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Hajibandeh S, Hajibandeh S, Maw A. Purse-string skin closure versus linear skin closure in people undergoing stoma reversal. Cochrane Database Syst Rev 2024; 3:CD014763. [PMID: 38470607 PMCID: PMC10930185 DOI: 10.1002/14651858.cd014763.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Stoma reversal is associated with a relatively high risk of surgical site infection (SSI), occurring in up to 40% of cases. This may be explained by the presence of microorganisms around the stoma site, and possible contamination with the intestinal contents during the open-end manipulation of the bowel, making the stoma closure site a clean-contaminated wound. The conventional technique for stoma reversal is linear skin closure (LSC). The purse-string skin closure (PSSC) technique (circumferential skin approximation) creates a small opening in the centre of the wound, enabling free drainage of contaminants and serous fluid. This could decrease the risk of SSI compared with LSC. OBJECTIVES To assess the effects of purse-string skin closure compared with linear skin closure in people undergoing stoma reversal. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases, and three trials registers on 21 December 2022. We also checked references, searched for citations, and contacted study authors to identify additional studies. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing PSSC and LSC techniques in people undergoing closure of stoma (loop ileostomy, end ileostomy, loop colostomy, or end colostomy) created for any indication. DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible studies, extracted data, evaluated the methodological quality of the included studies, and conducted the analyses. The most clinically relevant outcomes were SSI, participant satisfaction, incisional hernia, and operative time. We calculated odds ratios (ORs) for dichotomous data and mean differences (MDs) for continuous data, each with its corresponding 95% confidence interval (CI). We used the GRADE approach to rate the certainty of the evidence. MAIN RESULTS Nine RCTs involving 757 participants were eligible for inclusion. Eight studies recruited only adults (aged 18 years and older), and one study included people aged 12 years and older. The participants underwent elective reversal of either ileostomy (82%) or colostomy (18%). We considered all studies at high risk of performance and detection bias (lack of blinding) and four studies at unclear risk of selection bias related to random sequence generation. PSSC compared with LSC likely reduces the risk of SSI (OR 0.17, 95% CI 0.09 to 0.29; I2 = 0%; 9 studies, 757 participants; moderate-certainty evidence). The anticipated absolute risk of SSI is 52 per 1000 people who have PSSC and 243 per 1000 people who have LSC. The likelihood of being very satisfied or satisfied with stoma closure may be higher amongst people who have PSSC compared with people who have LSC (100% vs 89%; OR 20.11, 95% CI 1.09 to 369.88; 2 studies, 122 participants; low-certainty evidence). The results of the analysis suggest that PSSC compared with LSC may have little or no effect on the risk of incisional hernia (OR 0.51, 95% CI 0.07 to 3.70; I2 = 49%; 4 studies, 297 participants; very low-certainty evidence) and operative time (MD -2.67 minutes, 95% CI -8.56 to 3.22; I2 = 65%; 6 studies, 460 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS PSSC compared with LSC likely reduces the risk of SSI in people undergoing reversal of stoma. People who have PSSC may be more satisfied with the result compared with people who have LSC. There may be little or no difference between the skin closure techniques in terms of incisional hernia and operative time, though the evidence for these two outcomes is very uncertain.
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Affiliation(s)
- Shahab Hajibandeh
- General Surgery, Wales Deanery, Health Education and Improvement Wales, Nantgarw, UK
| | - Shahin Hajibandeh
- Department of General Surgery, University Hospital Coventry & Warwickshire, Coventry, UK
| | - Andrew Maw
- General Surgery, Glan Clwyd Hospital, Bodelwyddan, UK
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Hajibandeh S, Hajibandeh S, Evans L, Miller B, Waterman J, Ahmad SJS, Hale J, Higgi A, Johnson B, Pearce D, Helmy AH, Naguib N, Maw A. Predictive value of Hajibandeh index in determining peritoneal contamination in acute abdomen: A cohort study and meta-analysis. World J Gastrointest Surg 2023; 15:2747-2756. [PMID: 38222004 PMCID: PMC10784831 DOI: 10.4240/wjgs.v15.i12.2747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/01/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Hajibandeh index (HI), derived from combined levels of C-reactive protein, lactate, neutrophils, lymphocytes and albumin, is a modern predictor of peritoneal contamination and mortality in patients with acute abdominal pathology. AIM To validate the performance of HI in predicting the presence and nature of peritoneal contamination in patients with acute abdominal pathology in a larger cohort study and to synthesis evidence in a systematic review and meta-analysis. METHODS The STROBE guidelines and the PRISMA statement standards were followed to conduct a cohort study (ChiCTR2200056183) and a meta-analysis (CRD42022306018), respectively. All adult patients undergoing emergency laparotomy for acute abdominal pathology were eligible. The accuracy of the HI was evaluated using receiver operating characteristic (ROC) curve analysis in the cohort study and using weighted summary area under the curve (AUC) under the fixed and random effects modelling in the meta-analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 criteria were used for methodological quality assessment of the included studies. RESULTS A total of 1437 patients were included (700 from the cohort study and 737 from the literature search). ROC curve analysis of the cohort study showed that the AUC of HI for presence of contamination, purulent contamination and feculent contamination were 0.79 [95% confidence interval (CI): 0.76-0.82, P < 0.0001], 0.76 (95%CI: 0.72-0.80, P < 0.0001), and 0.83 (95%CI: 0.79-0.86, P < 0.0001), respectively. The meta-analysis showed that the pooled AUC of HI for presence of contamination, purulent contamination and feculent contamination were 0.79 (95%CI: 0.75-0.83), 0.78 (95%CI: 0.74-0.81), and 0.80 (95%CI: 0.77-0.83), respectively. CONCLUSION The HI is a strong and accurate predictor of intraperitoneal contamination. Although the available evidence is robust, it is limited to the studies conducted by our evidence synthesis group. We encourage other researchers to validate performance of HI in predicting the presence of intraperitoneal contamination and more importantly in predicting mortality following emergency laparotomy.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Shahin Hajibandeh
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Louis Evans
- Department of General Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Bethany Miller
- Department of General Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Jennifer Waterman
- Department of General Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Suhaib JS Ahmad
- Department of General Surgery, Ysbyty Gwynedd, Bangor LL57 2PW, United Kingdom
| | - Jay Hale
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Adnan Higgi
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Bethan Johnson
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Dafydd Pearce
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Ahmed Hazem Helmy
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Nader Naguib
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Andrew Maw
- Department of General Surgery, Glan Clwyd Hospital, Rhyl LL18 5UJ, United Kingdom
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Anwer AA, Hajibandeh S, Hajibandeh S, Waterman J, Miller B, Evans L, Maw A. WE5.6 Hajibandeh index is more accurate than NELA score in predicting mortality following emergency laparotomy in patients aged over 80. Br J Surg 2022. [DOI: 10.1093/bjs/znac248.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Aims
To compare performance of the Hajibandeh Index (HI) and National Emergency Laparotomy Audit (NELA) score in predicting mortality following emergency laparotomy (EL).
Methods
In compliance with STROCSS guidelines for observational studies a cohort study was conducted. All patients who underwent EL between January 2014 and January 2021 in our centre were included. The performance of HI and NELA score in predicting 30-day and 90-day postoperative mortality were compared. The discrimination of each test was evaluated using ROC curve analysis, classification using classification table and calibration using a plotted diagram of the expected versus observed mortality rates.
Results
Analysis of 700 patients showed that the predictive performance of the HI and NELA models were comparable (AUC: 0.86 vs 0.87, P=0.557). HI was significantly better than the NELA model in predicting postoperative mortality in patients aged over 80 (AUC: 0.85 vs 0.72, P=0.0174). The performances of both tools were comparable in patients with ASA status above 3 (AUC: 0.82 vs 0.82, P=0.9775), patients with intraperitoneal contamination (AUC: 0.77 vs 0.85, P=0.0728) and patients who needed a bowel resection (AUC: 0.85 vs 0.88, P=0.2749). Both tools were comparable in terms of classification and calibration.
Conclusions
Hajibandeh index is better than the NELA score in predicting mortality following EL in patients aged over 80. Its performance is comparable to NELA for all patients, patients with ASA status above 3, patients with intraperitoneal contamination or patients who need a bowel resection. We encourage other researchers to validate HI in predicting mortality following EL.
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Affiliation(s)
- Amal Azhar Anwer
- Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board , Pontyclun , UK
| | - Shahab Hajibandeh
- General Surgery, Wales Deanery, Health Education and Improvement Wales , UK
- Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board , Pontyclun , UK
| | - Shahin Hajibandeh
- Hepatobiliary and Pancreatic Surgery and Liver transplant Unit, Queen Elizabeth Hospital , Birmingham , UK
| | - Jennifer Waterman
- Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board , Pontyclun , UK
| | - Bethany Miller
- Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board , Pontyclun , UK
| | - Louis Evans
- Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board , Pontyclun , UK
| | - Andrew Maw
- Department of General Surgery, Glan Clwyd Hospital, Betsi Cadwaladr University Health Board , Rhyl , UK
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Hajibandeh S, Hajibandeh S, Waterman J, Miller B, Johnson B, Higgi A, Hale J, Pearce D, Evans L, Satyadas T, Mansour M, Havard T, Maw A. Hajibandeh Index versus NELA score in predicting mortality following emergency laparotomy: A retrospective Cohort Study. Int J Surg 2022; 102:106645. [DOI: 10.1016/j.ijsu.2022.106645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/30/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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Hajibandeh S, Shah J, Hajibandeh S, Asim U, Purchase D, Maw A, Mansour M. Erect chest x-ray is inadequately diagnostic and falsely reassuring in assessment of abdominal visceral perforation. Radiography (Lond) 2021; 28:249-250. [PMID: 34764008 DOI: 10.1016/j.radi.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 11/26/2022]
Affiliation(s)
- S Hajibandeh
- General Surgery, Wales Deanery, Health Education and Improvement Wales, United Kingdom; Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board, Pontyclun, United Kingdom.
| | - J Shah
- Department of General Surgery, North Manchester General Hospital, North Manchester Care Organisation, Manchester, United Kingdom
| | - S Hajibandeh
- Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - U Asim
- Department of General Surgery, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, United Kingdom
| | - D Purchase
- Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board, Pontyclun, United Kingdom
| | - A Maw
- Department of General Surgery, Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl, United Kingdom
| | - M Mansour
- Department of General Surgery, North Manchester General Hospital, North Manchester Care Organisation, Manchester, United Kingdom
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Hajibandeh S, Hajibandeh S, Smart NJ, Maw A. EP.FRI.12Meta-analysis of demographic and prognostic significance of right-sided versus left-sided acute diverticulitis. Br J Surg 2021. [DOI: 10.1093/bjs/znab312.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
To compare the demographic and prognostic outcomes of right-sided versus left-sided acute colonic diverticulitis
Methods
We performed a systematic review in accordance with the PRISMA statement standards to identify all observational studies comparing demographic factors and outcomes of right-sided versus left-sided acute colonic diverticulitis. We used the ROBINS-I tool to assess the risk of bias of included studies. Random effects modelling was applied to calculate pooled outcome data.
Results
Analysis of 2933 patients from nine studies suggests that right-sided diverticulitis affects younger patients (MD:-14.16,P<0.00001) and more male patients (OR:1.33,P=0.02) compared with left-sided diverticulitis. Smoking (OR:2.23,P<0.0001), alcohol consumption (OR:1.85,P=0.002) and co-morbidity (OR:0.21,P<0.00001) were more common in patients with right-sided diverticulitis. The risk of complicated diverticulitis was lower in the right-sided group (OR:0.21,P=0.001). More patients in the right-sided diverticulitis group had modified Hinchey stage I disease (OR:10.21,P<0.0001) while more patients in the left-sided group had stage II (OR:0.19,P<0.00001), stage III (OR:0.08,P=0.009) or stage IV disease (OR:0.02,P<0.00001). Right-sided diverticulitis was associated with a lower risk of recurrence (OR:0.49,P=0.04), failure of conservative management (OR:0.14,P=0.0006), the need for emergency surgery (OR:0.13,<0.00001) and shorter length of hospital stay (MD:-1.70,P=0.02).
Conclusions
Right-sided acute colonic diverticulitis predominantly affects younger male patients compared with left-sided disease and is associated with favourable outcomes as indicated by the lower risk of complications, failure of conservative management, need for emergency surgery, recurrence, and shorter length of hospital stay. More studies are required to compare the postoperative outcomes in patients with right-sided and left-sided diverticulitis undergoing emergency surgery.
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Affiliation(s)
- Shahab Hajibandeh
- General Surgery, Wales Deanery, Health Education and Improvement Wales, UK
| | - Shahin Hajibandeh
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Neil J Smart
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Andrew Maw
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
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Hajibandeh S, Hajibandeh S, Shah J, Maw A, Mansour M, Satyadas T. TP9.2.10The risk and predictors of mortality in octogenarians undergoing emergency laparotomy: A multicentre cohort study. Br J Surg 2021. [DOI: 10.1093/bjs/znab362.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
To evaluate the risk and predictors of postoperative mortality in octogenarians undergoing emergency laparotomy.
Methods
In compliance with STROCSS guideline for observational studies, we conducted a multicentre retrospective cohort study. All consecutive patients aged over 80 with acute abdominal pathology requiring emergency laparotomy between April 2014 and August 2019 were considered eligible for inclusion. The primary outcome measure was 30-day postoperative mortality and the secondary outcome measures were in-hospital mortality and 1-year mortality. Statistical analyses included simple descriptive statistics, binary logistic regression analyses, and Kaplan–Meier survival statistics.
Results
A total of 523 octogenarians were eligible for inclusion. Emergency laparotomy in octogenarians was associated with 21.8% (95% CI 18.3-25.6%) 30-day postoperative mortality, 22.6% (95% CI 19.0-26.4%) in-hospital mortality, and 40.2% (95% CI 35.9-44.5%) 1-year mortality. Binary logistic regression analysis identified ASA status (OR: 2.49,95% CI 1.82-3.38,P<0.0001) and peritoneal contamination (OR: 2.00, 95% CI 1.30-3.08, P = 0.002) as predictors of 30-day postoperative mortality. The ASA status (OR: 1.92,95% CI 1.50-2.46,P<0.0001), peritoneal contamination (OR: 1.57,95% CI 1.07-2.48,P=0.020) and presence of malignancy (OR: 2.06,95% CI 1.36-3.10,P=0.001) were predictors of 1-year mortality. Log-rank test showed significant difference in postoperative survival rates among patients with different ASA status (P < 0.0001) and between patients with and without peritoneal contamination (P = 0.0011).
Conclusions
Emergency laparotomies in patients older than 80 years with ASA status more than 3 in the presence of peritoneal contamination carries a high risk of immediate postoperative and 1-year mortality. There is a need to incorporate modern prognosticators into the available preoperative mortality risk assessment tools.
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Affiliation(s)
- Shahab Hajibandeh
- General Surgery, Wales Deanery, Health Education and Improvement Wales, United Kingdom
| | - Shahin Hajibandeh
- Department of General Surgery, Hereford County Hospital, Hereford, United Kingdom
| | - Jigar Shah
- Department of General Surgery, North Manchester General Hospital, Manchester, United Kingdom
| | - Andrew Maw
- Department of General Surgery, Glan Clwyd Hospital, Rhyl, United Kingdom
| | - Moustafa Mansour
- Department of General Surgery, North Manchester General Hospital, Manchester, United Kingdom
| | - Thomas Satyadas
- Department of Hepatobiliary and Pancreatic Surgery, Manchester Royal Infirmary Hospital, Manchester, United Kingdom
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Hajibandeh S, Hajibandeh S, Hussain I, Zubairu A, Akbar F, Maw A. Comparison of extended right hemicolectomy, left hemicolectomy and segmental colectomy for splenic flexure colon cancer: a systematic review and meta-analysis. Colorectal Dis 2020; 22:1885-1907. [PMID: 32757361 DOI: 10.1111/codi.15292] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022]
Abstract
AIM The aim of this work was to compare the outcomes of extended right hemicolectomy (ERH), left hemicolectomy (LH) and segmental colectomy (SC) for the surgical management of splenic flexure tumours. METHOD In compliance with PRISMA statement standards, a systematic review was performed to identify all studies comparing outcomes of ERH, LH and SC for the surgical management of splenic flexure tumours. Primary outcomes included anastomotic leakage and all postoperative complications. The secondary outcomes included operative time, R0 resection, number of harvested lymph nodes, > 12 harvested lymph nodes, severe complications, postoperative mortality, paralytic ileus, wound infection, pancreatic fistula, intra-abdominal abscess, need for reoperation, length of hospital stay, 5-year overall survival and 5-year disease-free survival. The ROBINS-I tool and GRADE system were used to assess the risk of bias and certainty of evidence, respectively. RESULTS Analysis of 956 patients from seven observational studies showed that ERH was associated with more paralytic ileus than LH (OR 2.74, P = 0.002) and SC (OR 6.67, P < 0.0001) and the operative time was shorter in SC than in ERH (mean difference 25.48, P < 0.0001) and LH (mean difference -17.94, P = 0.0002). There were no differences between ERH, LH and SC in terms of anastomotic leakage, postoperative complications, R0 resection, severe complications, postoperative mortality, wound infection, pancreatic fistula, intra-abdominal abscess, need for reoperation, length of hospital stay, > 12 harvested lymph nodes, 5-year overall survival and 5-year disease-free survival. CONCLUSIONS The available evidence, limited to observational studies, suggests that there is no difference between ERH, LH and SC in terms of postoperative morbidity and mortality, lymph node yield and cancer survival. Randomized controlled trials are required for definite conclusions.
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Affiliation(s)
- S Hajibandeh
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
| | - S Hajibandeh
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, UK
| | - I Hussain
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - A Zubairu
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - F Akbar
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
| | - A Maw
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
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Hajibandeh S, Hajibandeh S, Hussain I, Zubairu A, Akbar F, Maw A. Comparison of treatment strategies for splenic flexure colon cancer: reply to Wang et al. Colorectal Dis 2020; 22:2331-2332. [PMID: 32867000 DOI: 10.1111/codi.15340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023]
Affiliation(s)
- S Hajibandeh
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
| | - S Hajibandeh
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, UK
| | - I Hussain
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - A Zubairu
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - F Akbar
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
| | - A Maw
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
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Hajibandeh S, Hajibandeh S, Smart NJ, Maw A. Meta-analysis of the demographic and prognostic significance of right-sided versus left-sided acute diverticulitis. Colorectal Dis 2020; 22:1908-1923. [PMID: 32854157 DOI: 10.1111/codi.15328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/14/2020] [Indexed: 12/26/2022]
Abstract
AIM The aim of this work was to compare demographic factors, outcomes and prognosis for right-sided versus left-sided acute colonic diverticulitis. METHOD We searched MEDLINE, CINAHL, EMBASE, CENTRAL, Scopus and unpublished literature to identify all observational studies comparing demographic factors and outcomes of right-sided versus left-sided acute colonic diverticulitis (PROSPERO registration number CRD42020180075). We used the QUIPS tool to assess the risk of bias of included studies. Random effects modelling was applied to calculate pooled outcome data. RESULTS Analysis of 2933 patients from nine studies suggests that right-sided diverticulitis affects younger patients [mean difference (MD) -14.16 (-17.19, -11.14), P < 0.00001] and more male patients [odds ratio (OR) 1.33 (1.04, 1.71), P = 0.02] compared with left-sided diverticulitis. Smoking [OR 2.23 (1.50, 3.32), P < 0.0001], alcohol consumption [OR 1.85 (1.26, 2.71), P = 0.002] and comorbidity [OR 0.21 (0.15, 0.30), P < 0.00001] were more common in patients with right-sided diverticulitis. The risk of complicated diverticulitis was lower in the right-sided group [OR 0.21 (0.08, 0.55), P = 0.001]. More patients in the right-sided diverticulitis group had modified Hinchey Stage I disease [OR 10.21 (3.34, 31.22), P < 0.0001] while more patients in the left-sided group had Stage II [OR 0.19 (0.10, 0.38), P < 0.00001], Stage III [OR 0.08 (0.01, 0.54), P = 0.009] or Stage IV disease [OR 0.02 (0.00, 0.08), P < 0.00001]. Right-sided diverticulitis was associated with a lower risk of recurrence [OR 0.49 (0.25, 0.98), P = 0.04], failure of conservative management [OR 0.14 (0.04, 0.43), P = 0.0006], the need for emergency surgery [OR 0.13 (0.05, 0.36), P < 0.00001] and a shorter length of hospital stay [MD -1.70 (-3.08, -0.33), P = 0.02]. CONCLUSION Right-sided acute diverticulitis predominantly affects younger male patients compared with left-sided disease and is associated with favourable outcomes as indicated by the lower risk of complications, failure of conservative management, need for emergency surgery, recurrence and shorter length of hospital stay. More studies are required to compare the postoperative outcomes in patients with right-sided and left-sided diverticulitis undergoing emergency surgery.
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Affiliation(s)
- S Hajibandeh
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
| | - S Hajibandeh
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - N J Smart
- Department of Colorectal and General Surgery, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - A Maw
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
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Gala T, Wickramasekara N, Maw A. PPE for mobile phones? A practical technical tip for the hygienic use of a mobile phone by healthcare professionals during the COVID-19 pandemic. Ann R Coll Surg Engl 2020; 102:552-553. [PMID: 32803992 DOI: 10.1308/rcsann.2020.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- T Gala
- Glan Clwyd Hospital, Bodelwyddan, UK
| | | | - A Maw
- Glan Clwyd Hospital, Bodelwyddan, UK
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Hajibandeh S, Hajibandeh S, Maw A. The Available Evidence on Outcomes of Early versus Routine Stoma Closure Following Colorectal Resection Is Subject to Type 1 and 2 Errors. We Need More Randomised Controlled Trials. Surg Innov 2020; 28:163-165. [PMID: 32709215 DOI: 10.1177/1553350620946568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Shahab Hajibandeh
- Department of Colorectal and General Surgery, 97620Glan Clwyd Hospital, UK
| | - Shahin Hajibandeh
- Department of General Surgery, 1731Sandwell and West Birmingham Hospitals NHS Trust, UK
| | - Andrew Maw
- Department of Colorectal and General Surgery, 97620Glan Clwyd Hospital, UK
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Hajibandeh S, Hajibandeh S, Maw A. Recommendations on key practical measures in laparoscopic surgery during the COVID-19 pandemic. Br J Surg 2020; 107:e316-e317. [PMID: 32644196 PMCID: PMC7361629 DOI: 10.1002/bjs.11772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/10/2022]
Affiliation(s)
- S Hajibandeh
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
| | - S Hajibandeh
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - A Maw
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
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Hajibandeh S, Hajibandeh S, Matthews J, Palmer L, Maw A. Meta-analysis of survival and functional outcomes after total mesorectal excision with or without lateral pelvic lymph node dissection in rectal cancer surgery. Surgery 2020; 168:486-496. [PMID: 32620303 DOI: 10.1016/j.surg.2020.04.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/25/2020] [Accepted: 04/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND To compare outcomes of total mesorectal excision with or without lateral pelvic lymph node dissection for the treatment of rectal cancer. METHODS The electronic data sources were explored to capture all studies comparing total mesorectal excision with and without lateral pelvic lymph node dissection in patients undergoing operation for rectal cancer. Random effects modelling was utilized for the analyses. The uncertainties associated with varying follow-up periods among the included studies were resolved by analysis of time-to-event outcomes. RESULTS Eighteen comparative studies enrolling 6,133 patients were eligible. No difference was found between the 2 groups in terms of overall survival (hazard ratio: 0.92, 95% confidence interval 0.77-1.10, P = .36, I2 = 67%), overall survival at maximum follow-up (odds ratio: 1.02, 95% confidence interval 0.83-1.25, P = .86, I2 = 22%), 5-year overall survival (odds ratio: 1.01, 95% confidence interval 0.78-1.30, P = .94, I2 = 50%), disease-free survival (hazard ratio: 1.25, 95% confidence interval 0.87-1.82, P = .23, I2 = 74%), disease-free survival at maximum follow-up (odds ratio 1.07, 95% confidence interval 0.88-1.31, P = .50, I2 = 0%), 5-year disease-free survival (odds ratio: 1.07, 95% confidence interval 0.86-1.32, P = .54, I2 = 0%), local recurrence (odds ratio: 1.01, 95% confidence interval 0.72-1.42, P = .97, I2 = 34%), distant recurrence (odds ratio: 0.96, 95% confidence interval 0.62-1.46, P = .84, I2 = 18%), and total recurrence (odds ratio: 0.97, 95% confidence interval 0.72-1.29, P = .82, I2 = 0%). Total mesorectal excision with lateral pelvic lymph node dissection resulted in longer operative time (mean difference: 116.02, 95% confidence interval 89.20-142.83, P < .00001, I2 = 68%) and higher risks of postoperative complications (odds ratio: 1.59, 95% confidence interval 1.14-2.24, P = .007, I2 = 0%), urinary dysfunction (odds ratio: 6.66, 95% confidence interval 3.31-13.39, P < .00001, I2 = 23%), and sexual dysfunction (odds ratio: 9.67, 95% confidence interval 2.38-39.26, P = .002; I2 = 51%). The results remained consistent through separate analyses for randomized trials, observational studies, and patients with or without neoadjuvant chemoradiotherapy. CONCLUSION The available evidence suggests that lateral pelvic lymph node dissection results in greater postoperative morbidity, urinary dysfunction, and sexual dysfunction without improving recurrence and survival. Further evidence is needed from randomized controlled trials to enable experts in the nerve-sparing surgical experiences and neoadjuvant therapy experience to advise on the best treatment strategies for the management of rectal cancer patients including those with possible positive nodes on pretreatment imaging.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General and Colorectal Surgery, Glan Clwyd Hospital, The Betsi Cadwaladr University Health Board, Rhyl, United Kingdom.
| | - Shahin Hajibandeh
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Joseph Matthews
- Department of General and Colorectal Surgery, Glan Clwyd Hospital, The Betsi Cadwaladr University Health Board, Rhyl, United Kingdom
| | - Lucy Palmer
- Department of General and Colorectal Surgery, Glan Clwyd Hospital, The Betsi Cadwaladr University Health Board, Rhyl, United Kingdom
| | - Andrew Maw
- Department of General and Colorectal Surgery, Glan Clwyd Hospital, The Betsi Cadwaladr University Health Board, Rhyl, United Kingdom
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Hajibandeh S, Hajibandeh S, Maw A. Routine practice needs shifting from linear to purse-string skin closure in closure of stoma sites. Int J Colorectal Dis 2020; 35:569. [PMID: 31965298 DOI: 10.1007/s00384-020-03511-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Shahab Hajibandeh
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK.
| | - Shahin Hajibandeh
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Andrew Maw
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
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Hajibandeh S, Hajibandeh S, Maw A. Diathermy versus scalpel for skin incision in patients undergoing open inguinal hernia repair: A systematic review and meta-analysis. Int J Surg 2020; 75:35-43. [PMID: 31978649 DOI: 10.1016/j.ijsu.2020.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/17/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare outcomes of diathermy and scalpel for skin incision in patients undergoing open inguinal hernia repair. METHODS We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. We conducted a search of electronic information sources to identify all randomised controlled trials (RCTs) and observational studies comparing use of diathermy and scalpel for skin incision in patients undergoing inguinal hernia repair. Surgical site infection (SSI) was the primary outcome measure. Secondary outcome measures included haematoma, seroma, visual analogue scale (VAS) pain score at 6 h, 12 h, and 24 h, and incision time. We used Cochrane risk of bias tool and ROBINS-I tool to assess the risk of bias of randomised and non-randomised studies. Fixed-effect model was applied to calculate pooled outcome data. RESULTS We identified 9 studies, 4 randomised controlled trials and 5 prospective cohort studies, enrolling a total of 830 patients. Meta-analysis of RCTs showed no difference between the diathermy and scalpel groups in terms of surgical site infection (OR: 0.77, 95% CI 0.34, 1.75, P = 0.53), seroma (OR: 0.86, 95% CI 0.29, 2.55, P = 0.78), VAS pain score at 6 h (MD: -0.10, 95% CI -0.31, 0.11, P = 0.34), 12 h (MD: -0.10, 95% CI -0.13, 0.33, P = 0.40), and 24 h (MD: 0.03, 95% CI -0.16, 0.21, P = 0.79). Use of diathermy for skin incision was associated with shorter incision time (MD: -36.00, 95% CI -47.92, -24.08, P < 0.00001) and lower risk of haematoma (OR: 0.14, 95% CI 0.03, 0.65, P = 0.01). Meta-analysis of observational studies showed no difference between the diathermy and scalpel groups in terms of surgical site infection (OR: 0.87, 95% CI 0.54, 1.39, P = 0.55), haematoma (OR 0.14, 95% CI 0.02-1.23, P = 0.08), seroma (OR: 0.86, 95% CI 0.29, 2.55, P = 0.78), VAS pain score at 6 h (MD: -0.10, 95% CI -0.44, 0.24, P = 0.56), 12 h (MD: -0.10, 95% CI -0.26, 0.46, P = 0.58), and 24 h (MD: 0.10, 95% CI -0.27, 0.47, P = 0.59). Use of diathermy for skin incision was associated with shorter incision time (MD: -39.40, 95% CI -41.02, -37.78, P < 0.00001). The results remained consistent through sensitivity analyses. The between-study heterogeneity was low and the quality of the available evidence was moderate. CONCLUSIONS There is no difference between use of diathermy and scalpel for skin incision in patients undergoing open inguinal hernia repair in terms of surgical site infection, seroma and postoperative pain. Use of diathermy for skin incision may be associated with shorter incision time and may reduce the risk of haematoma formation.
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Affiliation(s)
- Shahab Hajibandeh
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK.
| | - Shahin Hajibandeh
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Andrew Maw
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
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Nageswaran H, Maw A. The nylon-tape retraction technique for laparoscopic appendicectomy. Ann R Coll Surg Engl 2016; 98:230. [PMID: 26741667 DOI: 10.1308/rcsann.2016.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Renehan AG, Malcomson L, Emsley R, Gollins S, Maw A, Myint AS, Rooney PS, Susnerwala S, Blower A, Saunders MP, Wilson MS, Scott N, O'Dwyer ST. Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis. Lancet Oncol 2015; 17:174-183. [PMID: 26705854 DOI: 10.1016/s1470-2045(15)00467-2] [Citation(s) in RCA: 491] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Induction of a clinical complete response with chemoradiotherapy, followed by observation via a watch-and-wait approach, has emerged as a management option for patients with rectal cancer. We aimed to address the shortage of evidence regarding the safety of the watch-and-wait approach by comparing oncological outcomes between patients managed by watch and wait who achieved a clinical complete response and those who had surgical resection (standard care). METHODS Oncological Outcomes after Clinical Complete Response in Patients with Rectal Cancer (OnCoRe) was a propensity-score matched cohort analysis study, that included patients of all ages diagnosed with rectal adenocarcinoma without distant metastases who had received preoperative chemoradiotherapy (45 Gy in 25 daily fractions with concurrent fluoropyrimidine-based chemotherapy) at a tertiary cancer centre in Manchester, UK, between Jan 14, 2011, and April 15, 2013. Patients who had a clinical complete response were offered management with the watch-and-wait approach, and patients who did not have a complete clinical response were offered surgical resection if eligible. We also included patients with a clinical complete response managed by watch and wait between March 10, 2005, and Jan 21, 2015, across three neighbouring UK regional cancer centres, whose details were obtained through a registry. For comparative analyses, we derived one-to-one paired cohorts of watch and wait versus surgical resection using propensity-score matching (including T stage, age, and performance status). The primary endpoint was non-regrowth disease-free survival from the date that chemoradiotherapy was started, and secondary endpoints were overall survival, and colostomy-free survival. We used a conservative p value of less than 0·01 to indicate statistical significance in the comparative analyses. FINDINGS 259 patients were included in our Manchester tertiary cancer centre cohort, 228 of whom underwent surgical resection at referring hospitals and 31 of whom had a clinical complete response, managed by watch and wait. A further 98 patients were added to the watch-and-wait group via the registry. Of the 129 patients managed by watch and wait (median follow-up 33 months [IQR 19-43]), 44 (34%) had local regrowths (3-year actuarial rate 38% [95% CI 30-48]); 36 (88%) of 41 patients with non-metastatic local regrowths were salvaged. In the matched analyses (109 patients in each treatment group), no differences in 3-year non-regrowth disease-free survival were noted between watch and wait and surgical resection (88% [95% CI 75-94] with watch and wait vs 78% [63-87] with surgical resection; time-varying p=0·043). Similarly, no difference in 3-year overall survival was noted (96% [88-98] vs 87% [77-93]; time-varying p=0·024). By contrast, patients managed by watch and wait had significantly better 3-year colostomy-free survival than did those who had surgical resection (74% [95% CI 64-82] vs 47% [37-57]; hazard ratio 0·445 [95% CI 0·31-0·63; p<0·0001), with a 26% (95% CI 13-39) absolute difference in patients who avoided permanent colostomy at 3 years between treatment groups. INTERPRETATION A substantial proportion of patients with rectal cancer managed by watch and wait avoided major surgery and averted permanent colostomy without loss of oncological safety at 3 years. These findings should inform decision making at the outset of chemoradiotherapy. FUNDING Bowel Disease Research Foundation.
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Affiliation(s)
- Andrew G Renehan
- Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Colorectal Surgery, The Christie NHS Foundation Trust, Manchester, UK.
| | - Lee Malcomson
- Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - Andrew Maw
- North Wales Cancer Treatment Centre, Rhyl, UK
| | | | - Paul S Rooney
- Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK
| | | | - Anthony Blower
- Department of Colorectal Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Mark P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Malcolm S Wilson
- Department of Colorectal Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Nigel Scott
- Royal Preston NHS Foundation Trust, Preston, UK
| | - Sarah T O'Dwyer
- Department of Colorectal Surgery, The Christie NHS Foundation Trust, Manchester, UK
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Nageswaran H, Maw A. SILA: not necessarily the next step? Response to: acute appendicitis can be treated with single-incision laparoscopy: a systematic review of randomized controlled trials. Colorectal Dis 2015; 17:644. [PMID: 25929333 DOI: 10.1111/codi.12985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/27/2015] [Indexed: 02/08/2023]
Affiliation(s)
| | - A Maw
- Ysbyty Glan Clwyd Hospital, Wales, UK
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20
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Maw A. Peer review report 1 on “Long-term outcome for open preperitoneal mesh repair of recurrent inguinal hernia”. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tanner NC, Maw A. A novel technique for negotiation of a complex fistula-in-ano using a flexible ureteral catheter. Ann R Coll Surg Engl 2014; 96:80. [PMID: 24417843 PMCID: PMC5137671 DOI: 10.1308/rcsann.2014.96.1.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- N C Tanner
- Betsi Cadwaladr University Health Board, UK
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Restieaux M, Maw A, Broadbent R, Jackson P, Barker D, Wheeler B. Neonatal extravasation injury: prevention and management in Australia and New Zealand-a survey of current practice. BMC Pediatr 2013; 13:34. [PMID: 23497004 PMCID: PMC3599986 DOI: 10.1186/1471-2431-13-34] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/28/2013] [Indexed: 11/12/2022] Open
Abstract
Background Extravasation injury remains an important cause of iatrogenic injury in neonatal intensive care. This study aims to describe the current approach to extravasation injury (EI) prevention and management in Neonatal Intensive Care Units (NICUs) in Australia and New Zealand. Methods A literature review regarding extravasation injury in the newborn was carried out to inform questionnaire design. An internet-based survey was then conducted with the clinical directors of the 27 tertiary NICUs in Australia and New Zealand. Results The survey received a 96% response rate. Approximately two thirds of Australian and New Zealand NICUs have written protocols for prevention and management of extravasation injury. Considerable practice variation was seen for both prevention and treatment of EI. 92% of units had experienced cases of significant EI. Conclusions Australian and New Zealand tertiary neonatal units clearly recognise EI as an important cause of iatrogenic morbidity and mortality. Significant variation still exists among units with regards to guidelines for both prevention and management of EI. We recommend that neonatal staff should remain vigilant, ensuring that guidelines for the prevention and treatment of EI are available, and rigorously followed.
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Affiliation(s)
- Matthew Restieaux
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Roy N, Maw A, Stuart-Smith K. Fluid optimization guided by oesophageal Doppler significantly improves bowel perfusion. Br J Anaesth 2011; 107:1012-3. [DOI: 10.1093/bja/aer364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
INTRODUCTION Deciding to operate on high risk patients suffering catastrophic surgical emergencies can be problematic. Patients are frequently classed as American Society of Anesthesiologists (ASA) grade 5 and, as a result, aggressive but potentially lifesaving intervention is withheld. The aim of our study was to review the short-term outcomes in patients who were classed as ASA grade 5 but subsequently underwent surgery despite this and to compare the ASA scoring model to other predictors of surgical outcome. METHODS All patients undergoing emergency surgery with an ASA grade of 5 were identified. Patient demographics, indications for surgery, intraoperative findings and outcomes were recorded. In addition to the ASA scores, retrospective Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P POSSUM) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated and compared to the observed outcomes. RESULTS Nine patients (39%) survived to discharge. ASA grade was a poor predictor of outcome. P POSSUM and APACHE II scores correlated significantly with each other and with observed outcomes when predicting surgical mortality. The median stay for survivors in the intensive care unit was nine days. CONCLUSIONS In times of an ageing population, the number of patients suffering catastrophic surgical events will increase. Intervention, with little hope of a cure, a return to independent living or an acceptable quality of life, leads to unnecessary end-of-life suffering for patients and their relatives, and consumes sparse resources. The accuracy and reliability of ASA grade 5 as an outcome predictor has been questioned. P POSSUM and APACHE II scoring systems are significantly better predictors of outcome and should be used more frequently to aid surgical decision-making in high risk patients.
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Affiliation(s)
- J Horwood
- Department of General Surgery, Glan Clwyd Hospital, Rhyl, UK.
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Ballal MS, Selvachandran SN, Maw A. Use of a patient consultation questionnaire and weighted numerical scoring system for the prediction of colorectal cancer and other colorectal pathology in symptomatic patients: a prospective cohort validation study of a Welsh population. Colorectal Dis 2010; 12:407-14. [PMID: 19570067 DOI: 10.1111/j.1463-1318.2009.01984.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE There is currently no system in widespread use that accurately prioritizes colorectal referrals in symptomatic patients with an acceptable degree of sensitivity and specificity. We have validated a weighted numerical scoring system for the prioritization of such colorectal referrals in an attempt to rectify this, with detection of colorectal cancer (CRC) the primary outcome. METHOD We conducted a prospective study of symptomatic patients referred by primary care to the colorectal service in a district general hospital. A computer-generated weighted numerical score (WNS) was derived from the primary symptoms and symptom combinations. Patients underwent colorectal investigations and a final diagnosis was established. Sensitivity, specificity and accuracy of CRC detection as determined by the WNS, Department of Health (DOH) and National Institute for Health and Clinical Excellence guidelines was determined. Primary Care compliance with guidelines was analysed. RESULTS A definitive diagnosis was established in 3457 patients. One hundred and eighty-six (5.4%) had CRC. The mean score for the cancer patients (76.9, 95%CI 72-81) was significantly higher than that of non-cancer patients (52, 95%CI 52-53) P < 0.001. Receiver Operator Curve analysis demonstrates a high discriminatory power for the Patient Consultation Questionnaire (PCQ) with an area under curve of 0.76. Compliance by primary care with the nationally recommended referral guidelines was poor with only 55% and 58% compliance with DOH and National Institute for Clinical Excellence referral guidelines for suspected cancer respectively. CONCLUSION The PCQ and the WNS is an efficient, objective system that allows the accurate prioritization of colorectal referrals with a high sensitivity for cancer and other serious colorectal pathologies.
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Affiliation(s)
- M S Ballal
- Department of Surgery, Leighton Research Unit, Mid Cheshire NHS trust, Middlewhich Road, Crewe, CW1 4QJ, UK
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Abstract
INTRODUCTION The aims of this study were to examine the trends in performance of open and laparoscopic appendicectomy at a district general hospital, and to compare the diagnostic outcomes in the two patient groups. PATIENTS AND METHODS Data were collected prospectively from patients undergoing an open or laparoscopic procedure for suspected appendicitis in an 8-year period between January 2000 and December 2007. RESULTS A total of 1700 patients (873 women, 827 men) with a median age of 24 years underwent surgery for suspected appendicitis in the study period. There were 1357 patients (group A) who underwent an open procedure for presumed appendicitis (610 women and 747 men [F:M ratio, 1:1.2]). There were 343 patients (group B) who underwent laparoscopy with or without laparoscopic appendicectomy (82 men and 261 women [F:M ratio, 1:0.31]). Over the study period, there was an increasing trend towards the performance of laparoscopic procedures for suspected appendicitis, increasing from 4% to 39% of the total per year. In group A, 1172 (86%) patients had appendicular pathology, while the appendix was normal histologically in 178 (13%). Other pathologies were diagnosed intra-operatively in 1%. In group B, 193 patients (56%) had appendicular pathology while in 150 (44%) the appendix was normal. In the subgroup with a normal appendix, 56 patients (37%) had another cause for their symptoms identified. CONCLUSIONS Laparoscopic appendicectomy is increasingly being performed. Laparoscopy is often used as a diagnostic tool in general surgical patients, particularly women, with lower abdominal pain. In effect, these patients are undergoing diagnostic laparoscopy, with or without appendicectomy. This has resulted in a lower positive appendicectomy rate, but a higher yield of diagnoses other than appendicitis, in the laparoscopic group. Overall appendicectomy rates, however, have remained unchanged.
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Affiliation(s)
- Fayyaz Akbar
- Department of General Surgery, Glan Clwyd Hospital, Rhyl, UK
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Abstract
INTRODUCTION To report our initial experience of laparostomy and immediate intra-abdominal vacuum therapy in patients with severe peritonitis due to intra-abdominal catastrophes. PATIENTS AND METHODS Twenty-seven patients underwent emergency laparotomy and laparostomy formation with the application of immediate intra-abdominal TRAC-VAC therapy (male:female ratio, 1:1.2; median age, 73 years; range, 34-84 years). Predicted mortality was assessed using the P-POSSUM score and compared with clinically observed outcomes. RESULTS Ten patients (37%) with a mean predicted P-POSSUM mortality of 72%, died of sepsis and multi-organ failure. Seventeen patients (mean P-POSSUM 48% expected mortality) survived to discharge. One patient with pancreatitis died from small bowel obstruction 1-year post discharge, two patients developed a small bowel fistula. One patient had an allergic reaction to the VAC dressing. Our patients, treated with laparostomy and TRAC VAC therapy, had a significantly improved observed survival when compared to P-POSSUM expected survival (P = 0.004). CONCLUSIONS Laparostomy with immediate intraperitoneal VAC therapy is a robust and effective system to manage patients with intra-abdominal catastrophes. There were significantly improved outcomes compared to the mortality predicted by P-POSSUM scores. Damage control surgery with laparostomy formation and intra-abdominal VAC therapy should be considered in patients with severe peritonitis.
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Affiliation(s)
- James Horwood
- Department of General Surgery, Glan Clwyd Hospital, Rhyl, UK
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Abstract
An elderly patient was referred urgently to our rapid access suspected colorectal cancer clinic with symptoms suspicious for malignancy. Despite exhaustive investigations, no cause for his symptomatology could be identified. However, his condition deteriorated and we elected to undertake exploratory surgery, at which time a congenital midgut malrotation, causing chronic small bowel obstruction, was identified. The malrotation was surgical corrected and the patient has made a full recovery.
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Affiliation(s)
- James Horwood
- Glan Clwyd Hospital, General Surgery, Chester, 43 Duchess Place, Victoria Road, Chester CH2 2JL, UK
| | - Fayaz Akbar
- Glan Clwyd Hospital, General Surgery, Department General Surgery, Rhyl LL18 5UJ, UK
| | - Andrew Maw
- Glan Clwyd Hospital, General Surgery, Department General Surgery, Rhyl LL18 5UJ, UK
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Patel A, Lefemine V, Chander A, Maw A. Right upper quadrant pain and fever following a fall in a 92 year old. Gut 2009; 58:569, 612. [PMID: 19299386 DOI: 10.1136/gut.2008.167981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- A Patel
- All-Wales Higher Surgical Training Programme, Glan Clwyd Hospital, Rhyl, Denbighshire, UK
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Affiliation(s)
- J Horwood
- Department of General Surgery, Glan Clwyd Hospital Rhyl, Denbighshire, UK
| | - A Maw
- Department of General Surgery, Glan Clwyd Hospital Rhyl, Denbighshire, UK
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Kulkarni T, Gollins S, Maw A, Hobson P, Byrne R, Widdowson D. Magnetic resonance imaging in rectal cancer downstaged using neoadjuvant chemoradiation: accuracy of prediction of tumour stage and circumferential resection margin status. Colorectal Dis 2008; 10:479-89. [PMID: 18318754 DOI: 10.1111/j.1463-1318.2007.01451.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim was to examine the accuracy of magnetic resonance imaging (MRI) in predicting circumferential resection margin (CRM) involvement, T- and N-stage in patients with locally advanced carcinoma of the rectum, who had undergone long-course downstaging chemoradiation (CRT). METHOD Patients with rectal cancer were selected for long-course downstaging CRT if their tumour was considered to threaten (< or = 1 mm) or involve the CRM on MRI. Eighty such patients had a repeat MRI at a median of 6 weeks post-CRT followed by surgical excision soon thereafter. The findings on the post-CRT MRI were compared with histological examination of the surgical specimen. RESULTS For CRM involvement, post-CRT restaging MRI had an accuracy of 81% (65/80) a sensitivity of 54% (7/13), a specificity of 87% (58/67), a positive predictive value of 44% (7/16) and a negative predictive value of 91% (58/64). Accuracy for T- and N-staging was 43% (34/80) and 78% (62/80), respectively. 38% of T-stages were overstaged and 20% understaged. 4% of N-stages were overstaged and 19% understaged. The 13 patients with histological positive CRM had worse clinical outcomes than the 67 patients with negative CRM in terms of disease-free survival (relative risk of reduced DFS 4.6, P = 0.001) and overall survival (relative risk of death 3.6, P = 0.016). CONCLUSION Magnetic resonance imaging has good specificity and negative predictive value for predicting an uninvolved CRM post downstaging CRT in locally advanced rectal cancer although sensitivity and positive predictive value for an involved CRM were unsatisfactory. The shortcomings of MRI stem from poor differentiation of viable tumour from posttreatment changes and inability to identify small nodal and tumour deposits. Clinical correlates in this group of patients have confirmed the importance of achieving a clear CRM at surgery.
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Affiliation(s)
- T Kulkarni
- Department of Surgery, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK
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Akbar F, Maw A. Potential risk of using intracorporeal gauze swabs in laparoscopic colorectal surgery. Colorectal Dis 2008; 10:199. [PMID: 17645571 DOI: 10.1111/j.1463-1318.2007.01314.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
In patients with anal fissures or anal ulceration, treatment with the drug nicorandil should be considered as a possible cause
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Affiliation(s)
- Fayyaz Akbar
- Department of General Surgery, Glan Clwyd Hospital, Rhyl LL18 5UJ
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35
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36
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Hadi HIA, Maw A, Sarmah S, Kumar P. Intraperitoneal tension-free repair of small midline ventral abdominal wall hernias with a Ventralex hernia patch: initial experience in 51 patients. Hernia 2006; 10:409-13. [PMID: 16932846 DOI: 10.1007/s10029-006-0127-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 07/26/2006] [Indexed: 10/24/2022]
Abstract
Midline ventral hernias are common. Tension-free mesh repair of ventral hernias is becoming popular due to the high recurrence rate with conventional techniques. We have used an open intraperitoneal technique using the Bard Ventralex hernia patch in midline ventral hernias (<or=3 cm). Fifty-one patients were treated (34 males and 17 females) with a mean age of 52.4 years (range 18-82). Forty-three patients were day cases. Operative times, analgesic use, overnight hospital stay and postoperative complications were recorded prospectively. The mean operative time was 30 min (range 10-68). Thirty-six patients required mild/moderate postoperative analgesia. Two patients had minor wound infections and one had seroma. There was one recurrence. Our early experience suggests that Ventralex hernia patch repair of small midline ventral hernias can be performed as a day case with minimal postoperative complications.
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Affiliation(s)
- H I A Hadi
- Department of General Surgery, Glan Clwyd Hospital, Denbighshire, Rhyl, LL18 5UJ, UK
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37
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Hadi HIA, Quah HM, Maw A. A missing tongue stud: an unusual appendicular foreign body. Int Surg 2006; 91:87-9. [PMID: 16774178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Appendicitis caused by foreign bodies after body piercing is rare. Previous reports have described a variety of foreign bodies that were either found incidentally in the appendix or were felt to be responsible for appendicitis. We report a case where a patient known to have previously ingested a "tongue stud" after a tongue piercing presented with chronic right iliac fossa pain. The missing "tongue stud" had impacted in the appendix and was successfully removed by laparoscopic appendicectomy with resolution of patient's symptoms. We review the literature covering the clinical management of patients presenting with foreign bodies in the appendix.
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Affiliation(s)
- H I A Hadi
- Department of General Surgery, Glan Clwyd Hospital, Denbigshire, United Kingdom
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Quah HM, Samad A, Neathey AJ, Hay DJ, Maw A. Does gum chewing reduce postoperative ileus following open colectomy for left-sided colon and rectal cancer? A prospective randomized controlled trial. Colorectal Dis 2006; 8:64-70. [PMID: 16519641 DOI: 10.1111/j.1463-1318.2005.00884.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Postoperative ileus is common after colorectal resection and can prolong hospital stay. Gum chewing, a type of sham feeding, may to stimulate gut motility via cephalic-vagal stimulation, and thereby reduce the length of ileus. This study aimed to determine whether gum chewing in the immediate postoperative period facilitated recovery from ileus following resection for left-sided colorectal cancer. METHODS In a prospective randomized control trial, 38 patients undergoing open surgery for left-sided colorectal cancer were allocated to standard postoperative care (control group, n = 19) or to standard postoperative care plus the immediate use of chewing gum (treatment group, n = 19). RESULT Control patients passed flatus by mean of 2.7 days (SD 1.0) and faeces by 3.9 days (SD 1.5); for the treatment group, this was 2.4 days (SD 1.0) and 3.2 days (SD 1.5) respectively, (NS, P = 0.56 and P = 0.38). Length of hospital stay was 11.1 days (SD 7.3) in control group and 9.4 days (SD 2.5) in the treatment group (NS, P = 0.75). CONCLUSION The addition of gum chewing to a standardized postoperative regimen did not reduce the period of postoperative ileus or shorten length of stay following open surgery for left-sided colorectal cancer.
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Affiliation(s)
- H M Quah
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
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Abstract
BACKGROUND Ileostomy carcinoma after colectomy for ulcerative colitis and familial adenomatous polyposis is rare. METHODS Forty-three case reports from the literature and a case of ours are reviewed. RESULTS The risk of malignancy following ileostomy formation appears to be increased compared to the very low incidence of primary small bowel carcinoma. Chronic physical or chemical irritation of the stoma may predispose the ileal mucosa to colonic metaplasia with subsequent adenoma formation, dysplasia and invasive malignant change. This is particularly so where ileostomies are fashioned for familial adenomatous polyposis and ulcerative colitis. CONCLUSION Routine surveillance of patients who have had an ileostomy for 15 years or longer may lead to earlier detection of this complication.
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Affiliation(s)
- H M Quah
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Denbingshire, UK
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Quah HM, Samad AKA, Hay DJ, Maw A. High risk of lower limb neuropraxia and litigations for a better view of the perineum. Ann R Coll Surg Engl 2005; 87:313-4. [PMID: 16082752 PMCID: PMC1963960 DOI: 10.1308/147870805x42509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gollins SW, Kodavatiganti R, Douglas AF, Maw A. The importance of recognising nephrotic syndrome as a cause of hypoproteinaemia in rectal cancer: Occam's Razor is sometimes violated. Clin Oncol (R Coll Radiol) 2005; 17:291-2. [PMID: 15997926 DOI: 10.1016/j.clon.2004.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Haemostasis from iatrogenic solid organ injury can be difficult to achieve. We describe the use of oxidized regenerated cellulose (Surgicel) and a Hanna-Belfast suction diathermy device to control minor solid organ haemorrhage
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Affiliation(s)
- H i A Hadi
- Department of General Surgery, Glan Clwyd Hospital, Denbighshire, Rhyl LL18 5UJ, UK
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Quah HM, Hay DJ, Maw A. A modified technique using the Yankauer sucker and argon plasma coagulation for anorectal procedures. Tech Coloproctol 2004; 8:47-8. [PMID: 15057591 DOI: 10.1007/s10151-004-0052-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2003] [Accepted: 10/14/2003] [Indexed: 10/26/2022]
Abstract
Argon plasma coagulation (APC) is a useful and effective treatment for some anorectal conditions. We describe a modification of the APC instrumentation that aids the application of APC in such cases.
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Affiliation(s)
- H M Quah
- Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, LL18 5UJ, UK
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Abstract
In certain surgical patients undergoing laparotomy it may be best to leave the abdomen open as a laparostomy. Care of the resulting wound represents a considerable medical and nursing challenge. This article presents such a case and the authors' initial experience of managing laparostomy wounds with vacuum-assisted closure.
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Affiliation(s)
- H M Quah
- Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, Wales, UK
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Affiliation(s)
- H M Quah
- Department of General Surgery, Glan Clwyd Hospital, rhyl, Denbigshire, UK
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Maw A, Concepcion R, Eu KW, Seow-Choen F, Heah SM, Tang CL, Tan AL. Prospective randomized study of bacteraemia in diathermy and stapled haemorrhoidectomy. Br J Surg 2003; 90:222-6. [PMID: 12555300 DOI: 10.1002/bjs.4057] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The incidence and consequences of bacteraemia associated with diathermy and stapled haemorrhoidectomy have not been studied previously. METHODS Two hundred and five healthy patients randomized to stapled haemorrhoidectomy or diathermy haemorrhoidectomy had perioperative blood cultures taken. The clinical sequelae of bacteraemia and complications of surgery were assessed prospectively. RESULTS Six patients were excluded for protocol violations. Eleven (11 per cent) of 101 patients with stapled and five (5 per cent) of 98 who had diathermy haemorrhoidectomy had positive blood cultures for organisms after haemorrhoidectomy, predominantly anaerobes commonly found within the bacterial flora of the anorectum (P = 0.19). Transient postoperative pyrexia in several patients did not correlate with detected bacteraemia and settled spontaneously without treatment. There were no serious complications from either operative technique, and no clinical consequences from proven bacteraemia. CONCLUSION Transient bacteraemia may complicate surgical haemorrhoidectomy but has no serious clinical consequences for healthy adults.
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Affiliation(s)
- A Maw
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore 169608
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Abstract
Stapled hemorrhoidectomy (mucosectomy) is a new technique that has recently been introduced for the treatment of third-degree and fourth-degree hemorrhoids and rectal mucosal prolapse. We present a case of severe retroperitoneal sepsis complicating stapled hemorrhoidectomy that was successfully treated by conservative means, further surgery therefore being avoided. The literature on the more serious complications associated with stapled hemorrhoidectomy is reviewed.
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Affiliation(s)
- Andrew Maw
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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Abstract
Access for transanal surgery is often suboptimal due to restricted access and poor instrumentation. The use of the purse-string anoscope to improve access for transanal procedures is described.
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Affiliation(s)
- A Maw
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore 169608
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Eccersley AJ, Maw A, Williams NS. Comparative study of two sites of colonic conduit placement in the treatment of constipation due to rectal evacuatory disorders. Br J Surg 1999; 86:647-50. [PMID: 10361187 DOI: 10.1046/j.1365-2168.1999.01071.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic constipation may be treated by antegrade colonic irrigation via a colonic conduit. METHODS Two alternative sites of colonic conduit construction were evaluated for their effect on the symptoms of 21 consecutive women with intractable constipation primarily due to rectal evacuatory disorders. The conduit was constructed in the sigmoid colon in the first 11 patients and in the transverse colon in the subsequent ten. Symptomatic outcome was evaluated clinically and by questionnaires, with a prospective quality of life assessment in the transverse group. RESULTS During a median follow-up of 12 (range 6-60) months, reflux or stenosis necessitated revision or dilatation in six patients. Irrigation with a median of 1.3 (0.8-2.0) litres of water achieved evacuation in all patients. Improvements in abdominal pain and bloating were reported by seven of the ten patients in the transverse conduit group, but benefit was found in only three of 11 in the sigmoid group. There was no significant improvement in quality of life scores. In the medium term, seven patients retained a transverse conduit compared with three with a sigmoid conduit. CONCLUSION The transverse colonic conduit offers better relief from the symptoms of constipation due to rectal evacuatory dysfunction than the sigmoid conduit.
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Affiliation(s)
- A J Eccersley
- Academic Department of Surgery, St Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London, UK
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