscopic cholecystectomy. Do we need to change our practice to look after ourselves?
Authors: Browning Matt , Johnson Courtney , Gore Megan , Alwis Anuradha , Soe Wunna , Walker Eleanor , Walmsley James , Chan David 
Published: November 2023

Abstract

Background
Up to 80% of surgeons report musculoskeletal problems which significantly affect their personal and professional lives. The cost of back pain alone in the NHS costs £400 million per year (for all staff), and surveyed surgeons report 40% have sustained an injury at work. Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures but the musculoskeletal impact of this procedure on surgeons is unknown, though anecdotally it is likely to be high.

Methods
We observed the positions held by surgeons undertaking laparoscopic cholecystectomy and measured them against the Rapid Entire Body Assessment (REBA) score, which is widely used to assess the risk of an activity causing musculoskeletal injury. The higher the score, the less ergonomic the posture and the higher the risk of long term harm. Photographs were taken of the operating surgeon with consent (excluding views of the patient) and then measured against the score to assess the risk. Operations were graded to give an average risk score which represents the need for a change of process to safeguard staff.

Results
Eight laparoscopic cholecystectomies, undertaken by 6 different surgeons were analysed. Scores for trunk posture were generally low but score for upper limb position were higher. The mean and median REBA scores were both 4 and the maximum score during one operation was 6.

Conclusions
The scores measured in this small study were very consistent and suggest that the practice of laparoscopic cholecystectomy as currently practised has a medium risk of causing operator harm; practice change is recommended to safeguard staff. Further research is needed with larger sample sizes as well as different arms for techniques such as position changes or robotic surgery, while observing outcomes for patients and time taken.
OGBN O08 The Safety and Efficacy of Laparoscopic Hiatus Hernia Repair with Biosynthetic Mesh (Phasix-ST®): A Single Centre Experience
Authors: Quake Sharmaine Yen Ling , Peter Bennett , Munipalle Phanibhushana Chakravarthy , Viswanath Yirupaiahgari 
Published: November 2023

Abstract

Background
Surgical management of large hiatus hernia (&gt; 5 cm defect) remains challenging due to high recurrence rates. Mesh augmentation in laparoscopic hiatal hernia repair has been used to reduce recurrences but carries risks such as mesh erosion, contraction, infection, and reaction to the foreign body. Introducing biosynthetic meshes offers a promising adjunct to primary suture repair of hiatal defects with enhanced tissue integration and reduced risk of infection. Phasix™ ST mesh is a biosynthetic mesh made of Poly-4-Hydroxybutyrate (P4HB). This study evaluates early patient outcomes following laparoscopic hiatal hernia repair with Phasix™ ST mesh, including its safety and efficacy profile.

Methods
This study was to evaluate outcomes of laparoscopic hiatus hernia repair using Phasix™ ST mesh in adult patients (&gt;18 years) at our institution. All patients undergoing this procedure between September 2020 to April 2023 were identified from a prospectively maintained database. Our standardised technique involved on-lay crural reinforcement with Phasix™ ST mesh after primary closure of the hiatal defect, followed by partial fundoplication. Patient records were reviewed retrospectively to assess these end-point measures: postoperative mortality and morbidity at 30 days, functional results reported during the follow-up period, and recurrence rates of hiatus hernia.

Results

Conclusions
This is the first study in the United Kingdom demonstrating that laparoscopic hiatus hernia repair with the use of Phasix™ ST mesh for crural reinforcement has low-rate complications, with most patients reporting symptom improvement and discontinuing PPI use in the early-term follow–up. Further long-term studies are needed to validate these findings.
OGBN O09V Multi-modal Approach with Fluorescence Imaging, Intraoperative Ultrasound and Laser Lithotripsy in the Laparoscopic Management of Complex Large Bile Duct Stones
Authors: Fernando Sherwin , Latif Javed , Bandlamudi Nanda , Bhatti Imran , Awan Altaf 
Published: November 2023

Abstract

Background
Choledocholithiasis is a common condition with various presentations. There are several approaches through which this can be managed. This presentation aims to explain novel techniques and various modalities in managing complex bile duct stones successfully with minimal invasive approach.

Methods
This video presentation depicts the procedure performed for large CBD stones with the use of indocyanine green (ICG) and intraoperative ultrasound (IOUS). The patient is a 61 year old gentleman presented with abdominal discomfort and deranged liver functions. Cross sectional imaging showed 2 large CBD calculi and attempt at endoscopic retrograde cholangio-pancreatigoraphy (ERCP) failed due to large impacted stones. Decision was made to proceed to single stage laparoscopic cholecystectomy and common bile duct exploration with use of ICG, IOUS and laser lithotripsy to achieve successful clearance of CBD.

Results
At laparoscopy, the CBD and common hepatic artery were identified with ICG and IOUS. A vertical choledochotomy was performed and choledochoscopy undertaken. Attempts to retrieve the stone with extraction basket were not successful. Laser lithotripsy was used to break the stones into smaller fragments which were subsequently retrieved using atraumatic graspers and extraction wire. Post operative period was uneventful and the patient was discharged home on day 2. Face to face follow-up at 6 weeks confirmed good recovery.

Conclusions
Laparoscopic management of complex CBD stones is challenging. Despite advances in endoscopy intervention, the role of surgery is irrefutable. Advanced laparoscopic skills and experience in bile duct exploration with advanced minimally invasive instruments and equipment are critical to achieve optimal patient outcomes, and mitigated the chances of conversion to open surgery which its associated morbidity. This presentation demonstrates a safe technique while working in the hostile area of the inflamed hepatocystic triangle and an alternative method in the retrieval of large common bile duct stones following failed ERCP.
OGC O03 Evolution in Laparoscopic Gastrectomy from a Randomized Controlled Trial through National Clinical Practice
Authors: Markar Sheraz , Visser Maurits , Luyer Misha , Nieuwenhuijzen Grard , Gisbertz Suzanne , Van Berge Henegouwen Mark , Ruurda Jelle , van Hillegersberg Richard 
Published: November 2023

Abstract

Background
Following Randomized Controlled Trials (RCT), the dissemination of complex interventions has been poorly studied. The LOGICA RCT included 10 Dutch centers and compared laparoscopic to open gastrectomy. The aim of this present study was to examine the influence of the LOGICA RCT upon the practice and outcomes from laparoscopic gastrectomy within the Netherlands.

Methods
Data were obtained from the Dutch Upper Gastrointestinal Cancer Audit (DUCA) on all gastrectomies performed in the Netherlands (2012–2021), and the LOGICA RCT from (2015–2018). Multilevel multivariable logistic regression analyses were performed to assess the effect of laparoscopic versus open gastrectomy upon clinical outcomes with the LOGICA RCT and DUCA datasets. These analyses were repeated to assess the effect of laparoscopic gastrectomy upon outcomes before, during, and after the LOGICA trial in the DUCA dataset.

Results
In total, 211 patients from the LOGICA RCT (105 open vs. 106 laparoscopic) and 4,131 patients from the DUCA dataset (1884 open vs. 2247 laparoscopic) were included. In 2012, laparoscopic gastrectomy was performed in 6% of patients, increasing to 82% of patients in 2021. No significant effect of laparoscopic gastrectomy on postoperative clinical outcomes was observed within the LOGICA RCT. Nationally within DUCA, a shift towards a beneficial effect of laparoscopic gastrectomy upon complications was observed, reaching a significant reduction on overall complications (aOR:0.62; 95%CI:0.46-0.82), severe complications (aOR:0.64; 95%CI:0.46-0.90) and cardiac complications (aOR:0.51; 95%CI:0.30-0.89) after the LOGICA trial.

Conclusions
The wider benefits of the LOGICA trial include safe dissemination of laparoscopic gastrectomy across the Netherlands. The robust surgical quality assurance programme in the design of the LOGICA RCT was crucial to facilitate the national dissemination of the technique following the trial and reducing potential patient harm during surgeons learning curve.
OGC O08 Quantification of fluorescence angiography for visceral perfusion assessment in gastric conduit reconstruction: measuring agreement between two software algorithms
Authors: Nijssen D J , Joosten J J , Osterkamp J , van Elzen R B , Svendsen M B , Dalsgaard M W , Homopes R , Gisbertz Suzanne , Achiam M P , van Berge Henegouwen Mark 
Published: November 2023

Abstract

Background
Building evidence suggests that fluorescence angiography is capable of reducing anastomotic leakage rates. Many software-based quantification algorithms have been developed aiming to obtain an objective measure for intraoperative visceral perfusion at the anastomotic site. Validation and comparison of these models in the current literature is scarce. The aim of this study was to measure agreement between two independently developed software algorithms for the quantitative assessment of visceral perfusion using indocyanine green fluorescence angiography.

Methods
81 video recordings from patients who underwent fluorescence angiography-guided Ivor Lewis esophagectomy with gastric conduit reconstruction between August 2020 and February 2022 were available for analysis. In this dataset, we standardized patient, theatre, camera and imaging display variables. Recordings were analyzed retrospectively based on intraoperatively selected regions of interest using two software based-quantification algorithms (AMS and CPH). Quantitative parameters derived from the fluorescence time curve (FTC) were recorded. The comparison focused on the predefined primary outcome variable for quantitative perfusion assessment "normalized maximum slope". Agreement between the two software algorithms was evaluated in a Bland-Altman analysis. Quantitative parameters in patients with anastomotic leakage were compared to those without.

Results
Out of 81 video recordings, 70 could be processed using both algorithms. The output values for the normalized maximum slope from the AMS and the CPH software held a moderate-to-strong correlation in a linear regression model (R-squared: 0.544, p&lt;0.001). The Bland-Altman plot indicated a mean±SD difference of 0.037±0.018 arbitrary units for the normalized maximum slope, with significant differences between the two software measurements (p&lt;0.001). Proportional bias was observed using linear regression in the Bland-Altman plot (R-squared=0.715, p&lt;0.001). Disparities between the two measurement methods became proportionally larger among higher mean values. Neither of the two software methods showed a significant difference in perfusion measurement between the anastomotic leakage and no leakage groups (p=0.32 and p=0.51). Differences in signal processing, such as smoothing techniques and window selection, were identified as potential factors contributing to the disparity in outcomes.

Conclusions
The two software-based quantification methods for visceral perfusion demonstrated significant differences. Varying agreement among quantification methods should be considered while interpreting studies that report quantitative parameters and derived thresholds for clinical endpoints, as there may be a limited external validity.
OGC O09 Fluorescence lymphography using indocyanine green in the prevention of chyle leakage after minimally invasive esophagectomy
Authors: Henckens S P G , van der Aa Dillen , Nijssen D J , Eshuis W J , Gisbertz Suzanne , van Berge Henegouwen Marc 
Published: November 2023

Abstract

Background
For oncological reasons, the thoracic duct is resected during esophagectomy for cancer. Its anatomy and vulnerability render it prone to injury and mainly side branches and collaterals are often hard to visualize. Chyle leakage is one of the most challenging complications in esophagectomy, with an incidence of 14-21%. The clinical implications for patients are prolonged thoracic drainage and hospital admission, additional reinterventions, unpleasant dietary restrictions, and decreased long-term survival. Fluorescence lymphography using indocyanine green (ICG) can accurately visualize the thoracic duct and collaterals, which may possibly reduce the incidence of chyle leakage and intra-operative detected chyle leakage can be treated directly.

Methods
A prospective observational cohort study will be performed. Patients aged over 18 years with resectable (cT1-4a, N0-3, M0) esophageal carcinoma undergoing a minimally invasive esophagectomy will be included. The primary endpoint of the study is postoperative chyle leakage. Secondary endpoints are overall morbidity and mortality, nature of dietary restrictions, reinterventions, hospital costs, 2 year survival rate and quality of life. Twenty-five milligram of ICG is dissolved in 10 ml of sterile water, obtaining a solution of 2.5 mg ICG per mL. In the McKeown esophagectomy, before the thoracic phase, the surgeon administers a bilateral bolus of 2 mL ultrasound-guided into inguinal lymph nodes. In an Ivor Lewis esophagectomy, 2mL of reconstituted ICG will be injected into the small bowel mesenteric root just under the peritoneum of the mesentery, at the level where the jejunostomy is placed. Additionally, 50 mL of cream is enterally administered through the just established feeding jejunostomy. Subsequently, the operating area is inspected for chyle leakage with fluorescence lymphography after thoracic duct ligation and just before terminating the procedure.

Results
We aim to include 50 patients to assess the feasibility of fluorescent lymphography using ICG and enteral cream to prevent chyle leakage after minimally esophagectomy. Inclusion is ongoing. At this time 39 of 50 patients are included. Results will be expected before the congress.

Conclusions
It is hypothesized that as a result of this technique the patients will benefit from lower incidence of postoperative chyle leakage, shorter thoracic drainage, reduced hospital admission, reduced dietary restriction, less re-interventions, and improved overall survival.
AHP P01 A Survey To Explore The Use Of Nutritional Outcome Measures In Clinical Practice By Dietitians In Oesophago-Gastric Cancer Care In The British Isles
Authors: Ford Kate , Grimshaw Kate , Owen Kellie , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
Dietitians in clinical practice face the challenge of providing high quality care whilst demonstrating clinical effectiveness and continuous improvement. Assessing the effectiveness of dietetic intervention is vital in ensuring the provision of clinically effective dietetic services. Nutritional outcome measures are key in identifying the impact of dietetic interventions; enabling dietitians to objectively measure the effectiveness of their care as well as providing patients, other health care professionals and commissioners with data around the value of care provision. Currently there are no specific nutritional outcomes associated with oesophago-gastric cancer care in the UK.

Methods
A survey was disseminated through direct personal emails to 93 Dietitians known to be working in UGI, a list derived from NOGCA audit sites of 2021, with the aim of assessing the current use of nutritional outcome measures by Dietitians working in oesophago-gastric cancer acute care in the British Isles. Further promotion was directed through a UGI Dietitians Forum and through social media posts. A YouTube video was produced and distributed alongside the survey, with the aim of providing education around identifying nutritional outcomes. The video also aimed to connect personally with people, with a visual presentation from the researcher.

Results
54 responses represented the entire patient journey.
Whilst 72% of respondents reported identifying and documenting dietetic outcomes, the quality of these assessments was low, mainly focusing on weight, weight changes and hand grip strength. Other common themes related to nutritional intake, quality of life and symptom impact. Less common outcomes measured included standardised nutritional assessment (PG-SGA), gastro-intestinal symptom evaluation, optimised prehabilitation, biochemical parameters and patient experience.
There was little standardisation in how outcomes are used and when they were taken. There is no national database available to collate OG nutritional outcome data, representing a missed opportunity to support national benchmarking.

Conclusions
This study has presented not only the inconsistencies in nutritional outcome data collection (definition, timing and tools) and the need for standardisation of outcomes use in this speciality, it has also demonstrated the challenges around the promotion of outcomes measures and application/roll out into clinical practice.
Novel ways of obtaining and evaluating nutritional outcomes will need to be considered. This will form the basis of a further research study, exploring barriers to completion of nutritional outcomes.
AHP P03 Challenges in the nutritional management of patients undergoing Endoluminal Vacuum therapy (EVT) for upper gastrointestinal (UGI) leaks and perforations
Authors: Owen Kellie , O’Mahony Seán , Farooq Naheed , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
The management of upper gastrointestinal (UGI) leaks and perforations is complex and challenging. Patients often have multiple comorbidities, have undergone major surgical interventions with protracted pathways, and are associated with compromised nutritional states. Endoluminal Vacuum therapy (EVT) is a novel approach to managing UGI leaks that aims to avoid unnecessary major surgical intervention. Optimising nutrition for this cohort is of paramount importance, however, this may be challenging to achieve due to repeated interventions and interruptions in nutritional support. This study aimed to objectively measure and describe some of these challenges and explore areas of development to optimise outcomes for patients.

Methods
A retrospective analysis of all leaks and perforations managed with EVT between September 2018 and June 2023 was undertaken. This included patients who had undergone cancer resections (oesophagectomy and gastrectomy), bariatric surgery and those presenting with benign disease (e.g. oesophageal perforation and iatrogenic injury). The setting was a regional tertiary oesophago-gastric and bariatric centre in the North-West of England serving a population of 3.5 million people. A comprehensive dataset relating to the nutritional status of patients preoperatively and the change in nutritional parameters was collected and analysed.

Results
59 patients (43 males; median age 61) were included; 88% were discharged from hospital. Median weight on admission and last EVT was 88.5kg (IQR 51-131kg) and 76.9kg. 31% had &gt;10% pre-admission weight loss (IQR 2.4-30%). Median weight loss to last EVT was 7.1% (IQR +16.5 to -18.1%) vs. 9.4% (IQR +2 to -23%) for overall stay. Initial feeding routes were 46% (27/59) jejunostomy, 41% (24/59) parenteral nutrition (PN), 12% (7/59) PN/jejunostomy, and 2% (1/59) naso-gastric. Median weight loss during admission was less (9%) in the jejunostomy cohort versus the other feeding groups (PN 12.4%, PN/jejunostomy 13.9%, nasogastric 9.2%).

Conclusions
Meeting the nutritional needs in this complex, co-morbid and often nutritionally deplete group is a challenging task. Management algorithms were heterogenous and lacked consistency. An accurate understanding of nutritional requirements was difficult due to a combination of a lack of clinically validated guidelines and little consensus regarding which data points should be used to measure nutritional provision. These issues must be addressed to accurately ascertain the role of nutritional optimisation in this cohort, and to be able to identify modifiable factors and areas of development that may improve patient outcomes.