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Hodgkinson JD, Worley G, Warusavitarne J, Hanna GB, Vaizey CJ, Faiz OD. Evaluation of the Ventral Hernia Working Group classification for long-term outcome using English Hospital Episode Statistics: a population study. Hernia 2021; 25:977-984. [PMID: 33712933 PMCID: PMC8370963 DOI: 10.1007/s10029-021-02379-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/14/2021] [Indexed: 11/30/2022]
Abstract
Purpose The Ventral Hernia Working Group (VHWG) classification of ventral/incisional hernia (IH) was developed by expert consensus in 2010. Subsequently, Kanters et al. have demonstrated the validity of a modified version of the system for predicting short-term outcomes. This study aims to evaluate the modified system for predicting hernia recurrence. Methods Patients undergoing IH surgery (defined by OPCS codes) in the England Hospital Episode Statistics (HES) database, from 1997 to 2012, were identified. Baseline demographics at index hernia operation and episodes of further hernia surgery (FHS) were recorded. Risk factors for FHS were identified using cox regression and evaluated against the modified-VHWG grade using receiver-operating characteristics (ROC). Results The final analysis included 214,082 index IH operations. Of these, 52.6% were female and mean age was 56.59 (SD15.9). An admission for FHS was found in 8.3% cases (17,714 patients). Multi-variate cox regression revealed contaminated hernia (p < 0.0001), pre-existing IBD (p < 0.0001) and hernia comorbidity (p = 0.05) to be significantly related to long-term FHS. Classifying patients using these factors, according to the modified-VHWG classification, revealed that compared to Grade 1, the hazard ratio (HR) of FHS increased in Grade 2 (HR 1.19; p < 0.0001) and further increased in Grade 3 (HR 1.79; p < 0.0001). ROC analysis revealed the area under the curve to be 0.73 (95% CI 0.73–0.74). Conclusion This analysis demonstrates the broad validity of the modified-VHWG classification in discriminating risk for FHS. Inclusion of pre-existing IBD as a factor defining Grade 2 patients would be recommended. This analysis is limited by the absence of certain factors within the HES database, such as BMI.
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Affiliation(s)
- J D Hodgkinson
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK. .,Department of Surgery and Cancer, Imperial College London, London, UK.
| | - G Worley
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - J Warusavitarne
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - G B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - C J Vaizey
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - O D Faiz
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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2
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Leo CA, Thomas GP, Bradshaw E, Karki S, Hodgkinson JD, Murphy J, Vaizey CJ. Long-term outcome of sacral nerve stimulation for faecal incontinence. Colorectal Dis 2020; 22:2191-2198. [PMID: 32954658 DOI: 10.1111/codi.15369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/08/2020] [Accepted: 09/06/2020] [Indexed: 12/11/2022]
Abstract
AIM Sacral nerve stimulation (SNS) is a minimally invasive treatment for faecal incontinence (FI). We report our experience of patients who have undergone SNS for FI with a minimum of 5 years' follow-up. This is a single centre prospective observational study with the aim to assess the long-term function of SNS. METHOD All patients implanted with SNS were identified from our prospective database. The date of implantation, first and last clinic follow-up, surgical complications and St Mark's incontinence scores were abstracted and analysed. RESULTS From 1996 to 2014, 381 patients were considered for SNS. Of these, 256 patients met the study inclusion criteria. Median age at implantation was 52 years (range 18-81). The ratio of women to men was 205:51. Indications were urge FI (25%), passive FI (17.9%) and mixed FI (57%). The median of the incontinence score at baseline was 19/24 and this improved to 7/24 at the 6-month follow-up. Of the total cohort, 235 patients received a medium-term follow-up (median 110 months, range 12-270) with a median continence score of 10/24 which was also confirmed at the telephone long-term follow-up on 185 patients (132 months, range 60-276). CONCLUSION This study demonstrates that SNS is an effective treatment in the long term. SNS results in an improvement of validated scores for approximately 60% of patients; however, there is a significant reduction of efficacy over time due to underlying causes.
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Affiliation(s)
- C A Leo
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Northwest London University NHS Trust, Harrow, UK.,Imperial College London, London, UK.,Northwick Park Hospital, London North West NHS Trust, Harrow, UK
| | - G P Thomas
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Northwest London University NHS Trust, Harrow, UK
| | - E Bradshaw
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Northwest London University NHS Trust, Harrow, UK
| | - S Karki
- Northwick Park Hospital, London North West NHS Trust, Harrow, UK
| | - J D Hodgkinson
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Northwest London University NHS Trust, Harrow, UK.,Imperial College London, London, UK
| | - J Murphy
- Imperial College London, London, UK
| | - C J Vaizey
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Northwest London University NHS Trust, Harrow, UK.,Imperial College London, London, UK
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3
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Leo CA, Cavazzoni E, Leeuwenburgh MMN, Thomas GP, Dennis A, Bassett P, Hodgkinson JD, Warusavitarne J, Murphy J, Vaizey CJ. Comparison between high-resolution water-perfused anorectal manometry and THD ® Anopress anal manometry: a prospective observational study. Colorectal Dis 2020; 22:923-930. [PMID: 31994307 PMCID: PMC7496679 DOI: 10.1111/codi.14992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
AIM Anorectal physiology tests provide a functional assessment of the anal canal. The aim of this study was to compare the results generated by standard high-resolution water-perfused manometry (WPM) with the newer THD® Anopress manometry system. METHOD This was a prospective observational study. Conventional manometry was carried out using a water-perfused catheter with high-resolution manometry and compared with the Anopress system with air-filled catheters. All patients underwent the two procedures successively in a randomized order. Time to arrive at the resting pressure plateau, resting, squeeze, straining pressure and visual analogue scale (VAS) scores for pain were recorded. A qualitative analysis of the two devices was performed. RESULTS Between 2016 and 2017, 60 patients were recruited. The time from insertion of the catheter to arriving at the resting pressure plateau was significantly lower with the Anopress compared with WPM: 12 s [interquartile range (IQR) 10-17 s] versus 100 s (IQR 67-121 s) (P < 0.001). A strong correlation between the manometric values of WPM and the Anopress was observed. Both procedures were well tolerated, although the VAS score for insertion of the WPM catheter was significantly higher. The Anopress was easier to use and more time-efficient than the WPM. CONCLUSION The pressure values obtained with Anopress correlated well with those of conventional manometry. The Anopress has the advantage of being less time-consuming, user-friendly and better tolerated by patients.
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Affiliation(s)
- C. A. Leo
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK,Imperial College of LondonLondonUK,The Royal London HospitalLondonUK
| | - E. Cavazzoni
- Santa Maria della Misericordia HospitalUniversità degli Studi di PerugiaPerugiaItaly
| | | | - G. P. Thomas
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | - A. Dennis
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | | | - J. D. Hodgkinson
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK,Imperial College of LondonLondonUK
| | - J. Warusavitarne
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | | | - C. J. Vaizey
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
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4
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Hodgkinson JD, de Vries FEE, Claessen JJM, Leo CA, Maeda Y, van Ruler O, Lapid O, Obdeijn MC, Tanis PJ, Bemelman WA, Constantinides J, Hanna GB, Warusavitarne J, Boermeester MA, Vaizey C. The development and validation of risk-stratification models for short-term outcomes following contaminated complex abdominal wall reconstruction. Hernia 2020; 24:449-458. [PMID: 32040789 DOI: 10.1007/s10029-019-02120-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Short-term outcomes for patients undergoing contaminated complex abdominal wall reconstruction (CCAWR), including risk stratification, have not been studied in sufficiently high numbers. This study aims to develop and validate risk-stratification models for Clavien-Dindo (CD) grade ≥ 3 complications in patients undergoing CCAWR. METHODS A consecutive cohort of patients who underwent CCAWR in two European national intestinal failure centers, from January 2004 to December 2015, was identified. Data were collected retrospectively for short-term outcomes and used to develop risk models using logistic regression. A further cohort, from January 2016 to December 2017, was used to validate the models. RESULTS The development cohort consisted of 272 procedures performed in 254 patients. The validation cohort consisted of 114 patients. The cohorts were comparable in baseline demographics (mean age 58.0 vs 58.1; sex 58.8% male vs 54.4%, respectively). A multi-variate model including the presence of intestinal failure (p < 0.01) and operative time (p < 0.01) demonstrated good discrimination and calibration on validation. Models for wound and intra-abdominal complications were also developed, including pre-operative immunosuppression (p = 0.05), intestinal failure (p = 0.02), increasing operative time (p = 0.04), increasing number of anastomoses (p = 0.01) and the number of previous abdominal operations (p = 0.02). While these models showed reasonable ability to discriminate patients on internal assessment, they were not found to be accurate on external validation. CONCLUSION Acceptable short-term outcomes after CCAWR are demonstrated. A robust model for the prediction of CD ≥ grade 3 complications has been developed and validated. This model is available online at www.smbari.co.uk/smjconv2.
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Affiliation(s)
- J D Hodgkinson
- Department of Colorectal Surgery, St Mark's Hospital, Academic Institute, Watford Road, Harrow, HA1 3UJ, UK. .,Department of Surgery and Cancer, Imperial College London, London, UK.
| | - F E E de Vries
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - J J M Claessen
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - C A Leo
- Department of Colorectal Surgery, St Mark's Hospital, Academic Institute, Watford Road, Harrow, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Y Maeda
- Department of Colorectal Surgery, St Mark's Hospital, Academic Institute, Watford Road, Harrow, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - O van Ruler
- Department of Surgery, IJsselland Ziekenhuis, Capelle a/D IJssel, The Netherlands
| | - O Lapid
- Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Centers Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - M C Obdeijn
- Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Centers Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - J Constantinides
- Department of Colorectal Surgery, St Mark's Hospital, Academic Institute, Watford Road, Harrow, HA1 3UJ, UK
| | - G B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - J Warusavitarne
- Department of Colorectal Surgery, St Mark's Hospital, Academic Institute, Watford Road, Harrow, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - M A Boermeester
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - C Vaizey
- Department of Colorectal Surgery, St Mark's Hospital, Academic Institute, Watford Road, Harrow, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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5
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Hodgkinson JD, Oke SM, Warusavitarne J, Hanna GB, Gabe SM, Vaizey CJ. Incisional hernia and enterocutaneous fistula in patients with chronic intestinal failure: prevalence and risk factors in a cohort of patients referred to a tertiary centre. Colorectal Dis 2019; 21:1288-1295. [PMID: 31218774 DOI: 10.1111/codi.14735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/24/2018] [Accepted: 04/08/2019] [Indexed: 12/14/2022]
Abstract
AIM This study aims to determine the prevalence of incisional hernia (IH) and enterocutaneous fistula (ECF) in patients with intestinal failure (IF) referred to a tertiary centre and to identify factors associated with their development. METHOD A retrospective case note review was undertaken of a prospectively maintained database of all patients on home parenteral nutrition between 2011 and 2016 at a UK tertiary referral centre for IF. Risk factors were identified using binary logistic regression. RESULTS The database search identified 447 patients, of whom 349 (78.1%) had surgery prior to developing IF. Eighty-one (23.2%) patients had an IH and 123 (35.2%) had an ECF at the time of referral. Of these, 51 (14.6%) had both IH and ECF. IH was associated with a high body mass index (P = 0.05), a history of a major surgical complication resulting in IF (P = 0.01), previous emergency surgery (P = 0.04), increasing number of operations (P = 0.02) and surgical site infection (SSI; P = 0.01). ECF was associated with complications relating to earlier surgery. (P ≤ .001), previous treatment with an open abdomen (P = 0.03), SSI (P = 0.001), intra-abdominal collection (P ≤ 0.001) and anastomotic leak (P = 0.02). CONCLUSION In this series, patients with IF had a prevalence of IH which was more than double that expected following elective laparotomy (about 10%) and one in three had an ECF. Risk factors for IH and ECF are discussed.
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Affiliation(s)
- J D Hodgkinson
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - S M Oke
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - J Warusavitarne
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - G B Hanna
- Department of Surgery and Cancer, Imperial College, London, UK
| | - S M Gabe
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - C J Vaizey
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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6
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Leo CA, Thomas GP, Hodgkinson JD, Segal JP, Maeda Y, Murphy J, Vaizey CJ. The Renew® anal insert for passive faecal incontinence: a retrospective audit of our use of a novel device. Colorectal Dis 2019; 21:684-688. [PMID: 30770633 DOI: 10.1111/codi.14587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/18/2018] [Accepted: 01/21/2019] [Indexed: 12/14/2022]
Abstract
AIM The Renew® anal insert is a recent treatment for patients who suffer from passive faecal incontinence (FI). Our aim was to assess the effectiveness of the insert and patients' satisfaction with it. METHOD A retrospective audit of patients who were treated with the Renew® anal insert was undertaken. The St Mark's Incontinence Score was used to evaluate clinical outcome. Renew® size, the number of inserts used per day and per week had also been recorded. Subjective assessment of symptoms, how beneficial Renew® was and how satisfied patients were with the device were all recorded. Major events and side effects were also noted. RESULTS Thirty patients received Renew® as a treatment for passive incontinence in 2016. The median St Mark's Incontinence Score was 15 (range 7-18) at baseline and 10 (range 2-18) at first follow-up (P < 0.0001) at a median of 11 (range 8-14) weeks. Eleven (37%) patients used the regular size and 19 (63%) the large size. Patients used an average of 1.67 inserts per day (range 1-3) on an average of 3.58 days per week (1-7). Three patients reported a deterioration in symptoms, seven (23%) had no change and 20 (67%) showed a significant improvement. Six patients (20%) did not like the device while 24 (80%) liked it. Seventeen patients (57%) wanted to continue this treatment in the long term. CONCLUSION The Renew® device seems to be an acceptable and effective therapeutic option for passive FI. Further work is needed to compare it with other treatments and establish its position in the treatment pathway.
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Affiliation(s)
- C A Leo
- Sir Alan Parks Physiology Unit, St Mark's Hospital and Academic Institute, London North West University Healthcare NHS Trust, Harrow, UK.,Imperial College London, London, UK
| | - G P Thomas
- Sir Alan Parks Physiology Unit, St Mark's Hospital and Academic Institute, London North West University Healthcare NHS Trust, Harrow, UK
| | - J D Hodgkinson
- Sir Alan Parks Physiology Unit, St Mark's Hospital and Academic Institute, London North West University Healthcare NHS Trust, Harrow, UK.,Imperial College London, London, UK
| | - J P Segal
- Sir Alan Parks Physiology Unit, St Mark's Hospital and Academic Institute, London North West University Healthcare NHS Trust, Harrow, UK.,Imperial College London, London, UK
| | - Y Maeda
- Sir Alan Parks Physiology Unit, St Mark's Hospital and Academic Institute, London North West University Healthcare NHS Trust, Harrow, UK
| | - J Murphy
- Imperial College London, London, UK
| | - C J Vaizey
- Sir Alan Parks Physiology Unit, St Mark's Hospital and Academic Institute, London North West University Healthcare NHS Trust, Harrow, UK.,Imperial College London, London, UK
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7
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Segal JP, Leo CA, Hodgkinson JD, Cavazzoni E, Bradshaw E, Lung PFC, Ilangovan R, Vaizey CJ, Faiz OD, Hart AL, Clark SK. Acceptability, effectiveness and safety of a Renew ® anal insert in patients who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis. Colorectal Dis 2019; 21:73-78. [PMID: 30218632 DOI: 10.1111/codi.14422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 04/11/2018] [Accepted: 09/03/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Restorative proctocolectomy has gained acceptance in the surgical management of medically refractive ulcerative colitis and cancer prevention in familial adenomatous polyposis. Incontinence following restorative proctocolectomy occurs in up to 25% of patients overnight. The Renew® insert is an inert single-use device which acts as an anal plug. The aim of this study was to assess the acceptability, effectiveness and safety of the Renew® insert in patients who have undergone restorative proctocolectomy. The device has yet to be assessed in patients who have undergone restorative proctocolectomy. METHOD This was a prospective study exploring the acceptability, effectiveness and safety of the Renew® insert in improving incontinence in patients who had undergone restorative proctocolectomy. A total of 15 patients with incontinence were asked to use the Renew® insert for 14 days following their standard care. The Incontinence Questionnaire-Bowels was used pre- and posttreatment to assess response and patients were asked to report the perceived acceptability, effectiveness and safety of the device at the end of the trial. RESULTS The device was acceptable to 8/15 (53%) of patients and was effective in 6/15 (40%). Only 2/15 (13%) of patients raised any safety concerns, and these were minor. The device was associated with a significant reduction in night seepage (P = 0.034). CONCLUSION In a small study, the Renew® insert can be both acceptable and effective and is also associated with few safety concerns. It is also associated with significant reductions in night-time seepage.
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Affiliation(s)
- J P Segal
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - C A Leo
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - J D Hodgkinson
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - E Cavazzoni
- Department of Surgery, University of Perugia, Perugia, Italy
| | | | - P F C Lung
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | | | - C J Vaizey
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - O D Faiz
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - A L Hart
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - S K Clark
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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8
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Leo CA, Murphy J, Hodgkinson JD, Vaizey CJ, Maeda Y. Does the Internet provide patients or clinicians with useful information regarding faecal incontinence? An observational study. G Chir 2018; 39:71-76. [PMID: 29694304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The Internet has become an important platform for information communication. This study aim to investigate the utility of social media and search engines to disseminate faecal incontinence information. METHODS We looked into Social media platforms and search engines. There was not a direct patient recruitment and any available information from patients was already on public domain at the time of search. A quantitative analysis of types and volumes of information regarding faecal incontinence was made. RESULTS Twelve valid pages were identified on Facebook: 5 (41%) pages were advertising commercial incontinence products, 4 (33%) pages were dedicated to patients support groups and 3 (25%) pages provided healthcare information. Also we found 192 Facebook posts. On Twitter, 2890 tweets were found of which 51% tweets provided healthcare information; 675 (45%) were sent by healthcare professionals to patients, 530 tweets (35.3%) were between healthcare professionals, 201 tweets (13.4%) were from medical journals or scientific books and 103 tweets (7%) were from hospitals or clinics with information about events and meetings. The second commonest type of tweets was advertising commercial incontinence products 27%. Patients tweeted to exchange information and advice between themselves (20.5%). In contrast, search engines as Google/Yahoo/Bing had a higher proportion of healthcare information (over 70%). CONCLUSION Internet appears to have potential to be a useful platform for patients to learn about faecal incontinence and share information; however, given one lack of focus of available data, patients may struggle to identify valid and useful information.
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9
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Leo CA, Maeda Y, Collins B, Thomas GP, Hodgkinson JD, Murphy J, Vaizey CJ. Current practice of continence advisors in managing faecal incontinence in the United Kingdom: results of an online survey. Colorectal Dis 2017; 19:O339-O344. [PMID: 28736932 DOI: 10.1111/codi.13823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 02/13/2017] [Accepted: 07/06/2017] [Indexed: 02/08/2023]
Abstract
AIM To investigate the current practice of continence advisors in the United Kingdom. METHOD Continence advisors were contacted by email or letter to participate in a survey. The survey contained 27 questions which addressed the practice of each continence advisor, their knowledge of continence management and the adequacy of their training. RESULTS Two hundred and twenty-six out of a total of 448 continence advisors (50.4%), responded. One hundred and seventy (76.9%) advisors treated both faecal and urinary incontinence, 51 (23.1%) treated urinary incontinence. Thirty-six advisors (16.1%) were lone workers and 130 (58.6%) had more than 10 years' experience. The majority of the advisors (75.6%) performed a digital rectal examination as part of their assessment. Regarding the management of faecal incontinence, 148 prescribed suppositories, 127 offered enemas and 147 advised on rectal irrigation. Most of the advisors taught pelvic floor exercises (n = 207) and urge resistance techniques (n = 188). One hundred and fifty-nine (87.4%) prescribed the Peristeen Coloplast® anal plug and 78 (47.6%) prescribed the Renew® anal insert. Eighty-nine advisors (42.6%) felt they had not been adequately trained to provide a bowel continence service. CONCLUSION The majority of continence advisors in the UK manage faecal incontinence. They are able to initiate a broad range of conservative treatment options; however, almost half of the advisors who answered the survey felt inadequately trained and may be better supported by further training.
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Affiliation(s)
- C A Leo
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK.,Imperial College London, London, UK
| | - Y Maeda
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK.,Imperial College London, London, UK
| | - B Collins
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK
| | - G P Thomas
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK
| | - J D Hodgkinson
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK.,Imperial College London, London, UK
| | - J Murphy
- Imperial College London, London, UK
| | - C J Vaizey
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK
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10
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Abstract
BACKGROUND Obturator hernia is a rare condition associated with a high morbidity and mortality. It is an uncommon cause of bowel obstruction most commonly described in elderly females with comorbidity. Surgical intervention is often delayed as a result of subtle presenting signs. Coexisting ipsilateral femoral hernia is an even rarer condition represented by non-exhaustive series in the literature. CASE PRESENTATION We report a case of a healthy 36 years old lady, nulliparous, with abdominal pain and swelling in the right groin. Preoperative CT showed only a right groin hernia, that was found to be femoral at operative intervention. She recovered and was discharged from hospital but represented with further symptoms of obstruction 9 days later. Diagnostic laparoscopy demonstrated a ipsilateral obturator hernia with associated bowel infarct. The bowel was resected and the defect was repaired. DISCUSSION AND CONCLUSIONS Obturator hernia presents subtly with medial thigh pain and no lump. They are notorious for difficulty to diagnosis. We describe the first case of coexisting ipsilateral femoral and obturator hernias in a young nulliparous woman with bowel obstruction. Appropriate intraoperative exploration should always be considered.
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11
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Hodgkinson JD, Maeda Y, Leo CA, Warusavitarne J, Vaizey CJ. Complex abdominal wall reconstruction in the setting of active infection and contamination: a systematic review of hernia and fistula recurrence rates. Colorectal Dis 2017; 19:319-330. [PMID: 28102927 DOI: 10.1111/codi.13609] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 09/01/2016] [Accepted: 11/28/2016] [Indexed: 02/08/2023]
Abstract
AIM Minimal evidence exists to guide surgeons on the risk of complications when performing abdominal wall reconstruction (AWR) in the presence of active infection, contamination or enterocutaneous fistula. This study aims to establish the outcomes of contaminated complex AWR. METHOD Analysis was conducted according to PRISMA guidelines. Systematic search of the MEDLINE, EMBASE and Pubmed databases was performed. Studies reporting exclusively on single-staged repair of contaminated complex AWR were included. Pooled data were analysed to establish rates of complications. RESULTS Sixteen studies were included, consisting of 601 contaminated complex AWRs, of which 233 included concurrent enterocutaneous fistula repair. The average follow-up period was 26.7 months. There were 146 (24.3%) reported hernia recurrences. When stratified by repair method, suture repair alone had the lowest rate of recurrence (14.2%), followed by nonabsorbable synthetic mesh reinforcement (21.2%), biological mesh (25.8%) and absorbable synthetic mesh (53.1%). Hernia recurrence was higher when fascial closure was not achieved. Of the 233 enterocutaneous fistula repairs, fistula recurrence was seen in 24 patients (10.3%). Suture repair alone had the lowest rate of recurrence (1.6%), followed by nonbiological mesh (10.3%) and biological mesh reinforcement (12%). Forty-six per cent of patients were reported as having a wound-related complication and the mortality rate was 2.5%. CONCLUSION It is feasible to perform simultaneous enterocutaneous fistula repair and AWR as rates of recurrent fistula are comparable with series describing enterocutaneous fistula repair alone. Hernias recurred in nearly a quarter of cases. This analysis is limited by a lack of comparative data and variability of outcome reporting.
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Affiliation(s)
| | - Y Maeda
- St Mark's Hospital and Academic Institute, London, UK
| | - C A Leo
- St Mark's Hospital and Academic Institute, London, UK
| | | | - C J Vaizey
- St Mark's Hospital and Academic Institute, London, UK
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12
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Leo CA, Campennì P, Hodgkinson JD, Rossitti P, Digito F, De Carli G, D'Ambrosi L, Carducci P, Seriau L, Terrosu G. Long-Term Functional Outcome after Internal Delorme's Procedure for Obstructed Defecation Syndrome, and the Role of Postoperative Rehabilitation. J INVEST SURG 2017; 31:256-262. [PMID: 28362517 DOI: 10.1080/08941939.2017.1300714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate long-term functional outcomes of Internal Delorme's Procedure (IDP) in patients refractory to conservative treatment for Obstructed Defecation Syndrome (ODS), and to compare those who received postoperative rehabilitation with those who did not. MATERIALS AND METHODS All patients with ODS refractory to nonoperative therapy were identified across three regional pelvic floor referral hospitals, and IDP was performed. Postoperatively selected patients received biofeedback therapy. Functional outcomes were established using the Cleveland Clinic Constipation (CCC) score and obstructed defecation score (OD score) preoperatively at 12 months and at the last available follow-up. Patient satisfaction was assessed with a visual analogue score. RESULTS From October 2006 to September 2013, IDP was performed in 170 patients: 77 received postoperative biofeedback and 93 did not. Mean follow-up was 6.3 years (range 1-8 years). CCC and OD scores improved significantly in both groups after 12 months and at the last follow-up (p > 0.05). When comparing two groups while there was no significant difference between CCC and OD scores at 12 months, score was significantly better in the group that received rehabilitation at the last follow-up (p = 0.001). Patient satisfaction was higher in the rehabilitation group (67%) compared with those without rehabilitation (55%). Clinical recurrence was recorded in nine patients who did not have postoperative rehabilitation. CONCLUSIONS It has been demonstrated that IDP is associated with good long-term functional outcomes. Patients receiving rehabilitation had a better long-term follow-up, a higher overall satisfaction, and lower recurrence rate when compared with the patients who did not receive postoperative rehabilitation.
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Affiliation(s)
- C A Leo
- a North West London NHS Trust, St Mark's Hospital Academic Institute , Middlesex , Harrow , UK
| | - P Campennì
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - J D Hodgkinson
- a North West London NHS Trust, St Mark's Hospital Academic Institute , Middlesex , Harrow , UK
| | - P Rossitti
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - F Digito
- c Department of Surgery , S. Antonio Hospital, S. Daniele del Friuli, Udine , Italy
| | - G De Carli
- d Department of Surgery , S. Maria del Prato Hospital , Feltre , Italy
| | - L D'Ambrosi
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - P Carducci
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - L Seriau
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - G Terrosu
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
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13
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Leo CA, Samaranayake S, Perry-Woodford ZL, Vitone L, Faiz O, Hodgkinson JD, Shaikh I, Warusavitarne J. Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single-incision abdominal laparoscopic surgery. Colorectal Dis 2016; 18:1162-1166. [PMID: 27110866 DOI: 10.1111/codi.13359] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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: 11/09/2015] [Accepted: 02/18/2016] [Indexed: 12/13/2022]
Abstract
AIM Laparoscopic surgery is well established for colon cancer, with defined benefits. Use of laparoscopy for the performance of restorative proctocolectomy (RPC) with ileoanal anastomosis is more controversial. Technical aspects include difficult dissection of the distal rectum and a potentially increased risk of anastomotic leakage through multiple firings of the stapler. In an attempt to overcome these difficulties we have used the technique of transanal rectal excision to perform the proctectomy. This paper describes the technique, which is combined with an abdominal approach using a single-incision platform (SIP). METHOD Data were collected prospectively for consecutive operations between May 2013 and October 2015, including all cases of restorative proctocolectomy with ileoanal pouch anastomosis performed laparoscopically. Only patients having a transanal total mesorectal excision (TaTME) assisted by SIP were included. The indication for RPC was ulcerative colitis (UC) refractory to medical treatment. RESULTS The procedure was performed on 16 patients with a median age of 46 (26-70) years. The male:female ratio was 5:3 and the median hospital stay was 6 (3-20) days. The median operation time was 247 (185-470) min and the overall conversion rate to open surgery was 18.7%. The 30-day surgical complication rate was 37.5% (Clavien-Dindo 1 in four patients, 2 in one patient and 3 in one patient). One patient developed anastomotic leakage 2 weeks postoperatively. CONCLUSION This initial study has demonstrated the feasibility and safety of TaTME combined with SIP when performing RPC with ileal pouch-anal anastomosis for UC.
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Affiliation(s)
- C A Leo
- St Mark's Hospital Academic Institute, Harrow, UK
| | | | | | - L Vitone
- St Mark's Hospital Academic Institute, Harrow, UK
| | - O Faiz
- St Mark's Hospital Academic Institute, Harrow, UK
| | | | - I Shaikh
- St Mark's Hospital Academic Institute, Harrow, UK
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14
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Morar PS, Faiz O, Hodgkinson JD, Zafar N, Koysombat K, Purcell M, Hart A, Warusavitarne J. Concomitant colonic disease (Montreal L3) and re-resectional surgery are predictors of clinical recurrence following ileocolonic resection for Crohn's disease. Colorectal Dis 2015; 17:O247-55. [PMID: 26291699 DOI: 10.1111/codi.13094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 03/10/2015] [Accepted: 05/26/2015] [Indexed: 02/08/2023]
Abstract
AIM Ileocolonic resection is reserved for patients with moderate to severe Crohn's disease. Postoperative clinical recurrence can occur in up to 55% of patients within 5 years. Predicting the risk of recurrence is key in deciding upon appropriate treatment strategies. This study aims to determine the incidence of postoperative clinical recurrence and predictors of recurrence in a specialist institution. METHOD The clinical case records of 142 patients who underwent either a one-stage or two-stage procedure for ileocolonic Crohn's disease from 1 January 2005 to 31 December 2010 were reviewed. Preoperative, perioperative and postoperative variables were extracted. Postoperative clinical recurrence was defined as an initiation or change in medical treatment for recurrent symptoms with endoscopic or radiological evidence of active disease. Time to clinical recurrence was measured in months after surgery. Univariate and multivariate analyses were performed. RESULTS Over the 6-year period, follow-up data were obtained on 142 patients over a median of 28.5 months. Clinical recurrence was demonstrated in 59 (41.5%) patients. The proportion of patients with clinical recurrence at 5 years was 48.2%. Predictors of recurrence included a re-resection for recurrent disease [hazard ratio (HR) 1.9; 95% CI 1.1-3.3; P = 0.02] and ileocolonic disease (HR 1.7; 95% CI 1.0-2.9; P = 0.05). CONCLUSION Identifying the predictors for postoperative clinical recurrence is important for determining the postoperative strategy. This study provides a unique perspective on the incidence of recurrence and associated predictors from the perspective of a specialist unit.
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Affiliation(s)
- P S Morar
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - O Faiz
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - J D Hodgkinson
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London, UK
| | - N Zafar
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London, UK
| | - K Koysombat
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Purcell
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London, UK
| | - A Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - J Warusavitarne
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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