1
|
Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
Collapse
|
2
|
Lederhuber H, Massey LH, Kantola VE, Siddiqui MRS, Sayers AE, McDermott FD, Daniels IR, Smart NJ. Clinical management of high-output stoma: a systematic literature review and meta-analysis. Tech Coloproctol 2023; 27:1139-1154. [PMID: 37330988 DOI: 10.1007/s10151-023-02830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/01/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE High output is a common complication after stoma formation. Although the management of high output is described in the literature, there is a lack of consensus on definitions and treatment. Our aim was to review and summarise the current best evidence. METHODS MEDLINE, Cochrane Library, BNI, CINAHL, EMBASE, EMCARE, and ClinicalTrials.gov were searched from 1 Jan 2000 to 31 Dec 2021 for relevant articles on adult patients with a high-output stoma. Patients with enteroatmospheric fistulas and case series/reports were excluded. Risk of bias was assessed using RoB2 and MINORS. The review was registered in PROSPERO (CRD42021226621). RESULTS The search strategy identified 1095 articles, of which 32 studies with 768 patients met the inclusion criteria. These studies comprised 15 randomised controlled trials, 13 non-randomised prospective trials, and 4 retrospective cohort studies. Eighteen different interventions were assessed. In the meta-analysis, there was no difference in stoma output between controls and somatostatin analogues (g - 1.72, 95% CI - 4.09 to 0.65, p = 0.11, I2 = 88%, t2 = 3.09), loperamide (g - 0.34, 95% CI - 0.69 to 0.01, p = 0.05, I2 = 0%, t2 = 0) and omeprazole (g - 0.31, 95% CI - 2.46 to 1.84, p = 0.32, I2 = 0%, t2 = 0). Thirteen randomised trials showed high concern of bias, one some concern, and one low concern. The non-randomised/retrospective trials had a median MINORS score of 12 out of 24 (range 7-17). CONCLUSION There is limited high-quality evidence favouring any specific widely used drug over the others in the management of high-output stoma. Evidence, however, is weak due to inconsistent definitions, risk of bias and poor methodology in the existing studies. We recommend the development of validated core descriptor and outcomes sets, as well as patient-reported outcome measures.
Collapse
Affiliation(s)
- H Lederhuber
- Royal Devon University HealthCare NHS Foundation Trust, Exeter, UK.
- Department of Colorectal Surgery, Royal Devon University HealthCare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
| | - L H Massey
- St. Mark's The National Bowel Hospital and Academic Institute, London, UK
| | - V E Kantola
- Royal Devon University HealthCare NHS Foundation Trust, Exeter, UK
| | - M R S Siddiqui
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - A E Sayers
- Royal Devon University HealthCare NHS Foundation Trust, Exeter, UK
| | - F D McDermott
- Royal Devon University HealthCare NHS Foundation Trust, Exeter, UK
| | - I R Daniels
- Royal Devon University HealthCare NHS Foundation Trust, Exeter, UK
| | - N J Smart
- Royal Devon University HealthCare NHS Foundation Trust, Exeter, UK
| |
Collapse
|
3
|
West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
|
4
|
Humphrey HN, Diodato A, Isner JC, Walker E, Lacy-Colson J, Nedjai B, Daniels IR. An internal pilot study of a novel rectal mucocellular sampling device to allow next-generation sequencing for colorectal disease. Tech Coloproctol 2023; 27:227-235. [PMID: 36166177 PMCID: PMC9514171 DOI: 10.1007/s10151-022-02704-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/03/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The ORI-EGI-02 study was designed to test the hypothesis that rectal mucus collected using a novel rectal sampling device (OriCol™), contains sufficient human deoxyribonucleic acid (DNA) of the required quality for Next Generation Sequencing (NGS), for colorectal disease genetic signature discovery. METHODS Using National Institute for Health and Care Research methodology, an internal pilot study was performed in January 2020-May 2021, at four sites in the United Kingdom, to assess the process of recruitment, consent, specimen acquisition and viability for analysis. Following an OriCol™ test, the sample was stabilized with a buffer solution to preserve the material, which was posted to the laboratory. Samples were processed using QIAamp® DNA Blood Midi kit to extract DNA and Quant-iT™ PicoGreen® dsDNA Reagent to quantify the retrieved DNA. DNA integrity was measured by Agilent TapeStation system. 25 ng of human amplifiable DNA was prepared for Next Generation Sequencing (NGS), which was performed on an Illumina NextSeq550 sequencer using the 300-cycle high output kit v2.5. RESULTS This study assessed the first 300 patients enrolled to the ORI-EGI-02 Study (n = 800). 290/300 (96.67%) were eligible to undergo OriCol™ sampling procedure and 285/290 (98.27%) had a successful OriCol™ sample taken. After transportation, extraction and quantification of DNA, 96.20% (279/290) of the samples had NGS successfully performed for bioinformatic analysis. CONCLUSIONS Our internal pilot study demonstrated that the OriCol™ sampling device can capture rectal mucus from unprepared bowel in subjects who could undergo a digital rectal examination. The technique could be applied irrespective of age, frailty, or co-morbidity. Completion of the study to 800 patients and analysis of NGS data for colorectal cancer mutations will now proceed.
Collapse
Affiliation(s)
- H N Humphrey
- Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX53BJ, Devon, UK
| | - A Diodato
- Origin Sciences, Granta Park, Cambridge, CB21 6AD, UK
| | - J-C Isner
- Origin Sciences, Granta Park, Cambridge, CB21 6AD, UK
| | - E Walker
- Origin Sciences, Granta Park, Cambridge, CB21 6AD, UK
| | - J Lacy-Colson
- Shrewsbury and Telford NHS Trust, Shrewsbury, SY3 8XQ, Shropshire, UK
| | - B Nedjai
- Origin Sciences, Granta Park, Cambridge, CB21 6AD, UK
- Centre for Prevention, Diagnosis and Detection, Queen Mary University of London, WIPH, Cancer Prevention Unit, London, UK
| | - I R Daniels
- Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX53BJ, Devon, UK.
- Origin Sciences, Granta Park, Cambridge, CB21 6AD, UK.
| |
Collapse
|
5
|
Jenkins E, Humphrey H, Finan C, Rogers P, McDermott FG, Smart NJ, Daniels IR, Watts AM. Long-term follow-up of bilateral gracilis reconstruction following extra-levator abdominoperineal excision. J Plast Reconstr Aesthet Surg 2023; 76:198-207. [PMID: 36527901 DOI: 10.1016/j.bjps.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Colorectal operations such as an extra-levator abdominoperineal (elAPE) excision for locally advanced or recurrent cancer create a significant perineal tissue deficit. Options for perineal reconstruction include bilateral pedicled gracilis muscle flaps (BPGMF). Fashioning the gracili into a 'weave' creates a muscular sling that supports pelvic contents and is a novel technique. Our series reports the outcomes of the BPGMF in 50 patients undergoing surgery for pelvic cancer. METHOD This is a retrospective, single-centre study of patients undergoing reconstruction of perineal defects using BPGMF. All surgeries took place between January 2008 and February 2021. The primary outcome measured was perineal wound healing. The secondary outcomes measured were complications of surgical sites and length of hospital stay (short term), flap integrity on follow-up imaging and functional outcomes (long term). RESULTS Fifty patients underwent perineal reconstruction using BPGMF (26 males). The median age was 62 years. The 30-day mortality was 2% (n = 1). The average follow-up period was 2 years. Complete perineal wound healing was 86% (42/49) at outpatient follow-up. Complication rates for the donor site and reconstructed site were 14% and 22%, respectively. Complications included infection (2% donor site, 12% perineum), haematoma (4% donor site), dehiscence (2% donor site, 4% perineum) and seroma (3% donor site, 2% perineum). CONCLUSION BPGMF offers a reliable and technically simple muscle flap to reconstruct large perineal defects. The muscle flap integrity appears maintained on follow-up imaging despite a lack of flap monitoring tools. This cohort had minimal functional impairment following BPGMF.
Collapse
Affiliation(s)
- E Jenkins
- Department of Plastic & Reconstructive Surgery, Royal Devon & Exeter Hospital, UK.
| | - H Humphrey
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, UK
| | - C Finan
- Department of Radiology, Royal Devon & Exeter Hospital, UK
| | - P Rogers
- Department of Radiology, Royal Devon & Exeter Hospital, UK
| | - F G McDermott
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, UK
| | - N J Smart
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, UK
| | - I R Daniels
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, UK
| | - A M Watts
- Department of Plastic & Reconstructive Surgery, Royal Devon & Exeter Hospital, UK
| |
Collapse
|
6
|
Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
Collapse
|
7
|
Murkin C, Rooshenas L, Smart N, Daniels IR, Pinkney T, Shabbir J, Rockall T, Bennett J, Torkington J, Randall J, Brandsma HT, Reeves B, Blazeby J, Blencowe NS. What should be included in case report forms? Development and application of novel methods to inform surgical study design: a mixed methods case study in parastomal hernia prevention. BMJ Open 2022; 12:e061300. [PMID: 36198447 PMCID: PMC9535162 DOI: 10.1136/bmjopen-2022-061300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe the development and application of methods to optimise the design of case report forms (CRFs) for clinical studies evaluating surgical procedures, illustrated with an example of abdominal stoma formation. DESIGN (1) Literature reviews, to identify reported variations in surgical components of stoma formation, were supplemented by (2) intraoperative qualitative research (observations, videos and interviews), to identify unreported variations used in practice to generate (3) a 'long list' of items, which were rationalised using (4) consensus methods, providing a pragmatic list of CRF items to be captured in the Cohort study to Investigate the Prevention of parastomal HERnias (CIPHER) study. SETTING Two secondary care surgical centres in England. PARTICIPANTS Patients undergoing stoma formation, surgeons undertaking stoma formation and stoma nurses. OUTCOME MEASURES Successful identification of key CRF items to be captured in the CIPHER study. RESULTS 59 data items relating to stoma formation were identified and categorised within six themes: (1) surgical approach to stoma formation; (2) trephine formation; (3) reinforcing the stoma trephine with mesh; (4) use of the stoma as a specimen extraction site; (5) closure of other wounds during the procedure; and (6) spouting the stoma. CONCLUSIONS This study used multimodal data collection to understand and capture the technical variations in stoma formation and design bespoke CRFs for a multicentre cohort study. The CIPHER study will use the CRFs to examine associations between the technical variations in stoma formation and risks of developing a parastomal hernia. TRIAL REGISTRATION NUMBER ISRCTN17573805.
Collapse
Affiliation(s)
- Charlotte Murkin
- Bristol NIHR Biomedical Research Centre and Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, UK
| | - Leila Rooshenas
- Bristol NIHR Biomedical Research Centre and Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, UK
| | - Neil Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon & Exeter Hospital, Exeter, Devon, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon & Exeter Hospital, Exeter, Devon, UK
| | - Tom Pinkney
- Academic Department of Surgery, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
| | - Jamshed Shabbir
- Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Timothy Rockall
- Department of Oesophago-gastric Surgery, The Royal Surrey County Hospital, Guildford, UK
| | - Joanne Bennett
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Jared Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - Jonathan Randall
- Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - H T Brandsma
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Barnaby Reeves
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane Blazeby
- Bristol NIHR Biomedical Research Centre and Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, UK
| | - Natalie S Blencowe
- Bristol NIHR Biomedical Research Centre and Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, UK
| |
Collapse
|
8
|
Drami I, Lord AC, Sarmah P, Baker RP, Daniels IR, Boyle K, Griffiths B, Mohan HM, Jenkins JT. Preoperative assessment and optimisation for pelvic exenteration in locally advanced and recurrent rectal cancer: A review. Eur J Surg Oncol 2021; 48:2250-2257. [PMID: 34922810 DOI: 10.1016/j.ejso.2021.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 01/06/2023] Open
Abstract
The pre-operative phase in planning a pelvic exenteration or extended resections is critical to optimising patient outcomes. This review summarises the key components of preoperative assessment and planning in patients with locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LLRC) being considered for potential curative resection. The preoperative period can be considered in 5 key phases: 1) Multidisciplinary meeting (MDT) review and recommendation for neoadjuvant therapy and surgery, 2) Anaesthetic preoperative assessment of fitness for surgery and quantification of risk, 3) Shared decision making with the patient and the process of informed consent, 4) Prehabilitation and physiological optimisation 5) Technical aspects of surgical planning. This review will focus on patients who have been recommended for surgery by the MDT and have completed neoadjuvant therapy. Other important considerations beyond the scope of this review are the various neoadjuvant strategies employed which in this patient group include Total Neo-adjuvant Therapy and reirradiation. Critical to improving perioperative outcomes is the dual aim of achieving a negative resection margin in a patient fit enough for extended surgery. Advanced, realistic communication is required pre-operatively and should be maintained throughout recovery. Optimising patient's physiological and psychological reserve with a preoperative prehabilitation programme is important, with physiotherapy, psychological and nutritional input. From a surgical perspective, image based technical preoperative planning is important to identify risk points and ensure correct surgical strategy. Careful attention to the entire patient journey through these 5 preoperative phases can optimise outcomes with the accumulation of marginal gains at multiple timepoints.
Collapse
Affiliation(s)
- I Drami
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK.
| | - A C Lord
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - P Sarmah
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - R P Baker
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - I R Daniels
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - K Boyle
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - B Griffiths
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - H M Mohan
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - J T Jenkins
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| |
Collapse
|
9
|
Kamarajah SK, Smart NJ, Daniels IR, Pinkney TD, Harries RL. Bioabsorbable mesh use in midline abdominal wall prophylaxis and repair achieving fascial closure: a cross-sectional review of stage of innovation. Hernia 2021; 25:3-12. [PMID: 32449096 PMCID: PMC7867504 DOI: 10.1007/s10029-020-02217-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Achieving stable closure of complex or contaminated abdominal wall incisions remains challenging. This study aimed to characterise the stage of innovation for bioabsorbable mesh devices used during both midline closure prophylaxis and complex abdominal wall reconstruction and to evaluate the quality of current evidence. METHODS A systematic review of published and ongoing studies was performed until 31st December 2019. Inclusion criteria were studies where bioabsorbable mesh was used to support fascial closure either prophylactically after midline laparotomy or for repair of incisional hernia with midline incision. Exclusion criteria were: (1) study design was a systematic review, meta-analysis, letter, review, comment, or conference abstract; (2) included less than p patients; (3) only evaluated biological, synthetic or composite meshes. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measure was the risk of bias in non-randomised studies of interventions (ROBINS-I) criteria for study quality. RESULTS Twelve studies including 1287 patients were included. Three studies considered mesh prophylaxis and nine studies considered hernia repair. There were only two published studies of IDEAL 2B. The remainder was IDEAL 2A studies. The quality of the evidence was categorised as having a risk of bias of a moderate, serious or critical level in nine of the twelve included studies using the ROBINS-I tool. CONCLUSION The evidence base for bioabsorbable mesh is limited. Better reporting and quality control of surgical techniques are needed. Although new trial results over the next decade will improve the evidence base, more trials in emergency and contaminated settings are required to establish the limits of indication.
Collapse
Affiliation(s)
- S K Kamarajah
- Department of Hepatobiliary and Pancreatic Surgery, Newcastle University NHS Trust Hospitals, Newcastle, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - T D Pinkney
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - R L Harries
- Department of Colorectal Surgery, Morriston Hospital, Swansea, SA6 6NL, UK.
| |
Collapse
|
10
|
Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham‐Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin KK, Aziz O, Baker RP, Bali M, Baseckas G, Bebington B, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Boyle K, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo‐Marulanda A, Chan KKL, Chang GJ, Chew MH, Chong PC, Christensen HK, Clouston H, Codd M, Collins D, Colquhoun A, Corr A, Coscia M, Coyne PE, Creavin B, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Enrique‐Navascues JM, Espin‐Basany E, Evans MD, Fearnhead NS, Flatmark K, Fleming F, Frizelle FA, Gallego MA, Garcia‐Granero E, Garcia‐Sabrido JL, Gentilini L, George ML, Ghouti L, Giner F, Ginther N, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Jenkins JT, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kristensen HØ, Kroon HM, Kusters M, Lago V, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Lydrup ML, Lyons A, Lynch AC, Mantyh C, Mathis KL, Margues CFS, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McArthur DR, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Morton JR, Mullaney TG, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, O’Dwyer ST, Palmer G, Pappou E, Park J, Patsouras D, Pellino G, Peterson AC, Poggioli G, Proud D, Quinn M, Quyn A, Radwan RW, van Ramshorst GH, Rasheed S, Rasmussen PC, Regenbogen SE, Renehan A, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Ryan ÉJ, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu V, Selvasekar C, Shaikh I, Hellawell G, Shida D, Simpson A, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Sumrien H, Sutton PA, Swartking T, Taylor C, Tekkis PP, Teras J, Thurairaja R, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Vasquez‐Jimenez W, Verhoef C, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Wheeler JMD, Wild J, Wilson M, de Wilt JHW, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, van Zoggel D, Winter DC. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative. Colorectal Dis 2020; 22:1258-1262. [PMID: 32294308 DOI: 10.1111/codi.15064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/24/2020] [Indexed: 02/08/2023]
Abstract
AIM At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. METHOD Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. RESULTS Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). CONCLUSION Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
Collapse
|
11
|
Coelho JAJ, McDermott FD, Cameron O, Smart NJ, Watts AM, Daniels IR. Single centre experience of bilateral gracilis flap perineal reconstruction following extra-levator abdominoperineal excision. Colorectal Dis 2019; 21:910-916. [PMID: 31017735 DOI: 10.1111/codi.14654] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/25/2019] [Indexed: 02/08/2023]
Abstract
AIM A variety of tissue flaps have been described for the closure of perineal wounds following abdominoperineal excision of the rectum (APE) or exenteration for locally advanced/recurrent rectal cancer and salvage surgery for anal cancer. The aim of this study was to demonstrate the utility of the bilateral pedicled gracilis muscle flaps (BPGMFs) as a reconstruction option in these patients. This is of particular benefit when using a laparoscopic approach for the abdominal component of the operation, avoiding disruption of the abdominal wall and risk of herniation with other reconstruction options, e.g. vertical rectus abdominis myocutaneous flaps. METHOD This is a retrospective single centre case series of patients who underwent reconstruction of perineal defects using BPGMFs using a novel weave technique, from January 2008 to August 2017. RESULTS There were 25 patients (16 female), with a median follow-up of 19 months (3-102). The indications for BPGMFs were cancer resection (21) and perineal hernia (4). The median length of stay was 14 days (6-60). All-cause mortality was 36% within the follow-up period. A healed perineal wound was achieved in 72% of patients within 30 days (84% of patients received neoadjuvant chemoradiotherapy). The overall donor site complication rate was 20% (including infection, dehiscence, numbness, haematoma and seroma) and 28% for the perineal site (including infection, dehiscence and prolapse). CONCLUSIONS BPGMFs provide an important option for reconstruction of the perineum particularly with a minimally invasive approach or with two stomas.
Collapse
Affiliation(s)
- J A J Coelho
- Department of Plastic & Reconstructive Surgery, Royal Devon & Exeter Hospital, Exeter, UK
| | - F D McDermott
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, Exeter, UK
| | - O Cameron
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, Exeter, UK
| | - N J Smart
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, Exeter, UK
| | - A M Watts
- Department of Plastic & Reconstructive Surgery, Royal Devon & Exeter Hospital, Exeter, UK
| | - I R Daniels
- Department of Colorectal Surgery, Royal Devon & Exeter Hospital, Exeter, UK
| |
Collapse
|
12
|
Brook AJ, De Haes F, Smart NJ, Mansfield SD, Daniels IR. Incidence of and risk factors for stoma-site incisional herniation after reversal. BJS Open 2019; 3:415. [PMID: 31183458 PMCID: PMC6551400 DOI: 10.1002/bjs5.50165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- A J Brook
- Exeter Surgical Health Service Research Unit Royal Devon and Exeter Hospital Barrack Road, Exeter EX2 5DW UK
| | - F De Haes
- Exeter Surgical Health Service Research Unit Royal Devon and Exeter Hospital Barrack Road, Exeter EX2 5DW UK
| | - N J Smart
- Exeter Surgical Health Service Research Unit Royal Devon and Exeter Hospital Barrack Road, Exeter EX2 5DW UK
| | - S D Mansfield
- Exeter Surgical Health Service Research Unit Royal Devon and Exeter Hospital Barrack Road, Exeter EX2 5DW UK
| | - I R Daniels
- Exeter Surgical Health Service Research Unit Royal Devon and Exeter Hospital Barrack Road, Exeter EX2 5DW UK
| |
Collapse
|
13
|
Abstract
Strong case
Collapse
Affiliation(s)
- I R Daniels
- Department of Surgery, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK
| | - N J Smart
- Department of Surgery, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK
| |
Collapse
|
14
|
Ho KK, Economou T, Smart NJ, Daniels IR. Radiological progression of end colostomy trephine diameter and area. BJS Open 2018; 3:112-118. [PMID: 30734022 PMCID: PMC6354228 DOI: 10.1002/bjs5.50109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/05/2018] [Indexed: 12/30/2022] Open
Abstract
Background Development of a parastomal hernia is common following abdominoperineal excision (APE). The true incidence is difficult to assess fully owing to differing lengths of follow‐up and techniques used to assess herniation; radiological or clinical. The primary aim of this study was to evaluate colostomy diameter by studying the rate of change of axial and sagittal trephine diameters, trephine area, and the ratio of the trephine over time. A secondary aim was to investigate variation in trephine area and variables affecting parasternal hernia over time. Methods Serial CT scans performed after APE from January 2006 to December 2014 were reviewed. Variables analysed included age, sex, trephine position relative to rectus abdominis muscle (RAM), type of incision for stoma creation, and axial and sagittal trephine diameters measured on follow‐up CT. A Bayesian hierarchical modelling framework was used to examine the relationship of trephine diameters, area and ratio over time. Results Of 112 patients undergoing APE, 103 were eligible for analysis; this included 91 colostomies (88·3 per cent) through the RAM and 12 (11·7 per cent) lateral to the RAM. Median age of the patients was 68 years. Sixty patients (58·3 per cent) had a circular and 43 (41·7 per cent) a cruciate incision for stoma creation. The sagittal trephine diameter increased by 0·22 (95 per cent credible interval 0·12 to 0·32) mm/month for both sexes. Women reported a significant increase in axial trephine diameters; the male : female ratio difference was −0·17 (−0·30 to −0·03) mm/month and for trephine areas −6·21 (0·96 to 13·7) mm2/month. Patient age, colostomy trephine location and shape of incision were not statistically significant variables for parasternal hernia. Conclusion Female sex was the only variable affecting the rate of increase in axial trephine diameter and trephine area over time.
Collapse
Affiliation(s)
- K K Ho
- University of Exeter Medical School Exeter UK
| | - T Economou
- Department of Mathematics University of Exeter Exeter UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital Exeter UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital Exeter UK
| |
Collapse
|
15
|
Köckerling F, Alam NN, Antoniou SA, Daniels IR, Famiglietti F, Fortelny RH, Heiss MM, Kallinowski F, Kyle-Leinhase I, Mayer F, Miserez M, Montgomery A, Morales-Conde S, Muysoms F, Narang SK, Petter-Puchner A, Reinpold W, Scheuerlein H, Smietanski M, Stechemesser B, Strey C, Woeste G, Smart NJ. What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia 2018; 22:249-269. [PMID: 29388080 PMCID: PMC5978919 DOI: 10.1007/s10029-018-1735-y] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/11/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Although many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations. METHODS A European working group, "BioMesh Study Group", composed of invited surgeons with a special interest in surgical meshes, formulated key questions, and forwarded them for processing in subgroups. In January 2016, a workshop was held in Berlin where the findings were presented, discussed, and voted on for consensus. Findings were set out in writing by the subgroups followed by consensus being reached. For the review, 114 studies and background analyses were used. RESULTS The cumulative data regarding biologic mesh under contaminated conditions do not support the claim that it is better than synthetic mesh. Biologic mesh use should be avoided when bridging is needed. In inguinal hernia repair biologic and biosynthetic meshes do not have a clear advantage over the synthetic meshes. For prevention of incisional or parastomal hernias, there is no evidence to support the use of biologic/biosynthetic meshes. In complex abdominal wall hernia repairs (incarcerated hernia, parastomal hernia, infected mesh, open abdomen, enterocutaneous fistula, and component separation technique), biologic and biosynthetic meshes do not provide a superior alternative to synthetic meshes. CONCLUSION The routine use of biologic and biosynthetic meshes cannot be recommended.
Collapse
Affiliation(s)
- F Köckerling
- Department of Surgery and Center of Minimally Invasive Surgery, Vivantes Hospital, 13585, Berlin, Germany.
| | - N N Alam
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - S A Antoniou
- Department of General Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - I R Daniels
- Exeter Surgical Health Services Research Unit, Royal Devon & Exeter Hospital, Exeter, UK
| | - F Famiglietti
- Department of Abdominal Surgery, University Hospital Gasthuisberg Campus, Louvain, Belgium
| | - R H Fortelny
- Department of General Surgery, Wilhelminenspital, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - M M Heiss
- Department of Visceral-, Vascular and Transplantation Surgery, Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - F Kallinowski
- Department of General and Visceral Surgery, Regional Hospital Bergstrasse GmbH, Heppenheim, Germany
| | | | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg Campus, Louvain, Belgium
| | - A Montgomery
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General und Digestive Surgery, University Hospital "Virgen del Rocio", Seville, Spain
| | - F Muysoms
- Department of Surgery, AZ Maria Middelares, Ghent, Belgium
| | - S K Narang
- Exeter Surgical Health Services Research Unit, Royal Devon & Exeter Hospital, Exeter, UK
| | - A Petter-Puchner
- Austrian Cluster of Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - W Reinpold
- Department of Surgery and Hernia Center, Wilhelmsburger Hospital "Gross Sand", Hamburg, Germany
| | - H Scheuerlein
- Department of General and Visceral Surgery, St. Vincenz Hospital, Paderborn, Germany
| | - M Smietanski
- Department of Surgery & Hernia Centre, District Hospital in Puck, Medical University of Gdansk, Gdansk, Poland
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | | | - C Strey
- Department of Surgery, Friederiken-Hospital, Hanover, Germany
| | - G Woeste
- Department of Surgery, University Hospital, Frankfurt/Main, Germany
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon & Exeter Hospital, Exeter, UK
| |
Collapse
|
16
|
Akingboye AA, Rajaretnam N, Daniels IR. Assessment of the inferior mesenteric vein diameter as a surrogate marker to evaluate response to neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma. Colorectal Dis 2018; 20:75-76. [PMID: 29027358 DOI: 10.1111/codi.13915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 02/08/2023]
Affiliation(s)
- A A Akingboye
- Department of General Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, Devon, UK.,Department of General Surgery, Colchester Hospital University Foundational Trust, Colchester, Essex, UK
| | - N Rajaretnam
- Department of General Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - I R Daniels
- Department of General Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, Devon, UK
| |
Collapse
|
17
|
Jones CS, Nowers J, Smart NJ, Coelho J, Watts A, Daniels IR. Pelvic floor reconstruction with bilateral gracilis flaps following extralevator abdominoperineal excision - a video vignette. Colorectal Dis 2017; 19:1120-1121. [PMID: 29053218 DOI: 10.1111/codi.13933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/12/2017] [Indexed: 02/08/2023]
Affiliation(s)
- C S Jones
- University of Exeter Medical School, Exeter, UK
| | - J Nowers
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - J Coelho
- Plastic and Reconstructive Surgery Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - A Watts
- Plastic and Reconstructive Surgery Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| |
Collapse
|
18
|
Lyons NJR, Cornille JB, Pathak S, Charters P, Daniels IR, Smart NJ. Systematic review and meta-analysis of the role of metronidazole in post-haemorrhoidectomy pain relief. Colorectal Dis 2017; 19:803-811. [PMID: 28589634 DOI: 10.1111/codi.13755] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/18/2017] [Indexed: 01/13/2023]
Abstract
AIM Conventional haemorrhoidectomy is still considered the reference standard for the management of severe or recurrent haemorrhoids. Pain is reported by patients to be the most common postoperative complication. Although the literature lacks a consensus on its effectiveness, metronidazole is often used to reduce postoperative pain. We have performed a meta-analysis of all randomized controlled trials (RCTs) that investigated the use of metronidazole for pain relief after haemorrhoidectomy. METHOD A systematic review was undertaken in accordance with the PRISMA protocol using the MESH headings 'haemorrhoidectomy', 'hemorhoidectomy', 'hemorrhoidectomy', 'haemorrhoid', 'metronidazole', 'Flagyl® ' 'antibiotic' and 'pain'. The search returned 421 articles of which eight were RCTs suitable for inclusion in the review with a total population of 437 patients. The outcomes of interest were postoperative pain intensity on days 1, 2 and 7 and on first defaecation as measured using a visual analogue scale. RESULTS The meta-analysis demonstrated a significant reduction in postoperative pain for patients treated with metronidazole with a reduced mean difference for the metronidazole group on day 1 of -1.42 (95% CI: -2.14 to -0.69, P = 0.0001), on day 2 of -1.43 (95% CI: -2.45 to -0.40, P = 0.006) and on day 7 of -2.40 (95% CI: -3.10 to -1.71, P < 0.00001). Pain on first defaecation was likewise reduced with a mean difference of -1.38 (95% CI: -2.15 to -0.60, P = 0.0005). Limitations of this study include variation in the grade of haemorrhoids treated and variability in the quality of included studies. CONCLUSION Metronidazole is a cheap, safe and effective intervention for reducing postoperative pain following conventional haemorrhoidectomy.
Collapse
Affiliation(s)
- N J R Lyons
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - J B Cornille
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - S Pathak
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - P Charters
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - I R Daniels
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - N J Smart
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| |
Collapse
|
19
|
Clarke TL, White DA, Osborne ME, Shaw AM, Smart NJ, Daniels IR. Predicting response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer with serum biomarkers. Ann R Coll Surg Engl 2017; 99:373-377. [PMID: 28462648 DOI: 10.1308/rcsann.2017.0030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction The aim of this study was to identify patient factors including serum biomarkers that may predict response to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer staged on magnetic resonance imaging. Prediction of response may be helpful when selecting patients for a non-operative programme. Methods A retrospective review was carried out of patients undergoing neoadjuvant CRT for rectal cancer, conducted at the Royal Devon and Exeter Hospital. All patients were managed through the multidisciplinary team. Receiver operating characteristic (ROC) curve analysis was undertaken to assess the ability of biomarkers to predict response to neoadjuvant CRT. The biomarkers assessed included neutrophils, lymphocytes, monocytes, haemoglobin, platelets, C-reactive protein and carcinoembryonic antigen. Results Seventy-three patients underwent neoadjuvant CRT between January 2006 and December 2011. Nine (12.3%) of these experienced a clinical complete response and were managed with a 'watch and wait' approach. An additional ten patients (13.7%) had a pathological complete response following surgery. Using ROC curve analysis, the biomarkers with the largest area under the curve (AUC) were pre-CRT haemoglobin and post-CRT lymphocyte concentrations, producing AUC values of 0.673 and 0.618 respectively for clinical complete response. Pre-CRT haemoglobin and neutrophil concentrations produced the highest AUC values for pathological complete response at 0.591 and 0.614 respectively. Conclusions None of the assessed biomarkers offer the ability to predict response to neoadjuvant CRT in patients with rectal cancer. They cannot therefore assist in identifying complete clinical or pathological responders who could be considered for a non-operative, observational approach.
Collapse
Affiliation(s)
- T L Clarke
- University of Exeter, UK.,Royal Devon and Exeter NHS Foundation Trust, UK
| | - D A White
- University of Exeter, UK.,Royal Devon and Exeter NHS Foundation Trust, UK
| | - M E Osborne
- Royal Devon and Exeter NHS Foundation Trust, UK
| | | | - N J Smart
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - I R Daniels
- Royal Devon and Exeter NHS Foundation Trust, UK
| |
Collapse
|
20
|
Jones CS, Nowers J, Watts A, Smart NJ, Daniels IR. Incisional hernia repair with retrorectus synthetic mesh and abdominoplasty - a video vignette. Colorectal Dis 2017; 19:301-302. [PMID: 28109044 DOI: 10.1111/codi.13611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/29/2016] [Indexed: 02/08/2023]
Affiliation(s)
- C S Jones
- University of Exeter Medical School, Exeter, UK
| | - J Nowers
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - A Watts
- Plastic and Reconstructive Surgery Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| |
Collapse
|
21
|
Cornille JB, Pathak S, Daniels IR, Smart NJ. Prophylactic mesh use during primary stoma formation to prevent parastomal hernia. Ann R Coll Surg Engl 2017; 99:2-11. [PMID: 27269439 PMCID: PMC5392779 DOI: 10.1308/rcsann.2016.0186] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 01/31/2023] Open
Abstract
Introduction Parastomal hernia (PSH) is a common problem following stoma formation. The optimal technique for stoma formation is unknown although recent studies have focused on whether placement of prophylactic mesh at stoma formation can reduce PSH rates. The aim of this study was to systematically review use of prophylactic mesh versus no mesh with regard to occurrence of PSH and peristomal complications. Methods A systematic search was performed using PubMed, Embase™ and the Cochrane Library to identify randomised controlled trials that analysed placement of prophylactic mesh versus no mesh at time of initial surgery. Meta-analysis was performed using random effects methods. Results A total of 506 studies were identified by our search strategy. Of these, 8 studies were included, involving 430 patients (217 mesh vs 213 no mesh). Prophylactic mesh placement resulted in a significantly lower rate of PSH formation (42/217 [19.4%] vs 92/213 [43.2%]) with a combined risk ratio of 0.40 (95% confidence interval [CI]: 0.21-0.75, p=0.004). Placement of prophylactic mesh did not result in increased peristomal complications (15/218 [6.9%] vs 16/227 [7.0%]) with a combined risk ratio of 1.0 (95% CI: 0.49-2.01, p=0.990). Conclusions Prophylactic placement of mesh at primary stoma formation may reduce the incidence of PSH, without an increase in peristomal complications. However, the overall quality of the randomised controlled trials included in the meta-analysis was poor, and should prompt caution regarding the applicability of the findings of the individual studies and the meta-analysis to everyday practice.
Collapse
Affiliation(s)
- J B Cornille
- Royal Devon and Exeter NHS Foundation Trust , UK
| | - S Pathak
- Royal Devon and Exeter NHS Foundation Trust , UK
| | - I R Daniels
- Royal Devon and Exeter NHS Foundation Trust , UK
| | - N J Smart
- Royal Devon and Exeter NHS Foundation Trust , UK
| |
Collapse
|
22
|
Abstract
Chronic intussusception as a cause of persistent abdominal pain in children is often an overlooked diagnosis. Here we present an eight-year-old boy, who at the age of three years had an acute intussusception reduced hydrostatically with barium and who subsequently had been extensively investigated both in Wales and in Switzerland, for persistent colicky abdominal pain. He was found to have chronic intussusception, with a Meckel’s diverticulum being the cause of his symptoms.
Collapse
Affiliation(s)
- N J West
- Princess Royal Hospital, Haywards Heath, West Sussex RH16 4EX, England
| | | | | |
Collapse
|
23
|
Tandon A, Pathak S, Lyons NJR, Nunes QM, Daniels IR, Smart NJ. Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg 2016; 103:1598-1607. [DOI: 10.1002/bjs.10268] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/05/2016] [Accepted: 06/10/2016] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Laparoscopic incisional and ventral hernia repair (LIVHR) is being used increasingly, with reported outcomes equivalent to those of open hernia repair. Closure of the fascial defect (CFD) is a technique that may reduce seroma formation and bulging after LIVHR. Non-closure of the fascial defect makes the repair of larger defects easier and reduces postoperative pain. The aim of this systematic review was to determine whether CFD affects the rate of adverse outcomes, such as recurrence, pseudo-recurrence, mesh eventration or bulging, and the rate of seroma formation.
Methods
A systematic search was performed of PubMed, Ovid, the Cochrane Library, Google Scholar and Scopus to identify RCTs that analysed CFD with regard to rates of adverse outcomes. A meta-analysis was done using fixed-effect methods. The primary outcome of interest was adverse events. Secondary outcomes were seroma, postoperative pain, mean hospital stay, mean duration of operation and surgical techniques employed.
Results
A total of 16 studies were identified involving 3638 patients, 2963 in the CFD group and 675 in the non-closure of facial defect group. Significantly fewer adverse events were noted following CFD than non-closure (4·9 per cent (79 of 1613) versus 22·3 per cent (114 of 511)), with a combined risk ratio (RR) of 0·25 (95 per cent c.i. 0·18 to 0·33; P < 0·001). CFD resulted in a significantly lower rate of seroma (2·5 per cent (39 of 1546) versus 12·2 per cent (47 of 385)), with a combined RR of 0·37 (0·23 to 0·57; P < 0·001), and shorter duration of hospital stay. No significant difference was noted in postoperative pain.
Conclusion
CFD during LIVHR reduces the rate of seroma formation and adverse hernia-site events.
Collapse
Affiliation(s)
- A Tandon
- Department of General Surgery, Aintree University Hospital, Liverpool, UK
| | - S Pathak
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J R Lyons
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Q M Nunes
- Department of General Surgery, Aintree University Hospital, Liverpool, UK
- National Institute for Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| |
Collapse
|
24
|
Noone TM, Smart NJ, Daniels IR. Response to Demetter et al.: review of the quality of total mesorectal excision does not improve the prediction of outcome. Colorectal Dis 2016; 18:724. [PMID: 26895814 DOI: 10.1111/codi.13302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/22/2016] [Indexed: 02/08/2023]
Affiliation(s)
- T M Noone
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK.
| |
Collapse
|
25
|
Chan KE, Pathak S, Smart NJ, Batchelor N, Daniels IR. The impact of cardiopulmonary exercise testing on patients over the age of 80 undergoing elective colorectal cancer surgery. Colorectal Dis 2016; 18:578-85. [PMID: 26417705 DOI: 10.1111/codi.13139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 07/20/2015] [Indexed: 12/07/2022]
Abstract
AIM Advanced age and occult cardiorespiratory disease are associated with increased morbidity and mortality following surgery. Cardiopulmonary exercise testing (CPET) may allow the identification of high-risk patients and facilitate planned postoperative critical care support. The aim of this study was to determine whether preoperative CPET in patients aged over 80 undergoing elective colorectal cancer resection was associated with improved outcome. METHOD All patients aged 80 years and above undergoing elective colorectal cancer resection between 1 March 2011 and 1 September 2013 were retrospectively analysed. Referral for CPET testing was at the discretion of the operating surgeon. Postoperative critical care unit (CCU) admission was based upon the CPET results. RESULTS Ninety-four patients were identified, of whom 48 underwent CPET testing. The CPET group were significantly older than the non-CPET group (85 vs 83 years, P = 0.04) and were more likely to have a planned admission to CCU postoperatively (P < 0.0001). Despite the increased use of CCU resources, the overall CCU length of stay (LOS) in the CPET group did not differ from the non-CPET group, but the non-CPET group had a higher proportion of Level-3 care. There were no differences in the incidence of unplanned CCU admission between the CPET and the non-CPET group (P = 0.23). There were no differences in overall LOS between the two groups (P = 0.42). There was no difference in mortality (P = 0.11), overall complications (P = 0.53) or severe complications (P = 0.3). CONCLUSION Preoperative CPET testing in patients aged over 80 undergoing elective colorectal cancer resection allows identification of higher-risk patients and mitigation of risk by preemptive admission to a CCU. This stratification allows equivalent results to be achieved in high- and low-risk elderly patients undergoing colorectal surgery.
Collapse
Affiliation(s)
- K E Chan
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - S Pathak
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - N Batchelor
- Department of Anaesthesia, Royal Devon and Exeter Hospital, Exeter, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter Hospital, Exeter, UK
| |
Collapse
|
26
|
Brook AJ, Mansfield SD, Daniels IR, Smart NJ. Incisional hernia following closure of loop ileostomy: The main predictor is the patient, not the surgeon. Surgeon 2016; 16:20-26. [PMID: 27161097 DOI: 10.1016/j.surge.2016.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/17/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Incisional hernia at the ileostomy site occurs in 0-48% of patients undergoing loop ileostomy closure. Risk factors for ileostomy-site hernia are not currently well understood. We explored the predictive value of patient and clinical factors for ileostomy-site hernias. METHOD Loop ileostomy reversals undertaken between 1st January 2009 and 31st December 2013 were retrospectively evaluated. Preoperative patient data (BMI, age, gender, blood pressure, diabetes), surgical variables (preoperative ileostomy marking, intraoperative management (suture type, closure method), postoperative complications (≤30 days), approach, urgency, and chemotherapy, hospital stay, stoma closure interval, follow-up duration) were collected. Patients were followed up by clinical examination and postoperative imaging. RESULTS 193 loop ileostomy reversals were identified. Operative indications included: colorectal cancer (n = 102, 52.8%); inflammatory bowel disease (n = 47, 24.3%); diverticulosis (n = 20, 10.4%); assorted indications (n = 19, 9.8%); and inflammatory fistulae (n = 5, 2.6%). Median duration of clinical follow-up was 20.5 months (0-69). Hernia occurred in 26 patients (13.5%), detected at a median of eight months post-reversal. Radiological follow-up occurred in 72% of patients and, as a reference standard, in 100% of patients diagnosed with a hernia. Concordance between clinical and radiological findings was 88.5%. Postoperative complications predicted higher hernia risk. BMI and preoperative blood pressure were significant hernia predictors. Differences in the type of suture material to close the defect (absorbable vs. non-absorbable) and stoma skin closure method (primary vs. secondary intention healing) were non-predictive of hernia. CONCLUSION Whilst BMI and patient comorbidity are the major hernia predictors, variability in surgical practice does not constitute a significant risk factor for ileostomy-site incisional hernia.
Collapse
Affiliation(s)
- A J Brook
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK.
| | - S D Mansfield
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK
| |
Collapse
|
27
|
Alam NN, Narang SK, Pathak S, Daniels IR, Smart NJ. Methods of abdominal wall expansion for repair of incisional herniae: a systematic review. Hernia 2016; 20:191-9. [DOI: 10.1007/s10029-016-1463-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/14/2016] [Indexed: 11/28/2022]
|
28
|
Alam NN, White DA, Narang SK, Daniels IR, Smart NJ. Systematic review of guidelines for the assessment and management of high-grade anal intraepithelial neoplasia (AIN II/III). Colorectal Dis 2016; 18:135-46. [PMID: 26559167 DOI: 10.1111/codi.13215] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 10/02/2015] [Indexed: 12/28/2022]
Abstract
AIM There is ambiguity with regard to the optimal management of anal intraepithelial neoplasia (AIN) III. The aim of this review was to assess and compare international/national society guidelines currently available in the literature on the management, treatment and surveillance of AIN III. We also aimed to assess the quality of the studies used to compile the guidelines and to clarify the terminology used in histological assessment. METHOD An electronic search of PubMed and Embase was performed using the search terms 'anal intraepithelial neoplasia', 'AIN', 'anal cancer', 'guidelines', 'surveillance' and 'management'. Literature reviews and guidelines or practice guidelines in peer reviewed journals from 1 January 2000 to 31 December 2014 assessing the treatment, surveillance or management of patients with AIN related to human papilloma virus were included. The guidelines identified by the search were assessed for the quality of evidence behind them using the Oxford Centre for Evidence-based Medicine 2011 Levels of Evidence. RESULTS The database search identified 5159 articles and two further guidelines were sourced from official body guidelines. After inclusion criteria were applied, 28 full-text papers were reviewed. Twenty-five of these were excluded, leaving three guidelines for inclusion in the systematic review: those published by the Association of Coloproctology of Great Britain and Ireland, the American Society of Colon and Rectal Surgeons and the Italian Society of Colorectal Surgery. No guidelines were identified on the management of AIN III from human papilloma virus associations and societies. All three guidelines agree that a high index of clinical suspicion is essential for diagnosing AIN with a disease-specific history, physical examination, digital rectal examination and anal cytology. There is interchange of terminology from high-grade AIN (HGAIN) (which incorporates AIN II/III) and AIN III in the literature leading to confusion in therapy use. Treatment varies from immunomodulation and photodynamic therapy to targeted destruction of areas of HGAIN/AIN II/III using infrared coagulation, electrocautery, cryotherapy or surgical excision but with little consensus between the guidelines. Recommendations on surveillance strategies are similarly discordant, ranging from 6-monthly physical examination to annual anoscopy ± biopsy. Over 50% of the recommendations are based on Level 3 or Level 4 evidence and many were compiled using studies that were more than 10 years old. CONCLUSION Despite concordance regarding diagnosis, there is significant variation in the guidelines over recommendations on the treatment and surveillance of patients with HGAIN/AIN II/III. All three sets of guidelines are based on low level, outdated evidence originating from the 1980s and 1990s.
Collapse
Affiliation(s)
- N N Alam
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, UK
| | - D A White
- Warwick Medical School, University of Warwick, Coventry, UK
| | - S K Narang
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, UK
| |
Collapse
|
29
|
Narang SK, Jones C, Alam NN, Daniels IR, Smart NJ. Delayed absorbable synthetic plug (GORE® BIO-A®) for the treatment of fistula-in-ano: a systematic review. Colorectal Dis 2016; 18:37-44. [PMID: 26542191 DOI: 10.1111/codi.13208] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/10/2015] [Indexed: 02/08/2023]
Abstract
AIM Recent advances in the treatment of fistula-in-ano have focused on surgical techniques that preserve sphincter integrity. Plugs that obliterate the lumen of the fistula track have been proposed as one such method, and may be derived from biological or delayed absorbable synthetic materials. Biological plugs have highly variable results and have not been widely adopted. The aim of this systematic review was to assess the effectiveness and safety of a delayed absorbable synthetic plug (GORE® BIO-A®) for treatment of anal fistula. METHOD A systematic review of all literature in the English language relevant to the use of a plug to treat anal fistula and published between 1 January 2008 and 15 February 2015 was carried out by searching MEDLINE, EMBASE and the Cochrane Library of Systematic Reviews/Controlled Trials for relevant literature. Relevant articles were identified, quality assessed using the methodological index for nonrandomized studies criteria and data were extracted by two independent researchers (SKN and NNA). The identified articles were assessed with regard to fistula healing rate, duration of follow-up and complication rates related to the use of delayed absorbable synthetic fistula plugs. RESULTS Twenty six potential articles were identified from the literature search. Using the predefined inclusion and exclusion criteria, six were included in the final analysis, data extraction and data synthesis. Of these included in the review only three were prospective in design. Complete data were available for 187 of the 221 patients who underwent this treatment. The age of the participants ranged from 19 to 82 years. The fistula healing rates were reported to be between 15.8% and 72.7% at a follow-up ranging between 2 and 19 months. Early or delayed plug extrusion occurred in 16 (8.5%) of the 187 patients. Deterioration in continence was reported in 11 (5.8%) of 187 patients. CONCLUSION There are insufficient high-quality data on the delayed absorbable synthetic (GORE® BIO-A®) fistula plug to draw meaningful conclusions regarding its effectiveness. It does, however, appear to be a simple and safe technique associated with low complication rates and a minor deterioration in continence in a few cases.
Collapse
Affiliation(s)
- S K Narang
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - C Jones
- University of Exeter Medical School, Exeter, Devon, UK
| | - N N Alam
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| |
Collapse
|
30
|
Warwick AM, Velineni R, Smart NJ, Daniels IR. Onlay parastomal hernia repair with cross-linked porcine dermal collagen biologic mesh: long-term results. Hernia 2015; 20:321-5. [PMID: 26685980 DOI: 10.1007/s10029-015-1452-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 12/03/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE The optimal technique and mesh type for parastomal hernia repair have yet to be ascertained. Biologic meshes have been advocated in parastomal hernia repair due to purported resistance to infection in contaminated fields. The aim of this study was to evaluate the effectiveness of additionally cross-linked acellular porcine dermal collagen mesh (Permacol) for onlay parastomal hernia repair. METHODS A retrospective review of case notes, and abdominal CT scans when available, was performed for consecutive patients who had a parastomal hernia repaired between January 2007 and May 2010. All hernias were repaired with onlay placement of the biologic mesh. Hernias were classified according to the Moreno-Matias classification where CT scans were available. RESULTS Over a 34-month period, 30 consecutive patients, median age 74 years, 17 female, underwent parastomal hernia repair using onlay biologic mesh. There were 23 paracolostomy and seven paraileostomy hernias. The hernia was primary in 26 patients. Pre-operative CT scans were available in 18 patients (Moreno-Matias Type 1 = 1, Type 2 = 4, Type 3 = 13). There was one perioperative death, and 29 patients were available for follow-up, and median duration of follow-up (either CT or clinical) was 36 months (range 3-79). Twenty-six patients developed recurrence of the parastomal hernia (89.6%), and median time to recurrence was 10 months (range 3-72),with Moreno-Matias Type 1 = 0, Type 2 = 4, Type 3 = 14, unknown = 8. Fifteen out of 26 patients have had repairs of the recurrence using a variety of techniques. Of these, 10 patients have had further recurrence. CONCLUSION Onlay repair of parastomal hernia with cross-linked porcine dermal collagen biologic mesh reinforcement has poor long-term outcomes with unacceptably high recurrence rates and should not be performed.
Collapse
Affiliation(s)
- A M Warwick
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK.
| | - R Velineni
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
| |
Collapse
|
31
|
Lyons NJR, Pathak S, Daniels IR, Smart NJ. Response to Heedman et al.: Variation at presentation among colon cancer patients with metastases: a population-based study. Colorectal Dis 2015; 17:1029-30. [PMID: 26250340 DOI: 10.1111/codi.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/15/2015] [Indexed: 02/08/2023]
Affiliation(s)
- N J R Lyons
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, Devon, UK.
| | - S Pathak
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, Devon, UK
| | - I R Daniels
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, Devon, UK
| | - N J Smart
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, Devon, UK
| |
Collapse
|
32
|
Kubota T, Mizuta T, Katagiri H, Shimaguchi M, Okumura K, Sakamoto T, Sakata T, Kunisaki S, Matsumoto R, Nishida K, Schaprynsky V, Vorovsky O, Romanchuk V, Basta M, Fischer J, Wink J, Kovach S, Tan WB, Tang SW, Clara ES, Hu J, Wijerathne S, Cheah WK, Shabbir A, Lomanto D, Siawash M, de Jager-Kieviet JWA, Tjon A Ten W, Roumen RM, Scheltinga MR, van Assen T, Boelens OB, van Eerten PV, Perquin C, DeAsis F, Salabat M, Leung D, Schindler N, Robicsek A, Denham W, Ujiki M, Bauder A, Mackay D, Maggiori L, Moszkowicz D, Zappa M, Mongin C, Panis Y, Köhler G, Hofmann A, Lechner M, Mayer F, Emmanuel K, Fortelny R, Gruber-Blum S, May C, Glaser K, Redl H, Petter-Puchner A, Narang S, Alam N, Campain N, McGrath J, Daniels IR, Smart NJ. Complex Cases in Abdominal Wall Repair and Prophilactic Mesh. Hernia 2015; 19 Suppl 1:S133-7. [PMID: 26518790 DOI: 10.1007/bf03355340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Kubota
- Tokyo Bay Medical Center, Urayasu, Japan
| | - T Mizuta
- Tokyo Bay Medical Center, Urayasu, Japan
| | - H Katagiri
- Tokyo Bay Medical Center, Urayasu, Japan
| | | | - K Okumura
- Tokyo Bay Medical Center, Urayasu, Japan
| | - T Sakamoto
- Tokyo Bay Medical Center, Urayasu, Japan
| | - T Sakata
- Tokyo Bay Medical Center, Urayasu, Japan
| | - S Kunisaki
- Tokyo Bay Medical Center, Urayasu, Japan
| | | | - K Nishida
- Yokosuka Uwamachi Hospital, Yokosuka, Japan
| | - V Schaprynsky
- National Pirogov Memorial Medical University Vinnitsa, Vinnitsa, Ukraine
| | - O Vorovsky
- National Pirogov Memorial Medical University Vinnitsa, Vinnitsa, Ukraine
| | - V Romanchuk
- National Pirogov Memorial Medical University Vinnitsa, Vinnitsa, Ukraine
| | - M Basta
- University of Pennsylvania Health System, Philadelphia, USA
| | - J Fischer
- University of Pennsylvania Health System, Philadelphia, USA.,Hospital of the University of Pennsylvania, Philadelphia, USA
| | - J Wink
- University of Pennsylvania Health System, Philadelphia, USA
| | - S Kovach
- University of Pennsylvania Health System, Philadelphia, USA.,Hospital of the University of Pennsylvania, Philadelphia, USA
| | - W B Tan
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - S W Tang
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - E Sta Clara
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - J Hu
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - S Wijerathne
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - W K Cheah
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - A Shabbir
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - D Lomanto
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - M Siawash
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | | | - W Tjon A Ten
- Department of Pediatrics, Máxima Medical Center, Veldhoven, Netherlands
| | - R M Roumen
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands.,Máxima Medical Center, Veldhoven, Netherlands.,Center of Excellence for Abdominal Wall and Groin Pain, SolviMáx, Eindhoven, Netherlands
| | - M R Scheltinga
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands.,Máxima Medical Center, Veldhoven, Netherlands.,Center of Excellence for Abdominal Wall and Groin Pain, SolviMáx, Eindhoven, Netherlands
| | - T van Assen
- Máxima Medical Center, Veldhoven, Netherlands
| | - O B Boelens
- Maasziekenhuis Pantein, Boxmeer, Netherlands
| | - P V van Eerten
- Máxima Medical Center, Veldhoven, Netherlands.,Center of Excellence for Abdominal Wall and Groin Pain, SolviMáx, Eindhoven, Netherlands
| | - C Perquin
- Máxima Medical Center, Veldhoven, Netherlands.,Center of Excellence for Abdominal Wall and Groin Pain, SolviMáx, Eindhoven, Netherlands
| | - F DeAsis
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - M Salabat
- Department of Surgery, University Chicago Pritzker School of Medicine, Chicago, USA
| | - D Leung
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - N Schindler
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University Chicago Pritzker School of Medicine, Chicago, USA
| | - A Robicsek
- Department of Clinical Analytics, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University Chicago Pritzker School of Medicine, Chicago, USA
| | - W Denham
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University Chicago Pritzker School of Medicine, Chicago, USA
| | - M Ujiki
- Department of Surgery, University Chicago Pritzker School of Medicine, Chicago, USA
| | - A Bauder
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | - D Mackay
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | - L Maggiori
- Colorectal Surgery, Hopital Beaujon, Clichy, France
| | - D Moszkowicz
- Colorectal Surgery, Hopital Beaujon, Clichy, France
| | - M Zappa
- Radiology, Hopital Beaujon, Clichy, France
| | - C Mongin
- Colorectal Surgery, Hopital Beaujon, Clichy, France
| | - Y Panis
- Colorectal Surgery, Hopital Beaujon, Clichy, France
| | - G Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
| | - A Hofmann
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - K Emmanuel
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
| | - R Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - S Gruber-Blum
- Cluster of Tissue engeneering, Ludwig Boltzmann Institute of Traumatology, Vienna, Austria
| | - C May
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - K Glaser
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - H Redl
- Cluster of Tissue engeneering, Ludwig Boltzmann Institute of Traumatology, Vienna, Austria
| | - A Petter-Puchner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - S Narang
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N Alam
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N Campain
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - J McGrath
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| |
Collapse
|
33
|
Giordano P, Pullan RD, Ystgaard B, Gossetti F, Bradburn M, McKinley AJ, Smart NJ, Daniels IR. The use of an acellular porcine dermal collagen implant in the repair of complex abdominal wall defects: a European multicentre retrospective study. Tech Coloproctol 2015; 19:411-7. [PMID: 26081430 DOI: 10.1007/s10151-015-1307-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of biological materials for the repair of complex abdominal wall defects has increased over the years; however, the role of these materials in routine practice remains unclear. The aim of the study was to evaluate clinical outcomes following the use of Permacol™ porcine collagen surgical implant in complex abdominal wall repair. METHODS This subset analysis of seven European sites from a multicentre retrospective study included patients undergoing open or laparoscopic surgery and treated with Permacol™ surgical implant. Inguinal, parastomal, diaphragmatic, perineal, and hiatal repairs were excluded. Only patients with at least 12 months of follow-up after surgery were included. RESULTS A total of 109 patients (56 males and 53 females) were included. Patients had a median of two comorbidities (range 0-6). Thirty-three per cent of patients were treated for recurrent hernia. All but one case used an open approach. Sixty-six per cent were Center for Disease Control wound class II-IV at the time of surgery. Fascial closure was achieved in 69%. Median follow-up length was 720 days (range 368-2857). Recurrence rates at 1 and 2 years were 9.2 and 18.3 %, respectively, and were higher in cases without fascial closure. One-year recurrence was higher following use of an onlay technique (P = 0.025). In a multivariate analysis, among 16 comorbidities examined only fascial closure significantly impacted 1-year recurrence (P = 0.049). CONCLUSIONS Data from this large retrospective multicentre European study strongly suggest the use of Permacol™ porcine collagen surgical implant to be safe and effective for complex abdominal wall repair. The recurrence rate was impacted by fascial closure.
Collapse
Affiliation(s)
- P Giordano
- Barts Health, Whipps Cross University Hospital, Whipps Cross Rd., Leytonstone, London, E11 1NR, UK,
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Alam NN, Smart NJ, Daniels IR. Response to 'perineal hernia formation following extralevator abdominoperineal excision'. Colorectal Dis 2015; 17:361. [PMID: 25615957 DOI: 10.1111/codi.12906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/12/2015] [Indexed: 02/08/2023]
Affiliation(s)
- N N Alam
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | | | | |
Collapse
|
35
|
Rossi BWP, Smart NJ, Daniels IR. Comment on Wille-Jørgensen et al.: Result of the implementation of multidisciplinary teams in rectal cancer. Colorectal Dis 2014; 15:1314-5. [PMID: 23869581 DOI: 10.1111/codi.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 05/16/2013] [Indexed: 02/08/2023]
Affiliation(s)
- B W P Rossi
- Exeter Colorectal Unit, Royal Devon and Exeter NHS Trust, Barrack Road, Exeter EX2 5DW, UK.
| | | | | |
Collapse
|
36
|
Pathak S, Nunes QM, Daniels IR, Smart NJ. Is C-reactive protein useful in prognostication for colorectal cancer? A systematic review. Colorectal Dis 2014; 16:769-76. [PMID: 25039573 DOI: 10.1111/codi.12700] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/03/2014] [Indexed: 12/16/2022]
Abstract
AIM With the advent of several different therapeutic strategies to manage the different stages of colorectal cancer, it would be beneficial to allow substratification of patients into groups who are most likely to benefit from costly interventions. The purpose of this review is to analyse the evidence from several retrospective studies examining the prognostic significance of C-reactive protein (CRP). METHOD A literature search was performed using PubMed, Embase, Cochrane Library, CINAHL and Google Scholar databases to identify studies that analysed CRP and its prognostic significance in all stages of operable colorectal cancer. The primary end-points of interest were overall survival and disease-free survival. RESULTS In all, 205 studies were identified by the search. Twelve involving 1705 patients fulfilled the inclusion criteria and were included. Three of the included studies including 305 patients considered Stage IV colorectal cancer and the impact of CRP on survival. Overall survival and disease-free survival were shorter in the presence of an elevated preoperative CRP in local and advanced colorectal cancer. CONCLUSION CRP may be useful for prognosis in patients with primary and metastatic colorectal cancer, but currently there is insufficient evidence to justify its routine use. Further well-designed prospective studies are needed to validate its role in substratification of patients for consideration of (neo)adjuvant therapies.
Collapse
Affiliation(s)
- S Pathak
- Department of HpB and Transplant Surgery, St James's University Hospital, Leeds, UK
| | | | | | | |
Collapse
|
37
|
Smart NJ, Daniels IR. Beyond enhanced recovery: authors' reply. Colorectal Dis 2014; 16:317-8. [PMID: 24629006 DOI: 10.1111/codi.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 01/19/2014] [Indexed: 02/08/2023]
Affiliation(s)
- N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon & Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK.
| | | |
Collapse
|
38
|
Knight HJ, Daniels IR, Smart NJ. Response to Tsiamoulos et al. (2014): does diverticular disease protect against sigmoid colon cancer? Colorectal Dis 2014; 16:220-1. [PMID: 24373417 DOI: 10.1111/codi.12547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 12/17/2013] [Indexed: 02/08/2023]
Affiliation(s)
- H J Knight
- Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
| | | | | |
Collapse
|
39
|
Godden AR, Marshall MJ, Grice AS, Daniels IR. Ultrasonography guided rectus sheath catheters versus epidural analgesia for open colorectal cancer surgery in a single centre. Ann R Coll Surg Engl 2013. [PMID: 24165343 DOI: 10.1308/003588413x13629960049270] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Epidural anaesthesia (EA) has been the accepted standard for postoperative analgesia in open abdominal surgery. However, it is not without significant risk. This study aimed to audit the effect of EA and ultrasonography placed rectus sheath catheters (RSCs) on analgesia as well as the incidence of postoperative complications following open colorectal cancer surgery. METHODS A three-year retrospective case note review was undertaken of all patients undergoing open colorectal cancer surgery at the Royal Devon and Exeter Hospital NHS Foundation Trust who received either EA or RSC for postoperative analgesia under the care of the senior authors. A single surgeon and single anaesthetist were practitioners. RESULTS The case notes of 120 patients were reviewed retrospectively: 85 patients had EA and 24 RSC while 11 patients were excluded from the study. The EA group experienced a significantly higher incidence of hypotension (systolic blood pressure <130 mmHg) than the RSC group on the first postoperative day (p=0.0001). There was no significant difference in pain score or opiate sparing properties between the groups (p=0.92). There was no significant difference in postoperative respiratory tract infection, anastomotic leak or wound complications between the groups (p=0.2, p=1.0 and p=0.5 respectively). The RSC group had a higher incidence of ileus than the EA group (4/24 vs 2/85, p=0.026). However, the numbers were too small to draw a reliable conclusion. CONCLUSIONS The use of ultrasonography guided RSCs has demonstrated effective postoperative analgesia equivalent to EA with the potential benefits of a reduced incidence of hypotension. A prospective randomised trial is now underway to compare RSC and EA in open abdominal and pelvic surgery.
Collapse
Affiliation(s)
- A R Godden
- Royal Devon and Exeter Hospital NHS Foundation Trust, UK
| | | | | | | |
Collapse
|
40
|
Affiliation(s)
- N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Exeter, UK.
| | | |
Collapse
|
41
|
Godden AR, Marshall MJ, Grice AS, Daniels IR. Ultrasonography guided rectus sheath catheters versus epidural analgesia for open colorectal cancer surgery in a single centre. Ann R Coll Surg Engl 2013; 95:591-4. [PMID: 24165343 PMCID: PMC4311537 DOI: 10.1308/rcsann.2013.95.8.591] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2013] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Epidural anaesthesia (EA) has been the accepted standard for postoperative analgesia in open abdominal surgery. However, it is not without significant risk. This study aimed to audit the effect of EA and ultrasonography placed rectus sheath catheters (RSCs) on analgesia as well as the incidence of postoperative complications following open colorectal cancer surgery. METHODS A three-year retrospective case note review was undertaken of all patients undergoing open colorectal cancer surgery at the Royal Devon and Exeter Hospital NHS Foundation Trust who received either EA or RSC for postoperative analgesia under the care of the senior authors. A single surgeon and single anaesthetist were practitioners. RESULTS The case notes of 120 patients were reviewed retrospectively: 85 patients had EA and 24 RSC while 11 patients were excluded from the study. The EA group experienced a significantly higher incidence of hypotension (systolic blood pressure <130 mmHg) than the RSC group on the first postoperative day (p=0.0001). There was no significant difference in pain score or opiate sparing properties between the groups (p=0.92). There was no significant difference in postoperative respiratory tract infection, anastomotic leak or wound complications between the groups (p=0.2, p=1.0 and p=0.5 respectively). The RSC group had a higher incidence of ileus than the EA group (4/24 vs 2/85, p=0.026). However, the numbers were too small to draw a reliable conclusion. CONCLUSIONS The use of ultrasonography guided RSCs has demonstrated effective postoperative analgesia equivalent to EA with the potential benefits of a reduced incidence of hypotension. A prospective randomised trial is now underway to compare RSC and EA in open abdominal and pelvic surgery.
Collapse
Affiliation(s)
- AR Godden
- Royal Devon and Exeter Hospital NHS Foundation Trust,UK
| | - MJ Marshall
- Royal Devon and Exeter Hospital NHS Foundation Trust,UK
| | - AS Grice
- Royal Devon and Exeter Hospital NHS Foundation Trust,UK
| | - IR Daniels
- Royal Devon and Exeter Hospital NHS Foundation Trust,UK
| |
Collapse
|
42
|
Smart NJ, Pathak S, Boorman P, Daniels IR. Synthetic or biological mesh use in laparoscopic ventral mesh rectopexy--a systematic review. Colorectal Dis 2013; 15:650-4. [PMID: 23517144 DOI: 10.1111/codi.12219] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 12/04/2012] [Indexed: 12/11/2022]
Abstract
AIM Laparoscopic ventral mesh rectopexy (VMR) is a surgical option for internal and external rectal prolapse with low perioperative morbidity and low recurrence rates. Use of synthetic mesh in the pelvis may be associated with complications such as fistulation, erosion and dyspareunia. Biological meshes may avoid these complications, but the long-term outcome is uncertain. Debate continues as to which type of mesh is optimal for laparoscopic VMR. METHOD A literature search was performed of electronic databases including MEDLINE, Embase and Scopus (2000-12). Studies describing outcomes relating to the mesh were included for review. Only English language studies were included. RESULTS Thirteen observational studies reported the outcome of 866 patients following laparoscopic VMR. Eleven reported the outcome using synthetic mesh with a median follow-up ranging from 7 to 74 months. Two studies reported the outcome with biological mesh with a median follow-up of 12 months. Pooled analysis of the studies demonstrated that 767 patients had a repair with synthetic mesh and 99 with a biological implant. There was no difference in recurrence (3.7 vs 4.0%, P = 0.78) or mesh complications (0.7 vs 0%, P = 1.0%) between synthetic and biological mesh repair. CONCLUSION Biological meshes appear to be as effective as synthetic meshes in the short term for laparoscopic VMR. Mesh complication rates are low in both groups. Long-term follow-up is required to ascertain if these findings persist.
Collapse
Affiliation(s)
- N J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
| | | | | | | |
Collapse
|
43
|
Abstract
There are unacceptably high rates of recurrence following surgery for incision hernia repair using suture repair techniques in isolation. As the reconstruction of abdominal walls has expanded with complex surgery, the materials used as adjuncts to support the repair have changed. In the article we review the current use of biologic meshes in abdominal wall reconstruction and the techniques used.
Collapse
Affiliation(s)
- A R Godden
- Exeter Health Services Research Unit, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon, UK
| | | | | |
Collapse
|
44
|
Abstract
Recent improvements in the outcome for low rectal cancer have focused on the reconstruction of the perineal defect following greater acceptance of the need for a wider perineal excision encompassing the levator ani complex. In this article we look at the use of biologic materials to close the perineal defect and compare this with the use of other techniques.
Collapse
Affiliation(s)
- M J Marshall
- Exeter Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | | | | |
Collapse
|
45
|
Marshall MJ, Bethune R, Daniels IR. Response to Rosenberg et al.: Current controversies in colorectal surgery: the way to resolve uncertainty and move forward. Colorectal Dis 2012; 14:1028-9. [PMID: 22697605 DOI: 10.1111/j.1463-1318.2012.03083.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
46
|
Dalton RSJ, Velineni R, Osborne ME, Thomas R, Harries S, Gee AS, Daniels IR. A single-centre experience of chemoradiotherapy for rectal cancer: is there potential for nonoperative management? Colorectal Dis 2012; 14:567-71. [PMID: 21831177 DOI: 10.1111/j.1463-1318.2011.02752.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM The aim of the study was to assess the outcome of patients who received chemoradiotherapy (CRT) for locally advanced rectal cancer, specifically those with complete clinical response (CCR) and who were then managed nonoperatively with a 'Watch and Wait' follow-up protocol. METHOD A retrospective study was carried out of patients undergoing preoperative CRT for rectal cancer, conducted in a district general hospital managing rectal cancer through the multidisciplinary team process. RESULTS Forty-nine patients received preoperative CRT over a 5-year period (2004-2009). Twelve (24%) were considered potentially to have had a complete response on MRI. Of these, six subsequently had clinical evidence of residual disease, leading to surgery (mean time to surgery, 24 weeks; range, 12-36 weeks). The remaining six had CCR, avoiding surgery (mean follow up, 26 months; range, 12-45 months), with all six patients disease free to date. A further six patients had complete pathological response (CPR) following surgery after comprehensive histopathological assessment of the specimen. CONCLUSION In this consecutive series of patients with locally advanced rectal cancer treated with CRT, 12% demonstrated a CCR and have been actively managed conservatively, thereby avoiding surgery. With further improvements in diagnostic assessment of response to CRT, this figure may rise.
Collapse
Affiliation(s)
- R S J Dalton
- Exeter Colorectal Unit, Department of Oncology, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | | | | | | | | | | | | |
Collapse
|
47
|
Bethune R, Marshall M, Daniels IR. Response to 'Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision?'. Colorectal Dis 2012; 14:389. [PMID: 22107045 DOI: 10.1111/j.1463-1318.2011.02891.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
48
|
Khan D, Smart NJ, Daniels IR. Minimal anatomical disruption in stoma formation: the lateral rectus abdominis positional stoma (LRAPS) - response to Stephenson et al. Colorectal Dis 2011; 13:229-30. [PMID: 21114749 DOI: 10.1111/j.1463-1318.2010.02525.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
49
|
Smart NJ, Velineni R, Khan D, Daniels IR. Parastomal hernia repair outcomes in relation to stoma site with diisocyanate cross-linked acellular porcine dermal collagen mesh. Hernia 2011; 15:433-7. [PMID: 21279662 DOI: 10.1007/s10029-011-0791-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/09/2011] [Indexed: 12/31/2022]
Abstract
PURPOSE Biologic meshes are increasingly used in parastomal hernia repair. This study evaluates the efficacy and safety of diisocyanate cross-linked acellular porcine dermal collagen mesh for parastomal hernia repair, with particular reference to the relationship of the stoma site to the rectus sheath. METHODS Hernias were repaired via a lateral approach, with onlay placement of the biologic mesh. A retrospective case note review and analysis of clinical outcomes was performed. The relationship of the stoma to the rectus sheath was determined by abdominal computed tomography (CT) and intraoperative findings. RESULTS Over a 16-month period, 27 consecutive patients, median age 72 years, underwent parastomal hernia repair utilising onlay biologic mesh to reinforce the external oblique aponeurosis. There were 20 paracolostomy and seven paraileostomy hernias. Eleven stomas passed through the rectus sheath and 16 were lateral to it. Recurrences occurred in 3 of 11 stomas within and 12 of 16 stomas lateral to the rectus sheath (P = 0.022). The median time to recurrence was 10.1 months. The median follow up of patients without recurrence was 16.6 months (range 0.2-39.3). There was one perioperative death. One patient developed a superficial post-operative abscess that was managed conservatively, but there were no complications related to the biologic mesh and no mesh required removal. CONCLUSIONS For parastomal hernias within the rectus sheath, diisocyanate cross-linked porcine dermal collagen mesh onlay repair gives good results and is safe to use. Repair of a parastomal hernia where the stoma is lateral to the rectus sheath has a significantly higher risk of recurrence and is not recommended.
Collapse
Affiliation(s)
- N J Smart
- Exeter Colorectal Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | | | | | | |
Collapse
|
50
|
Smart NJ, Khan D, Daniels IR. Letter. Re: Orenstein et al. (2010) Activation of human mononuclear cells by porcine biologic meshes in vitro. Hernia 14(4):401-407. Hernia 2010; 15:105-6. [PMID: 20953651 DOI: 10.1007/s10029-010-0741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/03/2010] [Indexed: 11/30/2022]
|