ORCID Profile
0000-0002-2065-3012
Current Organisations
Royal College of Surgeons of Edinburgh
,
University of QLD
,
Royal Australasian College of Surgeons
,
University of Queensland
,
Royal Brisbane and Women's Hospital
,
University of Sydney
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Publications
Recurrent pouch volvulus treated with robotic ventral graft pouch‐pexy
Publisher: Wiley
Date: 08-12-2023
DOI: 10.1111/ANS.18197
Drain fluid amylase as a biomarker for the detection of anastomotic leakage after rectal resection without a diverting ileostomy
Publisher: Wiley
Date: 06-01-2022
DOI: 10.1111/ANS.17461
Abstract: Anastomotic leak (AL) is the anathema of colorectal surgery. Early diagnosis is an essential segue to early intervention. A temporary erting ileostomy (TDI) does not prevent an AL and presents inherent complications of its own. Numerous drain fluid biomarkers (BM) have been studied in colorectal surgery and extravasated intraluminal substances (EILS) such as amylase have shown promise. The aim of this study was to assess drain fluid amylase (DFA) as a BM of AL after minimally invasive rectal resection without a TDI. A single centre prospective cohort study performed from 2018 to 2021. The primary outcome was DFA measured daily whilst the drain was in situ . Rectal tube amylase was also measured for the first two post‐operative days to quantitate the intra‐luminal levels of the enzyme. DFA was compared between patients who experienced AL and those who did not. Of the 62 patients studied, six (9.7%) experienced AL. There was a statistically significant difference in DFA between patients who experienced AL (Median:1373.5 U/L IQR: 306–7953) and patients who did not experience an AL (Median: 27.0 U/L IQR: 16–38) p 0.0001. The measurement of drain fluid amylase is a highly sensitive BM of early clinical anastomotic leak in patients undergoing a rectal resection with an extraperitoneal anastomosis and when a TDI is not incorporated. This simple, inexpensive and non‐invasive test should be considered in all patients as an adjunct to the clinical diagnosis and differentiation of AL from other postoperative complications.
Laparoscopic Resection for Diverticular Disease Follow-Up of 500 Consecutive Patients Reply
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
Transanal total mesorectal excision for rectal cancer: state of the art
Publisher: Springer Science and Business Media LLC
Date: 09-2018
DOI: 10.1007/S10151-018-1844-8
Abstract: Achieving a high-quality total mesorectal excision (TME) resection specimen is a central tenet of curative rectal cancer management. However, operating at the caudal extremity of the pelvis is inherently challenging and a number of patient- and tumour-related factors may increase the risk of obtaining a poor TME specimen and positive resection margins. Transanal TME (TaTME) is an advanced surgical technique developed to overcome the limitations in pelvic exposure and instrumentation of transabdominal surgery. This up-to-date narrative review describes the evolution of TME surgery, the indications for TaTME, current published outcomes, its limitations and future developments.
Patients Undergoing Ileoanal Pouch Surgery Experience a Constellation of Symptoms and Consequences Representing a Unique Syndrome A Report From the Patient-Reported Outcomes After Pouch Surgery (PROPS) Delphi Consensus Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-04-2021
Patient and pathological predictors of management strategy for malignant polyps following polypectomy: a systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 08-04-2022
DOI: 10.1007/S00384-022-04142-6
Abstract: Malignant polyps present a treatment dilemma for clinicians and patients. This meta-analysis sought to identify the factors that predicted the management strategy for patients diagnosed with a malignant polyp. A literature search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Collaboration prognostic studies guidelines. Reports from 1985 onwards were included, data on patient and pathological factors were extracted and random effects meta-analysis models were used. Fifteen studies were included. Seven studies evaluated lymphovascular invasion (LVI). The odds of surgery were significantly higher in malignant polyps with LVI (OR 2.20, 95% CI 1.36–3.55). Ten studies revealed the odds of surgery were significantly higher with positive polypectomy margins (OR 8.09, 95% CI 4.88–13.40). Tumour differentiation was compared in eight studies. There were significantly lower odds of surgery in malignant polyps with well/moderate differentiation compared with poor differentiation (OR 0.31, 95% CI 0.21–0.46). There were non-significant trends favouring surgical resection in younger patients, males and Haggitt 4/Kikuchi Sm3 lesions. There was considerable heterogeneity in the meta-analyses for the variables age, gender, polyp morphology and Haggitt/Kikuchi level ( I 2 75%). This meta-analysis has demonstrated that LVI, positive polypectomy resection margins, and poor tumour differentiation significantly predict malignant polypectomy patients who underwent subsequent surgery. Age and gender were important factors predicting management, but not consistently across studies, whilst polyp morphology and Haggitt/Kikuchi levels did not significantly predict the management strategy. Further research may assist in understanding the management preferences.
Reactive Oxygen Species as Mediators of Disease Progression and Therapeutic Response in Colorectal Cancer
Publisher: Mary Ann Liebert Inc
Date: 07-2023
Long-Term Outcomes of the Australasian Randomized Clinical Trial Comparing Laparoscopic and Conventional Open Surgical Treatments for Colon Cancer
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2012
In comparison with polypectomy, colorectal resection is associated with improved survival for patients diagnosed with malignant polyps.
Publisher: Wiley
Date: 02-11-2022
DOI: 10.1111/CODI.16369
Abstract: Patients diagnosed with a malignant polyp generally have favourable overall survival (OS) and cancer-specific survival (CSS). However, it is unclear how choice in management for malignant polyps may affect survival. Data from the Queensland Oncology Repository was analysed to derive a population wide assessment of the impact of management strategy on OS and CSS for patients diagnosed with malignant polyps. Log-rank testing, Kaplan-Meier and Cox-regression models were performed. Patients were matched using propensity score and Mahalanobis distance matching. A total of 1,646 patients were included with 240 deaths and 52 colorectal cancer related deaths until censor date. Following propensity score and Mahalanobis distance matching of patients undergoing polypectomy alone versus colorectal resection, there was no significant difference in the age groups (<60 years of age or ≥60 years of age), American Society of Anesthesiology score, comorbidity count or Association of ColoProctology of Great Britain and Ireland risk category. However, of note Log-rank testing demonstrated a significant difference in OS (p < 0.001) and CSS (p = 0.0061) between management strategies. Multivariable Cox-regression models in matched and un-matched patient cohorts demonstrated significantly lower hazards of death for OS with resection (p < 0.001). However, CSS was no longer significantly different between management groups in multivariable Cox-regression analysis (p = 0.073). Patients who underwent colorectal resection had significantly improved OS and CSS compared with polypectomy alone. Improved OS was furthermore seen on multivariable analysis, and in matched cohorts. Future research should investigate why this unexpected finding may be the case and whether updates to guidelines should be considered.
Reply to Gachabayov et al. ‘Consensus statement on TaTME: other thoughts’
Publisher: Wiley
Date: 12-12-2020
DOI: 10.1111/CODI.15434
Teaching Colorectal Surgery in the Laparoscopic Era; Is It Safe?
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.JSURG.2010.06.009
Abstract: With the introduction of laparoscopic colorectal surgery, the question is raised as to whether laparoscopic colectomies can safely be performed by surgical registrars, when supervised by experienced laparoscopic surgeons. In this study we have compared surgical outcomes of surgical registrars, fellows, and staff surgeons in a Dutch teaching hospital. Using a prospective database, the surgical outcomes of staff surgeons, fellows, and surgical registrars were compared. Pre- and postoperative complications were evaluated, including anastomotic failure. The percentage of reintervention, mortality, readmission, total hospital stay, and operating time were evaluated. The quality of the surgical resection was assessed by comparing the number of resected lymph nodes in malignant cases and the percentage of patients with adequate resection margins. Analysis was performed in 420 patients. The majority of surgery was performed by staff surgeons. Outcomes of surgery for staff surgeons, fellows, and surgical registrars were comparable with respect to complications, percentage of conversions, and oncological adequacy. Comprehensive training as a colorectal surgeon should include competence in laparoscopic resections. Our results show that laparoscopic colorectal surgery can safely be performed by surgical registrars with no increase of the number of conversions to laparotomy or the number of complications.
Surgical outcomes in steroid refractory acute severe ulcerative colitis: the impact of rescue therapy
Publisher: Wiley
Date: 27-02-2013
DOI: 10.1111/J.1463-1318.2012.03188.X
Abstract: The advent of rescue medical therapy (cyclosporin or infliximab) and laparoscopic surgery has shifted the paradigm in managing steroid refractory acute severe ulcerative colitis (ASUC). We investigated prospectively the impact of rescue therapy on timing and postoperative complications of urgent colectomy and subsequent restorative surgery for steroid refractory ASUC. All consecutive presentations of steroid refractory ASUC at the Royal Brisbane Hospital (1996-2009) were entered in the study. Data collated included demographics, clinical and laboratory parameters on admission, medical therapy and operative and postoperative details. Steroid refractory ASUC patients undergoing immediate colectomy were compared with those failing rescue therapy and requiring same admission colectomy. Of 108 steroid refractory ASUC presentations, 19 (18%) received intravenous steroids only and proceeded directly to colectomy. Rescue medical therapy was instituted in 89 (82%) patients with 30 (34%) failing to respond and proceeding to colectomy. There was no significant difference in the median time from admission to colectomy for rescue therapy compared with steroid-only cases (12 vs 10 days, P = 0.70) or 30-day complication rates (27%vs 47%, P = 0.22). The interval from colectomy to a subsequent restorative procedure was significantly longer for patients who failed rescue therapy (12 vs 5 months, P = 0.02). Furthermore 30-day complications following pouch surgery were significantly higher in patients who failed rescue therapy (32%vs 0%, P = 0.01). Rescue therapy in steroid refractory ASUC is not related to delay in urgent colectomy or increased post-colectomy complications.
Multicenter Study of Drain Fluid Amylase as a Biomarker for the Detection of Anastomotic Leakage After Ileal Pouch Surgery Without a Diverting Ileostomy
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2022
DOI: 10.1097/DCR.0000000000002376
Abstract: Anastomotic leak is the anathema of colorectal surgery. Early diagnosis is an essential segue to early intervention. A temporary defunctioning ileostomy does not prevent an anastomotic leak and presents inherent complications of its own. Drain fluid biomarkers have been studied in colorectal surgery but not in ileal pouch surgery. This study aimed to assess drain fluid amylase as a biomarker of anastomotic leak after ileal pouch surgery and without a erting ileostomy. This was a multicenter prospective observational cohort study. The study was conducted at 4 tertiary hospitals in Queensland, Australia. This study included elective patients undergoing restorative proctectomy and ileal pouch surgery. Measurement of rectal tube amylase and drain fluid amylase. The primary measure was observation of increased drain fluid amylase on the day of anastomotic leak. Fifty-three patients were studied. On the day of anastomotic leak, 4 patients in the anastomotic leak group who experienced an early anastomotic leak recorded a median drain fluid amylase of 21,897 U/L compared with a median drain fluid amylase of 25 U/L for those in the no anastomotic leak group ( p 0.0001). This study relies on the anastomotic leak occurring while the pelvic drain is in situ. The measurement of drain fluid amylase is a sensitive biomarker of early clinical anastomotic leak in patients undergoing restorative proctectomy with an ileal pouch and when a erting ileostomy is not incorporated. This simple, inexpensive, and noninvasive test should be considered in all patients with ileal pouches as an adjunct to the clinical diagnosis and differentiation of anastomotic leak from other postoperative complications. See Video Abstract at links.lww.com/DCR/B958. Estudio multicéntrico de la amilasa del líquido de drenaje como biomarcador para la detección de fugas anastomóticas después de una cirugía de reservorio ileal sin ileostomía de derivación La fuga anastomótica es el anatema de la cirugía colorrectal. El diagnóstico precoz es una transición esencial a la intervención temprana. Una ileostomía desfuncionalizante temporal no evita una fuga anastomótica y presenta sus propias complicaciones inherentes. Los biomarcadores del líquido de drenaje se han estudiado en la cirugía colorrectal, pero no en la cirugía del reservorio ileal. El objetivo fue evaluar la amilasa del líquido de drenaje como biomarcador de fuga anastomótica después de cirugía de reservorio ileal y sin ileostomía de derivación. Este fue un estudio de cohorte observacional prospectivo multicéntrico. El estudio se realizó en 4 hospitales terciarios en Queensland, Australia. Se incluyeron pacientes electivos sometidos a proctectomía restauradora y cirugía de reservorio ileal. Medición de la amilasa del tubo rectal y amilasa del líquido de drenaje. La medida principal fue la observación del aumento de la amilasa en el líquido de drenaje el día de la fuga anastomótica. Cincuenta y tres pacientes fueron estudiados. Los 4 pacientes que experimentaron una fuga anastomótica temprana registraron una mediana de amilasa en el líquido de drenaje de 21 897 U/L el día de la fuga anastomótica en comparación con una mediana de amilasa en el líquido de drenaje de 25 U/L para aquellos en el grupo sin fuga anastomótica (p 0,0001). Este estudio se basa en que la anastomosis ocurre mientras el drenaje pélvico está in situ. La medición de amilasa en el líquido de drenaje es un biomarcador sensible de fuga anastomótica clínica temprana en pacientes sometidos a proctectomía restauradora con reservorio ileal y cuando no se incorpora ileostomía derivativa. Esta prueba simple, económica y no invasiva se debe considerar en todos los pacientes con reservorio ileal como complemento del diagnóstico clínico y la diferenciación de la fuga anastomótica de otras complicaciones posoperatorias. Consulte Video Resumen en links.lww.com/DCR/B958. (Traducción—Dr Yolanda Colorado )
Laparoscopic resection for diverticular disease: Follow-up of 500 consecutive patients
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
Implementation science approaches to enhance uptake of complex interventions in surgical settings
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/AH18193
Abstract: Achieving practice change in the complex healthcare environment is difficult. Effective surgical care requires coordination of services across the continuum of care, involving interdisciplinary collaboration across multiple units, with systems and processes that may not connect effectively. Principles of enhanced recovery after surgery (ERAS) are increasingly being incorporated into facility policies and practice, but the literature reports challenges with both initial adherence and mid- to long-term sustainability. Greatest adherence is typically observed for the intraoperative elements, which are within the control of a single discipline, with poorest adherence reported for postoperative processes occurring in the complex ward environment. Using ERAS as an ex le, this perspective piece describes the challenges associated with implementation of complex interventions in the surgical setting, highlighting the value that implementation science approaches can bring to practice change initiatives and providing recommendations as to suggested course of action for effective implementation.
Management of High and Low Risk Malignant Polyps - A Population Wide Analysis.
Publisher: Wiley
Date: 27-09-2022
DOI: 10.1111/CODI.16328
Abstract: The management of malignant polyps is a treatment dilemma in selecting between polypectomy and colorectal resection. To assist clinicians, guidelines have been developed by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to provide treatment recommendations. This study compared management strategy based on the ACPGBI risk categorization for malignant polyps. Univariable and multivariable statistical analysis was undertaken to assess the factors predicting management strategy. A population‐wide analysis was performed of 1646 malignant polyps and the factors that predicted their management strategy, from Queensland, Australia, from 2011 to 2019. Overall, 31.55% of patients with very low or low risk disease proceeded to resection. Of those with high or very high risk disease, 36.69% did not proceed to resection. In very low and low risk polyps, age ( P = 0.003) and polyp location ( P 0.001) were significantly different between the colorectal resection group and the polypectomy alone group. In those with very high or high risk polyps age ( P 0.001), type of facility (public or private) for the colonoscopy ( P = 0.037), right colonic polyps compared to left colonic polyps ( P = 0.015) and rectal polyps ( P 0.001) and mismatch repair mutations present ( P = 0.027) were predictive of resection in high risk disease using a multivariable model. Over 30% of patients with very low and low risk malignant polyps proceeded to resection, against the advice of guidelines. Furthermore, over 35% of patients with very high or high risk malignant polyps did not proceed to resection. Education strategies may improve management decision choices. Furthermore, improvements in data collation will improve the understanding of management choices in the future.
PET Imaging Quantifying 68Ga-PSMA-11 Uptake in Metastatic Colorectal Cancer
Publisher: Society of Nuclear Medicine
Date: 05-2020
Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer
Publisher: Frontiers Media SA
Date: 30-05-2022
Abstract: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (& years) is rising, there is little data on functional outcomes in this group. The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, & years of age at time of diagnosis and with documented follow-up including functional outcomes. A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%) 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters.
Management of Low Colorectal Anastomotic Leakage in the Laparoscopic Era: More Than a Decade of Experience
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2017
DOI: 10.1097/DCR.0000000000000822
Abstract: Anastomotic leak after colorectal surgery increases postoperative mortality, cancer recurrence, permanent stoma formation, and poor bowel function. Anastomosis between the colon and rectum is a particularly high risk. Traditional management mandates laparotomy, disassembly of the anastomosis, and formation of an often-permanent stoma. After laparoscopic colorectal surgery it may be possible to manage anastomotic failure with laparoscopy, thus avoiding laparotomy. The purpose of this study was to determine the feasibility of the laparoscopic management of failed low colorectal anastomoses. This was a single-institute case series. A total of 555 laparoscopic patients undergoing anterior resection with primary anastomosis within 10 cm of the anus in the period 2000–2012 were included. Anastomotic failure, defined as any clinical or radiological demonstrable defect in the anastomosis complications using the Clavien–Dindo system mortality within 30 days and patient demographics and risk factors, as defined by the Charlson index, were measured. Leakage occurred in 44 (7.9%) of 555 patients, 16 patients with a erting ileostomy and 28 with no erting ileostomy. Leakage was more common in those with anastomoses cm form the anus, male patients, and those with a colonic J-pouch and rectal cancer. Diverting ileostomy was not protective of anastomotic leakage. In those patients with anastomotic leakage and a primary erting ileostomy, recourse to the peritoneal cavity was required in 4 of 16 patients versus 24 of 28 without a erting ileostomy ( p = 0.0002). In 74% of those cases, access to the peritoneal cavity was achieved through laparoscopy. Permanent stoma rates were very low, including 14 (2.5%) of 555 total patients or 8 (18.0%) of 44 patients with anastomotic leakage. Thirty-day mortality was rare (0.6%). This study was limited by the lack of a cohort of open cases for comparison. Laparoscopic anterior resection is associated with low levels of complications, including anastomotic leak, postoperative mortality, and permanent stoma formation. Anastomotic leakage can be managed with laparoscopy in the majority of cases. See Video Abstract at links.lww.com/DCR/A353.
Reproductive Burden and Its Impact on Female Labor Market Outcomes in India: Evidence from Longitudinal Analyses
Publisher: Springer Science and Business Media LLC
Date: 28-07-2022
DOI: 10.1007/S11113-022-09730-6
Abstract: We use nationally representative data from two waves of the Indian Human Development Survey to examine the role of inter-temporal changes in fertility behavior in influencing female labor market outcomes. Our multivariate regression estimates show that an increase in the number of children reduces labor force participation and earnings. We further investigated the impact of fertility changes on transitions from the labor market. The results show that women who had more than three children in both rounds of the survey had a 3.5% points higher probability of exiting from the labor market than their counterparts with two or fewer children net of other socio-demographic factors. Disaggregated analyses by caste, economic, educational status, and region show that the probability of dropping out of the labor market due to fertility changes varies by region and is greater for non-poor and primary to secondary schooling women and those from socially disadvantaged castes than poor, non-educated, and socially advantageous women.
Time for an Australian and New Zealand randomized controlled trial to study the modified Kono S anastomosis
Publisher: Wiley
Date: 12-2022
DOI: 10.1111/ANS.17991
A case study of ileal metaplasia and neoplasia in a patient with an ileal-rectal anatomosis
Publisher: Georg Thieme Verlag KG
Date: 06-2018
DOI: 10.1016/J.JCOL.2017.12.006
Abstract: A clear link between ulcerative colitis and the formation of dysplasia and neoplasia has been described. This increased risk remains even after subtotal colectomy and ileo-rectal anastomosis, necessitating life-long surveillance of the remaining ano-rectum. This case study highlights the importance in long-term follow up in this population, including proximal to the anastomosis as dysplastic changes can occur in the distal ileum.
International consensus definition of low anterior resection syndrome
Publisher: Wiley
Date: 10-02-2020
DOI: 10.1111/CODI.14957
Impact of microsatellite status in early-onset colonic cancer
Publisher: Oxford University Press (OUP)
Date: 28-04-2022
DOI: 10.1093/BJS/ZNAC108
Abstract: The molecular profile of early-onset colonic cancer is undefined. This study evaluated clinicopathological features and oncological outcomes of young patients with colonic cancer according to microsatellite status. Anonymized data from an international collaboration were analysed. Criteria for inclusion were patients younger than 50 years diagnosed with stage I–III colonic cancer that was surgically resected. Clinicopathological features, microsatellite status, and disease-specific outcomes were evaluated. A total of 650 patients fulfilled the criteria for inclusion. Microsatellite instability (MSI) was identified in 170 (26.2 per cent), whereas 480 had microsatellite-stable (MSS) tumours (relative risk of MSI 2.5 compared with older patients). MSI was associated with a family history of colorectal cancer and lesions in the proximal colon. The proportions with pathological node-positive disease (45.9 versus 45.6 per cent P = 1.000) and tumour budding (20.3 versus 20.5 per cent P = 1.000) were similar in the two groups. Patients with MSI tumours were more likely to have BRAF (22.5 versus 6.9 per cent P & 0.001) and KRAS (40.0 versus 24.2 per cent P = 0.006) mutations, and a hereditary cancer syndrome (30.0 versus 5.0 per cent P & 0.001 relative risk 6). Five-year disease-free survival rates in the MSI group were 95.0, 92.0, and 80.0 per cent for patients with stage I, II, and III tumours, compared with 88.0, 88.0, and 65.0 per cent in the MSS group (P = 0.753, P = 0.487, and P = 0.105 respectively). Patients with early-onset colonic cancer have a high risk of MSI and defined genetic conditions. Those with MSI tumours have more adverse pathology (budding, KRAS/BRAF mutations, and nodal metastases) than older patients with MSI cancers.
Argument for taTME
Publisher: AME Publishing Company
Date: 10-2020
Surgical management and long‐term functional outcomes after anastomotic leak in patients undergoing minimally invasive restorative rectal resection and without a diverting ileostomy
Publisher: Wiley
Date: 24-01-2022
DOI: 10.1111/ANS.17475
Abstract: Anastomotic leak (AL) is the anathema of colorectal surgery, with well‐documented adverse impacts on patient morbidity and mortality. The long‐term consequences of AL on bowel function and quality of life (QoL) is less well‐defined after minimally invasive surgery. By omitting a temporary erting ileostomy (TDI), it is postulated that the minimally invasive approach will lead to early diagnosis and expedient management of AL. This retrospective and cross‐sectional study included patients who underwent minimally invasive restorative rectal surgery with a low pelvic colorectal anastomosis and without a TDI at two tertiary hospitals in Brisbane, Australia between 2004 and 2018. Surgical management of AL is described and long‐term functional outcomes were evaluated through validated questionnaires. Two hundred and twenty‐four patients met inclusion criteria. AL was associated with lesion proximity to the anal verge ( P = 0.011), total mesorectal excision (TME) ( P .001) and advanced malignant disease ( P = 0.019). Twenty‐four patients experienced an AL (11%) diagnosed at a median of 5.5 days post‐operative. Survey responders ( n = 99, 62%) included 10 (10%) AL and 89 (90%) non‐AL patients, with a median follow‐up of 4 and 6.4 years. SF‐36 and FISI scores were comparable between groups, however AL patients had worse LARS scores ( P = 0.028). Patients undergoing TME, irrespective of AL, had poorer low anterior resection syndrome (LARS) ( P .001) and FISI scores ( P = 0.001). AL in patients undergoing minimally invasive low pelvic colorectal anastomosis without a TDI does not impact long term QoL. The occurrence of LARS is dependent on the extent of resection, rather than the occurrence of AL.
Diminishing lengths of subsequent bowel resections in the surgical management of ileal Crohn's disease
Publisher: Wiley
Date: 21-09-2022
DOI: 10.1111/ANS.18047
Abstract: Crohn's disease is a chronic inflammatory bowel disease that most commonly affects the ileum. As a result, it is associated with a high lifetime risk of one or more surgical resections. The surgical paradigm is to preserve intestinal length. This study aims to assess the length of ileum resected at the index operation and at subsequent ileocolic resections for Crohn's disease. This is a retrospective study assessing the clinical and pathological data of patients undergoing ileocolic resection for the management of Crohn's disease over the period 01/01/2002 to 31/07/2020 in two metropolitan Australian hospitals. One hundred and seventy-six patients were analysed: 130 underwent a single resection 31 underwent two resections and 15 underwent three resections. The median age at the first operation was 37.2 years (range 18-69) with 60% of patients female. The median length resected at the first surgery was 17.8 cm (IQR 12.0) for small bowel, and 5.0 cm (IQR 1.0) for large bowel. The length of ileum resected at the first surgery was significantly greater than that of the second (P = 0.0001), without significant differences between the second and third resections (P = 0.49). The time interval from diagnosis to the first surgery had no significant impact on the length of intestine resected at the index ileocolic resection. In Crohn's disease, the length of ileum removed at first resection is the greatest, with subsequent resection lengths less than the first.
International expert opinion on optimal treatment of anastomotic leakage after rectal cancer resection: a case-vignette study
Publisher: Springer Science and Business Media LLC
Date: 24-08-2022
DOI: 10.1007/S00384-022-04240-5
Abstract: Little is known about the optimal treatment of anastomotic leakage after low anterior resection (LAR) for rectal cancer and whether treatment strategy depends on leakage features and patient characteristics. The objective of this study was to determine which treatment principles are used by expert colorectal surgeons worldwide. In this international case-vignette study, participants completed a survey on their preferred treatment for 11 clinical cases with varying leakage features and two patient scenarios depending on surgical risk (a total of 22 cases). In total, 42 of 64 invited surgeons completed the survey from 18 countries worldwide. The majority worked at a university training hospital (62%) and had more than 15 years of experience performing LAR for rectal cancer (52%). Early leaks in septic patients were preferably treated by major salvage surgery, to some extent depending on the patient scenario. In early leaks in non-septic patients, drainage and faecal ersion were the cornerstones of the proposed treatment. Endoscopic vacuum therapy was more often proposed than percutaneous drainage. A minority proposed anastomotic reconstruction, more often for larger defects. Treatment of late leaks ranged from watchful waiting, drainage, or transanal repair to major (non-)restorative salvage surgery, with minimal influence of the degree of symptoms on the proposed strategy. Leaks of the blind loop and rectovaginal fistulae showed high variability in the proposed treatment strategy. This TENTACLE-Rectum case-vignette study demonstrates tailored treatment strategies depending on the clinical type of leak and patient characteristics, with variable degrees of consensus and knowledge gaps which should be addressed in future studies.
Laparoscopic Resection for Diverticular Disease
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2008
The National Aeronautics and Space Administration-task load index: NASA-TLX: evaluation of its use in surgery.
Publisher: Wiley
Date: 08-06-2022
DOI: 10.1111/ANS.17830
Abstract: The technical difficulty an operation creates for a surgeon is difficult to measure. Current measures are poor surrogates. In both research and teaching settings it would be valuable to be able to accurately measure this degree of difficulty. The National Aeronautics and Space Administration Task Load Index (NASA TLX) is a multi-dimensional scale designed to obtain workload estimates relating to a task. This study aimed to evaluate the NASA TLX as an objective measure of technical difficulty of an operation. Seven surgeons performed 127 pre-defined operations (minimally invasive right hemicolectomy & re-do bariatric surgery) and recorded a NASA TLX score after each operation. These scores were compared to numerous clinical parameters and the score was correlated with the subjective measure of whether the surgeon categorized the operation as "easy", "moderate" or "difficult". The NASA TLX score was significantly correlated with operative duration, blood loss, previous abdominal surgery and the surgeons' assessment of difficulty. It did not correlate with intra-operative or post-operative complications, conversion to open surgery or length of stay. The NASA TLX score provides a graded numerical score that that correlated significantly with the surgeon's assessment of the technical difficulty, and with operative duration, intra-operative blood loss and previous abdominal surgery. This novel application of this tool could be employed in both research and teaching settings to score surgical difficulty and monitor a trainee's proficiency over time.
Poor agreement among Australian and New Zealand clinicians is a barrier to implementation of early post‐operative feeding following colorectal surgery
Publisher: Wiley
Date: 05-12-2023
DOI: 10.1111/ANS.18007
Incisional hernia following ileostomy closure: who's at risk? The Gold Coast experience
Publisher: Wiley
Date: 18-11-2021
DOI: 10.1111/ANS.17359
Abstract: Diverting ileostomy is utilized to protect high‐risk anastomoses, though it is not shown to reduce the leak rate it may reduce the severe consequences of an anastamotic leak. In recent years mesh development has advanced to allow placement of meshes into potentially contaminated fields, such as an ostomy closure site. A retrospective review of all ileostomy closure procedures in Gold Coast from 1st January 2011 until 31st December 2018 were included. Patient demographics and surgical outcomes and follow up reviewed to identify any cases of incisional hernia relating to ostomy closure. A total of 193 patients were identified, after exclusions 171 were suitable for analysis within the study, a total of 25 incisional hernia detected radiologically or clinically. Two independent risk factors were identified BMI and ASA 3–4. Both had significant association with development of incisional hernia with a 3‐ and 2‐fold RR increase, respectively. This was also reflected in a subset analysis of BMI ranges demonstrating increased risk in the obese and severely obese group. The high‐risk group in our population was elevated BMI and ASA, these are the patients we would expect to benefit the most from targeted therapy to reduce the incidence of incisional hernia. Future studies to look at whether reducing BMI or prophylactic mesh placement are effective.
An umbrella systematic review of drain fluid analysis in colorectal surgery for the detection of anastomotic leak: Not yet ready to translate research studies into clinical practice
Publisher: Wiley
Date: 07-08-2021
DOI: 10.1111/CODI.15844
Abstract: Anastomotic leak (AL) is the most important complication of intestinal surgery with an anastomosis. Whilst a number of studies have defined risk factors for AL, frustratingly, low‐risk patients still develop AL. Studies have looked at drain fluid analysis for detection of AL, but these findings have failed to translate into routine clinical practice. This umbrella systematic review aims to provide an overview of the promising candidate biomarkers (BMs) that show potential to translate into clinical practice. A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane, KSR Evidence and the Epistemonikos databases on the 14 April 2021. Only systematic reviews of cohort or controlled studies measuring drain fluid biomarkers in humans were included. The methodological quality of the reviews was assessed using the AMSTAR 2 instrument. Clinical trial registries were searched for trials actively investigating drain fluid BMs. Candidate BMs were classified, and threshold values investigated. Nine systematic reviews, published between 2007 and 2020, met the inclusion criteria, and contained a total of 36 cohort studies. A total of 38 different BMs were studied. The most promising category of drain fluid BM was the extravasated intra‐luminal substances (EILS) and five registered trials of these BMs were found. Two of nine reviews were of moderate quality. The majority of BMs show inconsistent threshold values and are in the experimental stage. A number are not readily available for adoption into routine clinical practice. Most do not state a cut‐off value to be considered as diagnostic.
A population-based study of the management of rectal malignant polyps and the use of trans-anal surgery.
Publisher: Wiley
Date: 18-07-2022
DOI: 10.1111/ANS.17917
Abstract: Rectal malignant polyps can be managed by use of trans‐anal resections (TAR). Traditional techniques of resection have been replaced by use of platforms such as trans‐anal minimally invasive surgery (TAMIS) or trans‐anal endoscopic microsurgery (TEM). This study reviewed the management of rectal malignant polyps, in particular focussing on when clinicians used TAR. A population wide cohort study of all malignant rectal polyps diagnosed in Queensland, Australia from 2011 to 2018 was undertaken. Patient and pathological factors were compared across the management strategies of polypectomy, TAR and rectal resection. Overall 430 patients were diagnosed with a malignant rectal polyp during the study period, with 103 undergoing a TAR. There was increasing use of TAR across the study period as a management strategy ( P 0.001). Polypectomy alone was more likely to be the management strategy over TAR or rectal resection if there were clear margins ( P 0.001). The distance to the closest polypectomy margin was also significantly higher in the polypectomy group with mean clearance 2.09 mm in polypectomy group versus 0.86 mm in TAR group and 0.99 mm in resection group ( P 0.001). Rectal resection was more likely to be the management strategy over TAR if there was LVI ( P 0.001), depth of invasion was deeper ( P 0.001) and there was tumour budding ( P = 0.001). TAR is an effective management strategy for rectal polyps and is utilized particularly in rectal malignant polyps when there are close or involved margins. Future guideline development should consider incorporation of TAR given the advances in techniques afforded by TAMIS or TEM platforms.
Characteristics of Early-Onset vs Late-Onset Colorectal Cancer
Publisher: American Medical Association (AMA)
Date: 09-2021
DOI: 10.1001/JAMASURG.2021.2380
Abstract: The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.
Exploring the perioperative outcomes of a sample of successful adopters of transanal total mesorectal excision (taTME) during the learning phase
Publisher: Elsevier BV
Date: 04-2021
Prospective application of an implementation framework to improve postoperative nutrition care processes: Evaluation of a mixed methods implementation study
Publisher: Wiley
Date: 28-08-2018
Abstract: To describe prospective application of an implementation framework to guide and evaluate a quality improvement (QI) project to improve adherence to evidence-based postoperative diet guidelines (consistent with Enhanced Recovery After Surgery, ERAS) in older surgical patients. A hybrid mixed methods study guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was used. A pre-implementation audit identified gaps in nutrition-related care practices against ERAS guidelines for older surgical patients. Qualitative interviews explored barriers to practice change, informing development of the facilitated implementation strategy. Iterative facilitation interventions were identified by field notes and classified using i-PARIHS facilitator's tool-kit. Post-implementation audit measured implementation outcomes, and clinical processes and outcomes using controlled before-after comparative study. Implementation involved 17 discrete facilitation activities. Early postoperative diet upgrade was acceptable, well adopted (79%) and appropriate for 89% of patients. Fidelity (i.e. protocol delivered as intended) was 59%, with loss of fidelity primarily because of incorrect diet codes. Clinical processes and outcome evaluation (n = 155) compared data pre-implementation (intervention: n = 45, control: n = 27 mean age 73 (SD 6) years, 60% male) and post-implementation (intervention: n = 47, control: n = 36 mean age 74 (SD 6) years, 57% male). Patients on the intervention ward had higher odds of receiving early nutrition post-implementation (adjusted odds ratio [95% CI]: 6.5 [1.9-22.4], P = 0.01). Prospective application of an implementation framework supported planning and successful implementation in this QI project. Multi-level evaluation of facilitation strategies, implementation outcomes, and clinical processes and outcomes helps to understand areas of success and continuing challenges.
Giant faecolith as an unusual cause of small bowel obstruction: A case report
Publisher: Edorium Journals Pvt. Ltd.
Date: 2018
Teardrop flap for a perianal lesion - A video vignette.
Publisher: Wiley
Date: 29-07-2022
DOI: 10.1111/CODI.16251
Research Priorities in Prehabilitation for Patients Undergoing Cancer Surgery: An International Delphi Study
Publisher: Springer Science and Business Media LLC
Date: 24-08-2023
DOI: 10.1245/S10434-023-14192-X
Abstract: Recently, the number of prehabilitation trials has increased significantly. The identification of key research priorities is vital in guiding future research directions. Thus, the aim of this collaborative study was to define key research priorities in prehabilitation for patients undergoing cancer surgery. The Delphi methodology was implemented over three rounds of surveys distributed to prehabilitation experts from across multiple specialties, tumour streams and countries via a secure online platform. In the first round, participants were asked to provide baseline demographics and to identify five top prehabilitation research priorities. In successive rounds, participants were asked to rank research priorities on a 5-point Likert scale. Consensus was considered if 70% of participants indicated agreement on each research priority. A total of 165 prehabilitation experts participated, including medical doctors, physiotherapists, dieticians, nurses, and academics across four continents. The first round identified 446 research priorities, collated within 75 unique research questions. Over two successive rounds, a list of 10 research priorities reached international consensus of importance. These included the efficacy of prehabilitation on varied postoperative outcomes, benefit to specific patient groups, ideal programme composition, cost efficacy, enhancing compliance and adherence, effect during neoadjuvant therapies, and modes of delivery. This collaborative international study identified the top 10 research priorities in prehabilitation for patients undergoing cancer surgery. The identified priorities inform research strategies, provide future directions for prehabilitation research, support resource allocation and enhance the prehabilitation evidence base in cancer patients undergoing surgery.
Locoregional recurrences after transanal total mesorectal excision of rectal cancer during the exploration phase
Publisher: Oxford University Press (OUP)
Date: 19-06-2020
DOI: 10.1002/BJS.11753
Malignant polyps in the COVID-19 era: a population-based analysis.
Publisher: Wiley
Date: 24-01-2023
DOI: 10.1111/ANS.18253
Abstract: Malignant polyps represent the early development of colorectal adenocarcinoma. During 2020, there was widescale rationing of health‐care resources in response to the COVID‐19 pandemic. In particular there was deferral of some colonoscopy procedures required for timely malignant polyp detection. This study sought to assess how these deferrals affected the diagnosis of malignant polyps. A population wide analysis was performed of 2079 malignant polyps, diagnosed in Queensland, Australia from 2011 to 2020. A regression analysis, with 95% prediction intervals, was produced to determine whether there was a significant impact on the number of malignant polyps diagnosed in 2020 compared to previous years. Univariate statistical analysis of patient, procedural, and pathological variables was also performed. In 2020 there were 211 malignant polyps diagnosed, which was significantly lower than was predicted by the univariate regression analysis ( r 2 = 0.85, 95% prediction interval: 255.07–323.91, P 0.001). These malignant polyps were less likely to be diagnosed in a private setting ( P 0.001), and exhibited significantly less depth of submucosal invasion ( P = 0.017). There was no significant difference in the management strategy (polypectomy, resection or trans‐anal resection) between 2011 and 2019 and 2020. Because of the significant decrease in the number of malignant polyps, and the natural history of the disease, it is expected that there will be an increase in more advanced colorectal adenocarcinomas presenting in 2021 and beyond. This has implications for healthcare resources, particularly in light of the ongoing strain on health departments as a result of the COVID‐19 pandemic.
Renal dysfunction occurs following ileostomy formation and is independent of readmission
Publisher: Wiley
Date: 09-01-2023
DOI: 10.1111/ANS.18254
Abstract: Ileostomy formation may be permanent or intended as temporary to defunction a high‐risk pelvic anastomosis to reduce the risk of septic consequences of anastomotic leak. However, these procedures have a high rate of readmission, most commonly due to dehydration and associated with acute kidney injury (AKI). A single centre retrospective cohort study of patients who underwent ileostomy formation from 2015 to 2020 and analysed in two groups: those who needed readmission within 60 days and those who did not. Data collected included demographics and renal function and electrolytes at baseline (ileostomy formation) and at elective ileostomy closure. A total of 171 patients were included in the analysis, with a readmission rate 38% within 60 days of discharge. There was a significant increase in creatinine from baseline blood tests compared to date of elective ileostomy closure in both the readmission and no readmission arms. There was a significant decrease in eGFR from baseline blood tests compared with date of ileostomy closure in both readmission and no readmission arms. There was no significant difference in creatinine or eGFR between readmission and no readmission arms at date of ileostomy closure. Baseline serum sodium levels were lower in the readmission arm compared to no readmission arm. Ileostomy formation is associated with a deterioration in renal function, which occurs independent of whether the patient requires readmission to hospital. Low serum sodium may be used as a predictor for patients with an increased risk of readmission.
Amylase quantification in the terminal Ileum following formation of an Ileostomy
Publisher: Springer Science and Business Media LLC
Date: 09-11-2020
DOI: 10.1038/S41598-020-76349-Y
Abstract: Amylase is elevated in the foregut and has been used to confirm anastomotic integrity after pancreatic surgery. The physiological activity of pancreatic enzymes in the ileum has been studied in healthy volunteers but not quantitated with the simple and readily available amylase measurements employed with serum tests. We aim to quantitate the levels of amylase in the terminal ileum. This was a prospective, non-randomised, non-blinded, consecutive cohort study conducted at the Royal Brisbane and Women’s Hospital. Consecutive patients undergoing routine surgery with an ileostomy were invited to participate in the study. Ileostomy effluent was collected and analysed daily for the first 5 post-operative days. This validation cohort included 8 males and 3 females, with a mean age of 49 years. Median daily amylase levels ranged from 4470 U/L to 23,000 U/L, with no specimens falling within the laboratory serum reference range of 40 to 130 U/L. Two specimens were not available on day one post-operative due to complete ileus. The s le size of 11 patients is small but was considered sufficient given that 55 effluent specimens were anticipated for analysis. Amylase levels remain highly elevated as the enzyme transits through the length of the small intestine and measured in the terminal ileum, and can be readily quantitated by the existing testing methodology routinely available.
Does an ileostomy cover the surgeon or the anastomosis?
Publisher: Wiley
Date: 2022
DOI: 10.1111/ANS.17364
Anastomotic leak does not affect long-term and longitudinal functional outcomes after ileal pouch surgery for ulcerative colitis when managed aggressively
Publisher: Springer Science and Business Media LLC
Date: 27-08-2020
The Ideal Ileal-Pouch Design
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2012
International consensus definition of low anterior resection syndrome
Publisher: Wiley
Date: 10-02-2020
DOI: 10.1111/ANS.15421
Political determinants of health: (re) examining the role of governance in reducing maternal mortality
Publisher: Cambridge University Press (CUP)
Date: 30-03-2023
DOI: 10.1017/S1744133123000026
Abstract: Given change in the universal developmental agenda and the quality of governance in the last two decades, this paper re-examines the relationship between governance, health expenditure and maternal mortality using panel data for 184 countries from 1996 to 2019. By employing the ‘dynamic panel data regression model’, the study reveals that a one-point improvement in the governance index decreases maternal mortality by 10–21%. We also find that good governance can better translate health expenditure into improved maternal health outcomes through effective allocation and equitable distribution of available resources. These results are robust to alternative instruments, alternative dependent variables (such as infant mortality rate and life expectancy), estimation by different governance dimensions and at the sub-national level. Additional findings using ‘Quantile regression’ estimates show that the quality of governance matters more than the health expenditure in countries with a higher level of maternal mortality. While the ‘Path regression’ analysis exhibits the specific direct and indirect mechanisms through which the causal inference operates between governance and maternal mortality.
Cardiac assessment with thallium scanning prior to aortic aneurysm repair
Publisher: SAGE Publications
Date: 10-1999
DOI: 10.1016/S0967-2109(99)00031-9
Abstract: Coronary artery disease occurs commonly in patients with aortic aneurysms and is a major cause of morbidity and mortality. The role of screening and intervention for cardiac disease prior to aneurysm repair is controversial. The outcome after cardiac screening with thallium scanning and/or angiography in 102 consecutive patients undergoing aortic aneurysm repair was documented. Significant coronary artery disease was found in 34 (33%) patients and two patients had either coronary artery bypass or angioplasty prior to aneurysm repair. There was no cardiac mortality after aneurysm repair and the overall mortality on an intention-to-treat basis was 2%. There was good correlation between prior history of cardiac events, electrocardiography (ECG) and the results of screening with thallium scanning and angiography. There was no correlation between cardiac history, ECG and the incidence of cardiac events in the postoperative period. Significant coronary artery disease was found in 33% of patients without a cardiac history or abnormal ECG. Cardiac screening with thallium scanning confirmed a high incidence of significant coronary disease in patients with aortic aneurysm. In this study, cardiac intervention followed by expedient aneurysm repair in 20 patients was associated with zero mortality. The short-term benefit of such a policy is difficult to prove and its main advantage may be better long-term survival.
Transanal mesorectal excision: early outcomes in Australia and New Zealand
Publisher: Oxford University Press (OUP)
Date: 09-01-2021
DOI: 10.1093/BJS/ZNAA098
Abstract: Transanal total mesorectal excision (taTME) aims to overcome some of the technical challenges faced when operating on mid and low rectal cancers. Specimen quality has been confirmed previously, but recent concerns have been raised about oncological safety. This multicentre prospective study aimed to evaluate the safety of taTME among early adopters in Australia and New Zealand. Data from all consecutive patients who had taTME for rectal cancer from July 2014 to February 2020 at six tertiary referral centres in Australasia were recorded and analysed. A total of 308 patients of median age of 64 years underwent taTME. Some 75.6 per cent of patients were men, and the median BMI was 26.8 kg/m2. The median distance of tumour from anal verge was 7 cm. Neoadjuvant chemoradiotherapy was administered to 57.8 per cent of patients. The anastomotic leak rate was 8.1 per cent and there was no mortality within 30 days of surgery. Pathological examination found a complete mesorectum in 295 patients (95.8 per cent), a near-complete mesorectum in seven patients (2.3 per cent), and an incomplete mesorectum in six patients (1.9 per cent). The circumferential resection margin and distal resection margin was involved in nine patients (2.9 per cent), and two patients (0.6 per cent) respectively. Over a median follow-up of 22 months, the local recurrence rate was 1.9 per cent and median time to local recurrence was 30.5 months. This study showed that, with appropriate training and supervision, skilled minimally invasive rectal cancer surgeons can perform taTME with similar pathological and oncological results to open and laparoscopic surgery.
Risk taking propensity: Nurse, surgeon and patient preferences for diverting ileostomy
Publisher: Wiley
Date: 04-05-2022
DOI: 10.1111/CODI.16149
Abstract: The decision‐making process to defunction a pelvic colorectal anastomosis involves complex heuristics and is framed by surgeon personality factors. Risk taking propensity may be an important factor in these decisions and patient preferences have not been evaluated alongside surgeons and nurses. A prospective cross‐sectional study involving a one‐off interview and questionnaire assessing how risk taking propensity affects nurse, surgeon and patient preferences for a temporary defunctioning ileostomy (TDI) was performed. The risk taking index (RTI) was employed to evaluate risk taking propensity and the validated prospective measures of preference instruments to evaluate preferences for stoma avoidance in several scenarios by asking the in idual to consider trading or gambling years of remaining life expectancy. One hundred and fifty participants met the inclusion criteria, which included 30 (20.0%) surgical nurses, 20 (13.3%) colorectal surgeons and 100 (66.7%) patients. Surgeons had a significantly higher RTI (mean ± SD: 26.8 ± 6.7) than patients (mean ± SD: 20.0 ± 9.8) and nurses (mean ± SD: 23.0 ± 6.6) p = 0.002. Surgeons would consider that it would be in a patient's best interest to have a TDI at an AL rate of 15% or greater, whereas nurses and patients would do so at 28% and 25%, respectively ( p = 0.007). Surgeons were shown to have a higher risk taking propensity than patients and nurses but a significantly lower threshold of AL where they would consider a TDI is in the best interest of the patient.
International Consensus Definition of Low Anterior Resection Syndrome
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2020
DOI: 10.1097/DCR.0000000000001583
Abstract: Low anterior resection syndrome is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The low anterior resection syndrome score was designed as a simple tool for clinical evaluation of low anterior resection syndrome. Although the low anterior resection syndrome score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of low anterior resection syndrome that encompasses all aspects of the condition and is informed by all stakeholders. This international patient-provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting. Three expert groups participated: patients, surgeons, and other health professionals from 5 regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in 3 languages (English, Spanish, and Danish). The primary outcome measured was the priorities for the definition of low anterior resection syndrome. Three hundred twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96%, and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to 8 symptoms and 8 consequences that capture essential aspects of the syndrome. S ling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. This is the first definition of low anterior resection syndrome developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of low anterior resection syndrome. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in low anterior resection syndrome over time and with intervention.
Poverty, wealth inequality and financial inclusion among castes in Hindu and Muslim communities in Uttar Pradesh, India
Publisher: Wiley
Date: 17-02-2022
DOI: 10.1002/JID.3626
Abstract: This study estimates poverty, wealth inequality and financial inclusion, for the first time, at the sub‐caste level in both Hindus and Muslims using a unique survey data collected from 7124 households in Uttar Pradesh, India, during 2014–2015. The results confirm the existing hypothesis that Brahmins, Thakurs and other Hindu general castes have higher wealth accumulation, lower poverty and lesser exclusion from formal financial services than Dalits. Exclusion from formal financial services forces Dalits to depend primarily on informal financial sources for borrowing—which leads to financial misfortune and further dragging them into a vicious cycle of poverty.
Laparoscopic or open appendicectomy for suspected appendicitis in pregnancy and evaluation of foetal outcome in Australia
Publisher: Wiley
Date: 06-09-2017
DOI: 10.1111/ANS.13750
Abstract: Recent data suggest that laparoscopic appendicectomy (LA) in pregnancy is associated with higher rates of foetal loss when compared to open appendicectomy (OA). However, the influence of gestational age and maternal age, both recognized risk factors for foetal loss, was not assessed. This was a multicentre retrospective review of all pregnant patients who underwent appendicectomy for suspected appendicitis from 2000 to 2012 across seven hospitals in Australia. Perioperative data and foetal outcome were evaluated. Data on 218 patients from the seven hospitals were included in the analysis. A total of 125 underwent LA and 93 OA. There were seven (5.6%) foetal losses in the LA group, six of which occurred in the first trimester, and none in the OA group. After matching using propensity scores, the estimated risk difference was 5.1% (95% confidence interval (CI): 1.4%, 9.8%). First trimester patients were more likely to undergo LA (84%), while those in the third were more likely to undergo OA (85%). Preterm delivery rates (6.8% LA versus 8.6% OA CI: -12.6%, 5.3%) and hospital length of stay (3.7 days LA versus 4.5 days OA CI: -1.3, 0.2 days) were similar. This is the largest published dataset investigating the outcome after LA versus OA while adjusting for gestational and maternal age. OA appears to be a safer approach for pregnant patients with suspected appendicitis.
Gastrografin can be detected in ex vivo biological specimens by dual-energy CT scanning
Publisher: Wiley
Date: 15-06-2020
Current management of large bowel obstruction: a narrative review
Publisher: AME Publishing Company
Date: 07-2022
DOI: 10.21037/ALES-21-45
Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer The ALaCaRT Randomized Clinical Trial
Publisher: American Medical Association (AMA)
Date: 06-10-2015
Abstract: Laparoscopic procedures are generally thought to have better outcomes than open procedures. Because of anatomical constraints, laparoscopic rectal resection may not be better because of limitations in performing an adequate cancer resection. To determine whether laparoscopic resection is noninferior to open rectal cancer resection for adequacy of cancer clearance. Randomized, noninferiority, phase 3 trial (Australasian Laparoscopic Cancer of the Rectum ALaCaRT) conducted between March 2010 and November 2014. Twenty-six accredited surgeons from 24 sites in Australia and New Zealand randomized 475 patients with T1-T3 rectal adenocarcinoma less than 15 cm from the anal verge. Open laparotomy and rectal resection (n = 237) or laparoscopic rectal resection (n = 238). The primary end point was a composite of oncological factors indicating an adequate surgical resection, with a noninferiority boundary of Δ = -8%. Successful resection was defined as meeting all the following criteria: (1) complete total mesorectal excision, (2) a clear circumferential margin (≥1 mm), and (3) a clear distal resection margin (≥1 mm). Pathologists used standardized reporting and were blinded to the method of surgery. A successful resection was achieved in 194 patients (82%) in the laparoscopic surgery group and 208 patients (89%) in the open surgery group (risk difference of -7.0% [95% CI, -12.4% to ∞] P = .38 for noninferiority). The circumferential resection margin was clear in 222 patients (93%) in the laparoscopic surgery group and in 228 patients (97%) in the open surgery group (risk difference of -3.7% [95% CI, -7.6% to 0.1%] P = .06), the distal margin was clear in 236 patients (99%) in the laparoscopic surgery group and in 234 patients (99%) in the open surgery group (risk difference of -0.4% [95% CI, -1.8% to 1.0%] P = .67), and total mesorectal excision was complete in 206 patients (87%) in the laparoscopic surgery group and 216 patients (92%) in the open surgery group (risk difference of -5.4% [95% CI, -10.9% to 0.2%] P = .06). The conversion rate from laparoscopic to open surgery was 9%. Among patients with T1-T3 rectal tumors, noninferiority of laparoscopic surgery compared with open surgery for successful resection was not established. Although the overall quality of surgery was high, these findings do not provide sufficient evidence for the routine use of laparoscopic surgery. Longer follow-up of recurrence and survival is currently being acquired. anzctr.org Identifier: ACTRN12609000663257.
A development study of drain fluid gastrografin as a biomarker of anastomotic leak
Publisher: Korean Society of Coloproctology
Date: 30-04-2022
Abstract: Purpose: Anastomotic leakage (AL) is the anathema of colorectal surgery. Its occurrence leads to increased morbidity and mortality and a prolonged hospital stay. Much work has gone into studying various biomarkers in drain fluid to facilitate early detection of AL. This stage 2a development study aims to assess the safety and feasibility of reliably detecting the iodine in Gastrografin (GG Bayer Australia Ltd.) in drain fluid and stool s les by dual-energy computed tomography (DECT).Methods: This is a prospective, observational, controlled, consecutive cohort study establishing the safety and feasibility of the detection of GG in surgical drain fluid and stool as a biomarker of AL when patients with a low pelvic colorectal anastomosis undergo luminal flushing of the rectal tube with GG.Results: Ten consecutive patients were allocated to the saline flush group and the following 10 to the GG flush group. Three patients in the saline flush group developed an AL. One patient in the GG flush group developed an AL. An elevation in the drain fluid GG was detected using DECT on the day of clinical deterioration. None of the patients in the control group were found to have a positive result on DECT.Conclusion: This study demonstrates the safety of a novel approach to the early detection of AL from extraperitoneal colorectal anastomoses. The technique requires validation in a larger cohort and a multicenter study is planned to investigate the efficacy of GG rectal tube flushes as an early biomarker of AL in low pelvic anastomoses.
Long‐term outcomes of total colectomy for severe constipation
Publisher: Wiley
Date: 25-03-2023
DOI: 10.1111/CODI.16517
Abstract: Surgery for constipation is usually reserved for patients with severe and refractory symptoms because of concerns about perioperative morbidity and unpredictable functional outcomes. The aim of this paper is to identify the long‐term outcomes of patients who have undergone total colectomy and ileorectal anastomosis for severe constipation. Patients who had undergone a total colectomy and ileorectal anastomosis for severe constipation were identified from a prospectively maintained database and sent a postal survey assessing functional symptoms, patient satisfaction and the impact of symptoms on quality of life. Information regarding the surgery, perioperative complications and hospitalizations were also collected. Functional outcomes of the surgery were evaluated with the Gastrointestinal Quality of Life Index, St Marks incontinence score, Wexner continence score, obstructed defaecation syndrome score and Cleveland Clinic constipation score. Seventy‐one questionnaires were posted and 32 (45%) patients responded. The mean time since surgery was 15.3 years (range 2.9–30.4 years) Most patients were happy with the surgery. Ongoing symptoms were common, the most frequent of these were abdominal pain, experienced by 23 patients (71.9%), and faecal incontinence, experienced by 17 patients (53%). Fourteen patients (43.8%) required subsequent hospital admission due to bowel obstruction and eight patients (25%%) had subsequent surgery for adhesions. There was an association between patient quality of life and subsequent surgeries. Most patients were happy and viewed their life as improved following total colectomy for severe constipation. This is despite a high rate of ongoing functional symptoms.
Ileal Crohn's disease fistulating into a Meckel's diverticulum
Publisher: Wiley
Date: 22-02-2022
DOI: 10.1111/ANS.17572
Timing of surveillance colonoscopy following malignant colorectal polypectomy in Queensland.
Publisher: Wiley
Date: 03-10-2022
DOI: 10.1111/ANS.18069
Abstract: The management of malignant polyps presents a treatment challenge between a colorectal resection and polypectomy alone. Patients managed with polypectomy alone typically undergo surveillance for recurrent or metastatic disease, however, optimal timing of surveillance methods remains unclear. Guidelines recommend for completely resected malignant polyps, that a surveillance colonoscopy be perform 12 months from diagnosis. This study sought to clarify how patients with a malignant polyp were being colonoscopically surveilled if they did not undergo colorectal resection. A retrospective, population‐wide cohort analysis of all patients from 2011 to 2019 was performed using data from the Queensland Oncology Repository. Patient, procedural and pathological data were extracted for all patients diagnosed with a malignant polyp and timing of the first surveillance endoscopy was calculated. Statistical analysis comparing the timing of surveillance colonoscopy across multiple patients, procedural and histological characteristics were assessed. A total of 1646 patients were identified with a malignant polyp, with 797 patients managed with polypectomy and surveillance alone. The median time to surveillance endoscopy was 182 days with the mean 220.01 days. This was substantially sooner than the recommended clinical guidelines of 365 days. There were no patient or procedural characteristics which predicted a difference in the timing of surveillance colonoscopy. No pathological factors appeared to change the timing for surveillance endoscopy ( P 0.05). Overall, patients had surveillance endoscopy procedures substantially earlier than guideline recommendations. However, evidence underlying these guidelines and other surveillance methods for malignant polyps are not strong. Future technological developments, including improvements in imaging techniques, may provide additional options for surveillance of malignant polyps.
Palpable head on digital rectal examination: a rare case of uterine incarceration causing obstruction and perforation of an ileal pouch in mid‐term pregnancy
Publisher: Wiley
Date: 04-02-2021
DOI: 10.1111/ANS.16641
Laparoscopic orchidopexy for the intra-abdominal testis
Publisher: Springer Science and Business Media LLC
Date: 21-09-1999
Abstract: The role of laparoscopy in the management of the impalpable testis has been largely as a diagnostic tool only. Its therapeutic application as a single or two-stage Fowler-Stephens procedure for the intra-abdominal testis is assessed and a management algorithm derived. A retrospective review was performed of 26 children with 33 intra-abdominal testes (IAT) who were operated upon between 1992 and 1997 5 had a single-stage (6 testes) and 21 had a staged approach. All children had the operated testis located in an acceptable scrotal position on review. Six operations were performed as a single-stage procedure. Four testes were palpably smaller at follow-up: 2 in the single-stage (33.3%) and 2 in the two-stage group (7%). Of the 26 children, 24 were day-case admissions. Minor self-limiting complications were observed in 5 cases. Laparoscopic localisation and Fowler-Stephens orchidopexy can be safely employed in the definitive management of the IAT.
Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Australian Institution’s Experience
Publisher: Korean Society of Coloproctology
Date: 31-10-2021
Abstract: Purpose: We report outcomes and evaluate patient factors and the impact of surgical evolution on outcomes in consecutive ulcerative colitis patients who had restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) at an Australian institution over 26 years.Methods: Data including clinical characteristics, preoperative medical therapy, and surgical outcomes were collected. We ided eligible patients into 3 period arms (period 1, 1990 to 1999 period 2, 2000 to 2009 period 3, 2010 to 2016). Outcomes of interest were IPAA leak and pouch failure.Results: A total of 212 patients were included. Median follow-up was 50 (interquartile range, 17 to 120) months. Rates of early and late complications were 34.9% and 52.0%, respectively. Early complications included wound infection (9.4%), pelvic sepsis (8.0%), and small bowel obstruction (6.6%) while late complications included small bowel obstruction (18.9%), anal stenosis (16.8%), and pouch fistula (13.3%). Overall, IPAA leak rate was 6.1% and pouch failure rate was 4.8%. Eighty-three patients (42.3%) experienced pouchitis. Over time, we observed an increase in patient exposure to thiopurine (P=0.0025), cyclosporin (P=0.0002), and anti-tumor necrosis factor (P .00001) coupled with a shift to laparoscopic technique (P .00001), stapled IPAA (P .00001), J pouch configuration (P .00001), a modified 2-stage procedure (P=0.00012), and a decline in defunctioning ileostomy rate at time of IPAA (P=0.00002). Apart from pouchitis, there was no significant difference in surgical and chronic inflammatory pouch outcomes with time.Conclusion: Despite greater patient exposure to immunomodulatory and biologic therapy before surgery coupled with a significant change in surgical techniques, surgical and chronic inflammatory pouch outcome rates have remained stable.
International expert consensus guidance on indications, implementation and quality measures for transanal total mesorectal excision
Publisher: Wiley
Date: 07-2020
DOI: 10.1111/CODI.15147
Examining EphA2 expression in Colorectal Cancer
Publisher: Oxford University Press (OUP)
Date: 08-2022
Abstract: EphA2 is a potential therapeutic target for the treatment of colorectal cancer (CRC), however reports of EphA2 expression in CRC are inconsistent and often lack the context of a normal tissue comparator. The aim of this investigation is to undertake a detailed assessment of EphA2 protein expression across a range of pathological and normal specimens. 177 patient specimens (100 paired primary and normal colon, 42 paired primary and metastasis and 35 unpaired s les as part of a multi-tumour TMA) underwent immunohistochemical analysis (IHC) probing for EphA2 expression alongside a normal tissue array. Weak/moderate EphA2 expression was noted in normal tissues of the proximal GI tract (stomach, small intestine) with little expression in the colon/rectum with a significant upregulation of EphA2 noted in primary lesions compared to matched normal tissue controls (p& .0001). No difference in expression between stage of disease, sex or effect of patient age, location of s les (edge vs centre), stage of disease, T-stage or N-stage. EphA2 expression was significantly higher in primary lesions associated with M1 disease primaries (p=0.03). No difference in EphA2 expression was noted between matched primary and metastatic lesions (p& .05). In this study, EphA2 protein expression was significantly higher in CRC lesions compared to healthy tissue (p& .0001) with no diminution noted across a wide range of stages or lesion types. On this basis, diagnostic or therapeutic interventions targeting EphA2 are likely to be useful across a wide spectrum of disease.
Drain fluid amylase as a sensitive biomarker for the early detection of anastomotic leakage in ileal pouch surgery
Publisher: Wiley
Date: 12-01-2019
DOI: 10.1111/CODI.14536
Abstract: We studied the levels of amylase in drain fluid to investigate its utility as a biomarker of anastomotic leak in ileal pouch patients who did not have a covering loop ileostomy. The luminal contents of the small intestine are high in amylase. Ileal J pouches are formed for restoration of continuity in patients with ulcerative colitis after removal of the colon and rectum. A drain is placed alongside the ileal pouch in the pelvis. This study is a retrospective analysis of prospectively collected daily drain fluid amylase levels in consecutive patients undergoing restorative proctectomy and ileal J pouch anal anastomosis, without a covering loop ileostomy, between November 2016 and April 2018. Thirteen patients underwent surgery without a covering loop ileostomy. Two patients suffered an anastomotic leak and were returned to theatre, one on day 5 and the other on day 6 postoperatively. The mean daily drain fluid amylase level in those who did not leak was between 25 and 46 U/l with a range of 22-139 U/l for all s les collected. In the two patients who suffered a clinical leak the drain fluid amylase level rose to 22 432 and 10 212 U/l on the day of clinical leak diagnosis. The mean rectal tube (intraluminal) amylase level was 63 097 U/l as measured on day 1 postoperatively. In this small cohort of patients, the measurement of drain fluid amylase is a highly sensitive biomarker of clinical anastomotic leak.
An assessment of an Australasian pathway for the introduction of transanal total mesorectal excision (taTME)
Publisher: Wiley
Date: 2018
DOI: 10.1111/CODI.13964
Abstract: To evaluate the use of a pathway for the introduction of transanal total mesorectal excision (taTME) into Australia and New Zealand. A pathway for surgeons with an appropriate level of specialist training and baseline skill set was initiated amongst colorectal surgeons it includes an intensive course, a series of proctored cases and ongoing contribution to audit. Data were collected for patients who had taTME, for benign and malignant conditions, undertaken by the initial adopters of the technique. A total of 133 taTME procedures were performed following the introduction of a training pathway in March 2015. The indication was rectal cancer in 84% of cases. There was one technique-specific visceral injury, which occurred prior to that surgeon completing the pathway. There were no cases of postoperative mortality morbidity occurred in 27.1%. The distal resection margin was clear in all cases of rectal cancer, and the circumferential resection margin was positive in two cases. An intact or nearly intact total mesorectal excision was obtained in more than 98% of cases. This study demonstrates the safe and controlled introduction of a new surgical technique in a defined surgeon population with the use of a pathway for training. The authors recommend a similar pathway to facilitate the introduction of taTME to colorectal surgical practice.
Laparoscopic resection of advanced colorectal cancer
Publisher: Oxford University Press (OUP)
Date: 25-11-2010
DOI: 10.1002/BJS.7329
Abstract: Palliative resection of the primary tumour in asymptomatic patients with stage IV colorectal cancer is associated with improved survival and fewer complications. Laparoscopic surgery is widely employed in the curative treatment of colorectal cancer, but its value in advanced colorectal cancer remains unclear. All patients who underwent laparoscopic resection of primary colorectal cancer in this unit between June 1991 and Jan 2010 were entered into a prospective computerized database. Outcomes for patients with laparoscopic resection of stage IV colorectal cancer were compared with those of patients who had laparoscopic surgery for stage I disease. Some 185 patients with stage IV colorectal cancer who underwent laparoscopic resection were compared with 310 patients who had stage I colorectal cancer. Some 94·1 and 98·4 per cent of operations respectively were completed laparoscopically. Hospital stay was slightly longer in the group with stage IV disease (mean 6·2 versus 5·3 days P = 0·091). The 30-day mortality rate was 2·7 per cent in patients with stage IV disease and 0·6 per cent in those with stage I tumours (P = 0·061). There was no difference in complications. One-year survival rates were 77·8 and 99·0 per cent respectively (P & 0·001). Short-term outcomes after laparoscopic surgery for stage IV colorectal cancer in selected patients are equivalent to those for stage I cancers.
Missing parameters in malignant polyp histology reports: can appropriate decisions be made?
Publisher: Elsevier BV
Date: 02-2022
Geographical variation in the use of diverting loop ileostomy in Australia and New Zealand colorectal surgeons
Publisher: Korean Society of Coloproctology
Date: 31-10-2021
Abstract: Purpose: Anastomotic leak (AL) after a low pelvic anastomosis is a devastating complication, with short- and long-term morbidity and increased mortality. Surgeons may employ various adjuncts in an attempt to reduce AL rates or mitigate their impact. These include the use of temporary erting ileostomy (TDI), transanal or rectal tubes and pelvic drains. This questionnaire evaluates the preferences and routine use of these adjuncts in Australasian colorectal surgeons.Methods: A cross-sectional survey was administered to Australian and New Zealand colorectal surgeons on September 20, 2018. The study survey consisted of 15 questions exploring basic demographics and the number of rectal resections and ileal pouches performed in 12 months, along with the surgeon’s preference for the use of erting stomas, rectal tubes, and pelvic drains.Results: There were 90 respondents to the survey (31.6%). Surgeons in Western Australia (71.4%) were more likely to use a mandatory TDI in colorectal extraperitoneal anastomoses than surgeons in Queensland (14.3%). South Australian surgeons are more likely to employ a mandatory TDI (100%) for ileal pouches than Queensland surgeons (42.9%). Rectal tubes are not commonly utilized (40.0% never use them), and pelvic drains are (45.6% in all cases). Surgeons consider a median AL rate of 15% was felt to justify the use of a TDI in low pelvic anastomoses and a median AL rate of 10% for ileal pouchesConclusion: There is considerable geographical variation in colorectal surgical practice throughout Australia and New Zealand. While surgeons interrogate the same literature, there are presumably other factors that see translation into variations in clinical practice.
Disease-free Survival and Local Recurrence After Laparoscopic-assisted Resection or Open Resection for Rectal Cancer
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2019
C-reactive protein trajectory to predict colorectal anastomotic leak: PREDICT Study
Publisher: Oxford University Press (OUP)
Date: 16-07-2020
DOI: 10.1002/BJS.11812
Abstract: Anastomotic leak is a common complication after colorectal surgery, associated with increased morbidity and mortality, and poorer long-term survival after oncological resections. Early diagnosis improves short-term outcomes, and may translate into reduced cancer recurrence. Multiple studies have attempted to identify biomarkers to enable earlier diagnosis of anastomotic leak. One study demonstrated that the trajectory of C-reactive protein (CRP) levels was highly predictive of anastomotic leak requiring intervention, with an area under the curve of 0·961. The aim of the present study was to validate this finding externally. This was a prospective international multicentre observational study of adults undergoing elective colorectal resection with an anastomosis. CRP levels were measured before operation and for 5 days afterwards, or until day of discharge if earlier than this. The primary outcome was anastomotic leak requiring operative or radiological intervention. Between March 2017 and July 2018, 933 patients were recruited from 20 hospitals across Australia, New Zealand, England and Scotland. Some 833 patients had complete CRP data and were included in the primary analysis, of whom 41 (4·9 per cent) developed an anastomotic leak. A change in CRP level exceeding 50 mg/l between any two postoperative days had a sensitivity of 0·85 for detecting a leak, and a high negative predictive value of 0·99 for ruling it out. A change in CRP concentration of more than 50 mg/l between either days 3 and 4 or days 4 and 5 after surgery had a high specificity of 0·96–0·97, with positive likelihood ratios of 4·99–6·44 for a leak requiring intervention. This study confirmed the value of CRP trajectory in accurately ruling out an anastomotic leak after colorectal resection.
Prolonged use of thromboprophylaxis may not be necessary in laparoscopic colorectal surgery
Publisher: Springer Science and Business Media LLC
Date: 27-01-2011
DOI: 10.1007/S00384-011-1139-2
Abstract: Patients undergoing colorectal resections are considered high risk for developing thromboembolic disease. We postulate, however, that the rapid recovery and swift mobilization after laparoscopic resections reduce this risk and that these patients therefore do not need prolonged thromboprophylaxis. This hypothesis was tested in this paper. All patients who underwent laparoscopic colorectal surgery in our Colorectal Surgical Unit in the period from June 1991 until January 2010 were entered into a prospective database. The entire database was reviewed, and incidence of thromboembolic disease and significant bleeding complications were noted. Three thousand, three hundred sixty-four patients were laparoscopically operated on for colorectal disease and were entered in the database. Two thousand, one hundred twenty-seven patients were operated on for benign disease 1,230, for colorectal cancer, and four, for other malignancies. Two deep venous thromboses were encountered (0.059%), and ten patients had pulmonary embolism (0.30%). The combined venous thromboembolism (VTE) risk for the overall group of patients undergoing laparoscopic colorectal operations is 0.36%. The combined VTE risk was 0.57% (7/1,230) in patients with colorectal cancer and 0.24% (5/2,127) in patients with benign disease (p = 0.118). Bleeding complications occurred in 44 patients (1.3%). In our group, the combined VTE risk for the overall group of patients undergoing laparoscopic colorectal operations is 0.36%. Therefore, we postulate that the prolonged use of thromboprophylaxis is not indicated in the vast majority of patients undergoing laparoscopic colorectal surgery. In particular, patients undergoing laparoscopic resections for benign disease and without other risk factors have such a low VTE risk that prolonged prophylaxis is probably not warranted.
Related Organisations
Royal College Of Surgeons Of Edinburgh
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for David A Clark.