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Abdelrahim A, Ali O, Kamali D, Reddy A, Harrison S, Boshnaq M, Abudeeb H, Ashoush F, Qulaghassi M, Eldesouky S, Mansour M, Rahman-Casans SF, Osman K. Analysis of the outcomes of postdiverticulitis investigations: a multicentre cohort study including 1,120 patients. Ann R Coll Surg Engl 2025; 107:326-330. [PMID: 39382270 PMCID: PMC12043365 DOI: 10.1308/rcsann.2024.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 10/10/2024] Open
Abstract
INTRODUCTION The aim of this study was to assess the yield of the endoscopic investigations performed following the resolution of acute diverticulitis. METHODS A retrospective multicentre study included patients with multislice computed tomography (MSCT)-proven diverticulitis, in four NHS hospitals, between January 2016 and April 2023. The primary outcome was the rate of colonic cancer in the diseased segment. Secondary outcomes included the rate of malignancy in the nondiseased colonic segments, the benign colonic polyp detection rate, the rate of malignancy in the resected surgical specimens in patients who underwent an emergency surgery on the index admission and the rate of complications in the investigated group. RESULTS A total of 1,120 patients were included in the study, out of which 604 were females, with a median age of 61 years; 731 patients (65%) had uncomplicated diverticulitis (Hinchey 1A) while 389 (35%) had complicated diverticulitis (Hinchey 1B-4). Following the acute episode, 757 (74%) patients had subsequent endoscopic evaluation. The incidence of colorectal cancer (CRC) or advanced adenomas (AA) in patients with uncomplicated diverticulitis was 0.14%. In the complicated diverticulitis group, the incidence of CRC/AA in patients with Hinchey 1b and Hinchey 2 was 1.4% and 5.4%, respectively. Out of the 107 patients who underwent emergency colonic resection for suspected perforated diverticulitis, 18 (16.8%) had histological evidence of colonic malignancy. CONCLUSIONS Endoscopic investigations following uncomplicated diverticulitis have a low yield for sinister colonic pathology. Colonoscopy should be planned following complicated diverticulitis and in patients with uncomplicated diverticulitis with suspicious radiological finding on index imaging or in patients with ongoing clinical manifestations. In patients who undergo emergency surgery, oncological principles should be applied whenever possible.
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Affiliation(s)
| | - O Ali
- East Lancashire Hospitals NHS Foundation Trust, UK
| | - D Kamali
- County Durham and Darlington NHS Foundation Trust, UK
| | - A Reddy
- South Tees Hospitals NHS Trust, UK
| | - S Harrison
- County Durham and Darlington NHS Foundation Trust, UK
| | | | - H Abudeeb
- East Lancashire Hospitals NHS Foundation Trust, UK
| | - F Ashoush
- Gateshead Healthcare NHS Foundation Trust, UK
| | | | - S Eldesouky
- East Kent Hospitals NHS Foundation Trust, UK
| | | | | | - K Osman
- County Durham and Darlington NHS Foundation Trust, UK
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Shakweh E, Baby J, Younge L, Tozer P, Hart A. Perianal Crohn's disease: the experience of taking a multiprofessional approach in a tertiary centre setting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2025; 34:406-412. [PMID: 40257093 DOI: 10.12968/bjon.2025.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2025]
Abstract
Perianal fistulising Crohn's disease (PFCD) is a debilitating phenotype of Crohn's disease, with a lifetime incidence of 20-30% in people living with the dieases. Symptoms include perianal pain, perianal discharge and faecal incontinence, with repercussions for a patient's physical and mental health, psychosocial wellbeing and productivity. PFCD is challenging to treat, with existing therapeutic options achieving modest fistula remission rates only. While research initiatives are under way to characterise PFCD pathogenesis and optimal treatment approaches, the focus should be on early diagnosis and prompt management. This can be achieved with patient education, effective co-ordination of care within the multidisciplinary team and an accessible inflammatory bowel disease (IBD) service. IBD specialist nurses may be the first health professionals to encounter a patient with a new diagnosis of PFCD or its complications. This review article summarises the existing evidence relating to clinical aspects of PFCD from a multiprofessional perspective and discusses the role of a dedicated IBD surgical link nurse in PFCD management in a tertiary centre setting.
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Affiliation(s)
- Eathar Shakweh
- Inflammatory Bowel Disease Clinical Research Fellow, St Mark's National Bowel Hospital, London North West University Healthcare NHS Trust; Department of Metabolism, Digestion and Reproduction, Imperial College London
| | - Johncy Baby
- Inflammatory Bowel Disease Specialist Nurse, St Mark's National Bowel Hospital, London North West University Healthcare NHS Trust
| | - Lisa Younge
- Inflammatory Bowel Disease Specialist Nurse, St Mark's National Bowel Hospital, London North West University Healthcare NHS Trust
| | - Phil Tozer
- Consultant Colorectal Surgeon, St Mark's National Bowel Hospital, London North West University Healthcare NHS Trust; Department of Surgery and Cancer, Imperial College London
| | - Ailsa Hart
- Professor of Gastroenterology, St Mark's National Bowel Hospital, London North West University Healthcare NHS Trust
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Issa MT, Sultana E, Hamid M, Mohamedahmed AY, Albendary M, Zaman S, Bhandari S, Ball W, Narayanasamy S, Thomas P, Husain N, Peravali R, Sarma D. DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk-multicentre retrospective study. Int J Colorectal Dis 2025; 40:68. [PMID: 40088275 PMCID: PMC11910434 DOI: 10.1007/s00384-025-04858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2025] [Indexed: 03/17/2025]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all malignancies. Emerging trends of association with risk factors such as diverticulitis highlight the need for updated screening and follow-up protocols. We aimed to examine risk factors associated with the development of CRC within 12 months following an episode of acute diverticulitis, and identify areas to streamline follow-up. METHODS We performed a retrospective multicentre study of adult patients admitted in 2022 with computed tomography (CT) confirmed acute diverticulitis across four large NHS Trusts in the UK. Patient demographics, comorbidities, clinical presentation, vital signs, laboratory results, details of in-patient stay, and follow-up investigations were collected and analysed. Our primary outcome was the incidence of CRC within 12 months of index presentation with acute diverticulitis. Analysed secondary outcomes were potential patient risk factors associated with a diagnosis of CRC and follow-up protocols. All statistical analysis was performed using R (version 4.4) and P-values of < 0.05 were considered statistically significant. RESULTS A total of 542 patients with acute diverticulitis over the study period were included. The median age of our cohort was 62 (51-73) years, and 204 (37.6%) were male. Ten (1.8%) patients were diagnosed with CRC within the 12-month period. Hinchey grade Ib was significantly associated with CRC (OR 4.51, P = 0.028). Colonoscopic follow-up requests were associated with age between 40 and 60 years, mild white cell count (WCC) elevation, and a hospital stay of 3-7 days. Male gender, age between 18 and 40 years, and elevated C-reactive protein (CRP) were all strongly associated with CRC but not statistically significant. Follow-up was inconsistent with 53.7% of the cohort having luminal investigations. CONCLUSION The incidence of CRC was in-keeping with published literature. Hinchey grade 1b was significantly associated with a subsequent CRC diagnosis. These findings emphasise the need for specialised radiological review of CT scans to detect underlying malignancy. Moreover, standardised follow-up protocols following an episode of acute diverticulitis are needed to avoid missing malignant lesions.
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Affiliation(s)
- Mohamed Talaat Issa
- Department of General and Colorectal Surgery, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Emiko Sultana
- Department of General and Colorectal Surgery, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK
| | - Mohammed Hamid
- Department of General and Colorectal Surgery, Walsall Manor Hospital, Walsall Healthcare NHS Trust, Walsall, UK
| | - Ali Yasen Mohamedahmed
- Department of General and Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Queen's Hospital Burton, Burton On Trent, UK
| | - Mohamed Albendary
- Department of General Surgery, North West Anglia NHS Trust, Peterborough, UK
| | - Shafquat Zaman
- Department of General and Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Queen's Hospital Burton, Burton On Trent, UK.
- College of Medical and Dental Sciences, School of Medicine, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Santosh Bhandari
- Department of General Surgery, North West Anglia NHS Trust, Peterborough, UK
| | - William Ball
- Department of General and Colorectal Surgery, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK
| | - Sangara Narayanasamy
- Department of General and Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Queen's Hospital Burton, Burton On Trent, UK
| | - Pradeep Thomas
- Department of General and Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Queen's Hospital Burton, Burton On Trent, UK
| | - Najam Husain
- Department of General and Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Queen's Hospital Burton, Burton On Trent, UK
| | - Rajeev Peravali
- Department of General and Colorectal Surgery, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Diwakar Sarma
- Department of General and Colorectal Surgery, Sandwell and West Birmingham NHS Trust, Birmingham, UK
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Banks J, Rashid A, Wilson TR, Challand CP, Lee MJ. Process and outcome differences in the care of patients undergoing elective and emergency right hemicolectomy. Ann R Coll Surg Engl 2025; 107:188-193. [PMID: 39081169 PMCID: PMC11877162 DOI: 10.1308/rcsann.2024.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 03/05/2025] Open
Abstract
INTRODUCTION Up to 30% of patients with colorectal cancer present as an emergency and have worse outcomes than elective patients. Compared with left-sided cancers, malignancies arising in the right colon are significantly under-researched. We sought to compare cancer care quality and clinical outcomes between emergency and elective presentations of right-sided colon cancer (RCC). METHODS This multicentre, retrospective study included all patients who underwent operative management for a RCC, from 1 April 2017 to 31 March 2022. Data were collected from electronic patient records, and host and tumour factors as well as outcomes between emergency and elective cohorts were compared. RESULTS Overall, 806 patients (median age 72 years) were included. Some 175 patients (22%) presented as an emergency: 140 in obstruction and 35 with tumour perforation, compared with 1 patient with tumour perforation in the elective group (p < 0.001). The emergency group had higher rates of postoperative complications (59.1% vs 20.0%, p < 0.001), increased 90-day mortality (13.7% vs 1.3%, p < 0.001) and a longer hospital stay (5 vs 10 days, p < 0.001). From the emergency cohort only 29.2% of eligible patients received adjuvant chemotherapy and in multivariate regression analysis emergency presentation was associated with a decreased likelihood of receiving adjuvant chemotherapy (odds ratio 0.26 [0.14-0.47], p < 0.001). CONCLUSIONS Both short- and long-term outcomes after emergency presentation of RCC are poor, with inadequate access to subsequent chemotherapy. Strategies addressing emergency presentations of left-sided tumours have moved towards temporisation and elective surgery. Delaying major resectional surgery for optimisation may improve outcomes and access to adjuvant therapies for RCC.
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Affiliation(s)
| | | | - TR Wilson
- Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
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Hashi R, Thamer R, Hassan A, Canna K, Ahmed M, Hassan MT, Badi S, Ahmed MH. A Contemporary Multifaceted Insight into the Association Between Diabetes Mellitus and Diverticular Disease: An Update About Geriatric Syndrome. Geriatrics (Basel) 2025; 10:30. [PMID: 39997529 PMCID: PMC11855509 DOI: 10.3390/geriatrics10010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 12/06/2024] [Accepted: 02/13/2025] [Indexed: 02/26/2025] Open
Abstract
Introduction: Diverticular disease, once considered a rare geriatric gastrointestinal condition, has now become a prevalent disorder associated with increased morbidity and healthcare costs. The spectrum of complications from diverticular disease ranges from incidental findings to more serious issues such as bleeding and diverticulitis. Symptomatic diverticular disease represents a significant economic burden in the western world. Diabetes mellitus is a major global health issue. As global aging accelerates, geriatric syndromes such as diabetes mellitus (DM) and diverticular disease (DD) are becoming increasingly prevalent. Understanding their interplay is critical, particularly within the geriatric population. Both conditions are linked to lifestyle, dietary habits, and changes in gut physiology. Additionally, age-related alterations in the gut microbiome and immune system make this association more complex, contributing to morbidity and healthcare burdens in older adults. The primary aim of this review is to provide an update on the association between diabetes mellitus and diverticular disease. Methods: This narrative review explores the association between diabetes mellitus and diverticular disease. Relevant articles were identified by searching major databases. Results: Risk factors for diverticular disease include insulin resistance, diabetes mellitus, smoking, non-alcoholic fatty liver disease, lack of physical activity, a low-fibre diet, and a high-carbohydrate diet. These risk factors are also associated with the development of diabetes mellitus. Major population studies indicate that diabetes can either increase the risk of diverticular disease or have a neutral impact. A complication of diabetes mellitus includes impaired intestinal peristalsis and enteric nervous system dysfunction, which can ultimately lead to the formation of intestinal diverticula. High-calorie foods low in fibre are a staple in the diets of many type 2 diabetes mellitus patients, contributing to gut dysbiosis. A detrimental consequence of dysbiosis is a breach in the protective intestinal barrier, which promotes the development of diverticulosis. Conclusions: Diabetes mellitus may be associated with diverticular disease, and the risk factors that contribute to diabetes mellitus can also be linked to diverticular disease. Further studies are needed to explore the complex relationship between diabetes mellitus and diverticular disease.
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Affiliation(s)
- Ridwan Hashi
- Medical School, The University of Buckingham, Buckingham MK18 1EG, UK;
| | - Rahma Thamer
- Department of Trauma and Orthopaedic, Oxford University Hospital, Oxford OX3 9DU, UK;
| | - Ahmed Hassan
- Faculty of Medicine, Alexandria University, Alexandria 5424041, Egypt;
| | - Khalid Canna
- Department of Surgery, Bedford Hospital NHS Trust, Bedfordshire MK42 9DJ, UK;
| | - Musaab Ahmed
- College of Medicine, Ajman University, Ajman P.O. Box 346, United Arab Emirates;
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
| | - Mohamed T. Hassan
- Kasr Alainy Faculty of Medicine, Cairo University, Cairo 12613, Egypt;
| | - Safaa Badi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University, Khartoum 11111, Sudan;
| | - Mohamed H. Ahmed
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
- Honorary Senior Lecturer of the Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham MK18 1EG, UK
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Khan Z, Challand CP, Lee MJ. Management of acute colonic pseudo-obstruction: opportunities to improve care? Ann R Coll Surg Engl 2025; 107:106-111. [PMID: 38445579 PMCID: PMC11785443 DOI: 10.1308/rcsann.2024.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Acute colonic pseudo-obstruction (ACPO) is a functional bowel obstruction characterised by colonic dilatation in the absence of mechanical obstruction on imaging. Complications include bowel ischaemia, perforation and death. The aim of this study was to explore outcomes for patients treated for ACPO and to assess adherence to current ACPO treatment guidelines. METHODS This is a retrospective service evaluation and included patients with a diagnosis of ACPO between 1 March 2018 and 31 March 2023. Process measures were identified following discussion with the clinical team from published guidance. Patients were identified using clinical coding and radiological text reports. Cases were eligible for inclusion if they had radiologically confirmed ACPO. Data were collected following review of patient notes into Microsoft Excel. Descriptive analysis was performed with no formal statistical assessment. RESULTS A total of 45 patients were identified, of whom 13 were admitted under general surgery. All patients received admission bloods (n=45). Nearly all patients had computed tomography imaging (43/45, 96%). Only 3/45 (6.7%) of the patients received optimal conservative management (intravenous infusion, nil by mouth, flatus tube, treatment of reversible causes). In all, 11/45 (24%) required further treatment, of whom 7 received this within 72 h. The leading (11/45) complication following diagnosis of ACPO was hospital-acquired pneumonia. Mortality was seen in 9/45. CONCLUSIONS ACPO is often managed remotely by general surgeons. This may impact on the quality of conservative management, and timeliness of endoscopic or pharmacological intervention. Further work is needed to optimise management.
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Swan R, MacVicar E, Carey K, Damaskos D, Ventham N. Outcomes of emergency colorectal surgery within a non-colorectal split site service-a retrospective cohort study. Ir J Med Sci 2025; 194:263-270. [PMID: 39514160 DOI: 10.1007/s11845-024-03837-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Emergency colorectal surgery carries a high risk of morbidity and mortality. Subspecialisation and split-site geographically distinct services may lead to critically unwell patients presenting to a non-colorectal specialist centre requiring urgent on-site intervention. AIMS This study aims to determine outcomes of this high-risk patient cohort. METHODS An observational retrospective study of emergency colorectal laparotomies at the Royal Infirmary of Edinburgh (RIE) between January 2016 and August 2020 was performed. The primary outcome was 30-day mortality. Secondary outcomes included rate of primary anastomosis, complications and overall mortality. Subgroup analysis of the vascular ischaemia cohort and colorectal surgeon involvement was performed. RESULTS One hundred and eighteen patients were included. The median NELA (National Emergency Laparotomy Audit) score was 6.4% (IQR 2.5%-16.7%) and the 30-day mortality rate was 22% (26/118). The rate of primary anastomosis was 24.6%. Twenty-five patients had a vascular ischaemic pathology demonstrating a higher median NELA score (14.3%, IQR 5-22.4% vs. non-ischaemic group 5.7%, IQR 1.7-14.2%, p = 0.013) and thirty-day mortality (44%, 11/25 vs. 16.1%, 15/93, p = 0.006) than those without ischaemic pathology. Colorectal surgeon involvement in cases without ischaemia (23/93) was associated with a similar 30-day mortality (13.1% colorectal surgeon vs. 17.1% non-colorectal specialist surgeon, p = 0.755) and rate of primary anastomosis (30.4% colorectal surgeon vs. 31.8% non-colorectal specialist surgeon, p = 1). CONCLUSIONS The high mortality rate described highlights a specific group of unwell patients unfit for transfer. Research registration number: researchregistry7101.
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Affiliation(s)
- Rebecca Swan
- General and Upper GI Surgical Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
| | - Emma MacVicar
- General and Upper GI Surgical Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Kate Carey
- Department of Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Dimitrios Damaskos
- General and Upper GI Surgical Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
- Department of Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Nicholas Ventham
- Academic Coloproctology, Western General Hospital, Edinburgh, UK
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Thorndal C, Kragsnaes MS, Nilsson AC, Holm DK, dePont Christensen R, Ellingsen T, Kjeldsen J, Bjørsum-Meyer T. Safety and efficacy of faecal microbiota transplantation in patients with acute uncomplicated diverticulitis: study protocol for a randomised placebo-controlled trial. Therap Adv Gastroenterol 2025; 18:17562848241309868. [PMID: 39758967 PMCID: PMC11694295 DOI: 10.1177/17562848241309868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 12/10/2024] [Indexed: 01/07/2025] Open
Abstract
Background Little is known about the involvement of gut microbiota in the disease course of diverticulitis and the potential benefits of manipulating the gut milieu. We propose to conduct a randomised placebo-controlled feasibility trial of faecal microbiota transplantation (FMT) given as capsules to patients with acute uncomplicated diverticulitis. Objectives The objective is primarily to investigate the feasibility of clinical safety, explore efficacy associated with FMT in this patient population, and examine changes in patient-reported quality of life and the composition and function of the gut microbiota. Design Study protocol for a randomised placebo-controlled trial. Methods and analysis Participants with acute, uncomplicated diverticulitis, as confirmed by computed tomography (CT) scan, will be recruited from Odense University Hospital (Denmark) and randomly assigned to either the intervention group or the control group. The intervention group will consist of 20 patients who receive encapsulated FMT. The control group will also consist of 20 patients, receiving placebo capsules. Primary safety endpoint: Patient safety is monitored by (a) the number of re-admissions and (b) the number of adverse events within 3 months of FMT/placebo; Primary efficacy endpoint: Reduction in the proportion of patients treated with antibiotics within 3 months following FMT/placebo; Secondary outcome: Change from baseline to 3 months in the GI-QLI questionnaire. Results will be analysed using an intention-to-treat approach. Adverse events or unintended consequences will be reported. Ethics and discussion This is the first study to investigate the safety and efficacy of FMT in patients with acute uncomplicated diverticulitis. The project has the potential to broaden the knowledge and literature on the role of the intestinal microbiota in diverticulitis, and we believe it will elevate our understanding of cause and effect. Trial registration Informed consent is obtained from all participants. The study is approved by the regional ethics committee (ref. S-20230023) and the Danish Data Protection Agency (ref. 24/2435). The trial was registered on clinicaltrials.gov (NCT06254625) on 10th February 2024.
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Affiliation(s)
- Camilla Thorndal
- Department of Surgery, Odense University Hospital, Baagøes Alle 15, Odense 5000, Denmark
| | - Maja Skov Kragsnaes
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | | | - Rene dePont Christensen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Torkell Ellingsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Jens Kjeldsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastrointestinal Diseases, Odense University Hospital, Odense, Denmark
| | - Thomas Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Crook DL, Padfield OME. A systematic review and meta-analysis of the use of packing in the management of perianal abscesses. Ann R Coll Surg Engl 2025; 107:29-34. [PMID: 38563064 PMCID: PMC11791527 DOI: 10.1308/rcsann.2023.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Perianal abscesses are common presentations and reasons for emergency general surgery admissions. Management involves incision and drainage of the abscess and packing the cavity with internal wound dressings. This meta-analysis aimed to assess in adults if packing an abscess or leaving it unpacked leads to a significant difference in the outcomes of pain on wound dressing, time to healing, rate of fistulation and abscess recurrence. METHODS Randomised controlled trials (RCTs) with participants aged 18 years or older that compared packing of perianal abscess cavities with no packing between 2002 and 2022 were searched for in December 2022 on OVID Medline and Embase, the CENTRAL register of trials, PubMed and Google Scholar. Risk of bias was assessed using the Cochrane Risk of Bias tool. Random effects meta-analysis was conducted on the data extracted. RESULTS Three RCTs involving 490 patients were analysed for the outcomes of abscess recurrence and postoperative fistula formation; the data were not adequate to assess pain on dressing and time to healing. For unpacked versus packed, the pooled relative risk of abscess recurrence was 1.57 (95% confidence interval (CI) 0.764, 3.29, p=0.219) and for fistula formation 0.686 (95% CI 0.430, 1.09, p=0.114). These results suggest there is no significant benefit to packing abscess cavities. CONCLUSIONS Analysis of the outcomes suggests there is no significant difference with regards to rates of abscess recurrence or fistula formation between the packed and unpacked groups; however, appropriately powered RCTs are required in this area to provide more primary evidence to inform best practice and clinical management.
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Agirman E, Disci E, Peksoz R, Atamanalp SS. Primary anastomosis versus stoma following urgent sigmoidectomy for sigmoid volvulus: 58-year experience in a tertiary referral center. Pak J Med Sci 2024; 40:2513-2517. [PMID: 39634902 PMCID: PMC11613403 DOI: 10.12669/pjms.40.11.10543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/12/2024] [Accepted: 09/29/2024] [Indexed: 12/07/2024] Open
Abstract
Objectives Primary anastomosis and stoma are the main options in the restoration of intestinal continuity following urgent sigmoidectomy in sigmoid volvulus (SV). Our purpose was to evaluate the outcomes of both techniques in a 1,083-patient SV series. Methods Total 1,083 cases with SV treated in Ataturk University Research Hospital in 58-year period between June 1966 and July 2024 were included in this study. We reviewed the records of 612 patients (56.5%) retrospectively, while the remaining 471 cases (43.5%) were evaluated prospectively. We investigated some preoperative, operative, and postoperative characteristics in non-matched analyses. Results Among total 379 patients treated with urgent colectomy, primary anastomosis was used in 173 cases (45.6%), while stoma was required in 206 patients (54.4%). The mean age was significantly lower in primary anastomosis group (P<0.005), while male/female ratios were statistically similar (P>0.05). Mean ASA score (P<0.001) and rates of shock (P<0.001), bowel gangrene (P<0.001), bowel perforation (P<0.01), and risky bowel (P<0.005) were also significantly lower in the primary anastomosis group. When stoma closure was considered, operation time was significantly shorter (P<0.001), additionally, morbidity and mortality rates were significantly lower in the primary anastomosis group (P<0.001, in each). The distributions of reoperation rates were statistically similar in both groups (P>0.05). Conversely, hospitalization time was significantly shorter and cost was significantly lower in the primary anastomosis group (P<0.001, in each). Conclusion Primary anastomosis has some advantages in comparison to stoma in the restoration of intestinal continuity following urgent sigmoidectomy in SV. However, stoma is generally preferred in patients with bad health status, old age, and risky bowel. New prospective randomized clinical studies or matched analyses may help to clarify the optimal choice.
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Affiliation(s)
- Enes Agirman
- Enes Agirman, MD. Assistant Professor, Department of General Surgery, Erzurum City Hospital, Erzurum, Turkiye
| | - Esra Disci
- Esra Disc, MD. Associate Professor, Faculty of Medicine, Department of General Surgery, Ataturk University, Erzurum, Turkiye
| | - Rifat Peksoz
- Rifat Peksoz, MD. Associate Professor, Faculty of Medicine, Department of General Surgery, Ataturk University, Erzurum, Turkiye
| | - Sabri Selcuk Atamanalp
- Sabri Selcuk Atamanalp, MD Professor, Faculty of Medicine, Department of General Surgery, Ataturk University, Erzurum, Turkiye
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Almughamsi AM. Catastrophic outcome following misidentification of bowel anatomy during Hartmann's reversal: A case report and technical considerations. Int J Surg Case Rep 2024; 125:110633. [PMID: 39602936 PMCID: PMC11638636 DOI: 10.1016/j.ijscr.2024.110633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 11/14/2024] [Accepted: 11/16/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Reversal of Hartmann's procedure is a complex surgery with potential complications. This case report describes a rare and severe complication following an attempted reversal. CASE PRESENTATION A 53-year-old male who had undergone a Hartmann's procedure for non-metastatic sigmoid colon cancer presented with bowel obstruction 10 days after attempted reversal surgery at another hospital. Imaging studies suggested an entero-colic fistula. Emergency laparotomy revealed dense adhesions and multiple bowel injuries. The procedure was terminated, and controlled fistulae were created. MANAGEMENT AND OUTCOME The patient required two months of intensive care. A subsequent surgery excised the fistulae and restored intestinal continuity, leaving the patient with an end colostomy and approximately 120 cm of ileum. CONCLUSION This case highlights the potential risks of Hartmann's reversal and emphasizes the importance of proper patient selection, timing, and surgical expertise. It underscores the need for thorough preoperative evaluation and preparation when attempting such complex surgeries.
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Mikalonis M, Avlund TH, Løve US. Danish guidelines for treating acute colonic obstruction caused by colorectal cancer-a review. Front Surg 2024; 11:1400814. [PMID: 39628919 PMCID: PMC11611878 DOI: 10.3389/fsurg.2024.1400814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 10/28/2024] [Indexed: 12/06/2024] Open
Abstract
Acute onset of colonic obstruction caused by colorectal cancer occurs in approximately 14% of Danish patients with colon cancer(1). Given that colorectal cancer is a common cancer with about 4,500 new cases annually, acute onset will occur in a reasonably large number of patients in Danish emergency departments, and all surgeons should be familiar with the treatment principles. A revised guideline from the Danish Colorectal Cancer Group is currently underway, and this status article reviews the latest knowledge and recommendations.
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Affiliation(s)
| | | | - Uffe Schou Løve
- Department of Surgery, Regional Hospital Viborg, Viborg, Denmark
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13
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Mohamedahmed AY, Hamid M, Issa M, Albendary M, Sultana E, Zaman S, Bhandari S, Sarma D, Ball W, Thomas P, Husain N. Ambulatory management of acute uncomplicated diverticulitis (AmbUDiv study): a multicentre, propensity score matching study. Int J Colorectal Dis 2024; 39:184. [PMID: 39557684 PMCID: PMC11573821 DOI: 10.1007/s00384-024-04759-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2024] [Indexed: 11/20/2024]
Abstract
INTRODUCTION Recent studies have suggested that ambulatory management is feasible for acute uncomplicated diverticulitis (AUD); however, there is still no consensus regarding the most appropriate management settings. This study presents a multi-centre experience of managing patients presenting with AUD, specifically focusing on clinical outcomes and comparing ambulatory treatment with in-patient management. METHODS A retrospective multi-centre study was conducted across four hospitals in the UK and included all adult patients with computed tomography (CT) confirmed (Hinchey grade 1a) acute diverticulitis over a 12-month period (January - December 2022). Patient medical records were followed up for 1-year post-index episode, and outcomes were compared between those treated through the ambulatory pathway versus inpatient treatment using 1:1 propensity score matching (PSM). All statistical analysis was performed using the R Foundation for Statistical Computing, version 4.4. RESULTS A total of 348 patients with Hinchey 1a acute diverticulitis were included (260 in-patients; 88 ambulatory pathway), of which nearly a third (31.3%) had a recurrent disease. Inpatient management was dominant (74.7%), with a median of 3 days of hospital stay. PSM resulted in 172 patients equally divided between the two care settings. Ambulatory management was associated with a lower readmission rate (P = 0.02 before PSM, P = 0.08 after PSM), comparable surgical (P = 0.57 before PSM, 0% in both groups after PSM) and radiological interventions (P = 0.99 before and after PSM) within one year. In both matched and non-matched groups, a strong association between readmissions and inpatient management was noted in univariate analysis (P = 0.03 before PSM, P = 0.04 after PSM) and multivariate analysis (P = 0.02 before PSM, P = 0.03 after PSM). CONCLUSION Our study supports the safety and efficacy of managing patients with AUD through a well-designed ambulatory care pathway. In particular, hospital re-admission rates are lower and other outcomes are non-inferior to in-patient treatment. This has implications for substantial cost-savings and better utilisation of limited healthcare resources.
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Affiliation(s)
- Ali Yasen Mohamedahmed
- Department of General and Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Queen's Hospital Burton, Burton on Trent, UK
| | - Mohammed Hamid
- Department of General Surgery, Wye Valley NHS Trust, Hereford County Hospital, Hereford, UK
| | - Mohamed Issa
- Department of General and Colorectal Surgery, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Mohamed Albendary
- Department of General Surgery, North West Anglia NHS Trust, Peterborough, UK
| | - Emiko Sultana
- Department of General and Colorectal Surgery, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Shafquat Zaman
- Department of General and Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Queen's Hospital Burton, Burton on Trent, UK.
- College of Medical and Dental Science, School of Medicine, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Santosh Bhandari
- Department of General Surgery, North West Anglia NHS Trust, Peterborough, UK
| | - Diwakar Sarma
- Department of General and Colorectal Surgery, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - William Ball
- Department of General and Colorectal Surgery, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Pradeep Thomas
- Department of General and Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Queen's Hospital Burton, Burton on Trent, UK
| | - Najam Husain
- Department of General and Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Queen's Hospital Burton, Burton on Trent, UK
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Dawes AJ, Gahagan JV. Stoma Complications. Clin Colon Rectal Surg 2024; 37:387-397. [PMID: 39399130 PMCID: PMC11466528 DOI: 10.1055/s-0043-1777453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
Stoma-related complications are among the most common sources of perioperative morbidity in colorectal surgery. Complications can occur intraoperatively, in the immediate postoperative period, or even months to years after stoma creation. Although some will require urgent surgical intervention, most are treated nonoperatively with a combination of education, appliance adjustment, and behavioral intervention. Optimal management of stoma complications nearly always requires a multidisciplinary team approach, including surgeons, enterostomal therapists, and other allied health professionals, depending on the specific situation. Patients with a functional stoma should be expected to be able to do anything that patients without a stoma can do with minimal exceptions. The treatment of stoma complications therefore centers on improving stoma function and maximizing quality of life. Although timely and comprehensive intervention will result in the resolution of most stoma complications, there is no substitute for preoperative planning and meticulous stoma creation.
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Affiliation(s)
- Aaron J. Dawes
- Section of Colon and Rectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
| | - John V. Gahagan
- Section of Colon and Rectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
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15
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Al-Sarireh H, Al-Sarireh A, Mann K, Hajibandeh S, Hajibandeh S. Effect of surgeon's seniority and subspeciality interest on mortality after emergency laparotomy: A systematic review and meta-analysis. Colorectal Dis 2024; 26:1495-1504. [PMID: 38898583 DOI: 10.1111/codi.17079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
AIM To evaluate effect of surgeon's seniority (trainee surgeon vs. consultant surgeon) and surgeon's subspeciality interest on postoperative mortality in patients undergoing emergency laparotomy (EL). METHOD A systematic review was conducted and reported according to the Cochrane Handbook for Systematic Reviews and the PRISMA statement standards, respectively. We evaluated all studies comparing the risk of postoperative mortality in patients undergoing EL between (a) trainee surgeon and consultant surgeon, and (b) surgeon without and with subspeciality interest related to pathology. Random effects modelling was applied for the analyses. The certainty of evidence was assessed using the GRADE system. RESULTS Analysis of 256 844 patients from 13 studies showed no difference in the risk of postoperative mortality between trainee-led and consultant-led EL (OR: 0.76, p = 0.12). However, EL performed by a surgeon without subspeciality interest related to the pathology was associated with a higher risk of postoperative mortality compared with a surgeon with subspeciality interest (OR: 1.38, p < 0.00001). In lower gastrointestinal (GI) pathologies, EL done by upper GI surgeons resulted in higher risk of mortality compared with lower GI surgeons (OR: 1.43, p < 0.00001). In upper GI pathologies, EL done by lower GI surgeons resulted in higher risk of mortality compared with upper GI surgeons (OR: 1.29, p = 0.05). CONCLUSION While confounding by indication cannot be excluded, level 2 evidence with moderate certainty suggests that trainee-led EL may not increase the risk of postoperative mortality but EL by a surgeon with subspeciality interest related to the pathology may reduce the risk of mortality.
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Affiliation(s)
| | | | - Karan Mann
- Department of General Surgery, Morriston Hospital, Swansea, UK
| | - Shahin Hajibandeh
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
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16
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Hamel C, Avard B, Belanger C, Chatterjee A, Hartery A, Lim H, Kanagaratnam S, Fung C. Canadian Association of Radiologists Gastrointestinal Imaging Referral Guideline. Can Assoc Radiol J 2024; 75:462-472. [PMID: 38183236 DOI: 10.1177/08465371231217230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
The Canadian Association of Radiologists (CAR) Gastrointestinal Expert Panel consists of radiologists, a gastroenterologist, a general surgeon, a family physician, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 20 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 58 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 85 recommendation statements specific to the adult population across the 20 scenarios. This guideline presents the methods of development and the referral recommendations for dysphagia/dyspepsia, acute nonlocalized abdominal pain, chronic abdominal pain, inflammatory bowel disease, acute gastrointestinal bleeding, chronic gastrointestinal bleeding/anemia, abnormal liver biopsy, pancreatitis, anorectal diseases, diarrhea, fecal incontinence, and foreign body ingestion.
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Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Barb Avard
- North York General Hospital, Toronto, ON, Canada
| | | | - Avi Chatterjee
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Angus Hartery
- Eastern Health, Memorial University, St. Clare's, St. John's, NL, Canada
| | - Howard Lim
- University of British Columbia, BC Cancer, Vancouver Centre, Vancouver, BC, Canada
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17
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Hamel JF, Alves A, Beyer-Bergot L, Zerbib P, Bridoux V, Manceau G, Panis Y, Buscail E, Khaoudy I, Gaillard M, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Godet C, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Defourneaux V, Maggiorri L, Rebibo L, Christou N, Talal A, Mege D, Aubert M, Bonnamy C, Germain A, Mauvais F, Tresallet C, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Ouaissi M, Pellegrin A, Sabbagh C, Venara A. Stenosis of the colorectal anastomosis after surgery for diverticulitis: A national retrospective cohort study. Colorectal Dis 2024; 26:1437-1446. [PMID: 38886887 DOI: 10.1111/codi.17076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 05/11/2024] [Accepted: 05/25/2024] [Indexed: 06/20/2024]
Abstract
AIM The aim of this work was to investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis. METHOD This is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie. The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right-sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage. RESULTS Of the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75-6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32-5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19-0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2-4.75 and OR = 12.95, 95% CI = 9.11-18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted. CONCLUSION AL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery.
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Affiliation(s)
- Jean-Francois Hamel
- Faculty of Health, Department of Medicine, University of Angers, Angers, France
- Department of Biostatistics, University Hospital of Angers, Angers, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
| | - Laura Beyer-Bergot
- Department of Digestive Surgery Assistance, Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - Philippe Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Université Lille Nord de France, Lille, France
| | - Valérie Bridoux
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France
| | - Gilles Manceau
- Department of Surgery, European Georges Pompidou Hospital, Paris, France
| | - Yves Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Etienne Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - Iman Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - Martin Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - Manon Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - Alexandre Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
| | - Clarisse Eveno
- Department of Digestive Surgery, University Hospital of Lille, Lille, France
| | - Catherine Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - Bodgan Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - Camille Godet
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France
| | - Yassine Eid
- Department of Digestive Surgery, Robert Bisson Hospital, Lisieux, France
| | - Emilie Duchalais
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hôpital Lyon Sud, Lyon, France
| | - Anais Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | | | - Léon Maggiorri
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | - Lionel Rebibo
- Department of Digestive, Esogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Niki Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - Ali Talal
- Department of Digestive Surgery, Argentan Hospital, Argentan, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - Mathilde Aubert
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - Cécile Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France
| | | | - François Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - Christophe Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Sorbonne Paris Nord University, Paris, France
| | - Jean Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - Alexis Laurent
- Department of Digestive Surgery, Créteil Hospital, Créteil, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Martin Bertrand
- Department of Digestive Surgery, University Hospital of Nîmes, Nîmes, France
| | - Damien Massalou
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France
| | - Benoit Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, Clamart, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplantation, Trousseau Hospital, University Hospital of Tours, Tours, France
| | | | - Charles Sabbagh
- Department of Surgery, Amiens University Hospital, Amiens, France
| | - Aurélien Venara
- Faculty of Health, Department of Medicine, University of Angers, Angers, France
- UMR INSERM 1235, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
- Department of Surgery, Angers University Hospital, Angers, France
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McHugh FT, Ryan ÉJ, Ryan OK, Tan J, Boland PA, Whelan MC, Kelly ME, McNamara D, Neary PC, O'Riordan JM, Kavanagh DO. Management Strategies for Malignant Left-Sided Colonic Obstruction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials and Propensity Score Matching Studies. Dis Colon Rectum 2024; 67:878-894. [PMID: 38557484 DOI: 10.1097/dcr.0000000000003256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND The optimal treatment strategy for left-sided malignant colonic obstruction remains controversial. Emergency colonic resection has been the standard of care; however, self-expanding metallic stenting as a bridge to surgery may offer short-term advantages, although oncological concerns exist. Decompressing stoma may provide a valid alternative, with limited evidence. OBJECTIVE To perform a systematic review and Bayesian arm random-effects model network meta-analysis comparing the approaches for management of malignant left-sided colonic obstruction. DATA SOURCES A systematic review of PubMed, Embase, Cochrane Library, and Google Scholar databases was conducted from inception to August 22, 2023. STUDY SELECTION Randomized controlled trials and propensity score-matched studies. INTERVENTIONS Emergency colonic resection, self-expanding metallic stent, and decompressing stoma. MAIN OUTCOME MEASURES Oncologic efficacy, morbidity, successful minimally invasive surgery, primary anastomosis, and permanent stoma rates. RESULTS Nineteen of 5225 articles identified met our inclusion criteria. Stenting (risk ratio 0.57; 95% credible interval, 0.33-0.79) and decompressing stomas (risk ratio 0.46, 95% credible interval: 0.18-0.92) resulted in a significant reduction in the permanent stoma rate. Stenting facilitated minimally invasive surgery more frequently (risk ratio 4.10; 95% credible interval, 1.45-13.13) and had lower overall morbidity (risk ratio 0.58; 95% credible interval, 0.35-0.86). A pairwise analysis of primary anastomosis rates showed increased stenting (risk ratio 1.40; 95% credible interval, 1.31-1.49) compared with emergency resection. There was a significant decrease in the 90-day mortality with stenting (risk ratio 0.63; 95% credible interval, 0.41-0.95) compared with resection. There were no differences in disease-free and overall survival rates, respectively. LIMITATIONS There is a lack of randomized controlled trials and propensity score matching data comparing short-term and long-term outcomes for diverting stomas compared to self-expanding metallic stents. Two trials compared self-expanding metallic stents and diverting stomas in left-sided malignant colonic obstruction. CONCLUSIONS This study provides high-level evidence that a bridge-to-surgery strategy is safe for the management of left-sided malignant colonic obstruction and may facilitate minimally invasive surgery, increase primary anastomosis rates, and reduce permanent stoma rates and postoperative morbidity compared with emergency colonic resection.
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Affiliation(s)
- Fiachra T McHugh
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Éanna J Ryan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Odhrán K Ryan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Jonavan Tan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Patrick A Boland
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Maria C Whelan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Michael E Kelly
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Paul C Neary
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - James M O'Riordan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Dara O Kavanagh
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Department of Surgical Affairs, Royal College of Surgeons Ireland, Dublin, Ireland
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Atamanalp SS. Laparoscopic Sigmoid Colectomy with Natural Orifice Specimen Extraction in Sigmoid Volvulus. Eurasian J Med 2024; 56:142-145. [PMID: 38798007 PMCID: PMC11332260 DOI: 10.5152/eurasianjmed.2024.24420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Sigmoid volvulus (SV), the twisting of the sigmoid colon around its own base, is a relatively rare colonic obstruction form. Endoscopic detorsion is the first-line management option in uncomplicated patients. However, recurrence risk is as high as 90%, with a risk of mortality up to 35%. Although procedures such as sigmoidopexy, sigmoidomesopexy, sigmoidomesoplasty, extraperitonealization, or percutaneous endoscopic sigmoidopexy may prevent or reduce SV recurrence, laparoscopic sigmoid colectomy with natural orifice specimen extraction appears to be the optimal choice in selected cases. Cite this article as: Atamanalp SS. Laparoscopic sigmoid colectomy with natural orifice specimen extraction in sigmoid volvulus. Eurasian J Med. Published online May 2, 2024. doi:10.5152/ eurasianjmed.2024.24420.
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20
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Mateș IN. Diverting Stoma-Related Evisceration: A Comprehensive Review of 28 Case Reports Published in the Medical Literature in English. Cureus 2024; 16:e59621. [PMID: 38832178 PMCID: PMC11145463 DOI: 10.7759/cureus.59621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Evisceration is an exceptional complication of diverting a stoma (a common procedure, often considered a minor surgery) with peculiar, specific, features (distinct-to-usual incisional evisceration), due to the presence of a stoma. Available data are limited to a few case reports; some aspects are not fully documented. The results of 28 case reports (full-text articles published in the English literature) were analyzed using 14 variables: age and gender; pathology; surgical setting; index surgery and type of stoma; intended stoma creation; time from surgery to evisceration; type of evisceration; visceral content; cause of evisceration; specific predisposing/risk factors; surgical approach; resection of nonviable content; surgical stoma treatment; and short-term outcome. Urgent surgery resulted in 46.42% resection of nonviable eviscerated content and 7.14% mortality. All issues (some not discussed in previous reviews) were analyzed, to highlight their clinical relevance for surgical practice. The mechanisms (types of evisceration) are different in parastomal and transstomal/intrastomal evisceration; they should be considered as distinct entities. The real (underlying) etiology was identified in 26/28 case reports (92.85%): surgical failure, such as inadequate technique/tactics/strategy (12/26 case reports, 46.15%); trauma (7/26 case reports, 26.92%); and spontaneous necrosis (6/26 case reports, 21.42%). Parastomal hernia and/or prolapse (10/28 case reports, 35.71%) were specific predisposing factors; in such cases, early surgical treatment is recommended. Temporary stoma was a potential risk factor, both for early as well as for late evisceration (e.g., long-standing temporary stoma); in such cases, early take-down or conversion to definitive stoma is beneficial. A local surgical approach (avoiding median laparotomy) was used in 13/28 (46.42%) of case reports. Seven different surgical options were used for surgical stoma treatment, demonstrating versatility; the initial stoma site was preserved in 22/28 (78.57%) of case reports.
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Affiliation(s)
- Ioan Nicolae Mateș
- Clinic of General and Esophageal Surgery, Saint Mary Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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Schembari E, Richardson C, King AT, Layfield DM. Mesh mediated fascial traction in the management of the open abdomen: A video vignette. Colorectal Dis 2024; 26:207-210. [PMID: 38030879 DOI: 10.1111/codi.16816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Elena Schembari
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carl Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew T King
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David M Layfield
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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22
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Maes-Carballo M, Gómez-Fandiño Y, García-García M, Martín-Díaz M, De-Dios-de-Santiago D, Khan KS, Bueno-Cavanillas A. Colorectal cancer treatment guidelines and shared decision making quality and reporting assessment: Systematic review. PATIENT EDUCATION AND COUNSELING 2023; 115:107856. [PMID: 37451055 DOI: 10.1016/j.pec.2023.107856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Physicians must share decisions and choose personalised treatments regarding patients´ beliefs and values. OBJECTIVE To analyse the quality of the recommendations about shared decision making (SDM) in colorectal (CRC) and anal cancer treatment clinical practice guidelines (CPGs) and consensus statements (CSs). METHODS Guidelines were systematically reviewed following prospective registration (Prospero: CRD42021286146) without language restrictions searching 15 databases and 59 professional society websites from January 2010 to November 2021. A validated 31-item SDM quality assessment tool was employed to extract data in duplicate. RESULTS We identified 134 guidelines. Only 46/134 (34.3 %) mentioned SDM. Fifteen (11.1 %) made clear, precise and actionable recommendations, while 9/134 (6.7 %) indicated the strength of the SDM-related recommendations. CPGs underpinned by systematic reviews reported SDM more often than those based on consensus or reviews (35.9 % vs 32.0 %; p = 0.031). Guidelines that reported following quality tools (i.e., AGREE II) more commonly commented about SDM than when it was not reported (75.0 % vs 32.0 %; p = 0.003). CONCLUSION AND PRACTICE IMPLICATIONS Most of the CRC and anal treatment guidelines did not mention SDM and it was superficial. Guidelines based on systematic reviews and those using quality tools demonstrated better reporting of SDM. Recommendations about SDM in these guidelines merit urgent improvement.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; Hospital Público de Verín, Ourense, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Yolanda Gómez-Fandiño
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Manuel García-García
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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23
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Scott MJ, Aggarwal G, Aitken RJ, Anderson ID, Balfour A, Foss NB, Cooper Z, Dhesi JK, French WB, Grant MC, Hammarqvist F, Hare SP, Havens JM, Holena DN, Hübner M, Johnston C, Kim JS, Lees NP, Ljungqvist O, Lobo DN, Mohseni S, Ordoñez CA, Quiney N, Sharoky C, Urman RD, Wick E, Wu CL, Young-Fadok T, Peden CJ. Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS ®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care. World J Surg 2023; 47:1850-1880. [PMID: 37277507 PMCID: PMC10241558 DOI: 10.1007/s00268-023-07020-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra- and postoperative aspects of care. METHODS Experts in aspects of management of high-risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL. RESULTS Twenty-three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process. CONCLUSIONS These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.
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Affiliation(s)
- Michael J. Scott
- Department of Anesthesiology and Critical Care Medicine, Leonard Davis Institute for Health Economics, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
- University College London, London, UK
| | - Geeta Aggarwal
- Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey UK
| | - Robert J. Aitken
- Sir Charles Gardiner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
| | - Iain D. Anderson
- Salford Royal NHS Foundation Trust, Stott La, Salford, M6 8HD UK
- University of Manchester, Manchester, UK
| | - Angie Balfour
- Western General Hospital, NHS Lothian, Edinburgh, EH4 2XU Scotland
| | | | - Zara Cooper
- Harvard Medical School, Kessler Director, Center for Surgery and Public Health, Brigham and Women’s Hospital and Division of Trauma, Burns, Surgical Critical Care, and Emergency Surgery, Brigham and Women’s Hospital, 1620 Tremont Street, Boston, MA 02120 USA
| | - Jugdeep K. Dhesi
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - W. Brenton French
- Department of Surgery, Virginia Commonwealth University Health System, 1200 E. Broad Street, Richmond, VA 23298 USA
| | - Michael C. Grant
- Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Folke Hammarqvist
- Department of Emergency and Trauma Surgery, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital Huddinge, Hälsovägen 3. B85, 141 86 Stockholm, Sweden
| | - Sarah P. Hare
- Department of Anaesthesia, Perioperative Medicine and Critical Care, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY UK
| | - Joaquim M. Havens
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Daniel N. Holena
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Carolyn Johnston
- Department of Anesthesia, St George’s Hospital, Tooting, London, UK
| | - Jeniffer S. Kim
- Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA 9110 USA
| | - Nicholas P. Lees
- Department of General and Colorectal Surgery, Salford Royal NHS Foundation Trust, Scott La, Salford, M6 8HD UK
| | - Olle Ljungqvist
- Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - Dileep N. Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, 701 85 Orebro, Sweden
| | - Carlos A. Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 – 49, 760032 Cali, Colombia
- Sección de Cirugía de Trauma y Emergencias, Universidad del Valle – Hospital Universitario del Valle, Cl 5 No. 36-08, 760032 Cali, Colombia
| | - Nial Quiney
- Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU5 7XX UK
| | - Catherine Sharoky
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Richard D. Urman
- Department of Anesthesiology, The Ohio State University and Wexner Medical Center, 410 West 10Th Ave, Columbus, OH 43210 USA
| | - Elizabeth Wick
- Department of Surgery, University of California San Francisco, 513 Parnassus Ave HSW1601, San Francisco, CA 94143 USA
| | - Christopher L. Wu
- Department of Anesthesiology, Critical Care and Pain Medicine-Hospital for Special Surgery, Department of Anesthesiology-Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021 USA
| | - Tonia Young-Fadok
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, 5777 e. Mayo Blvd., Phoenix, AZ 85054 USA
| | - Carol J. Peden
- Department of Anesthesiology Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA 90033 USA
- Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 USA
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24
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Morris PD, Allaway MGR, Wright D. How to do mesh-mediated fascial traction for delayed primary closure of the open abdomen. ANZ J Surg 2023; 93:1999-2002. [PMID: 37128158 DOI: 10.1111/ans.18474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/19/2023] [Accepted: 04/09/2023] [Indexed: 05/03/2023]
Abstract
The open abdomen can be a life-saving resuscitative manoeuvre in patients with catastrophic abdominal pathologies, however, can lead to the need for delayed primary closure. The most recent guidelines released from the European Hernia Society and World Society for Emergency Surgery both suggest mesh-mediated fascial traction in conjunction with negative pressure wound therapy as the preferred method in this situation. We present a detailed 'how to do it' on this technique.
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Affiliation(s)
- Paul David Morris
- Department of General Surgery, Blacktown and Mt Druitt Hospital, New South Wales, Blacktown, Australia
- University of Sydney, Camperdown, New South Wales, Australia
| | | | - Danette Wright
- Department of General Surgery, Blacktown and Mt Druitt Hospital, New South Wales, Blacktown, Australia
- University of Sydney, Camperdown, New South Wales, Australia
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25
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Luton OW, Mortimer M, Hopkins L, Robinson DBT, Egeler C, Smart NJ, Harries R. Is there a role for botulinum toxin A in the emergency setting for delayed abdominal wall closure in the management of the open abdomen? A systematic review. Ann R Coll Surg Engl 2023; 105:306-313. [PMID: 35174720 PMCID: PMC10066655 DOI: 10.1308/rcsann.2021.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Emergency laparotomy for either trauma or non-trauma indications is common and management is varied. Use of the open abdomen technique allowing for planned re-look is an option; however, performing delayed definitive fascial closure (DFC) following this can be a challenge. The use of botulinum toxin-A (BTX) infiltration into the lateral abdominal wall has been well documented within the elective setting; its use within the emergency setting is undecided. This systematic review assesses the efficacy and safety of BTX injection into the lateral abdominal wall muscles in the emergency setting. The primary outcome is DFC rate. METHODS Systematic review was performed according to the PROSPERO registered protocol (CRD42020205130). Papers were dual screened for eligibility, and included if they met pre-stated criteria where the primary outcome was DFC. Articles reporting fewer than five cases were excluded. Bias was assessed using the Cochrane Risk of Bias and Joanna Brigg's appraisal tools. FINDINGS Fourteen studies were screened for eligibility, twelve full texts were reviewed and two studies were included. Both studies showed evidence of bias due to confounding factors and lack of reporting. Both studies suggested significantly higher rates of DFC than reported in the literature against standard technique (90.7% vs 66%); however, these data are difficult to interpret due to strict study inclusion criteria or lack of a control population. CONCLUSION The use of BTX is deemed safe and its effects in the emergency situation may have great potential. Unfortunately, to date, there is insufficient evidence to facilitate opinion.
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Affiliation(s)
- OW Luton
- Health Education and Improvement Wales, UK
| | | | - L Hopkins
- Health Education and Improvement Wales, UK
| | | | - C Egeler
- Swansea Bay University Health Board, UK
| | - NJ Smart
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - R Harries
- Swansea Bay University Health Board, UK
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26
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Bradea C, Tarcoveanu E, Munteanu V, Lupascu CD, Andriesi-Rusu FD, Ciobanu DG, Vasilescu AM. Laparoscopic Hartmann Procedure—A Surgery That Still Saves Lives. Life (Basel) 2023; 13:life13040914. [PMID: 37109443 PMCID: PMC10142299 DOI: 10.3390/life13040914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Background: A Hartmann operation, which is the intervention by which the lower part of the sigmoid and the upper part of the rectum are resected with the closing of the rectal stump and end colostomy, has as its indications: advanced or complicated rectosigmoid neoplasm, moderate biological condition of the patient, peritoneal sepsis, intestinal occlusion and fragile colonic wall, especially in the context of inflammatory changes. The Hartmann procedure can save lives even at the cost of a stoma reversal failure. Methods: The cases operated with the Hartmann procedure by an open approach or laparoscopic approach in our clinic, between 1 January 2016 and 31 December 2020, were admitted in this study and their medical records were reviewed, also making a comparison between the two types of approach. Univariate statistical comparisons but also a multivariate analysis was performed. Results: We performed 985 operations for intestinal and colonic occlusion (7.15% of the total operations in the clinic), 531 (54%) were non-tumor occlusions and 454 (46%) were occlusive tumors (88 Hartmann operations). Of these, 7.3% were laparoscopically performed (7 laparoscopic Hartmann operations and 23 diagnostic laparoscopies). A total of 11 cases (18%) also had colonic perforation. We compared laparoscopic Hartmann with open Hartmann and observed the benefits of laparoscopy for postoperative morbidity and mortality. The presence of pulmonary and cardiac morbidities is associated with the occurrence of general postoperative morbidities, while peritonitis is statistically significantly associated with the occurrence of local complications that are absent after the laparoscopic approach. Conclusions: The Hartmann procedure is still nowadays an operation widely used in emergency situations. Laparoscopy may become standard for the Hartmann procedure and reversal of the Hartmann procedure, but the percentage of laparoscopy remains low due to advanced or complicated colorectal cancer, poor general condition both at the first and second intervention, and the difficulties of reversal of the Hartmann procedure.
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27
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Singh K, Liptrot S, Tou S, Mehigan B, McCormick P, Ravi N, Reynolds J, Al Chalabi H. A multicentre study assessing the role of routine colonoscopy after acute uncomplicated diverticulitis and the incidence of colorectal cancer diagnosis. Int J Colorectal Dis 2023; 38:84. [PMID: 36976397 DOI: 10.1007/s00384-023-04374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE The low rates of colonic malignancy detected on interval colonoscopy for patients diagnosed with diverticulitis have led recent studies to question the utility of the practice. The aim of this study was to assess the detection rate of colorectal cancer on colonoscopy for patients with a first episode of acute uncomplicated diverticulitis across three separate centres in Ireland and the UK. METHODS A retrospective review was performed of patients with a first episode of acute, uncomplicated diverticulitis who underwent interval colonoscopy at three separate centres in the UK and Ireland between 2007 and 2019. The follow-up period was one year. RESULTS A total of 5485 patients were admitted with acute diverticulitis between the three centres. All patients had CT verified diverticulitis. A 90.8% (n = 4982) underwent subsequent colonic evaluation with colonoscopy. Of these, a histologically proven diagnosis of colorectal carcinoma was made in 1.28% (n = 64). CONCLUSION Routine colonoscopy following an episode of acute, uncomplicated diverticulitis may not be necessary in every patient. It may be appropriate to reserve this more invasive investigation for those with higher risk factors for malignancy.
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Affiliation(s)
- Kaushiki Singh
- Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK.
| | - Sarah Liptrot
- University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Sam Tou
- University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | | | | | | | | | - Hasan Al Chalabi
- Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK
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28
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Dean HF, Britton E, Farrow E, Abdel-Khaleq S, Lakin N, Bradbury M, Cook T. Can endoscopic follow-up after acute diverticulitis be rationalised? Surg Endosc 2023:10.1007/s00464-023-09997-6. [PMID: 36932189 PMCID: PMC10023004 DOI: 10.1007/s00464-023-09997-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Acute diverticulitis (AD) is a common cause of presentation to emergency surgical services. Follow-up with endoluminal investigation to exclude colorectal cancer (CRC) remains controversial. Guidelines are increasingly moving to a more restrictive follow-up based on severity of disease and age. The purpose of this observational study was to assess the prevalence of CRC in AD patients and the impact of follow-up on endoscopy services. METHODS Patients admitted with a diagnosis of AD over a 2-year period were reviewed. The proportion of patients undergoing endoscopic follow-up and the CRC detection rate were recorded. The potential impact of a more conservative approach to follow-up was evaluated. RESULTS There were 484 patients with AD presenting 546 times (M:F = 198:286; median age = 63 years). 80% of admissions were aged 50 or older. There were 43 emergency interventions in 39 patients (10 percutaneous drain; 33 surgery). The remainder were managed conservatively. 28 patients (5.1%) underwent colonic resection with cancer found in one specimen (3.6%). 287 patients underwent endoluminal follow-up with cancer diagnosed in 3 cases (1.0%). There was no significant difference in the prevalence of CRC between patients requiring emergency surgery and those managed conservatively, or between patients with complicated versus uncomplicated diverticulitis. CONCLUSION CRC masquerading as acute diverticulitis is rare. The incidence of neoplasia both at endoscopic follow-up and in patients requiring emergency intervention is low. Conservative follow-up strategies appear safe, but their effectiveness in reducing the burden on endoscopy services may be limited by current age-based recommendations. Restricting follow-up to those with complicated AD would reduce the number of patients requiring endoluminal investigation by 70%.
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Affiliation(s)
- Harry Frederick Dean
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK.
| | - Emily Britton
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
| | - Emily Farrow
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
| | - Sameerah Abdel-Khaleq
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
| | - Natasha Lakin
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
| | - Molly Bradbury
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
| | - Tim Cook
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
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29
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Bawa D, Khalifa YM, Khan S, Norah W, Noman N. Surgical outcomes and prognostic factors associated with emergency left colonic surgery. Ann Saudi Med 2023; 43:97-104. [PMID: 37031374 PMCID: PMC10082940 DOI: 10.5144/0256-4947.2023.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Mortality from emergency left-sided colorectal surgery can be substantial due to acuteness of the presentation and the urgent need to operate in the setting of a limited preparation in a morbid patient. OBJECTIVES Determine the 30-day postoperative outcomes and identify risk factors for complications and mortality following emergency colorectal operations. DESIGN Retrospective SETTINGS: Three tertiary hospitals in three countries. PATIENTS AND METHODS Factors that were studied included age, sex, ASA score, type and extent of the operation, and presence/absence of malignancy. Unadjusted 30-day patient outcomes examined were complications and mortality. Differences in proportions were assessed using the Pearson chi-square test while logistic regression analyses were carried out to evaluate the correlation between risk factors and outcomes. MAIN OUTCOME MEASURES 30-day postoperative morbidity and mortality SAMPLE SIZE: 104 patients. RESULTS Among 104 patients, 70 (67.3%) were men, and 34 (32.7%) were women. The mean (SD) age was 57.2 (17.1) years. The most common indication for emergency colonic surgery was malignant obstruction in 33 (31.7%) patients. The postoperative complication rate was 24% (25/104), and the mortality rate was 12.5% (13/104) within 30 days of the operation. The ASA status (P=.02), presence of malignancy (P=.02), and the presence of complications (P=.004) were significantly related to mortality in the multivariable logistic regression analysis. CONCLUSIONS The 30-day mortality of emergency colorectal operations is greatly influenced by the presence of malignancy in the colon and physiological status at the time of the procedure. LIMITATIONS The retrospective design and small sample size. CONFLICT OF INTEREST None.
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Affiliation(s)
- Dauda Bawa
- From the Department of Surgery, King Abdullah Hospital Bisha, RIyadh, Saudi Arabia
| | | | - Saleem Khan
- From the Department of Surgery, King Abdullah Hospital Bisha, RIyadh, Saudi Arabia
| | - Waddah Norah
- From the Department of Surgery, Haql General Hospital, Haql, Tabuk, Saudi Arabia
| | - Nibras Noman
- From the Department of Surgery, University of Liverpool, Merseyside, United Kingdom
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30
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Mohamed I, Harries RL. Contemporary management of parastomal hernia. Br J Surg 2023; 110:299-301. [PMID: 36640131 DOI: 10.1093/bjs/znac448] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/01/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Imran Mohamed
- Department of General Surgery, Swansea Bay University Health Board, Swansea, UK
| | - Rhiannon L Harries
- Department of General Surgery, Swansea Bay University Health Board, Swansea, UK
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31
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Kalaiselvan R, Slade DAJ, Soop M, Burnett H, Lees NP, Anderson ID, Lal S, Carlson GL. Impact of negative pressure wound therapy on enteroatmospheric fistulation in the septic open abdomen. Colorectal Dis 2023; 25:111-117. [PMID: 36031878 DOI: 10.1111/codi.16318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 02/02/2023]
Abstract
AIM The effect of negative pressure wound therapy (NPWT) on the pathogenesis and outcome of enteroatmospheric fistulation (EAF) in the septic open abdomen (OA) is unclear. This study compares the development and outcome of EAF following NPWT with that occurring in the absence of NPWT. METHODS Consecutive patients admitted with EAF following abdominal sepsis at a National Reference Centre for intestinal failure between 01 January 2005 and 31 December 2015 were included in this study. Patients were divided into two groups based on those that had been treated with NPWT and those that had not (non-NPWT) and characteristics of their fistulas compared. Clinical outcomes concerning nutritional autonomy at 4 years and time to fistula development, size of abdominal wall defect and complete fistula closure were compared between groups. RESULTS A total of 160 patients were admitted with EAF following a septic abdomen (31-NPWT and 129-non-NPWT). Median (range) time taken to fistulation after OA was longer with NPWT (18 [5-113] vs. 8 [2-60] days, p = 0.004); these patients developed a greater number of fistulas (3 [2-21] vs. 2 [1-10], p = 0.01), involving a greater length of small bowel (42.5 [15-100] cm vs. 30 [3.5-170] cm, p = 0.04) than those who did not receive NPWT. Following reconstructive surgery, nutritional autonomy was similar in both groups (77% vs. 72%) and a comparable number of patients were also fistula-free (100% vs. 97%). CONCLUSIONS Negative pressure wound therapy appears to be associated with more complex and delayed intestinal fistulation, involving a greater length of small intestine in the septic OA. This did not, however, appear to adversely affect the overall outcome of intestinal and abdominal wall reconstruction in this study.
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Affiliation(s)
- Ramya Kalaiselvan
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Dominic A J Slade
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Mattias Soop
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Hugh Burnett
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Nicholas P Lees
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Iain D Anderson
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon Lal
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Gordon L Carlson
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
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32
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Cao AMY, Lam VW, Rickard MJFX. Endoscopic findings after
CT
proven acute diverticulitis: a systematic review and meta‐analysis. ANZ J Surg 2022; 93:1150-1158. [DOI: 10.1111/ans.18190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/12/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Amy Millicent Yesheng Cao
- Department of Surgery Macquarie University Hospital Sydney New South Wales Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences Macquarie University Sydney New South Wales Australia
| | - Vincent Wai Lam
- Department of Surgery Macquarie University Hospital Sydney New South Wales Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences Macquarie University Sydney New South Wales Australia
- Department of Hepatobiliary Surgery Westmead Hospital Sydney New South Wales Australia
| | - Matthew John Francis Xavier Rickard
- Department of Surgery Macquarie University Hospital Sydney New South Wales Australia
- Discipline of Surgery, School of Medicine, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
- Division of Colorectal Surgery, Department of Surgery Concord Repatriation General Hospital Sydney New South Wales Australia
- Department of Surgery Macquarie University Hospital Sydney New South Wales Australia
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Mj O, Turner GA, A S, Frizelle FA, R P. Distinct changes in the colonic microbiome associated with acute diverticulitis. Colorectal Dis 2022; 24:1591-1601. [PMID: 35950499 PMCID: PMC10087140 DOI: 10.1111/codi.16271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 01/07/2023]
Abstract
AIM The pathogenesis of acute diverticulitis (AD) remains incompletely understood, despite it being one of the most common gastrointestinal conditions worldwide. The aim of this study was to investigate the role of the colonic microbiome in the pathogenesis of AD. METHOD A prospective case-control study was performed, comparing the microbiome of AD patients with that of controls, using 16S rRNA sequencing of rectal swab samples. RESULTS The microbiome of individuals with AD showed lower diversity than that of controls. There were significant compositional differences observed, with a lower abundance of commensal bacterial families and genera such as Lachnospiraceae, Ruminococcus and Faecalibacterium in AD patients compared with controls, and there was an increase in several genera with known pathogenic roles including Fusobacteria, Prevotella and Paraprevotella. CONCLUSION This is the largest study to date to examine the microbiota of AD patients, and adds evidence to the proposed hypothesis that alterations in the colonic microbiome play a role in the pathogenesis of AD.
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Affiliation(s)
- O'Grady Mj
- Whanganui Hospital, Wanganui, New Zealand
| | - Greg A Turner
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Sulit A
- University of Otago, Christchurch, New Zealand
| | - Frank A Frizelle
- University of Otago, Christchurch, New Zealand.,Christchurch Hospital, Christchurch, New Zealand
| | - Purcell R
- University of Otago, Christchurch, New Zealand
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34
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Maes-Carballo M, García-García M, Gómez-Fandiño Y, De-Dios-de-Santiago D, Martínez-Martínez C, Bueno-Cavanillas A, Khan KS. Guidance documents for colorectal and anal cancer treatment: A systematic quality and reporting assessment. Colorectal Dis 2022; 24:1472-1490. [PMID: 35852231 DOI: 10.1111/codi.16270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/01/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023]
Abstract
AIM Evidence-based medicine is essential for clinical practice. Clinical practice guidelines (CPGs) and consensus statements (CSs) ought to follow a consistent methodology to underpin high-quality healthcare. We systematically analysed the quality and reporting of colorectal (CRC) and anal cancer CPGs and CSs. METHODS Embase, MEDLINE, Scopus, Web of Science, the Cochrane Database of Systematic Reviews and online sources (59 professional society websites and eight guideline databases) were systematically searched following prospective registration (PROSPERO no. CRD42021286146) by two reviewers independently, without language restrictions. CPGs and CSs about CRC and anal cancer treatment were included from January 2018 to November 2021 and were assessed using the AGREE II tool (per cent of maximum score) and the RIGHT tool (per cent of total 35 items) for quality and reporting respectively. RESULTS The median overall quality and reporting of the 59 guidelines analysed were 55.0% (interquartile range 47.0-62.0) and 58% (interquartile range 50.0-67.9), respectively, with a proportion scoring less than half (<50%) for quality (20/59, 33.9%) and reporting (15/59, 25.4%). Guidance reported that following AGREE II methodology scored better on average than that without (AGREE II 77.7% vs. 47.6%, P = 0.001; RIGHT 50.0% vs. 33.9%, P = 0.001). Guidelines based on systematic reviews had better quality and reporting on average than those based on consensus (AGREE II 56.5% vs. 46.6%, P = 0.001; RIGHT 36.9% vs. 35.4%, P = 0.019). CONCLUSION The quality and reporting of colorectal and anal cancer treatment CPGs and CSs were poor. Despite AGREE II and RIGHT inherent methodological limitations, few high-quality guidelines were found. Despite wide variability in scoring different domains, they merit urgent improvement in all areas. It has also been demonstrated that CPGs and CSs should be underpinned by systematic reviews collecting the best available clinical research findings.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain.,Hospital Público de Verín, Ourense, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Manuel García-García
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Yolanda Gómez-Fandiño
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | | | - Carmen Martínez-Martínez
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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35
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Vial I, Varghese T, Sheikh A. Concomitant brain and liver abscesses: a rare complication of acute diverticulitis. J Surg Case Rep 2022; 2022:rjac297. [PMID: 35774477 PMCID: PMC9238298 DOI: 10.1093/jscr/rjac297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 12/31/2022] Open
Abstract
Diverticular disease is one of the most common colonic pathologies in the Western world. In the UK, ~80% of the population aged over 85 years are diagnosed with it. Most of these cases are asymptomatic. Yet, they can become problematic when the diverticula bleed, become infected (diverticulitis) or perforate. Other well-known complications of diverticular disease are acute inflammation, stenosis, fistulation and abscess formation. In this case report, we describe a delayed presentation of metastatic abscesses (liver and brain) from a prior acute diverticulitis with contained perforation and abscess formation.
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Affiliation(s)
- Izziddine Vial
- Correspondence address. Department of General Surgery, East Lancashire NHS Trust, Royal Blackburn Hospital, Haslingden Rd, Blackburn BB2 3HH, UK. Tel: +44 7709770702; E-mail:
| | | | - Adnan Sheikh
- Department of General Surgery, East Lancashire NHS Trust, Blackburn, UK
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36
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Hutchings A, O'Neill S, Lugo-Palacios D, Moler Zapata S, Silverwood R, Cromwell D, Keele L, Bellingan G, Moonesinghe SR, Smart N, Hinchliffe R, Grieve R. Effectiveness of emergency surgery for five common acute conditions: an instrumental variable analysis of a national routine database. Anaesthesia 2022; 77:865-881. [PMID: 35588540 PMCID: PMC9540551 DOI: 10.1111/anae.15730] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 12/29/2022]
Abstract
The effectiveness of emergency surgery vs. non-emergency surgery strategies for emergency admissions with acute appendicitis, gallstone disease, diverticular disease, abdominal wall hernia or intestinal obstruction is unknown. Data on emergency admissions for adult patients from 2010 to 2019 at 175 acute National Health Service hospitals in England were extracted from the Hospital Episode Statistics database. Cohort sizes were: 268,144 (appendicitis); 240,977 (gallstone disease); 138,869 (diverticular disease); 106,432 (hernia); and 133,073 (intestinal obstruction). The primary outcome was number of days alive and out of hospital at 90 days. The effectiveness of emergency surgery vs. non-emergency surgery strategies was estimated using an instrumental variable design and is reported for the cohort and pre-specified sub-groups (age, sex, number of comorbidities and frailty level). Average days alive and out of hospital at 90 days for all five cohorts were similar, with the following mean differences (95%CI) for emergency surgery minus non-emergency surgery after adjusting for confounding: -0.73 days (-2.10-0.64) for appendicitis; 0.60 (-0.10-1.30) for gallstone disease; -2.66 (-15.7-10.4) for diverticular disease; -0.07 (-2.40-2.25) for hernia; and 3.32 (-3.13-9.76) for intestinal obstruction. For patients with 'severe frailty', mean differences (95%CI) in days alive and out of hospital for emergency surgery were lower than for non-emergency surgery strategies: -21.0 (-27.4 to -14.6) for appendicitis; -5.72 (-11.3 to -0.2) for gallstone disease, -38.9 (-63.3 to -14.6) for diverticular disease; -19.5 (-26.6 to -12.3) for hernia; and - 34.5 (-46.7 to -22.4) for intestinal obstruction. For patients without frailty, the mean differences (95%CI) in days alive and out of hospital were: -0.18 (-1.56-1.20) for appendicitis; 0.93 (0.48-1.39) for gallstone disease; 5.35 (-2.56-13.28) for diverticular disease; 2.26 (0.37-4.15) for hernia; and 18.2 (14.8-22.47) for intestinal obstruction. Emergency surgery and non-emergency surgery strategies led to similar average days alive and out of hospital at 90 days for five acute conditions. The comparative effectiveness of emergency surgery and non-emergency surgery strategies for these conditions may be modified by patient factors.
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Affiliation(s)
- A Hutchings
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - S O'Neill
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D Lugo-Palacios
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - S Moler Zapata
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - R Silverwood
- Centre for Longitudinal Studies, University College London, London, UK
| | - D Cromwell
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - L Keele
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - G Bellingan
- Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | - S R Moonesinghe
- Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
| | - N Smart
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - R Hinchliffe
- Bristol Surgical Trials Centre, University of Bristol, Bristol, UK
| | - R Grieve
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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37
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Mohamed I, Egeler C, Ford S, White T, Harris DA, Harries RL. Botulinum Toxin A infiltration in conjunction with negative-pressure wound dressing and mesh-mediated traction in management of the open abdomen. Br J Surg 2022; 109:780-781. [PMID: 35543277 DOI: 10.1093/bjs/znac150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/11/2022] [Accepted: 04/23/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Imran Mohamed
- Department of General Surgery, Swansea Bay University Health Board, Swansea, UK
| | - Christian Egeler
- Department of Anaesthesia, Swansea Bay University Health Board, Swansea, UK
| | - Simon Ford
- Department of Anaesthesia, Swansea Bay University Health Board, Swansea, UK
| | - Thomas White
- Department of Anaesthesia, Swansea Bay University Health Board, Swansea, UK
| | - Dean A Harris
- Department of General Surgery, Swansea Bay University Health Board, Swansea, UK
| | - Rhiannon L Harries
- Department of General Surgery, Swansea Bay University Health Board, Swansea, UK
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38
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Recommendations for the Management of Sigmoid Volvulus. Dis Colon Rectum 2022; 65:e85. [PMID: 34775403 DOI: 10.1097/dcr.0000000000002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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39
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Atamanalp SS, Peksoz R. Sigmoid volvulus: Treatment options and volvulus recurrence. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.10294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sigmoid Volvulus (SV) is principally treated with non-operative decompression, whereas it may require surgical management in some situations. Depending upon the treatment method, SV recurs in about one fourth of the cases, which doubles the mortality and morbidity rates. In this paper, we discuss the management and related recurrence of SV in the light of the largest single-center SV series over the world.
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40
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Atamanalp SS. Endoscopic Decompression of Sigmoid Volvulus: Review of 748 Patients. J Laparoendosc Adv Surg Tech A 2021; 32:763-767. [PMID: 34748412 DOI: 10.1089/lap.2021.0613] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Sigmoid volvulus (SV) is the twisting of the sigmoid colon around itself. Endoscopy both helps diagnosis and provides treatment in the absence of peritonitis or perforation in SV. Nevertheless, there are some controversies or limitations on this subject. The aim of this study is to evaluate the current role of the endoscopic decompression in the treatment of SV. Materials and Methods: The clinical records of 1040 patients with SV treated over a 55-year period from June 1966 to July 2021 were reviewed retrospectively until June 1986 and prospectively thereafter. For each case, preoperational parameters, treatment options, and prognosis were noted. Results: Endoscopic decompression was tried in 748 patients (71.9%). The procedure was successful in 585 cases (83.2%), whereas unsuccessful in 118 (16.8%) of 703 patients (94.0%) with viable bowel. The mortality rate was 0.5% (4 patients), the morbidity rate was 1.9% (14 patients), the early recurrence rate was 5.5% (32 patients), whereas the mean hospitalization period was 34.6 hours (range: 24-96 hours). Conclusions: Despite some controversies or limitations in some subjects including the strategy in ischemic or gangrenous cases, the factors affecting the success, kind of the used instruments, technical details of the application, role of the flatus tubes, and the specific topics such as SV in childhood or pregnancy, endoscopic decompression is the first-line therapy in selected patients with SV.
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