bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP6.1.2 Endoscopic versus Laparoscopic Surgical Management of Achalasia: A Decision Analysis
Authors: Bradley Alison , Sayers Anna , Chin Mei Ying , Webb Hannah , Basu Sinjini , Buter Anton 
Published: November 2022

Abstract

Aims
To compare achalasia treatment outcomes at one and two years post intervention.

Methods
A decision-tree model was populated with data from 36 randomised controlled trials to compare: pneumatic dilation, botulinum toxin injection, Heller myotomy (+/- Dor or Toupet), Dor and peroral endoscopic myotomy (POEM).
Freeman-Tukey arcsine square root transformation under random effects model, to account for heterogeneity, was used to calculate weighted pooled model transition probabilities. Utility was 1, 0.5 and 0 for treatment success without significant complication, success with significant complications and treatment failure respectively. Deterministic sensitivity analysis and Monte Carlo Probabilistic Sensitivity Analysis (PSA) set to 10000 iterations tested model uncertainty.

Results
Laparoscopic Heller myotomy had marginally superior utility over POEM but only if the risk of significant complications remained less than 7.2% and 7.9% at one and two years respectively.

Conclusion
Superior treatment selection depends on individual risk of complications. Future research should therefore focus on personalised risk stratification and cost-effectiveness implications.
SP6.1.9 Long-term Impact of Mini-Gastric Bypass on Inflammatory Cytokinesin Cohort of Morbidly Obese Patients: a Prospective Study
Authors: Salman Mohamed , Noureldin Khaled , Issa Mohamed , Tourky Mohamed , Bisheet George 
Published: November 2022

Abstract
Bariatric surgery has become a wide world popular surgery. Evolution in its techniques is progressive to achieve best outcomes. Purpose One anastomosis gastric bypass (OAGB) is a promising bariatric procedure. We performed this study to evaluate the changes in a group of inflammatory cytokines 12 months after OAGB.

Methods
A single-arm prospective study was conducted on obese patients who underwent OAGB. Serum levels of the following adipocytokines were monitored pre- and 12 months postoperatively: adiponectin, leptin, interleukin 6 (IL-6), interleukin 8 (IL-8) levels, tumor necrosis factor-alpha (TNF-α), serum amyloid A (SAA), high-sensitivity C-reactive protein (hs-CRP), and monocyte chemotactic protein 1 (MCP-1).

Results
A total of 62 patients were included with a mean age of 43.9 ± 6.8 years old. Serum adiponectin increased significantly from7.64 ± 0.29 to 8.76 ± 0.42 μg/mL 12 months after the operation (p &lt; 0.001). hs-CRP and IL-6 decreased significantly 12 months after the OAGB from 3323.35 ± 643.4 ng/mL and 3.72 ± 7.7 pg/mL to 1376.81 ± 609.4 ng/mL and 3.64 ± 6.9 pg/mL, respectively (p &lt; 0.001). The MCP-1 showed significant increase in its level after OAGB as well (p = 0.014). In contrary, there were no significant changes in serum levels of IL-8 (p = 0.12) and TNF-α (p = 0.84) 12 months after the operation. The correlation analysis showed significant correlations between initial body mass index (BMI) with serum adiponectin, IL-8, and serum SAA.

Conclusion
OAGB can significantly impact the inflammatory cytokine profile in obese patients with possible subsequent protection from obesity-related comorbidities such as insulin resistance, cardiovascular diseases, and certain cancers.
SP7.5 Psychomotor assessments of fundamental ability are associated with the future operative performance of surgical trainees
Authors: Toale Conor , Ryan Donncha M , Doherty Eva , Traynor Oscar J , Morris Marie , Kavanagh Dara O 
Published: November 2022

Abstract

Introduction
Assessments of visuospatial, psychomotor and perceptual ability correlate with simulated operative performance. This study investigates the association between fundamental technical ability and future operative performance as measured through both in-theatre and simulation-based assessments.

Methods
Core surgical trainees in the Republic of Ireland recruited from 2016–2019 participated in validated assessments of fundamental technical ability; Pictorial Surface Orientation (PicSOr) testing of perceptual ability, ‘paper-based’ visuospatial aptitude assessments, and psychomotor testing using a grooved pegboard. Operative performance was assessed using the in-theatre Supervised Structured Assessment of Operative Performance (SSAOP) tool, and Operative Surgical Skill (OSS) assessments (multi-station simulation-based assessments) performed over a 2-year core training period. SSAOP assessments were scored using a 15-point checklist and a global 5-point Operative Performance score. Univariate (Pearson) correlations and multiple linear regression were used to explore the association between fundamental ability and operative performance, controlled for both operative experience and centile scores from the trainee's undergraduate medical degree.

Results
Aggregated fundamental ability scores strongly correlated with performance in all submitted SSAOP assessments using the Total Checklist score (B = 0.75, t(168) = 3.17, p = 0.002) and weakly correlated with Overall Performance scores (B = 0.04, t(168) = 3.16, p = 0.002), independent of operative experience and centile scores. Fundamental ability scores were also predictive of OSS assessment scores on multivariate analysis (B = 0.219, t(168) = 2.22, p = 0.03).

Conclusion
Fundamental technical ability is predictive of future performance in both in-theatre workplace-based assessments of operative skill and simulation-based assessments of operative performance.
SP8.1.1 Emergency Vs Elective Common Bile Duct Exploration, A District General Hospital Experience over 6 years
Authors: Al-Ardah Mahmoud , Barnett Rebecca E , Rottenburg Hannah , Clarke Michael , clark James , Finlay Ian 
Published: November 2022

Abstract

Introduction
Laparoscopic Common bile duct exploration (LCBDE) is a relatively new approach for clearing choledocholithiasis. The aim of this study is to assess the feasibility of this approach to clearing CBD stones in an emergency setting.

Methods
Retrospective data collection and analysis was carried out for 207 consecutive cases of LCBDE performed over 6 years (2015–2020). The patients were divided into two groups according to the operation performed as an emergency or elective. We compared demographics, perioperative data, post-operative complications, and outcomes.

Results
207 cases of LCBDE were performed during the time period. 122 performed as an emergency, and 85 on an elective list. Of the emergency cases, 37 performed because of cholangitis either mild or moderate in severity according to Tokyo grading system.
Ninety-six percent of the emergency cases and 94.1% of the elective cases were completed laparoscopically. Length of stay post-operatively was 3.3 +6.3 days in the emergency and 3.5 +4.6 days after elective.
Successful clearance achieved at the end of the operation in 99% of the patients in the emergency group, clearance failed in one case. In the elective group 100% of the patients has a successful clearance at the end of the operation.
Twelve patients (emergency) and 8 patients of the elective cases required post-operative ERCP to manage retained stones, recurrent stones or bile leak (p=0.921). Three patient required re-operation for post operative complications in each group.

Conclusion
Common bile duct exploration in emergency settings is feasible, with high success rate if performed by surgeons with advanced laparoscopic biliary skills.
SP8.1.2 Group and Saves for Laparoscopic Cholecystectomies: An Unnecessary Expense?
Authors: Cole Kirsty , Jamnadass Enakshee , Ward James , Hou David 
Published: November 2022

Abstract

Aims
The aim of this study was to analyse the necessity of routine group and saves (G+S) in patients undergoing laparoscopic cholecystectomies and to establish whether it would be safe to cease this practice. In doing so, we aim to reduce financial burden and workload, whilst maintaining safe clinical outcomes.

Methods
This was a retrospective study into all consecutive patients that underwent an elective or emergency laparoscopic cholecystectomy in Royal Hampshire County Hospital (RHCH) from May 2019 - May 2021. IT systems and clinical notes were analysed to identify the quantity of pre-operative G+S samples sent, and the proportion of patients that required a postoperative blood transfusion.

Results
Over 24 months, 427 laparoscopic cholecystectomies were performed in RHCH, 70% of which were elective. In total, 682 G+S samples were processed (1.6/patient), resulting in a cost of £16504. Two patients received a postoperative blood transfusion (0.5%). One of these patients presented with an UGI bleed, whilst the other presented with a haemolytic crisis. They were therefore predictable, pre-operative conditions, for which a post-operative transfusion had been planned prior to surgery.

Conclusion
In conclusion, this study suggests that performing routine G+S for all laparoscopic cholecystectomy patients has created an unnecessary workload and financial burden on this small DGH. Furthermore, during this 24 months, this practice had no clinical advantage. We therefore advise that sending pre-operative G+S samples should be a clinical decision made on a case by case basis, rather than a default for all patients.
SP8.2.6 Risk Prediction in Emergency Giant Hiatus and Diaphragmatic Hernia Repairs
Authors: Alasmar Mohamed , Moore Eleanor , McKechnie Iona , Chaparala Ram 
Published: November 2022

Abstract

Aims
Emergency presentation of giant hiatus and diaphragmatic hernias are associated with significant morbidity and mortality. The preoperative risk prediction tools not only can help clinicians stratify risk, but they can also be valuable tools to outline surgical risks to patients and families. This study aimed to evaluate the suitability of different risk prediction models when predicting morbidity and mortality in emergency giant hiatus and diaphragmatic hernia repairs.

Methods
This was a retrospective cohort study of all emergency hiatus and diaphragmatic hernia repairs at a tertiary upper gastrointestinal centre from 2010 to 2021. We compared the outcomes to the predicted mortality and morbidity of different risk prediction models. The mortality models SORT, NELA and ACS-NSQIP were compared using the area under the curve (AUC). We evaluated morbidity by calculating the comprehensive complication index (CCI). Using Spearman correlation, CCI was compared to P-POSSUM and ACS-NSQIP predicted morbidity.

Results
108 patients were included in the analysis. The 30-day mortality rate was 6.93%. ACS-NSQIP had the highest predictive power for mortality (AUC ¼ 0.845) in comparison to NELA (AUC¼0.809) and SORT (AUC ¼ 0.740). Both ACS-NSQIP and P-POSSUM showed moderate correlation to CCI (rho ¼ 0.489, p &lt; 0.001 and 0.446, p &lt; 0.001 respectively).

Conclusions
ACS-NSQIP is a better predictor of both mortality and morbidity in emergency giant hiatus and diaphragmatic hernia repairs when compared to NELA, P-POSSUM and SORT. Multi-centre prospective studies could be used to validate these findings. ACS-NSQIP may have a role in pre-assessment and consenting emergency giant hiatus and diaphragmatic hernia repairs.
SP10.1.1 A retrospective study: Rectal foreign bodies, enter at your own risk…
Authors: Chowdhury Ashim , Havelka Eva , O’Farrell Eoin , Pangeni Anang , Shrestha Ashish Kiran 
Published: November 2022

Abstract

Aims
Entrapped rectal foreign bodies (FB) are being encountered by acute surgical teams with increasing frequency and can be a challenge to manage. This study aims to highlight typical patient demographics, risk factors for presentation and management options for these patients.

Methods
Between 2017 and 2021, 29 cases of rectal FB were diagnosed and managed at East Kent Hospital University Foundation trust. Retrospective data taken from theatre directory and electronic notes was used to audit patient demographics, co-morbidities, the type of foreign body and the extraction technique.

Results
The majority of patients were male (87%). The patient's age ranged from 15 to 78 years, with a median age of 48 years. In the majority of cases, the FB had become entrapped during sexual activity. Nineteen patients (65%) underwent examination under GA for removal, seven patients (24%) were manually evacuated and three required a laparotomy (10.3%). Nine patients (31%) had a history of known mental health problems. The most common FB removed was a roll-on deodorant (n=5).

Conclusion
Cases of rectal FB's needing surgical management typically involve male patients in their 40's. While a small proportion can have manual evacuation, the majority require examination under anesthetic and in some cases a laparotomy. While a larger study would be required for significance, it appears a history of mental health problems may predispose patients to presenting with this problem. Patients present with a wide range of foreign body type, typically items commonly found in the home, the most common being roll on deodorant.
SP10.1.10 Management of Acute Sigmoid Volvulus in a Single Scottish Health Board
Authors: May Victoria , Drever Sara Katherine , Ramsay George 
Published: November 2022

Abstract

Aim
The Emergency General Surgery guidelines from the ACPGBI were recently published and recommend that definitive management should be planned on index admission with sigmoid volvulus. However, the evidence base for these recommendations was low. We aim assess the current practice of Sigmoid Volvulus (SV) in a Single Scottish Health board.

Method
A retrospective review of patients with acute SV managed at two hospitals between 2011 and 2021 was conducted. Individuals were identified through inpatient coding and case notes reviewed electronically. Operative intervention, colonoscopic decompression and short and long term outcomes were noted.

Results
Of 105 patients treated, 41 were female. The mean age at presentation was 73.2 (range: 38–94 years). In total, 70 patients (66.7%) underwent decompression alone and 35 (33.3%) were treated with surgical intervention. There was no difference in mean age, number of co-morbidities and number of previous operations between the two groups. Of the decompression group, 35 (50%) presented on a single occasion. However, the mean number of re-presentations was 3.3 (range 2–29) and the mean time to re-presentation was 136.5 days (range 5–1224 days). There were no recorded inpatient deaths following surgical intervention.

Conclusion
The most common method of acute SV management has been decompression on its own. There were no differences observed in patient demographics between the intervention groups, suggesting that there are no set criteria to determine method of intervention. However, representation remains commonplace and operative intervention had few complications indicating a likely required increase in definitive surgical approaches.
TU1.5 Endoscopic electroporation for inoperable oesophagogastric cancer: Preliminary results from a phase II clinical trial (The VECTOR Trial)
Authors: Jackson Andrew , James Eleanor , Vohra Ravinder , Humes David , Parsons Simon 
Published: November 2022

Abstract

Aims
Electrochemotherapy (ECT) combines the use of low-dose chemotherapy with reversible electroporation to increase intracellular uptake of chemotherapeutic agents and improve tumoral cytotoxicity. Although a well-established treatment modality in primary skin and cutaneous metastases, the effects of ECT in the treatment of advanced oesophagogastric cancer are unknown. Development of the endoVE/ePORE system now allows endoscopic delivery of ECT.
We aim to recruit thirty patients to the VECTOR trial to assess the efficacy of endoscopic ECT in the local treatment of inoperable oesophagogastric cancer.

Methods
The study began recruitment in March 2020. Patients undergo a single treatment of endoscopic ECT alongside a dose of intravenous Bleomycin. Validated dysphagia and QoL scores (Ogilvie, EORTC QLQ-C30/ OES18) are used to assess symptomatic response to treatment. Local tumour response is assessed with interval gastroscopy and cross-sectional imaging.

Results
Six males and one female with a mean age of 71 years (41–88) have received endoscopic ECT.Four patients had received oncological therapy prior to enrolment. The mean procedural time was 22 minutes.All patients were discharged within 24 hours of treatment.Over 50% of patients reported significant improvements in their dysphagia score at 6-week follow-up with concomitant improvement in their QoL metrics.

Conclusions
Early experience of endoscopic ECT is safe, well tolerated and can be performed in the endoscopy suite with sedation and analgesia. Improvements in patients’ symptomatology are promising and may indicate this as an alternative to stenting.We are yet to demonstrate favourable tumour response on follow up imaging and endoscopy.Careful patient selection is key to negate post procedural complications.
TU1.7 The correlation between BITE score and weight outcomes in Mini/One Anastomosis Gastric Bypass patients – an update with 24-month post-operative results
Authors: Gurunath Tharun Muthu , Edwards Olivia , Sufi Pratik , Parmar Chetan 
Published: November 2022

Abstract

Background
The Bulimic Investigatory Test, Edinburgh (BITE) self-report questionnaire is used to assess the risk of bulimic and binge eating habits in bariatric patients preoperatively. This study aimed to investigate the correlation between preoperative BITE scores and weight loss at 3, 6, 12, 18 and 24 months follow up in patients with Mini-Gastric Bypass (MGB-OAGB).

Method
Consecutive patients who received MGB-OAGB between 2016–2018 completed the BITE questionnaire at initial assessment and were included in this prospective study. Baseline demographics were measured. Excess body weight loss (%EBWL) and total weight loss (%TWL) were calculated on the day of surgery and at 3, 6, 12, 18 and 24 months follow up.

Results
120 patients were eligible with an average age of 43 (± 10.84) years. 21.67% (n=26) had high BITE scores (≥20), 44.17% (n=53) had medium BITE scores (10–19), and 34.17% (n=41) had low BITE scores (≤9). Low and Medium BITE groups had similar outcomes at each follow up. The low BITE group had greater %EBWL and %TWL compared to high BITE group across all the follow ups, however this difference was not significant. There were no reoperations or mortality.

Conclusion
MGB-OAGB results in good weight loss at 3, 6 and 12 months post-operatively independent of BITE scores. There was no significant difference between pre-operative binge eating behaviours on post-operative weight outcomes. To extend the study, further research between the effect of pre-operative psychological input on weight outcomes could be investigated. Going forward, comparative study in patients with RYGB and sleeve gastrectomy would be recommended.
TU1.10 Oesophageal/ Oesophagogastric Junction Cancer: EUS Role Revisited
Authors: Viswanath Nakul Gokhare , Bohra Ashok 
Published: November 2022

Abstract

Introduction
Oesophageal and Oesophago-gastric junctional (OGJ) cancer remains a challenge both from the perspective of early diagnosis, prompt staging and subsequent treatment. The prognosis of these cancers is directly related to the stage of the disease at diagnosis. CT scan followed by Endoscopic ultrasound (EUS) are investigations which help with the T and N staging. In conjunction with staging tools like PET and laparoscopy there is a resultant delay with frequent breaching of treatment targets. Reducing the number of investigations potentially avoids delays in the management pathway.

Methods
We conducted a retrospective audit on patients who have had oesophageal cancer resections from 2017 to 2021. We compared the accuracy of the CT scan in comparison to EUS staging preoperatively with final histopathological staging. Patients who had neo-adjuvant therapy were excluded from the final histological comparisons.

Results
CT is routinely performed in all patients with oesophageal cancer. All oesophageal cancers going for treatment had EUS staging. EUS staging was found most useful for Tx and T1 stages. We did not find EUS additionally useful for T2 and T3 stages. EUS is useful for T4 stages to help exclude inoperability.

Conclusion
Modern multi-slice CT scans provide a comparable accuracy to EUS for T2 and T3. This suggests that EUS staging can be avoided for CT stage T2 and T3 cancers of the oesophagus and GOJ. This is in keeping with current NICE guidance. EUS has a role in TX, T1 and T4 cancers and can be selectively used as per other specific indications.
TU2.4 Synthesis review with meta-analysis on risk of incisional hernia following transverse versus vertical midline incision for specimen extraction in patients undergoing laparoscopic colorectal resections
Authors: Ahsan Amiya , Nour Hussameldin M , Baig Mirza K , Sains Parv , Sajid Muhammad S 
Published: November 2022

Abstract

Objective
The objective of this article is to explore the risk of incisional hernia (IH) occurrence at the site of specimen extraction following laparoscopic colorectal resection (LCR), highlighting the comparison between transverse incision versus midline vertical abdominal incision.

Method
Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases like MEBASE, MEDLINE and pubmed was performed to find all types of comparative studies reporting the incidence of IH at the specimen extraction site of transverse or vertical midline incision following LCR. The analysis of the pooled data was done using the RevMan statistical software.

Result
Twenty-five comparative studies (including 2 RCTs) on 10362 patients fulfilled the inclusion criteria. There were 4944 patIents in the transverse incision group and 5418 patients in the vertical midline incision group. In the random effects model analysis, the use of transverse incision for specimen extraction following LCR reduced the risk of IH development [odds ratio 0.30, 95% CI (0.19–0.49), z= 4.88, p=0.00001]. However, there was significant heterogeneity (Tau2 = 0.97; Chi2= 109.98, df = 24(p=0.00004; I2 = 78%) among included studies.

Conclusion
Transverse incision used for specimen extraction following LCR seems to reduce the risk of postoperative IH incidence compared to vertical midline abdominal incisions.