Jonathan D. Hodgkinson

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

Laparoscopic surgery is well established for colon cancer, with defined benefits. Use of laparoscopy for the performance of restorative proctocolectomy (RPC) with ileoanal anastomosis is more controversial. Technical aspects include difficult dissection of the distal rectum and a potentially increased risk of anastomotic leakage through multiple firings of the stapler. In an attempt to overcome these difficulties we have used the technique of transanal rectal excision to perform the proctectomy. This paper describes the technique, which is combined with an abdominal approach using a single‐incision platform (SIP).

Determining Predictors for Intra-abdominal Septic Complications Following Ileocolonic Resection for Crohn’s Disease—Considerations in Pre-operative and Peri-operative Optimisation Techniques to Improve Outcome

BACKGROUND AND AIMS Intra-abdominal septic complications [IASC] following ileocolonic resection for Crohns disease are common. Determining risk factors for these complications can aid pre-operative and peri-operative strategies to reduced morbidity. This study aims to determine the incidence and predictors of intra-abdominal septic complications following ileocolonic resection for Crohns disease. METHODS A single-centre, retrospective study was conducted. The clinical case notes of patients with histopathologically proven Crohns disease, who underwent an ileocolonic resection as a one-stage or two-stage procedure, were reviewed. The primary endpoint was the formation of intra-abdominal septic complications within a 30-day post-operative time frame. RESULTS Overall 163 patients underwent 175 ileocolonic procedures. Post-operative intra-abdominal septic complications were demonstrated in 9% [13/142] of one-stage procedures and 12% [4/33] of two-stage procedures [p = 0.2]. Post-operative IASCs following a one-stage procedure demonstrated associations with smokers [p = 0.004], intraoperative abdominal sepsis [p = 0.005], concomitant upper gastrointestinal Crohns [p = 0.015], the presence of peri-operative anaemia [p = 0.037], hypoalbuminaemia [< 25g/l] [p = 0.04], and histologically involved margins [p = 0.001]. Multivariate analysis demonstrated the presence of intra-abdominal sepsis (hazard ratio [HR] 8.6, 95% confidence interval [CI]: 1.2 60.1] and the use of peri-operative biologicals [HR 24.6, 95% CI: 2.0-298] as independent predictors of post-operative intra-abdominal septic complications. CONCLUSIONS This study highlights specific variables that may be contributory to poor outcome. These findings may be important when optimising patients for surgery, as well as planning an appropriate operative strategy. Further prospective studies and a larger sample size are required to validate these findings.

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

Minimal evidence exists to guide surgeons on the risk of complications when performing abdominal wall reconstruction (AWR) in the presence of active infection, contamination or enterocutaneous fistula. This study aims to establish the outcomes of contaminated complex AWR.

Concomitant colonic disease (Montreal L3) and re-resectional surgery are predictors of clinical recurrence following ileocolonic resection for Crohn's disease.

Ileocolonic resection is reserved for patients with moderate to severe Crohns disease. Postoperative clinical recurrence can occur in up to 55% of patients within 5 years. Predicting the risk of recurrence is key in deciding upon appropriate treatment strategies. This study aims to determine the incidence of postoperative clinical recurrence and predictors of recurrence in a specialist institution.

Technical Tips and Tricks of Outpatients Treatments for Hemorrhoids

Hemorrhoids are a common condition affecting the anorectum. The clinician must accurately diagnose the condition and exclude more sinister causes responsible for the same symptoms. A focused history and thorough examination help in establishing a differential diagnosis. The treatment modality is guided by the degree of the hemorrhoids. Conservative measures should be employed, including dietary advice and toileting techniques, to treat acute inflammation and as a long-term method of reducing symptom recurrence and worsening disease. A wide range of out-patient therapies are available and all have been shown to be effective in experienced hands and when used in the correct clinical context. Here we present an approach to out-patient treatment C. A. Leo (*) · J. D. Hodgkinson · C. J. Vaizey · J. Warusavitarne Surgery, St Mark’s Hospital Academic Institute, London North West NHS Trust, Harrow, UK Department of surgery and cancer, Imperial College of London, London, UK e-mail: a.leo@nhs.net; cosimoleo@gmail.com; jonathanhodgkinson@nhs.net; cvaizey@nhs.net; j.warusavitarne@nhs.net P. Chandrasinghe Surgery, St Mark’s Hospital Academic Institute, London North West NHS Trust, Harrow, UK Department of surgery and cancer, Imperial College of London, London, UK Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka e-mail: pcchandrasinghe@gmail.com # Springer International Publishing AG 2018 C. Ratto et al. (eds.), Hemorrhoids, Coloproctology 2, https://doi.org/10.1007/978-3-319-51989-0_14-1 1 methods including conservative treatments, medical therapies, and simple interventions.

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

PurposeThis study aims to compare the outcomes of posterior component separation and transversus abdominis release (PCSTAR) with the open anterior component separation (OACS) technique. OACS, first described by Ramirez et al. (Plast Reconstr Surg 86(3):519–526, 1990), has become an established technique for local myofascial advancement in abdominal hernia surgery. PCSTAR, described by Novitsky et al. (Am J Surg 204(5):709–716, 2012), is being used more frequently and is rapidly becoming the technique of choice in complex ventral hernia repair.MethodsAnalysis was conducted according to PRISMA guidelines. A systematic search of the MEDLINE, EMBASE and Pubmed databases was performed. Studies reporting exclusively on midline ventral hernia repair were reviewed. Studies describing PCSTAR were selected and compared to matched studies describing OACS. Meta-analysis was used to compare outcomes between the two-pooled groups.ResultsSeven studies describing 281 cases of PCSTAR for midline incisional hernia using a retromuscular mesh placement were identified. Six comparable studies describing 285 cases of OACS and retromuscular mesh placement were identified from the same search. Pooled analysis demonstrated a hernia recurrence rate of 5.7% (3.0–8.5) for PCSTAR and 9.5% (4.0–14.9) for OACS. Comparative analysis demonstrated no significant difference between hernia recurrence rate (p = 0.23). The use of bridging mesh was not significantly reduced by the use of PCSTAR (3.1%) when compared to ACS (7.5%) (p = 0.22). No significant difference was found in wound complication rates between PCSTAR and OACS, respectively, ‘superficial’ 10.9 vs 21.6% (p = 0.15); and ‘deep’ 9.5 vs 12.7% (p = 0.53).ConclusionsThese data suggest PCSTAR have comparable outcomes to OACS. This analysis is limited by the lack of comparative studies and heterogenicity in the OACS group.

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

Restorative proctocolectomy has gained acceptance in the surgical management of medically refractive ulcerative colitis and cancer prevention in familial adenomatous polyposis. Incontinence following restorative proctocolectomy occurs in up to 25% of patients overnight. The Renew® insert is an inert single‐use device which acts as an anal plug. The aim of this study was to assess the acceptability, effectiveness and safety of the Renew® insert in patients who have undergone restorative proctocolectomy. The device has yet to be assessed in patients who have undergone restorative proctocolectomy.

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

To investigate the current practice of continence advisors in the United Kingdom.