bluuebunny/crossref_metadata_2025_split huggingface dataset:
BS O05 Should we be doing routine post-operative blood tests in patients undergoing elective bariatric surgery?
Authors: Hill Sarah , Thomas Christophe , Mahawar Kamal , Courtney Michael 
Published: December 2022

Abstract

Background
Bariatric and metabolic surgery (BMS) has a low complication and readmission rate; complications however, when they do occur, can be major and life-threatening. Routine post-operative blood testing (POBT) is commonplace following BMS to assess for complications but has resource implications. We aimed to assess whether POBT in our unit predicted complication or readmission rates. We found no existing studies evaluating the efficacy of routine POBT in the bariatric surgery cohort.

Methods
All patients undergoing BMS between July ’20 – June ’21 were retrospectively identified from our local database. Data gathered were: Patient demographics; operation, POBT (FBC, U&E, CRP); length of stay; 30-day complications and 30-day readmissions. Financial cost of POBT were also calculated. Descriptive statistics and Fishers exact test were used to analyse results.

Results
149 patients were identified (OAGB - 81, RYGB - 32, LSG - 36); all had POBT. 115 patients (77%) were discharged on the expected post-operative day (median LOS - 1 days). 38 patients (25.5%) had abnormal POBT results according to defined parameters laid out in our protocol. Abnormal POBT resulted in a change to management plan in 8 patients (5.4%), with subsequent increased LOS for further investigation or observation; in all of these cases there were signs of deterioration via observations and/or clinical symptoms. 8 (5.4%) patients were readmitted in 30-days, 3 of whom had abnormal POBT following their surgery. There was no statistical correlation between abnormal POBT and 30-day readmission rate, p=0.42. POBT in the cohort total cost was in the region of £2400.

Conclusions
In this study we observed that POBT did not predict adverse outcome without clinical signs of deterioration. A considerable number of POBT are performed routinely without clinical indication. A patient-specific approach is recommended based on intra-operative and post-operative clinical assessment rather than routine usage, resulting in cost savings to the Trust and better patient flow with safe and efficient discharges. It is also important to consider the financial impact of performing routine POBT in all patients undergoing BMS; due to both the costs of POBT, staff hours as well as the potential costs due to delayed discharges.
BS O07 Secondary Hyperparathyroidism Before and After Bariatric Surgery: a Prospective Study with 2-Year Follow-Up
Authors: Salman Mohamed , Tourkey Mohamed , Noureldin Khaled , Khalid Sadaf , Issa Mohamed , Elewa Ahmed , Shaaban Hossam , Salman Ahmed , Elsherbiney Mohammed , Elhaj Mujahid , lee Shiela , Gebril Mahmoud 
Published: December 2022

Abstract

Background
Secondary hyperparathyroidism (SHPT) is linked to obesity. Bariatric surgery may be associated with calcium and vitamin D deficiencies leading to SHPT. This study aimed to detect the prevalence of SHPT before and after bariatric surgery

Methods
This prospective study assessed the prevalence of SHPT after sleeve gastrectomy (SG, n = 38) compared to one anastomosis gastric bypass (OAGB, n = 86). All patients were followed up for two years. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry.

Results
Of the 124 patients, 71 (57.3%) were females, and 53 (42.7%) were males, with a mean age of 37.5 ± 8.8 years. Before surgery, 23 patients (18.5%) suffered from SHPT, and 40 (32.3%) had vitamin D deficiency. The prevalence of SHPT increased to 29.8% after 1 year and 36.3% after 2 years. SHPT was associated with lower levels of vitamin D and calcium and higher reduction of BMD in the hip but not in the spine. After 2 years, SHPT was associated with a significantly lower T-score in the hip. SHPT and vitamin D deficiency were significantly more common in patients subjected to OAGB compared to SG (p = 0.003 and p &lt; 0.001, respectively). There is a strong negative correlation between vitamin D levels and parathormone levels before and after surgery.

Conclusions
The prevalence of SHPT is high in obese patients seeking bariatric surgery, especially with lower vitamin D levels. Bariatric surgery increases the prevalence of SHPT up to 2 years. Gastric bypass is associated with a higher risk of developing SHPT compared to SG.
HPB O04 Venous thromboembolism after hepatectomy: comparison between open and minimally invasive liver resection. Results of a systematic review with meta-analysis
Authors: Lancellotti Francesco , Coletta Diego , de’Liguori Carino Nicola , Jegatheeswaran Santhalingam , Maruccio Martina , Siriwardena Ajith , Jamdar Saurabh 
Published: December 2022

Abstract

Background
Even though the risk of postoperative venous thromboembolism (VTE) after liver resection is well recognized, the association between surgical approach and VTE risk is unknown. This study aims to compare VTE rates following open liver resection (OLR) and minimally invasive liver resection (MILR).

Methods
MEDLINE, Web Of Sciences and EMBASE databases were analyzed to identify eligible studies. The studies that we included in the meta-analysis were published between February 2016 and May 2021. The last database search was performed on May 22nd, 2022. Studies were considered suitable if they reported a comparison between OLR and MILR (including laparoscopic liver resection [LLR] or robotic liver resection, [RLR]), or if postoperative VTE was the main focus of the study. Extracted data were pooled and subsequently used in a meta-analysis.

Results
14 studies including 11356 patients met inclusion criteria and were considered for meta-analysis, with a total of 5622 patients who underwent OLR and 5734 patients who underwent MILR. Overall, our findings showed that VTE rate was higher among patients who underwent OLR compared to MILR (2.8% vs 1.4%, p=&lt;00001). Similarly, the subgroup analysis showed a higher rate of deep venous thrombosis (DVT) (1.4% vs 0.7%, p=0.02) and pulmonary embolism (PE) (1.3% vs 0.7%, p=0.002) in patients who underwent OLR compared to MILR.

Conclusions
Patients who undergo OLR have a higher incidence of postoperative VTE when compared to MILR. This finding is consistent for both DVT and PE.
OGBN O05 Safety and efficacy of endoscopic self-expanding stent insertion for benign oesophageal strictures – retrospective review of a single-centre case series
Authors: Huppler Lucy , chung Tham Ji , Lin Benjamin , Shaw Alice , Byrne Benjamin E 
Published: December 2022

Abstract

Background
Benign oesophageal strictures (BOS) are common and are most often managed with endoscopic balloon or bougie dilation. While self-expanding stents (SES) are a key tool for managing malignant strictures, their role in management of BOS is less well defined, usually being reserved for refractory strictures. Potential benefits include reduced frequency of intervention to stabilise nutritional status, and risks include migration, perforation or erosion. We conducted a single-centre retrospective review of our experience using SES for BOS to evaluate their safety and efficacy.

Methods
All patients undergoing SES insertion at a tertiary oesophago-gastric surgery unit between November 2015 and November 2020 were retrospectively identified using cross-referencing across 3 internal software systems. Patients undergoing primary SES insertion for BOS were identified, records were retrieved and reviewed. Data was collected on pre-insertion stricture management, post-procedure complications and outcomes including further interventions within the next year.

Results
During the study period, 425 oesophageal SES were inserted. From these cases, 18 patients underwent primary SES insertion for BOS. 14/18 (78%) of patients were male with a mean age of 68 years. Causes of BOS were reflux (7, 39%), 360 degree radiofrequency ablation of dysplastic Barrett's oesophagus (7, 39%), radiotherapy for squamous cell carcinoma (2, 11%), post-achalasia treatment stricture (1, 6%) and anastomotic stricture (1, 6%). In the 12 months prior to SES insertion, patients underwent a median of 3 (IQR 2–4) balloon dilations. During the immediate preceding month, patients underwent a median of 1 (IQR 0–1) dilations.
There were no cases of perforation, bleeding or erosion associated with SES insertion. 5 of 18 (28%) stents migrated. Median interval to the next endoscopy was just over 5 weeks (36 days (IQR 27.25–48). During the following 12 months after stent insertion, patients underwent a median of 5 (IQR 3–9.5) further endoscopies after primary stent insertion.

Conclusions
Stent insertion for BOS is safe and can provide a period of several weeks before further intervention is required. This may facilitate a period during which oral nutrition can be improved. However, SES for BOS is associated with a significant rate of migration, and patients continue to require frequent interventions after stent insertion. We suggest that SES insertion in this setting should be reserved for selected cases where intensive early dilation has failed to achieve progression in diameter with improvement in symptoms and nutrition as part of a standardised approach to improve management of BOS.
OGC O04 A Preoperative Scoring Model to Estimate the Risk of Conduit Necrosis in Oesophagectomy Patients - Results From the Oesophago-Gastric Anastomosis Audit
Authors: Halle-Smith James , Kamarajah Sivesh , Evans Richard , Griffiths Ewen 
Published: December 2022

Abstract

Background
Both conduit necrosis (CN) and anastomotic leak (AL) after oesophagectomy is associated with high morbidity and mortality and therefore identification of preoperative, modifiable risk factors are desirable. Once identified, risk factors can be used to create a risk scoring model which can be used to aid preoperative counselling and guide postoperative management. The aim of this study was to use the prospectively collected, multicentre data from the Oesophago-Gastric Anastomosis Audit (OGAA) to generate a risk scoring model for conduit necrosis and anastomotic leak after oesophagectomy.

Methods
This prospective multicentre cohort study included patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018 (with 90 days of follow-up). Definitions for AL and CN were those set out by the Esophageal Complications Consensus Group. Univariate and multivariate analyses were performed to identify risk factors for both AL and CN. The cohort was then randomly split into a derivation an validation set. A risk score was then produced for both AL and CN using the derivation set, then internally validated using the validation set.

Results
This study included 2247 oesophagectomies across 137 hospitals in 41 countries. The AL rate was 14.2% (n = 319) and CN rate was 2.7% (n = 60). Preoperative factors that were independent predictors of CN were: body mass index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status, previous myocardial infarction (MI) and smoking history. These were converted into a risk-scoring model and internally validated using the validation set with an area under the receiver operating characteristic curve (AUROC) of 0.775. Preoperative factors that were independent predictors of AL were cardiovascular comorbidity (previous MI, peripheral vascular disease, previous stroke) and chronic obstructive pulmonary disease (COPD). This was converted to a risk scoring model but when internally validated the AUROC showed insufficient predictive ability (0.618).

Conclusions
The present risk scoring model provides an internally validated tool to estimate a patient's risk of CN preoperatively. This could be used to inform preoperative counselling and guide postoperative management. External validation is required to further assess the predictive ability of this score. Despite a large dataset, AL proves difficult to predict using preoperative factors.
OGC O08 Endoscopic surveillance alone is feasible and safe in type I gastric neuroendocrine neoplasms less than 10mm in diameter
Authors: Exarchou Klaire , Hu Haiyi , Stephens Nathan A , Moore Andrew R , Kelly Mark , Lamarca Angela , Mansoor Wasat , Hubner Richard , McNamara Mairead G , Smart Howard , Howes Nathan R , Valle Juan W , Pritchard D Mark 
Published: December 2022

Abstract

Background
Type I gastric neuroendocrine neoplasms (g-NENs) have a low risk of metastasis and a generally favourable prognosis. Patients with small type I g-NENs (≤10mm) frequently require no treatment, whereas those with larger polyps usually undergo resection. We evaluated the safety and outcomes of endoscopic surveillance after no initial treatment in selected patients with type I g-NENs.

Methods
Retrospective analysis of type I g-NEN patients across two European Neuroendocrine Tumour Society Centers of Excellence 2003–2019.

Results
Following initial assessment, 87 of 115 patients with type I g-NEN (75 with polyps ≤10mm) received no initial treatment and underwent endoscopic surveillance. 79/87 (91%) demonstrated no clinically meaningful change in tumour size or grade over a median 62 month follow up. Only two patients developed NEN progression that required a change in management and two other patients developed gastric adenocarcinoma/high grade dysplasia; all four initially had ≥11mm g-NENs.

Conclusions
Patients with ≤10mm type I g-NENs were unlikely to develop clinically significant tumour progression and in most cases, resection was not needed. The endoscopic surveillance interval could therefore potentially be safely increased to every 2–3 years in such patients. However, lifelong surveillance is still advocated due to the additional risk of developing gastric adenocarcinoma.
BS P01 Obesity – the last bastion of prejudice and stigma in the NHS?
Authors: Sokhal Balamrit , Menon S P K , Oputa S , Nanthakumar Nakulan , Ridwan Rahman Mohammed , Fabgemi Ona-Omovefe , Rao Vittal 
Published: December 2022

Abstract

Background
There is anecdotal evidence to suggest that patients with obesity face stigma in the NHS

Methods
A multiple-choice survey was sent out to consultants in a university teaching hospital with an established bariatric surgery unit. Respondents provided information on demographics and perceptions of obesity and bariatric surgery. Results were presented as frequencies and this was analysed.

Results
There were 167 consultant respondents with M:F = 114:53. 58% belonged to medical speciality and the rest belonged to the surgical speciality. 90% had over 10 years of NHS experience. 46.7% were in the normal BMI range and 3.5% had BMI 35 and above. 1.8% were not aware that obesity is classified as a disease. 42.5% felt that obesity is a self-inflicted disease. 73.4% agreed that bariatric surgery should be funded by the NHS, but 12% disagreed. 4.2% were of the opinion that bariatric surgery is a waste of money. 97% agreed that bariatric surgery resulted in weight loss and resolution of comorbidities.

Conclusions
There is a significant negative perception that obesity is a self inflicted life style disease even amongst the consultant work force reinforcing the premise that perhaps obesity is the last bastion of prejudice in the NHS.
BS P03 Safety of Laparoscopic Cholecystectomy in patients with BMI &gt; 35 kg/m2 without preoperative screening for Obstructive Sleep Apnoea
Authors: Lee Shiela , Salman Mohamed , Chong Eric , Mahawar Kamal 
Published: December 2022

Abstract

Background
Preoperative Obstructive Sleep Apnoea (OSA) screening, followed by sleep studies as indicated, is commonly performed for patients undergoing bariatric surgery in our hospital but not for patients with similar weight undergoing other surgeries such as laparoscopic cholecystectomy. The purpose of this audit was to understand if laparoscopic cholecystectomy can be performed safely in patients with a Body Mass Index (BMI) ≥35 kg/m2 without such screening.

Methods
Patients with a BMI ≥ 35 kg/m2 undergoing elective laparoscopic cholecystectomy between 2nd May 2014 and 4th April 2022 were included. Patients with known OSA were excluded and no patients were referred for sleep studies. Data on patient demographics, co-morbidities, and any intraoperative or postoperative surgical complications were extracted and analysed. Univariate associations between different preoperative and operative variables and 30-day morbidity were studied using the Fisher's exact test.

Results
A total of 434 patients were included in the audit (64 male, 370 female). The mean age was 49 +/- 15 years. The mean weight and BMI were 110 +/- 20 kg (range 70–79kg) and 37 +/- 6 kg/m2 respectively. The mean operating time was 70 +/- 31 minutes (median=62). Approximately, 92% (398/434) had a day case procedure. The readmission rate at 30-day was 1% (5/434). There were no intraoperative complications. 17 patients had post-operative complications including deep vein thrombosis (n=2), leak in transverse colon secondary to cholecysto-colic fistula (n=1), wound infection (n=9), bile leak and post-op ERCP (n=3), common bile duct stone requiring ERCP (n=1) and pneumonia (n=1). No patients required ITU or HDU admission for further organ support.
The 30-day mortality rate was 0% (0/434) while the 30-day morbidity rate was 3.9% (17/434). ASA grade, previous abdominal surgery, hypertension, diabetes, dyslipidemia, smoking history, chronic obstructive pulmonary disease, ischemic heart disease, fatty liver disease, preoperative liver reducing diet, number of ports, and conversion to laparotomy were not associated with increased 30-day morbidity rate (p&lt;0.05) on univariate analysis. Higher BMI values (≥40 and ≥50 kg/m2) were also not associated with increased 30-day morbidity rate (p&lt;0.05).

Conclusions
This audit demonstrated that laparoscopic cholecystectomy can be performed safely without the need for preoperative sleep studies in patients with BMI ≥35 kg/m2.
BS P05 Laparoscopic repair of internal hernia post Roux-en-Y Gastric Bypass: Our tricks and technique
Authors: Elshaer Ahmed , Gouda Mohammed 
Published: December 2022

Abstract

Background
The incidence of internal herniation (IH) post Roux-en-Y gastric bypass (RYGB) is variable across literature (0.5–11%). This may be partially related to the difference in the operative techniques of RYGB. Routine closure of mesenteric and Petersen's defects has shown noticeable decline in the incidence of IH over last few years. Nevertheless, it didn't prevent the development of IH at long-term follow up.

Methods
We describe a video of a case with a large non-obstructing mesenteric internal hernia post RYGB. A 33 years old female patient presented to our bariatric clinic with recurrent attacks of post-prandial abdominal pain over 6 months. She had RYGB 2.5 years before this presentation, with EWL of 65%. Of note, the mesenteric and Petersen's defects were closed in the original RYGB operation. CT scan showed suspicious findings of internal herniation without obstructing signs. Patient had a laparoscopic exploration which showed a large internal herniation through mesenteric defect containing more than two thirds of bowel length. Closure of the defect was done by a purse string technique using non-absorbable prolene 2/0 stitch after reduction of the bowel. Patient had an uneventful postoperative recovery. She denied any further attacks of abdominal pain at her follow up till 6 months postoperatively.

Conclusions
Diagnosis of non-obstructing internal herniation post RYGB is very challenging. Low threshold for laparoscopic exploration in suspicious cases of remittent abdominal pain is highly recommended. CT scan can't rule out IH completely due to its intermittent nature. Laparoscopic repair remains the optimal approach, even in the large IH, with favourable outcomes. Appropriate identification of the bowel configuration is the key step in such procedure.
OGBN P03 Per oral endoscopic myotomy (POEM) for primary achalasia: single-centre, retrospective analysis of 128 patients
Authors: Theophilidou Elena , Catton James 
Published: December 2022

Abstract

Background
Achalasia is a neurodegenerative motility disorder of the oesophagus, presenting with the main symptoms of dysphagia, weight loss, chest pain, and regurgitation. Surgical myotomy is considered the gold standard treatment. However, peroral endoscopic myotomy (POEM) seems to be a safe and effective alternative option which was introduced in 2008. POEM is a procedure performed endoscopically, which allows transection of the muscular fibres of the distal oesophagus and of the lower oesophageal sphincter. In our centre POEM has become a more frequent management option to treat primary achalasia when compared to surgical myotomy. The aim of the study is to analyse the outcomes from a single centre experience.

Methods
From June 2015 to May 2022, 128 patients underwent a POEM procedure to treat primary achalasia. We performed a retrospective analysis focusing on short term outcomes.

Results
All 128 patients underwent gastroscopy and manometry as part of the pre-operative workup to diagnose achalasia. Out of the 128 patients, 66 (52%) were women with age ranging from 17 to 79. BMI values ranged from 17 to 42. At 3/128 occasions the procedure was abandoned due to technical difficulty with all 3 patients at the early days of performing POEM highlighting the learning curve of the procedure. 6/128 patients had ongoing symptoms of achalasia post POEM and went on to have a laparoscopic Heller's myotomy. Median length of stay is 2 days (1–11). 6/128 had Clavien Dindo complications class 2 and 2/128 patients required aspiration of peumoperitoneum intra-op and one patient requiring chest drain insertion for surgical emphysema. 15/128 patients had a post-operative water soluble contrast swallow study to exclude leak following challenging cases or concerns for perforation. The median Eckardt score at last follow-up decreased from 7 to 1.

Conclusions
Our results show that POEM is a safe procedure to treat primary achalasia with minimal complications and preferable outcomes for patients in terms of symptom control. It can performed safely by experienced oesophageal surgeons and there are very good short-term outcomes. In our unit POEM is the primary treatment modality for achalasia.