Welcome to The Royal London Hospital
Encouraged by new opportunities to focus mainly on his passion for pelvic floor conditions andcomplex benign diseases, Mr Leo has now moved to Barts NHS Trust. He has gained a lot ofexperience while working as a Consultant at St Mark’s and Northwick Park Hospital and he is nowhappy to carry this experience while serving his …
Fellow of European Board of Surgery in Coloproctology (FEBS)
Mr Leo was recently awarded in Munich by the European Society of Colorectal Surgery (ESCP) with one of the highest qualifications in surgery, confirming skills and knowledge in Coloproctology.
Edge Medical laser
Mr Leo now uses the newest Edge Medical laser for non invasive treatments for anal fistula, pilonidal sinus and haemorrhoids. This new gadget with great cost effectiveness is convenient giving great results and better outcome for our patients. Available both in private sector at OneWelbeck, and NHS at London North West Healthcare NHS Trust.
EPSiT: Endoscopic non invasive treatment for pilonidal sinus
This video shows results of our study on EPSiT. A simple negative pressure dressing is added at the end of the procedure minimising the recurrence.
Magazine interview: Piles during Pregnancy
https://theweekendpages.com/samantha-faiers/#1
Welcome to The London Clinic
Started a new adventure at The London Clinic. I couldn’t be more proud of my team and all people who have supported me until this day.
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 »
Welcome to OneWelbeck
Mr Leo now operates at OneWelbeck, a specialist hospital for minimally-invasive day surgery and outpatient diagnostics in the heart of Central London. OneWelbeck
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 …
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 …
THD® Anopress: portable anorectal manometry
This video demonstrates how to use the newer portable manometer THD® Anopress. In this specific case the Anopress was used in an healthy volunteer to better demonstrate normal values.
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.
This video presentation was given by Mr Alex Leo 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.
Early Post Partum Gallstone Pancreatitis and fundus first gallbladder dissection
A case report of a young woman having a severe gallstone pancreatitis 2 weeks after an emergency C section. In this video we show brief steps for a laparoscopic cholecystectomy with a fundus first approach and intra operative cholangiogram. Mr Kamran Kurashi & Mr Cosimo Alex Leo London North West NHS University Trust.
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 »
IOC: Intraoperative Cholangiography
This short video presents an intraoperative cholangiography during a laparoscopic cholecystitis.
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 …
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 …
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. …
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 …
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 …
Long‑term outcomes after contaminated complex abdominal wall reconstruction Read More »
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 …
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 …
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 …
The Renew® Anal Insert for Passive Faecal Incontinence: a retrospective audit of our use of a novel device.
Abstract Introduction The Renew® 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 Renew® Anal Insert was undertaken. The St Mark’s Incontinence Score was used …
Evaluation of the Portable THD® Anopress Device in Patients with Faecal Incontinence
Abstract Background THD® 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 THD® 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 …
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 …
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 …
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). …
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 …
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 …
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 …
Acceptability, effectiveness and safety of a Renew® 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 Renew® insert is an inert single-use device which acts as an anal plug. The aim of this study was …
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 …
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 …
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 …
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 …
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 …
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, …
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 …
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 …
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 …
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 …
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 …
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 …
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 …