Publications
230 results found
Kontovounisios C, Smith J, Dawson P, et al., 2018, The Ostom-i (TM) Alert Sensor: a new device to measure stoma output, Techniques in Coloproctology, Vol: 22, Pages: 697-701, ISSN: 1123-6337
Oms L, Kalakouti E, Simillis C, et al., 2018, Surgical Site Infections Related to ESBL Pathogens Post Colon Surgery, WOUNDS-A COMPENDIUM OF CLINICAL RESEARCH AND PRACTICE, Vol: 30, Pages: 249-250, ISSN: 1044-7946
Kalakouti E, Simillis C, Pellino G, et al., 2018, Surgical Site Infections Related to ESBL Pathogens Post Colon Surgery Response, Wounds: a compendium of clinical research and practice, Vol: 30, Pages: 250-250, ISSN: 1044-7946
Simillis C, Afxentiou T, Pellino G, et al., 2018, A systematic review and meta-analysis comparing adverse events and functional outcomes of different pouch designs after restorative proctocolectomy, COLORECTAL DISEASE, Vol: 20, Pages: 664-675, ISSN: 1462-8910
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- Citations: 23
Yeung KTD, Smith E, Kontovounisios C, et al., 2018, Abdominal wall reconstruction MDT: the modern approach, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 191-191, ISSN: 0007-1323
Nikolaou S, Qiu S, Fiorentino F, et al., 2018, Systematic review of blood diagnostic markers in colorectal cancer, Techniques in Coloproctology, Vol: 22, Pages: 481-498, ISSN: 1123-6337
The purpose of this systematic review was to compare the diagnostic ability of blood markers for colorectal cancer (CRC). A systematic review of the literature for diagnostic blood markers for primary human colorectal cancer over the last 5 years was performed. The primary outcome was to assess the diagnostic ability of these markers in diagnosing colorectal cancer. The secondary outcome was to see whether the marker was compared to other markers. The tertiary outcome was to assess diagnostic ability in early versus late CRC, including stage IV disease. We identified 51 studies (29 prospective, 14 retrospective, and 8 meta-analyses). The markers were divided in broadly four groups: nucleic acids (RNA/DNA/messenger RNA/microRNAs), cytokines, antibodies, and proteins. The most promising circulating markers identified among the nucleid acids were NEAT_v2 non-coding RNA, SDC2 methylated DNA, and SEPT9 methylated DNA. The most promising cytokine to detect CRC was interleukin 8, and the most promising circulating proteins were CA11-19 glycoprotein and DC-SIGN/DC-SIGNR. Sensitivities of these markers for detecting primary colorectal carcinoma ranged from 70 to 98% and specificities from 84 to 98.7%. The best studied blood marker was SEPT9 methylated DNA, which showed great variability with sensitivities ranging from 48.2 to 95.6% and specificities from 80 to 98.9%, making its clinical applicability challenging. If combined with fecal immunochemical test (FIT), the sensitivity improved from 78 to 94% in detecting CRC. Methylated SEPT9, methylated SDC2, and -SIGN/DC-SIGNR protein had better sensitivity and specificity than CEA or CA 19-9. With the exception of SEPT9 which is currently being implemented as a screening test for CRC all other markers lacked reproducibility and standardization and were studied in relatively small population samples.
Qiu S, Pellino G, Warren OJ, et al., 2018, Mixed adenoneuroendocrine carcinoma of the colon and rectum, ACTA CHIRURGICA BELGICA, Vol: 118, Pages: 273-277, ISSN: 0001-5458
Pellino G, Gallo G, Pallante P, et al., 2018, Noninvasive biomarkers of colorectal cancer: role in diagnosis and personalised treatment perspectives, Gastroenterology Research and Practice, Vol: 2018, ISSN: 1687-6121
Colorectal cancer (CRC) is the third leading cause of cancer-related deaths worldwide. It has been estimated that more than one-third of patients are diagnosed when CRC has already spread to the lymph nodes. One out of five patients is diagnosed with metastatic CRC. The stage of diagnosis influences treatment outcome and survival. Notwithstanding the recent advances in multidisciplinary management and treatment of CRC, patients are still reluctant to undergo screening tests because of the associated invasiveness and discomfort (e.g., colonoscopy with biopsies). Moreover, the serological markers currently used for diagnosis are not reliable and, even if they were useful to detect disease recurrence after treatment, they are not always detected in patients with CRC (e.g., CEA). Recently, translational research in CRC has produced a wide spectrum of potential biomarkers that could be useful for diagnosis, treatment, and follow-up of these patients. The aim of this review is to provide an overview of the newer noninvasive or minimally invasive biomarkers of CRC. Here, we discuss imaging and biomolecular diagnostics ranging from their potential usefulness to obtain early and less-invasive diagnosis to their potential implementation in the development of a bespoke treatment of CRC.
Simillis C, Lal N, Qiu S, et al., 2018, Sacral nerve stimulation versus percutaneous tibial nerve stimulation for faecal incontinence: a systematic review and meta-analysis, INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, Vol: 33, Pages: 645-648, ISSN: 0179-1958
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- Citations: 15
Kelly ME, Glynn R, Aalbers AGJ, et al., 2018, Factors affecting outcomes following pelvic exenteration for locally recurrent rectal cancer, BRITISH JOURNAL OF SURGERY, Vol: 105, Pages: 650-657, ISSN: 0007-1323
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- Citations: 101
Kontovounisios C, Tekkis PP, Simillis C, 2018, Characteristics of Surgical Site Infection Following Colorectal Surgery in a Tertiary Center: Extended-spectrum β-Lactamase-producing Bacteria Culprits in Disease, Wounds, Vol: 30, Pages: 108-113, ISSN: 1044-7946
© 2018 HMP Communications. All rights reserved. Introduction. Surgical site infection (SSI) is a well-known complication of colorectal surgery associated with increased morbidity and hospital stay. Antimicrobial prophylaxis can reduce the risk of SSI by as much as 75%. Extended-spectrum β-lactamase (ESBL)-producing pathogens make the successful use of such prophylaxis a challenge and are a real threat to patient care following colorectal surgery. Objective. The aim of this study is to report the common characteristics of SSIs after colorectal surgery and to highlight the prevalence, risk factors, and clinical relevance of ESBL infections among these patients in a tertiary center. Materials and Methods. All patients who underwent bowel resection operation (ie, laparoscopy, laparotomy, or laparoscopic-assisted colectomy) for benign or malignant colorectal disease were identified retrospectively from the prospective database of the colorectal department in the authors' tertiary center from March 2015 to March 2016. Results. There were 123 patients included in this study, of which 21% (n = 26) had a SSI. The microorganisms isolated in the surgical sites included Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, Proteus mirabilis, Morganella morganii, and Enterobacter cloacae. Thirty-eight percent of the wound infections grew ESBL-producing pathogens in their wound cultures and 62% grew non-ESBL microbes. Conclusions. More than one-third of the wound infections were due to ESBL-producing pathogens, which were resistant to the antibiotic prophylaxis given. Inappropriate antibiotic usage can delay postoperative recovery. High-risk patients for ESBL colonization may benefit from preoperative screening based on an established protocol. The cost effectiveness of an ESBL screening program needs to be further studied.
Kalakouti E, Simillis C, Pellino G, et al., 2018, Characteristics of Surgical Site Infection Following Colorectal Surgery in a Tertiary Center: Extended-spectrum beta-Lactamase-producing Bacteria Culprits in Disease, WOUNDS-A COMPENDIUM OF CLINICAL RESEARCH AND PRACTICE, Vol: 30, Pages: 108-113, ISSN: 1044-7946
Zucker B, Kontovounisios C, 2018, It is time to improve the quality of medical information distributed to students across social media, Advances in Medical Education and Practice, Vol: 2018, Pages: 203-205, ISSN: 1179-7258
The ubiquitous nature of social media has meant that its effects on fields outside of social communication have begun to be felt. The generation undergoing medical education are of the generation referred to as “digital natives”, and as such routinely incorporate social media into their education. Social media’s incorporation into medical education includes its use as a platform to distribute information to the public (“distributive education”) and as a platform to provide information to a specific audience (“push education”). These functions have proved beneficial in many regards, such as enabling constant access to the subject matter, other learners, and educators. However, the usefulness of using social media as part of medical education is limited by the vast quantities of poor quality information and the time required to find information of sufficient quality and relevance, a problem confounded by many student’s preoccupation with “efficient” learning. In this Perspective, the authors discuss whether social media has proved useful as a tool for medical education. The current growth in the use of social media as a tool for medical education seems to be principally supported by students’ desire for efficient learning rather than by the efficacy of social media as a resource for medical education. Therefore, improvements in the quality of information required to maximize the impact of social media as a tool for medical education are required. Suggested improvements include an increase in the amount of educational content distributed on social media produced by academic institutions, such as universities and journals.
Ramage L, Mclean P, Simillis C, et al., 2018, Functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer, Updates in Surgery, Vol: 70, Pages: 15-21, ISSN: 2038-131X
Adequate oncological outcomes have been demonstrated with rectal resection and handsewn coloanal anastomosis (CAA) in tumours in close proximity to the internal anal sphincter. Our aim was to assess functional differences between handsewn CAA and ultralow stapled anastomosis. Participants were identified from a single-surgeon series. Included participants underwent anorectal physiology testing of anal sphincter function, in addition to completion of several questionnaires: Wexner Incontinence Score (WIS); Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ); Low Anterior Resection Syndrome (LARS) Score; SF36. Non-parametric data compared using the Mann-Whitney U test. 20 participants were included; 11 stapled and 9 handsewn. Mean follow-up was 2.95 ± 1.97 years. The mean LARS score was 21.9 ± 1.97 years in the stapled group versus 29.4 ± 9.57 in the handsewn group (p = 0.133). The Wexner incontinence score was significantly higher in the handsewn group (p = 0.0076), with a mean score of 4.6 ± 3.69 versus 10.9 ± 4.76. The incontinence domain of the BBUSQ was also significantly worse in patients with a handsewn anastomosis (p = 0.001). With the exception of general health (p = 0.035) and social functioning (p = 0.035), which were worse in the handsewn groups, the other six domains of the SF-36 showed no statistical difference between groups. Anorectal physiology scores were not significantly different. Handsewn CAA anastomosis is known to be safe and oncologically feasible. Patient selection should be vigorous, with preoperative counseling regarding the likelihood of incontinence to manage patients' expectations and promote comparable quality of life in the long-term.
Pellino G, Warren O, Mills S, et al., 2018, Comparison of Western and Asian Guidelines Concerning the Management of Colon Cancer, DISEASES OF THE COLON & RECTUM, Vol: 61, Pages: 250-259, ISSN: 0012-3706
Zucker BE, Tekkis P, Kontovounisios C, 2018, Is Reality Limiting Patient Understanding? A Discussion of the Implications of Augmented Reality Technology to Patient Understanding., Surgical Innovation, Pages: 1553350617751462-1553350617751462, ISSN: 1553-3506
Ramage L, Simillis C, Yen C, et al., 2017, Magnetic resonance defecography versus clinical examination and fluoroscopy: a systematic review and meta-analysis, TECHNIQUES IN COLOPROCTOLOGY, Vol: 21, Pages: 915-927, ISSN: 1123-6337
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- Citations: 14
Yeap ZH, Simillis C, Qiu S, et al., 2017, Diagnostic accuracy of anorectal manometry for fecal incontinence: a meta-analysis, Acta Chirurgica Belgica, Vol: 117, Pages: 347-355, ISSN: 0001-5458
© 2017 The Royal Belgian Society for Surgery. Background: Anorectal manometry (ARM) is conventionally used to assess patients with fecal incontinence (FI). This review aims to establish the diagnostic accuracy of ARM for FI. Method: A search of MEDLINE, EMBASE, Science Citation Index Expanded and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library was performed. Studies examining the sensitivity and specificity of ARM measures, either individually or combined, in the diagnosis of FI, were included. Data analysis was conducted using the bivariate statistical method. Results: Seven studies were included out of an initial search of 1499 studies. The summary sensitivity and specificity for ARM as an overall test were 0.80 (95% confiden ce interval (CI): 0.69–0.88) and 0.80 (95% CI: 0.65–0.90), respectively. The diagnostic odds ratio (DOR) for ARM was found to be 16.61 (95% CI: 5.52–50.03). The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) for ARM were found to be 4.09 (95% CI: 2.11–7.94) and 0.25 (95% CI: 0.14–0.42), respectively. Subgroup analysis based on four studies reporting on maximum resting pressure (MRP) demonstrated a sensitivity, specificity, DOR, PLR and NLR of 0.60 (95% CI: 0.38–0.79), 0.93 (95% CI: 0.80–0.97), 20.0 (95% CI: 4.00–91.00), 8.60 (95% CI: 3.00–24.30) and 0.43 (95% CI: 0.24–0.76), respectively. Conclusion: ARM has been shown to be an accurate test for diagnosing FI. Further studies are required to establish the diagnostic accuracy of individual ARM measures.
Kontovounisios C, Tekkis P, 2017, Locally Advanced Disease and Pelvic Exenterations., Clin Colon Rectal Surg, Vol: 30, Pages: 404-414, ISSN: 1531-0043
Advanced primary and recurrent colorectal cancer can be successfully treated by experienced, dedicated centers delivering good outcomes with low mortality and morbidity. Development and implementation of a comprehensive referral pathway is to be encouraged. Multidisciplinary team management is essential in the management of this complex group of patients and is associated with significantly more complete preoperative evaluation and more accurate provision of patient information, as well as improved access to the most appropriate individualized management plan. A structured selection process can improve outcomes through standardized approaches to service delivery to provide the highest quality of care.
Kong E, Nikolaou S, Qiu S, et al., 2017, A systematic review of sacral nerve stimulation for faecal incontinence following ileal pouch anal anastomosis, Updates in Surgery, Vol: 70, Pages: 1-5, ISSN: 2038-131X
Faecal incontinence is a common complication of ileal pouch anal anastomosis (IPAA) and seems to worsen with time. The aim of this paper is to review the evidence of the use of sacral nerve stimulation (SNS) for patients with faecal incontinence after IPAA. A literature search was performed on PubMed and Cochrane databases for all relevant articles. All studies, which reported the outcome of SNS in patients with faecal incontinence after IPAA, were reviewed. Three papers were identified, including a case report, cohort study and retrospective study. The total number of patients was 12. The follow-up duration included 3 months, 6 months and 24 months. After peripheral nerve evaluation, definitive implantation was performed in 10 (83.3%) patients. All three studies reported positive outcomes, with CCF scores and incontinence episodes improving significantly. Preliminary results suggest good outcome after permanent SNS implant. Studies with larger sample sizes, well-defined patient characteristics and standardized outcome measures are required to fully investigate the effect of SNS in IPAA patients.
Zucker B, Malietzis G, Kontovounisios C, 2017, An Unexpected Cause of Acute Abdomen, GASTROENTEROLOGY, Vol: 153, Pages: E4-E5, ISSN: 0016-5085
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- Citations: 1
Ramage L, Yen C, Qiu S, et al., 2017, Does a missed obstetric anal sphincter injury at time of delivery affect short-term functional outcome?, Annals of The Royal College of Surgeons of England, Vol: 100, Pages: 26-32, ISSN: 0035-8843
Introduction This study aimed to ascertain whether missed obstetric anal sphincter injury at delivery had worse functional and quality of life outcomes than primary repair immediately following delivery. Materials and methods Two to one propensity matching was undertaken of patients presenting to a tertiary pelvic floor unit with ultrasound evidence of missed obstetric anal sphincter injury within 24 months of delivery with patients who underwent primary repair at the time of delivery by parity, grade of injury and time to assessment. Outcomes compared included Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score, Short Form-36, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire and anorectal physiology results. Results Thirty-two missed anal sphincter injuries were matched two to one with sixty-two patients who underwent primary repair of an anal sphincter defect. Mean time to follow-up was 9.31 ± 6.79 months. Patients with a missed anal sphincter injury had suffered more incontinence, as seen in higher the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ; 30.56% ± 14.41% vs. 19.75% ± 15.65%, P = 0.002) and Wexner scores (6.00 ± 3.76 vs. 3.67 ± 4.06, P = 0.009). They also had a worse BBUSQ urinary domain score (28.25% ± 14.9% vs. 17.01 ± 13.87%, P = 0.001) and worse physical functioning as measured by the Short Form-36 questionnaire (P = 0.045). There were no differences in other outcomes compared, including anorectal physiology and sexual function. Discussion In the short-term, patients with a missed obstetric anal sphincter injury had significantly worse faecal incontinence and urinary function scores, however quality of life and sexual function were largely comparable between groups. Conclusions Longer-term follow-up is needed to assess the effects of missed obstetric anal sphincter injury over time.
McCluney S, Panayi V, Sheehan-Dare G, et al., 2017, Trends in patients presenting with a perforated peptic ulcer in a central London hospital over a 10 year period, 20th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland (AUGIS), Publisher: WILEY, Pages: 48-48, ISSN: 0007-1323
McCluney S, Sheehan-Dare G, Panayi V, et al., 2017, Referral patterns and outcomes of patients presenting with acute cholecystitis to a central London teaching hospital: retrospective review over a 10 year period, 20th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland (AUGIS), Publisher: WILEY, Pages: 36-37, ISSN: 0007-1323
McCluney S, Sheehan-Dare G, Panayi V, et al., 2017, Ten year experience of acute pancreatitis at a central London teaching hospital: may deprivation impact upon outcome and length of stay?, 20th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland (AUGIS), Publisher: WILEY, Pages: 14-14, ISSN: 0007-1323
McCluney S, Panayi V, Sheehan-Dare G, et al., 2017, Gallbladder perforation at a central London teaching hospital: a ten-year review, 20th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland (AUGIS), Publisher: WILEY, Pages: 39-40, ISSN: 0007-1323
Baird DLH, Simillis C, Kontovounisios C, et al., 2017, A systematic review of transabdominal levator division during abdominoperineal excision of the rectum (APER), TECHNIQUES IN COLOPROCTOLOGY, Vol: 21, Pages: 701-707, ISSN: 1123-6337
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- Citations: 4
Pellino G, Simillis C, Qiu S, et al., 2017, Social media and colorectal cancer: A systematic review of available resources, PLOS One, Vol: 12, ISSN: 1932-6203
AimSocial media (SM) can provide information and medical knowledge to patients. Our aim was to review the literature and web-based content on SM that is used by Colorectal Cancer (CRC) patients, as well as surgeons’ interaction with SM.MethodStudies published between 2006 and 2016 were assessed. We also assessed the impact of several hashtags on Twitter with a freeware (Symplur).ResultsNine studies were included assessing Twitter (78%), Forums/Cancer-survivor networks (33%), and Facebook (22%). Aims included use of SM by CRC patients (67%), cancer-specific usage of SM with different types of cancer (44%), content credibility (33%), and influence in CRC awareness (33%). Prevention was the most common information that CRC patients looked for, followed by treatment side-effects. Only 2% of CRC SM users are doctors. SM use by colorectal consultants was suboptimal. Only 38% of surgeons had a LinkedIn account (most with less than 50 connections), and 3% used Twitter. A steep increase of tweets was observed for searched Hashtags over time, which was more marked for #ColonCancer (+67%vs+38%, #Coloncancer vs #RectalCancer). Participants engaged with colon cancer increased by 85%, whereas rectal cancer ones increased by 29%. The hashtag ‘#RectalCancer’ was mostly tweeted by colorectal surgeons. The official twitter account of American Society of Colorectal Surgeons (@fascrs_updates) was the most active account.ConclusionCRC patients and relatives are increasingly engaging with SM. CRC surgeons’ participation is poor, but we confirm a trend toward a greater involvement. Most SM lack of authoritative validation and the quality of shared content still is largely anecdotic and not scientifically evidenced-based. However, SM may offer several advantages over conventional information sharing sources for CRC patients and surgeons, and create connections with mutual enrichment.
Marechal L, Granados A, Ethapemi L, et al., 2017, Modelling of anal sphincter tone based on pneumatic and cable-driven mechanisms, 2017 IEEE World Haptics Conference, WHC 2017, Publisher: IEEE, Pages: 376-381
Motivated by the need for improving a haptics-based simulation tool for learning and training digital rectal examinations, a sphincter tone model and its actuation is conceived and developed. Two approaches are presented: One based on pneumatics actuation and the other using cable-driven mechanical actuation using servo motors. Clinical scenarios are modelled as profiles based on studies of anorectal manometry and adapted with clinical input. Both designed mechanisms and scenarios were experimentally evaluated by six experts, Nurse Practitioners in Continence and Colorectal Surgeons. Results show that both mechanisms produce enough pressure on examining finger and profiles are able to generate a wide range of healthy and abnormal cases. Either approach could be used to provide a more realistic experience during training of sphincter tone assessment.
Pellino G, Simillis C, Kontovounisios C, et al., 2017, Colorectal cancer diagnosed during pregnancy: systematic review and treatment pathways, EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, Vol: 29, Pages: 743-753, ISSN: 0954-691X
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