bluuebunny/crossref_metadata_2025_split huggingface dataset:
BJS 3 On the use of Cytosponge as a tool to manage the burden of Barrett’s surveillance
Authors: Singh Gautam , Asarbakhsh Mariam , Verma Harsh , Olejnik Hannah , McDonald Claire , Saha Arin 
Published: August 2023

Abstract

Introduction
After the Covid pandemic, a backlog of over a million endoscopies built up in the UK. Many patients with Barrett’s oesophagus did not receive surveillance within recommended time frames as Barrett’s surveillance endoscopies take more time. This study aimed to assess the role of the Cytosponge test in Barrett’s surveillance and whether it could help reduce endoscopy backlogs.

Methods
251 patients waiting for Barrett’s surveillance prior to or in 2022 were triaged. Patients suitable for Cytosponge were approached and offered this procedure in lieu of endoscopy. Outcomes, complications and reduction in endoscopy usage were measured.

Results
193 patients (77%) had a Cytosponge procedure as their primary Barrett’s surveillance. Of the remaining 58 patients, 26 were unsuitable and 29 patients could not be contacted to discuss the test. 3 patients declined a Cytosponge. 121 patients (62%) had waited longer than their recommended interval for Barrett’s surveillance.
There were no significant complications. Urgent endoscopy was required in 18 patients (9%) after Cytosponge; 15 patients had abnormal findings and 3 patients had an inadequate sample. 175 patients (91%) did not require endoscopic assessment after Cytosponge and have been booked for routine surveillance.

Conclusions
Over 90% of patients who had a Cytosponge for Barrett’s surveillance did not require endoscopy. This ‘saved’ almost 440 points of endoscopy time (or 44 endoscopy lists). Given that around 1% of adults develop Barrett’s oesophagus, these data suggest substantial opportunities to reduce burden of surveillance endoscopies if Cytosponge was used as a primary test for Barrett’s oesophagus.
SP1.4 Evaluating the impact of increased sub-specialist cover on NELA outcomes: A retrospective single centre study
Authors: Vaughan-Burleigh Sebastian , Hollyman Marianne 
Published: August 2023

Abstract

Aims
Emergency general surgery is managed by upper gastrointestinal (UGI) and colorectal surgeons. Outcomes are improved when emergency procedures are within the specialty of the surgeon. This study evaluates the impact of surgeon specialisation and increased consultant cross-cover on patient outcomes.

Methods
The local NELA database was analysed between November 2013 and May 2022. Procedures were classified into UGI, colorectal, or general. Comparison was made between procedures performed within or outside of surgeon sub-specialty and before and after a modified consultant rota was introduced. Primary outcome was 30-day mortality.

Results
A total of 1,313 NELA procedures were performed (90 UGI, 606 colorectal, 617 general); 167 (13%) procedures were performed outside the surgeon sub-speciality. Mortality was lower following procedures within sub-specialty (7.6% vs 12.6%, p=.029). Mortality was lower following colorectal operations performed by colorectal surgeons (colorectal 6.8% vs UGI; 14.0%, p=.01). Multivariate analysis demonstrated that procedures within a surgeon sub-specialty were still associated with lower mortality (OR 0.76, p&lt;0.01) when urgency of operation was accounted for.
In 2019, following addition of cross-cover in the consultant rota, the number of operations performed outside of sub-specialty was reduced (2013-2019; 15.4% vs 2019-2022; 9.8%, p=.05). Across the data collection period mortality decreased overall (2013-2019; 10.0% vs 2019-2022; 6.5%, p&lt;0.01). There was a trend towards decreased mortality following operations outside the surgeon sub-specialty (2013-2019, 14.4%, 2019-2022, 8.9%, p=0.32).

Conclusion
Mortality following laparotomy is reduced when the procedures are within the sub-specialty of the operating surgeon. Rota changes to allow sub-speciality cover can improve peri-operative mortality.
SP1.7 DILEMMAs in emergency laparotomy care: preliminary results of an international quality enhancement initiative focused on decision making
Authors: Perin Giordano , Bellio Gabriele , Ghirardo Sergio , Favero Alberto , Hormis Anil , Cresswell Andrew 
Published: August 2023

Abstract

Aim
The aim of our study is to assess how professionals take decisions when evaluating suitability of patients for emergency laparotomy or palliation.

Methods
We created and validated a dataset of 90 case vignettes based on real patients admitted with surgical pathology correctable only via an emergency laparotomy. We removed information concerning real life outcomes. We submitted the vignettes to consultants and trainees in surgery, anaesthesia and intensive care, asking them if they would offer an emergency laparotomy. Concordance between assessors and real life decisions, accuracy scores (the lower the value the higher the likelihood of operating on patients that survived) and inconsistency scores were calculated. Judgement Analysis methodology (binomial logistic regression) was used to identify variables relevant to the decision making process for each participant.

Results
This report includes results for the first 100 participants. Twelve centres provided data (4 from Italy, 7 from the UK, 1 from Greece). 47 consultants, 9 SAS doctors, 28 higher trainees, 13 core trainees or equivalent took part in the study. 59 were surgeons, 25 anaesthetists and 9 intensivists. Average concordance between decision makers and real life was 78.9%. Median accuracy was 16.5 (IQR 11-30.5). Median inconsistency was 13% (IQR 7%-20%). Accuracy and consistency were better for consultants and worse for trainees. Judgment Analysis demonstrated differences between grades, specialities and institutions.

Conclusions
Different clinicians, when faced with the same information, make different decisions. Our data supports the adoption of multidisciplinary decision making protocols as well as senior involvement.
SP7.1 Effect of gastrojejunal anastomosis diameter in laparoscopic one-anastomosis gastric bypass for the treatment of morbid obesity and related disorders: a comparative study
Authors: Elabbassy Islam , Elgohary Hatem , Abdulrahman Mohammed Gamal , Boshnak Noha 
Published: August 2023

Abstract

Background
One-anastomosis gastric bypass (OAGB) is a safe and effective bariatric procedure that employs a long gastric pouch with antecolic loop gastrojejunal (GJ) anastomosis. The optimum anastomosis diameter is still unclear, as there are many differences in the literature.

Aim
This study aims to evaluate the short-term effect of different GJ anastomosis diameters in patients offered laparoscopic OAGB regarding weight loss, bile reflux, and nutritional and metabolic effect. Patients and methods A total of 59 patients were included in this study, and they were divided into two groups: group A included patients with GJ anastomosis made by a 45-mm stapler reload, and group B included patients with GJ anastomosis made by 20 mm of the stapler reload.

Results
There was no statistically significant difference between groups regarding postoperative mean BMI at 3, 6, 9 months, and 1 year; excess weight loss (EWL%); remission of comorbidities; and bile reflux (P&gt;0.05). Hypoalbuminemia was significantly more evident in group B at 3, 9 months, and 1 year, with P values of less than 0.001, 0.035, and 0.031, respectively. Moreover, group B patients had more iron-deficiency anemia, which was statistically significant at 3, 6, and 9 months (P&lt;0.05), whereas there was no significant difference at 1 year (P=0.128).

Conclusion
OAGB is an effective bariatric procedure, but the use of a 45-mm stapler reload for GJ anastomosis may be associated with less nutritional deficiencies than using 20 mm of the reload. Further studies are needed on a larger number of patients with long-term follow-up.
SP7.2 Marginal ulcers following one-anastomosis gastric bypass: a systematic review
Authors: Lee Shiela , Supparamaniam Shreyas , Varghese Chris , Mahawar Kamal 
Published: August 2023

Abstract

Aims
This systematic review aims to understand the incidence rates, associated factors, and management of MU following OAGB.

Methods
Four databases (PubMed, Cochrane CENTRAL, Embase) were used to systematically identify all studies on OAGB where authors had reported on MU. Data were collected on basic demographics, incidence rates, risk factors, and management of this condition.

Results
Thirty-two studies involving 8868 patients were analysed. The mean age and preoperative BMI were 40.9+/-4.5 years and 47.6+/-5.6 kg/m2 respectively. Approximately 72.0% (6388/8868) of patients were females. 20.6% (1825/8868) had preoperative gastroesophageal reflux disease. The mean operative time was 90.6+/-33.5 minutes. Only 14.1% (1252/8868) of patients were described to have been prescribed proton-pump inhibitors after surgery. The overall incidence of marginal ulcers was 2.59% (95% CI 1.89-3.52). Approximately 23.2% (53/228) of these presented within 12 months. 17.5% (40/228) were diagnosed with marginal ulcers after having endoscopy due to symptoms. Patients with a 45 mm sized gastrojejunal anastomosis (OR: 0.997, 95% CI 0.995-0.997, p=0.004) with double layer closure of stapler site (OR: 0.996, 95% CI: 0.994-0.998, p&lt;0.001) were significantly less likely to develop a MU. Approximately, 88.1% (141/160) of patients were treated conservatively with proton-pump inhibitors (PPIs). The 30-day morbidity rate was 4.6% (411/8868). The 30-day morbidity rate including Clavien Dindo classification ≥ 3 was 1.3% (119/8868). Mortality rate was 0.1% (11/8868).

Conclusion
Marginal ulcer is an uncommon complication following one anastomosis gastric bypass. Majority of patients are treated conservatively with PPIs. This is the first systematic review in literature characterising MU after OAGB.
SP7.4 Autologous blood transfusion reduces the requirement for peri-operative allogenic blood transfusion in patients undergoing major hepatobiliary surgery
Authors: Lakha Adil Siraj , Chadha Radhika , Maher Keith , Barbosa Antonio , Reddy Srikanth , Gordon-Weeks Alex 
Published: August 2023

Abstract

Aims
Major HPB surgery is associated with a high risk of major blood loss. We aimed to assess whether autologous transfusion of blood salvaged intra-operatively reduces the requirement for post-operative allogenic transfusion. This is clinically important because blood is a scarce resource and allogenic transfusion is associated with the potential for morbidity.

Methods
We analysed data from a prospective database of 501 patients undergoing major HPB resection (2015–2022). Patients who received cell salvage (n=264) were compared with those who did not (n=237). Non-autologous transfusion was assessed from the time of surgery to 5 days post-surgery, and blood loss tolerance was calculated using the Lemmens-Bernstein-Brodosky formula. Multivariate analysis was used to identify factors associated with the need for allogenic blood transfusion.

Results
32% of lost blood volume was replaced through autologous transfusion in patients receiving cell salvage. Although cell salvage patients experienced significantly higher intra-operative blood loss compared with the non-cell salvage group (1360ml vs 971ml, p=0.0005), they received significantly less allogenic red blood cell units (1.5 vs 0.92 units/patient, p=0.03). In addition, more of the non-cell salvage patients required low-level transfusion (≤3 units). Use of cell salvage and correction of blood loss tolerance are both independently associated with avoidance of transfusion. There was no difference in major morbidity, 30 or 90-day mortality between the groups.

Conclusions
Use of cell salvage was associated with a reduction in allogenic blood transfusion. Further work is needed to understand whether this is a cost-effective means of reducing allogenic transfusion to support the routine use of intraoperative cell salvage in major HPB surgery.
SP7.10 Laparoscopic Cholecystectomy Operation Notes (LaCON) Quality Improvement Project
Authors: Kapsampelis Panagiotis , Price Daniela , Saunders Jada , Bezzaa Sabrina , Gerogiannis Ioannis 
Published: August 2023

Abstract

Aims
Accurate and comprehensive operation notes are essential for patient care, quality assurance and medico-legal purposes. Laparoscopic cholecystectomy is a common procedure where the quality of operative documentation can impact future patient care. The LaCON project aims to evaluate and improve the quality of LC operation notes with a view to implementing a novel software for standardised operation note creation.

Method
We retrospectively reviewed operation notes of LCs performed at our institution between August and November 2022. Electronic notes were assessed against the Royal College of Surgeons' Good Surgical Practice standard, consisting of 18 items.

Results
We assessed a total of 80 operation notes. There was 100% compliance in surgeon's name, operation name, incision, port placement, and closure technique. High-scoring items included indication (98%), operative findings (98%), operation date (91%) and assistant's name (90%). Among the lowest-scoring items were detailed postoperative instructions (46%), designation as elective or emergency (38%), intraoperative complications-problems (36%), additional procedures performed (23%), operative diagnosis (16%) and estimated blood loss (8%).

Conclusions
We identified several areas for improvement in LC operation notes. The next step of the LaCON project is to standardise operation notes by implementing an evidence-based standardised proforma for LC. This will be accessible through an online app that integrates with our hospital's electronic record system. It will also allow the extraction of operative data for research and audit purposes. This integrated online system has the potential for wider distribution across other procedures, specialities and centres to ensure high standards of safety and care and enhance collaborative multi-centre research.
SP8.9 Pre-operative blood tests in abscess patients: Audit and cost analysis
Authors: Tattsbridge Jasmine , Hang Shaun , Aukland Adam , Abdelrahman Shadi 
Published: August 2023

Abstract

Introduction
Abscess is one of the most common presentations in the emergency surgical setting. It is common practice in our unit to perform blood tests as part of the initial triage process by our nurses. However, NICE guidance (NG45) recommends that bloods should not be taken routinely for patients undergoing minor surgery (including abscess) who are ASA 1 or 2.

Aims
To determine the department’s compliance with NICE guidance, identify ways to improve compliance if required, Identify methods to improve patient experience e.g. waiting times and perform a cost analysis of unnecessary blood tests.

Methods
Retrospective analysis of 100 consecutive patients from June to September 2022, who had incision and drainage of abscess. The patients were selected from Surgical Emergency Unit admission book. Patient data including demographics, immunological compromise status, Morbidities such as diabetes, abscess site, anaesthetic type, blood tests performed and results, and admission and discharge times.

Results
56 females, 44 males. Majority fall in age group 25-59. 7 patients were ASA 3 or higher. 10 patients were diabetic.
93 patients had blood tests performed preoperatively. 16 patients had CRP &gt;50, and 9 patients had WCC &gt;15. Only 6 patients spent more than 1 day inpatient.
Cost of unnecessary blood tests in this group is 4,092£, cost over a year period is 24,552£.

Conclusion
There was poor compliance with NICE guidance costing the trust 24,552£ yearly. Blood tests did not change management plans or patients’ course. Better compliance can improve patient experience and save significant cost.
SP9.10 Identifying Malnutrition in Emergency General Surgery (EGS): A Systematic Review
Authors: Ashmore Daniel , Rashid Adil , Wilson Timothy , Halliday Vanessa , Lee Matthew 
Published: August 2023

Abstract

Aims
Emergency general surgery (EGS) practice is high risk. Surgery is a key part of treatment, with resultant catabolic stress and frequent need for nutritional support. Aims of this study were to examine the current methods of defining and determining malnutrition in EGS. This included examining the use of nutrition screening and assessment tools, and other measures of malnutrition.

Methods
Medline, Embase, CINAHL, trial registries and relevant journals published between January 2000 and January 2022 were searched for studies of adult patients with any EGS diagnosis, managed operatively or conservatively with an assessment of nutritional status. Mixed populations were included if more than 50% of patients were EGS or EGS results could be separately extracted. Studies whereby patients had received nutritional support were excluded.

Results
From 6,700 studies screened, 324 full texts were retrieved, and 31 were included in the analysis. A definition of malnutrition was provided in 75% (n = 23) of studies, with nutritional status being determined by a variety of methods. Seven nutrition screening tools and nine ‘assessment’ tools were reported. To define malnutrition, the most commonly used primary or secondary marker of nutritional status was body mass index followed by albumin level.

Conclusions
Wide variation exists in approaches to identify malnutrition risk in EGS patients, using a range of tools and nutrition markers. Future studies should seek to standardise nutrition screening and assessment in the EGS setting as two discrete processes. This will permit better understanding of malnutrition risk in surgical patients.
SP9.11 Comparison of non-mesh Desarda technique versus Lichtenstein technique for inguinal hernia repair: A systematic review and meta-analysis of 14 comparative studies
Authors: Mohamedahmed Ali Yasen , Wuheb Ali Ahmed , Albendary Mohamed , Sillah Abdul Karim 
Published: August 2023

Abstract

Background
The aims of this systematic review and meta-analysis were to compare non-mesh Desarda technique (DT) with the standard mesh-based Lichtenstein technique (LT) for inguinal hernia repair.

Methods
A systematic literature search for comparative studies comparing between DT and LT was conducted using electronic databases and Google scholar service. Studies were evaluated for hernia recurrence, post-operative complications, and time to return to work. We pooled the data using fixed effects model and random effects model after assessing the heterogeneity among the included studies.

Results
A total number of 14 studies were included in this meta-analysis with a total number of 3673 patients divided between Desarda group (n=1794) and Lichtenstein group (n= 1879). There was no difference in terms of recurrence between the Desarda repair and Lichtenstein repair group [P = 0.47]. There was a significant lower rate of overall post-operative complications [P=0.0001], seroma [P=0.0002] and (SSI [P = 0.03] in the Desarda group. The two groups showed comparable results for haematoma [P=0.12], scrotal oedema [P=0.25], and testicular atrophy [P=0.15]. Moreover, Desarda group was associated with shorter operative time and return to work when compared to Lichtenstein group, [P=0.01] and [P=0.008], respectively.

Conclusion
DT and LT were found to have comparable results in terms of hernia recurrence rate, haematoma formation, and testicular atrophy. However, DT is superior to LT in terms of reducing postoperative mesh-attributed complications, such as SSI and Seroma formation besides shorter operative time and return to work. We recommend performing a well-designed, large cohort RCT to evaluate the cost-effectivity and impact in less economically developed countries.
SP10.2 Systematic review and meta-analysis of self-expanding metal stents in the management of benign large bowel obstruction
Authors: Fardanesh Armin , George Jayan , Hughes Daniel , Stavropoulou-Tatla Stavroula , Mathur Pawan 
Published: August 2023

Abstract

Aims

Methods
This systematic review protocol was registered on Prospero (ID: CRD42021239363). Seven online databases were searched for relevant papers, with subsequent abstract and full-text screening by two reviewers. The primary outcome was the technical success of stenting. Pooled rates of successful stenting and related complications were calculated through meta-analysis of proportions performed using random effects.

Results
266 papers were collected with 15 studies included for analysis. 290 patients were included with an average age of 68, and a male predominance of 57%. The pooled rate of clinical success was 94.4% (95%CI 90.3 – 96.8%). The pooled rate of technical success was 76.0% (95%CI: 64.9-84.5%). Adverse effects were low; perforation 9% (19.9 – 38.6%), recurrence 28% (19.9 – 38.6%) and stent migration (14.6 – 36.0%). The reporting on long-term outcomes of stenting as a bridge to surgery was vastly variable.

Conclusions
This study demonstrates SEMS could be clinically effective and safe in benign LBO. We propose the introduction of a widescale database to assess current practice and its clinical application.
SP10.16 Impact of joint surgical and medical management on outcomes in inflammatory bowel disease. A retrospective review of medical management and surgical outcomes in a District General
Authors: Shaukat Mubasher , Zaman Iqbal , Ditta Allah , Junejo Muneer 
Published: August 2023

Abstract

Aim
A combined medical and surgical team approach for management of inflammatory bowel disease (IBD) facilitates optimized medical and surgical management through dedicated MDTs and clinics. These benefits were delivered during the COVID-19 pandemic impacting planned medical care.

Method
Data was collected for all IBD patients undergoing resection surgery over 16 years of age covering a 2-year period before and a 2-year period after the impact of COVID-19 pandemic and start of a combined IBD practice. It included demographics, immune-suppression and planned and unplanned surgery between January 2018 to September 2021.

Results
62 patients underwent major resection surgery. Six were excluded for non-IBD related indication (malignancy, infective colitis and volvulus). Of the remaining 56 patients, 20 (35.7%) had Crohn’s Disease, 35 (62.5%) had Ulcerative colitis and one (1.8%) with indeterminate colitis on histopathology. The median age was 43.6 years (16 to 80) with 64.3% females.
In the first 2-year period, 73.7% (14) underwent surgery with high perioperative immunosuppression. This reduced to 26.3% (5) in the combined IBD period. Proportion of patients undergoing emergency surgery declined from 59% to 12.5%. Use of biologics increased from 29% to 50% of patients with the average of 0.71 vs 2.13 failed biologics use before surgical intervention.

Conclusion
Combined medical and surgical IBD practice offers optimised care through timely escalation of medical treatment and reduces risks associated with major emergency surgery. Despite the restrictions to planned surgical treatment during the COVID-19 pandemic, improved outcomes were achieved with combined practice for IBD patients.