Savvas Papagrigoriadis

Feasibility and morbidity of reversal of Hartmann's.

Objective  Reversal of Hartmanns is a major surgical procedure and associated with substantial morbidity and mortality.

Review article: the current and evolving treatment of colonic diverticular disease

Background  Formation of colonic diverticula, via herniation of the colonic wall, is responsible for the development of diverticulosis and consequently diverticular disease. Diverticular disease can be associated with numerous debilitating abdominal and gastrointestinal symptoms (including pain, bloating, nausea, constipation and diarrhoea).

Diverticular disease hospital admissions are increasing, with poor outcomes in the elderly and emergency admissions

Background  Diverticular disease has a changing disease pattern with limited epidemiological data.

Impact of diverticular disease on hospital costs and activity

Background  Diverticulosis is very common in the UK and patients with clinically significant diverticular disease present regularly to departments of surgery as acute emergencies or chronic problems. There are no national data on the hospital prevalence, clinical implications or financial impact of diverticular disease hence the extent of the clinical problem is as yet not quantified.

Diverticular disease has an impact on quality of life – results of a preliminary study

Objective  Diverticular disease (DD) is common in the western world, and carries a significant morbidity. Although patients can have long standing symptoms no research on quality of life (QoL) in DD exists in the literature. Assessment of QoL may be useful in decision making and selection of patients who would be appropriate candidates for elective surgical treatment. The aim of this study was to examine whether DD has an impact on QoL.

Increased diverticular complications with nonsteriodal anti- inflammatory drugs and other medications: a systematic review and meta-analysis

Complications of colonic diverticula, perforation and bleeding are a source of morbidity and mortality. A variety of drugs have been implicated in these complications. We present a systemic review and meta‐analysis of the literature to assess the importance of this relationship.

Is theatre utilization a valid performance indicator for NHS operating theatres

BackgroundUtilization is used as the principal marker of theatre performance in the NHS. This study investigated its validity as: a managerial tool, an inter-Trust indicator of efficient theatre use and as a marker of service performance for surgeons.MethodsA multivariate linear regression model was constructed using theatre data comprising all elective general surgical operating lists performed at a NHS Teaching hospital over a seven-year period. The model investigated the influence of: operating list size, individual surgeons and anaesthetists, late-starts, overruns, session type and theatre suite on utilization (%).Results7,283 inpatient and 8,314 day case operations were performed on 3,234 and 2,092 lists respectively. Multivariate analysis demonstrated that the strongest independent predictors of list utilization were the size of the operating list (p < 0.01) and whether the list overran (p < 0.01). Surgeons differed in their ability to influence utilization. Their overall influence upon utilization was however small.ConclusionTheatre utilization broadly reflects the surgical volume successfully admitted and operated on elective lists. At extreme values it can expose administrative process failure within individual Trusts but probably lacks specificity for meaningful use as an inter-Trust theatre performance indicator. Unadjusted utilization rates fail to reflect the service performance of surgeons, as their ability to influence it is small.

Increased presence of serotonin-producing cells in colons with diverticular disease may indicate involvement in the pathophysiology of the condition.

IntroductionSerotonin is an important neuroendocrine transmitter participating in the control of colonic motor activity through neural and biochemical mechanisms in the Enteric Nervous System (ENS). A possible pathophysiological factor for diverticular disease (DD) is altered colonic motility. The study compared the distribution of serotonin cells (SC) in the colonic mucosa of patients with diverticular disease to controls.MethodsSixteen paraffin specimens with sigmoid diverticular disease were selected and sections of bowel without diverticula from the same specimen were used as its own control. The resection margins from sixteen colonic specimens excised for sigmoid cancer were additional controls. Immunocytochemical staining for serotonin cells was performed on 4-μm tissue sections with polyclonal antibody (NCL-SEROTp). The number of serotonin-positive cells per ten microscopic fields (×200) was assessed in all groups and the staining distribution was defined as low (0–33%), moderate (>33–66%) and high (>66%) according to the percentage of the entire cell containing contrast material. The control specimens were blinded before analysis. Student’s t test was used for statistical analysis and significance level was set as P < 0.05.ResultsThe mean number of serotonin-positive cells per ten fields in the colonic mucosa of specimens with diverticular disease was significantly higher [252.44 (SD 90.64)] than the specimen’s own control [147.31 (SD 50.16)] and at normal resection margins of cancer specimens [228.38 (SD 120.10)]. The paired analysis between diverticular disease specimens and its own control (paired t test) showed significant differences for moderate (P = 0.008), high (P = 0.001) and total (P = 0.002) number of serotonin cells. There was no evidence of significance between mean DD and cancer values.DiscussionIncreased presence of SCs and the higher proportion of high and moderate staining cells (indicating increased hormone content) indicate the possible role of serotonin in DD. This may be contributing to the pathogenesis of the condition by altered colonic motility in the affected segments in a similar way as in irritable bowel syndrome.

Review article: the pathogenesis of diverticular disease--current perspectives on motility and neurotransmitters.

Aliment Pharmacol Ther 2011; 33: 799–800

We still need to operate at night

IntroductionIn the past the National Confidential Enquiry into Peri-operative deaths (NCEPOD) have advocated a reduction in non-essential night-time operating in NHS hospitals. In this study a retrospective analysis of the emergency general surgical operative workload at a London Teaching centre was performed.MethodsAll general surgical and vascular emergency operations recorded prospectively on the theatre database between 1997 and 2004 were included in the study. Operations were categorised according to whether they commenced during the daytime(08:01–18:00 hours), evening(18:01–00:00 hours) or night-time(00:01–08:00 hours). The procedure type and grade of the participating surgical personnel were also recorded. Bivariate correlation was used to analyse changing trends in the emergency workload.ResultsIn total 5,316 emergency operations were performed over the study period. The numbers of daytime, evening and night-time emergency procedures performed were 2,963(55.7%), 1,832(34.5%), and 521(9.8%) respectively. Laparotomies and complex vascular procedures collectively accounted for half of all cases performed after midnight whereas they represented only 30% of the combined daytime and evening emergency workload. Thirty-two percent (n = 166) of all night-time operations were supervised or performed by a consultant surgeon. The annual volume of emergency cases performed increased significantly throughout the study period. Enhanced daytime (r = 0.741, p < 0.01) and evening (r = 0.548, p < 0.01) operating absorbed this increase in workload. There was no significant change in the absolute number of cases performed at night but the proportion of the emergency workload that took place after midnight decreased significantly throughout the study (r = -0.742, p < 0.01).ConclusionA small but consistent volume of complex cases require emergency surgery after midnight. Provision of an emergency general surgical service must incorporate this need.