AlexLeo

Refining and improving the assessment and treatment of faecal incontinence

AbstractFaecal incontinence (FI) is a common symptom. There are a variety of invasive treatments available, however, the benign nature of this problem and the varying degrees of severity, mean that conservative management is usually pursued first. The aims of this thesis were to investigate: the current practice of continence advisors who deliver conservative management in …

Refining and improving the assessment and treatment of faecal incontinence Read More »

Negative pressure‑assisted endoscopic pilonidal sinus treatment

Abstract Background Endoscopic pilonidal sinus treatment (EPSiT) is a novel minimally invasive option for the treatment of pilonidal sinus disease (PSD). To optimise the postoperative wound management after EPSiT, an ultraportable negative pressure wound therapy (NPWT) device was used. The aim of this study was to assess the clinical outcomes of negative pressure-assisted (NPA) EPSiT. …

Negative pressure‑assisted endoscopic pilonidal sinus treatment Read More »

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Abstract Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this studyaimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort …

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study Read More »

Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices

Abstract Background In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This …

Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices Read More »

Early diagnosis and monitoring of OASIS to prevent and delay FI. Part 2/1. Mrs Bulchandani.

This video presentation was given by Ms Bulchandani at the ESCP 2020. The aim was to inform the audience on how early diagnosis and monitoring obstetric anal sphincter injuries (OASIS) may prevent and delay faecal incontinence. Part 2/1. Mr Alex Leo Consultant General and Colorectal Surgery, Northwick Park and St Mark’s Hospital, London North West …

Early diagnosis and monitoring of OASIS to prevent and delay FI. Part 2/1. Mrs Bulchandani. Read More »

Long‐term outcome of sacral nerve stimulation for faecal incontinence

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 …

Long‐term outcome of sacral nerve stimulation for faecal incontinence Read More »

Initial experience with SphinKeeper™ intersphincteric implants for faecal incontinence in the United Kingdom: a two-centre retrospective clinical audit

Abstract Aim The SphinKeeper™ artificial bowel sphincter implant is relatively new surgical technique for the treatment of refractory faecal incontinence. This study presents the first experience in two UK tertiary centres. Method This is a retrospective audit of prospectively collected clinical data in relation to technique, safety, feasibility and short-term effectiveness from patients undergoing surgery …

Initial experience with SphinKeeper™ intersphincteric implants for faecal incontinence in the United Kingdom: a two-centre retrospective clinical audit Read More »

Laparoscopic Cholecystectomy with Veress needle technique

This educational video describes a standard technique for a laparoscopic cholecystectomy using a Veress needle technique, one 12 mm port and 3, 5 mm trocars. This particular case was performed in a 29 years old gentleman with cholelithiasis and a previous episode of acute cholecystitis that required hospitalisation and conservative treatment with IV antibiotics. Surgeons: …

Laparoscopic Cholecystectomy with Veress needle technique Read More »

General surgery and COVID‑19: review of practical recommendations in the first pandemic phase

Abstract Background In March 2020, the World Health Organization confirmed COVID-19 infection as a pandemic. The absence of previous knowledge of the COVID-19 has made the decision-making difficult including in the surgical departments. The purpose of this report was to review the management recommendations regarding surgical activity and changes to surgical practice, identifying concordances and …

General surgery and COVID‑19: review of practical recommendations in the first pandemic phase Read More »

Randomized Pilot Study: Anal Inserts Versus Percutaneous Tibial Nerve Stimulation in Patients With Fecal Incontinence

Abstract Background Anal inserts and percutaneous tibial nerve stimulation may be offered to those with fecal incontinence in whom other conservative treatments have failed. Objective We aimed to compare anal inserts and percutaneous tibial nerve stimulation. Design This was an investigator-blinded randomized pilot study. Settings The study was conducted at a large tertiary care hospital. …

Randomized Pilot Study: Anal Inserts Versus Percutaneous Tibial Nerve Stimulation in Patients With Fecal Incontinence Read More »

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Abstract Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in …

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study Read More »

Long‑term outcomes after contaminated complex abdominal wall reconstruction

Abstract Purpose Complex abdominal wall repair (CAWR) in a contaminated operative field is a challenge. Available literature regarding long-term outcomes of CAWR comprises studies that often have small numbers and heterogeneous patient populations. This study aims to assess long-term outcomes of modified-ventral hernia working group (VHWG) grade 3 repairs. Because the relevance of hernia recurrence …

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The development and validation of risk‑stratification models for short‑term outcomes following contaminated complex abdominal wall reconstruction

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 riskstratification models for Clavien–Dindo (CD) grade ≥ 3 complications in patients undergoing CCAWR. Methods A consecutive cohort of patients who underwent CCAWR in two …

The development and validation of risk‑stratification models for short‑term outcomes following contaminated complex abdominal wall reconstruction Read More »

Comparison between high-resolution water-perfused anorectal manometry and THD Anopress anal manometry: aprospective observational study

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 …

Comparison between high-resolution water-perfused anorectal manometry and THD Anopress anal manometry: aprospective observational study Read More »

Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate

Abstract Background Right hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn’s disease (CD) and malignant ones like colon cancer (CC). Aim To investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD. Methods This is a sub-group analysis of the European Society …

Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate Read More »

The RenewÂŽ Anal Insert for Passive Faecal Incontinence: a retrospective audit of our use of a novel device.

Abstract Introduction The RenewÂŽ Anal Insert is a recent treatment for patients who suffer from passive faecal incontinence (FI).  The aim was to assess the effectiveness of the insert and patient satisfaction. Method A retrospective audit of patients who were treated with the RenewÂŽ Anal Insert was undertaken. The St Mark’s Incontinence Score was used …

The RenewÂŽ Anal Insert for Passive Faecal Incontinence: a retrospective audit of our use of a novel device. Read More »

Evaluation of the Portable THDÂŽ Anopress Device in Patients with Faecal Incontinence

Abstract Background THDÂŽ Anopress has been promoted as a new portable anal manometer providing measurements of whole anal canal pressures. This study aims to report the anorectal function of patients suffering from Faecal Incontinence (FI) using this new device and the associated patient comfort. Methods We reviewed data from patients suffering from FI who had …

Evaluation of the Portable THDÂŽ Anopress Device in Patients with Faecal Incontinence Read More »

An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)

Abstract Introduction Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. Methods A pre-planned analysis of the European Society …

An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME) Read More »

Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit

Abstract Introduction Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided …

Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit Read More »

The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit

Abstract Background Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion …

The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit Read More »

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit

Abstract Introduction The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). …

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit Read More »

Evaluation of 153 Asymptomatic Subjects Using the Anopress Portable Anal Manometry Device

Abstract Background/Aims The Anopress device is a new portable manometry system. The aim of this study is to formulate normative data using this new device by recording the anorectal function of asymptomatic subjects. Patient comfort was also assessed. Methods Anorectal function was assessed in asymptomatic volunteers using the Anopress. All volunteers were examined in a …

Evaluation of 153 Asymptomatic Subjects Using the Anopress Portable Anal Manometry Device Read More »

Technical Tips and Tricks of Outpatients Treatments for Hemorrhoids

Abstract Hemorrhoids are a common condition affecting the anorectum. The clinician must accurately diagnose the condition and exclude more sinister causes responsible for the same symptoms. A focused history and thorough examination help in establishing a differential diagnosis. The treatment modality is guided by the degree of the hemorrhoids. Conservative measures should be employed, including …

Technical Tips and Tricks of Outpatients Treatments for Hemorrhoids Read More »

Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery

Abstract Introduction The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR …

Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery Read More »

The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection: an international multicentre, prospective audit

Abstract Aim There is little evidence to support choice of technique and configuration for stapled anastomoses after right hemicolectomy and ileocaecal resection. This study aimed to determine the relationship between stapling technique and anastomotic failure. Method Any unit performing gastrointestinal surgery was invited to contribute data on consecutive adult patients undergoing right hemicolectomy or ileocolic …

The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection: an international multicentre, prospective audit Read More »

Acceptability, effectiveness and safety of a RenewÂŽ anal insert in patients who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis.

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 RenewÂŽ insert is an inert single-use device which acts as an anal plug. The aim of this study was …

Acceptability, effectiveness and safety of a RenewÂŽ anal insert in patients who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis. Read More »

A meta-analysis comparing open anterior component separation with posterior component separation and transversus abdominis release in the repair of midline ventral hernias

Abstract Purpose This study aims to compare the outcomes of posterior component separation and transversus abdominis release (PCSTAR) with the open anterior component separation (OACS) technique. OACS, first described by Ramirez et al. (Plast Reconstr Surg 86(3):519-526, 1990), has become an established technique for local myofascial advancement in abdominal hernia surgery. PCSTAR, described by Novitsky …

A meta-analysis comparing open anterior component separation with posterior component separation and transversus abdominis release in the repair of midline ventral hernias Read More »

The benefit of tumor molecular profiling on predicting treatments for colorectal adenocarcinomas

Abstract We evaluated the benefit of tailoring treatments for a colorectal adenocarcinoma cancer cohort according to tumor molecular profiles, by analyzing data collected on patient responses to treatments that were guided by a tumor profiling technology from Caris Life Sciences. DNA sequencing and immunohistochemistry were the main tests that predictions were based upon, but also …

The benefit of tumor molecular profiling on predicting treatments for colorectal adenocarcinomas Read More »

Risk factors for unfavourable postoperative outcome in patients with Crohn’s disease undergoing right hemicolectomy or ileocaecal resection an international audit by ESCP and S-ECCO

Abstract Background Patient and disease-related factors, as well as operation technique all have the potential to impact on postoperative outcome in Crohn’s disease. The available evidence is based on small series and often displays conflicting results. Aim To investigate the effect of pre- and intra-operative risk factors on 30-day postoperative outcome in patients undergoing surgery …

Risk factors for unfavourable postoperative outcome in patients with Crohn’s disease undergoing right hemicolectomy or ileocaecal resection an international audit by ESCP and S-ECCO Read More »

Five year experience of the treatment of squamous cell carcinoma of the anus

Abstract Objectives The best treatment of early stage anal squamous cell carcinoma (SCC) is under debated. Wide local excision (WLE) may be considered adequate for stage 1 anal margin cancer. This study demonstrates our experience in treatment of patients with SCC over 5 years. Patients and methods We conducted a retrospective study of patients who …

Five year experience of the treatment of squamous cell carcinoma of the anus Read More »

Current practice of continence advisors in managing faecal incontinence in the United Kingdom: results of an online survey

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 …

Current practice of continence advisors in managing faecal incontinence in the United Kingdom: results of an online survey Read More »

Screening for Squamous Cell Anal Cancer in HIV Positive Patients: A Five-Year Experience

Abstract Aim Potential screening modalities for early diagnosis of squamous cell anal cancer (SCC) in HIV patients include digital anorectal examination (DARE), anal Papanicolaou testing (Pap test), human papilloma virus (HPV) cotesting, and high-resolution anoscopy. The aim of this study was to demonstrate the results of a five-year screening program for SCC in HIV patients. …

Screening for Squamous Cell Anal Cancer in HIV Positive Patients: A Five-Year Experience Read More »

Single Port Laparoscopic Surgery for Complex Crohn’s Disease Is Safe with a Lower Conversion Rate

Abstract Purpose  Single port laparoscopic surgery (SPLS) is a technique which is increasing in popularity. The benefit of SPLS in complex Crohn’s disease (CD), which includes a significant cohort of young patients sometimes needing multiple operations, has not been comprehensively assessed. This study analyses our early experience with this technique. Methods Patients who underwent SPLS …

Single Port Laparoscopic Surgery for Complex Crohn’s Disease Is Safe with a Lower Conversion Rate Read More »

Long-Term Functional Outcome after Internal Delorme’s Procedure for Obstructed Defecation Syndrome, and the Role of Postoperative Rehabilitation

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 withODS refractory to nonoperative therapy were identified across three regional pelvic floor referral hospitals, …

Long-Term Functional Outcome after Internal Delorme’s Procedure for Obstructed Defecation Syndrome, and the Role of Postoperative Rehabilitation Read More »

Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit

Abstract Aim The anastomosis technique used following rightsided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn). Method This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a …

Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit Read More »

Restorative Proctocolectomy in Elderly IBD Patients: A Multicentre Comparative Study on Safety and Efficacy

Abstract Background and Aims Restorative proctocolectomy in elderly inflammatory bowel disease [ IBD] patients is controversial and limited data are available on the outcomes of surgery. The aim of this study was to evaluate the safety, efficacy, and long-term results of ileal-pouch-anal anastomosis in elderly patients, in a multicentre survey from European referral centres. Methods …

Restorative Proctocolectomy in Elderly IBD Patients: A Multicentre Comparative Study on Safety and Efficacy Read More »

Complex abdominal wall reconstruction in the setting of active infection and contamination: a systematic review of hernia and fistula recurrence rates

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 toestablish the outcomes of contaminated complex AWR. Method Analysis was conducted according to PRISMA guidelines. Systematic search of the MEDLINE, EMBASE and Pubmed …

Complex abdominal wall reconstruction in the setting of active infection and contamination: a systematic review of hernia and fistula recurrence rates Read More »

Coexisting incarcerated femoral and obturator hernia: a case report

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 …

Coexisting incarcerated femoral and obturator hernia: a case report Read More »

Complete Remission of Unresectable Hepatocellular Carcinoma After Combined Sorafenib and Adjuvant Yttrium-90 Radioembolization

Abstarct Sorafenib has improved the median overall survival of unresectable or otherwise untreatable hepatocellular carcinoma (HCC) of *3 months, compared to supportive cares. Complete response, although rare, has been reported. The authors reported herein a case of complete biochemical and radiological remission of advanced unresectable HCC with lymph node metastasis and tumoral portal vein thrombosis …

Complete Remission of Unresectable Hepatocellular Carcinoma After Combined Sorafenib and Adjuvant Yttrium-90 Radioembolization Read More »

Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single-incision abdominal laparoscopic surgery

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 …

Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single-incision abdominal laparoscopic surgery Read More »

Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen

Abstract Aim Idiopatic thrombocytopenic purpura (ITP) is the most common indication for splenectomy. The failure rate of surgery is about 8% and the failure rate after splenectomy is approximately 28% for all patients. When the presence of an accessory spleen is diagnosed, splenectomy is recommended. Laparoscopic approach is considered the first choice. Patients and methods …

Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen Read More »

Macrocystic serous cystadenoma of the pancreas: Report of 4 cases

Abstract Background Macrocystic serous cystadenomas (MaSCA) are rare benign tumor of the pancreas which represent an atypical macroscopic morphologic variant of serous cystadenomas (SCA). They are characterized by a limited number of cysts with a diameter of >2 cm and share imaging features overlapping those of mucinous cystic neoplasm (MCN) and branch-duct intraductal papillary mucinous …

Macrocystic serous cystadenoma of the pancreas: Report of 4 cases Read More »

Non-erosive and uncomplicated erosive reflux diseases: Difference in physiopathological and symptom pattern

Abstract Aim To investigate differences in the physiopathological findings (manometry and pH monitoring) and symptomsbetween cases of non-erosive reflux disease (NERD) and erosive reflux disease (ERD) found positive at 24 hpH monitoring. Methods For a total of 670 patients who underwent 24 h pH monitoring, esophageal manometry and upper endoscopy were retrospectively evaluated, assessing the …

Non-erosive and uncomplicated erosive reflux diseases: Difference in physiopathological and symptom pattern Read More »