Imperial College London

Mr Jamie Murphy BChir PhD FRCS FASCRS - Consultant Colorectal Surgeon

Faculty of MedicineDepartment of Surgery & Cancer

Clinical Senior Lecturer in Colorectal Surgery
 
 
 
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Contact

 

jamie.murphy

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
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67 results found

Leo CA, Thomas GP, Hodgkinson JD, Leeuwenburgh M, Bradshaw E, Warusavitarne J, Murphy J, Vaizey CJet al., 2021, Randomized Pilot Study: Anal Inserts Versus Percutaneous Tibial Nerve Stimulation in Patients With Fecal Incontinence., Dis Colon Rectum, Vol: 64, Pages: 466-474

BACKGROUND: Anal inserts and percutaneous tibial nerve stimulation may be offered to those with fecal incontinence in whom other conservative treatments have failed. OBJECTIVE: We aimed to compare anal inserts and percutaneous tibial nerve stimulation. DESIGN: This was an investigator-blinded randomized pilot study. SETTINGS: The study was conducted at a large tertiary care hospital. PATIENTS: Adult patients with passive or mixed fecal incontinence were recruited. INTERVENTIONS: Patients were randomly assigned to receive either the anal inserts or weekly percutaneous tibial nerve stimulation for a period of 3 months. MAIN OUTCOME MEASURES: The primary end point was a 50% reduction of episodes of fecal incontinence per week as calculated by a prospectively completed 2-week bowel diary. Secondary end points were St Mark's incontinence score, International Consultation on Incontinence Questionnaire-Bowel scores (for bowel pattern, bowel control, and quality of life), use of antidiarrheal agents, estimates of comfort and acceptability. RESULTS: Fifty patients were recruited: 25 were randomly assigned to anal inserts and 25 were randomly assigned to percutaneous tibial nerve stimulation. All completed treatment. A significant improvement of scores in the 2-week bowel diary, the St Mark's scores and the International Consultation on Incontinence Questionnaire-Bowel scores, was seen in both groups after 3 months of treatment. A reduction of ≥50% fecal incontinence episodes was reached by 76% (n = 19/25) by the anal insert group, compared with 48% (n = 12/25) of those in the percutaneous tibial nerve stimulation group (p = 0.04). The St Mark's fecal incontinence scores and the International Consultation on Incontinence Questionnaire-Bowel scores for bowel pattern, bowel control, and quality of life (p = 0.01) suggest similar improvement for each group. LIMITATIONS: A realistic sample size calculation could not be performed because of the paucity of objective prospective

Journal article

Leo CA, Thomas GP, Bradshaw E, Karki S, Hodgkinson JD, Murphy J, Vaizey CJet al., 2020, Long-term outcome of sacral nerve stimulation for faecal incontinence, COLORECTAL DISEASE, Vol: 22, Pages: 2191-2198, ISSN: 1462-8910

Journal article

Leo CA, Leeuwenburgh M, Orlando A, Corr A, Scott SM, Murphy J, Knowles CH, Vaizey CJ, Giordano Pet al., 2020, Initial experience with SphinKeeper (TM) intersphincteric implants for faecal incontinence in the UK: a two-centre retrospective clinical audit, COLORECTAL DISEASE, Vol: 22, Pages: 2161-2169, ISSN: 1462-8910

Journal article

Leo CA, Cavazzoni E, Leeuwenburgh MMN, Thomas GP, Dennis A, Bassett P, Hodgkinson JD, Warusavitarne J, Murphy J, Vaizey CJet al., 2020, Comparison between high-resolution water-perfused anorectal manometry and THD(R)Anopress anal manometry: a prospective observational study, Colorectal Disease, Vol: 22, Pages: 923-930, ISSN: 1462-8910

AimAnorectal physiology tests provide a functional assessment of the anal canal. The aim of this study was to compare the results generated by standard high‐resolution water‐perfused manometry (WPM) with the newer THD® Anopress manometry system.MethodThis was a prospective observational study. Conventional manometry was carried out using a water‐perfused catheter with high‐resolution manometry and compared with the Anopress system with air‐filled catheters. All patients underwent the two procedures successively in a randomized order. Time to arrive at the resting pressure plateau, resting, squeeze, straining pressure and visual analogue scale (VAS) scores for pain were recorded. A qualitative analysis of the two devices was performed.ResultsBetween 2016 and 2017, 60 patients were recruited. The time from insertion of the catheter to arriving at the resting pressure plateau was significantly lower with the Anopress compared with WPM: 12 s [interquartile range (IQR) 10–17 s] versus 100 s (IQR 67–121 s) (P < 0.001). A strong correlation between the manometric values of WPM and the Anopress was observed. Both procedures were well tolerated, although the VAS score for insertion of the WPM catheter was significantly higher. The Anopress was easier to use and more time‐efficient than the WPM.ConclusionThe pressure values obtained with Anopress correlated well with those of conventional manometry. The Anopress has the advantage of being less time‐consuming, user‐friendly and better tolerated by patients.

Journal article

Palaniappan V, Noble E, Qi J, Lewis J, Sahid SM, Reese G, Paraskeva P, Souvatzi, Stoyanov D, Murphy J, Elson Det al., 2020, Optical Polarization-resolved Imaging of Human Colon Cancer Tissue, London Surgery Symposium

Conference paper

Vallance AE, Harji D, Fearnhead NS, Acheson A, Adams K, Adams R, Alsina D, Antoniou A, Arnott R, Bach S, Battersby N, Bedford M, Beggs A, Belcher E, Boulstridge L, Boyle K, Bradbury J, Braun M, Brown E, Brown G, Burling D, Cameron I, Campbell K, Carney K, Cecil T, Chapman M, Chapman S, Chong P, Coyne P, Clark S, Crane S, Daniels I, Davies J, Davies L, Davies M, Dawson C, Dawson P, Duff M, Demick A, Elavia K, Gardner R, Evans M, Fenwick S, Galbraith S, Good J, Gilbert D, Griffiths B, Hargest R, Hill J, Hompes R, Huguet E, Jenkins J, Kapur S, Karandikar S, Katte C, Kumar N, Langman G, Lim M, Lopes de Azevedo-Gilbert R, Macdonald A, Machesney M, Mathur P, Maxwell-Armstrong C, McArthur D, McDermott F, McDermott U, Mirnezami A, Mitchell P, Mohamed F, Moran B, Morris M, Murphy J, Nakas A, Norris C, O'Dwyer S, Panagiotopoulou I, Pellino G, Polignano F, Powell C, Renehan A, Rowbottom P, Sagar P, Samuel L, Seligmann J, Shaikh I, Simpson A, Skaife P, Skarrot P, Speake W, Stearns A, Stylianides NA, Sutton P, Swarnkar K, Taylor C, Tebala G, Thorpe G, Tiernan J, Toogood G, Vimalchandran D, Walker K, Walsh C, Warren O, Wasan H, Welsh F, Wheeler J, Whitley S, Wilson M, Winter D, Youssef Het al., 2019, Making an IMPACT: A priority setting consultation exercise to improve outcomes in patients with locally advanced, recurrent and metastatic colorectal cancer, European Journal of Surgical Oncology, ISSN: 0748-7983

Journal article

Leo CA, Thomas GP, Hogkinson JD, Segal JP, Maeda Y, Murphy J, Vaizey CJet al., 2019, The Renew® Anal Insert for Passive Faecal Incontinence: a retrospective audit of our use of a novel device., Colorectal Dis

INTRODUCTION: The Renew® Anal Insert is a recent treatment for patients who suffer from passive faecal incontinence (FI). The aim was to assess the effectiveness of the insert and patient satisfaction. METHOD: A retrospective audit of patients who were treated with the Renew® Anal Insert was undertaken. The St Mark's Incontinence Score was used to evaluate clinical outcome. Renew® size, the number of inserts used per day and per week had also been recorded. Subjective assessment of symptoms, how beneficial Renew® was and how satisfied patients were with the device were all recorded. Major events and side effects were also noted. RESULTS: Thirty patients received Renew® as a treatment for passive incontinence in 2016. The median St Mark's FI score was 15 (range 7-18) at baseline and 10 (range 2-18) at first follow-up (p=<0.0001) at a median of 11 (range 8-14) weeks. Eleven (37%) patients used the regular size and 19 (63%) used the large size. Patients used an average of 1.67 inserts/day (range 1 - 3), on an average of 3.58 days/week (1 - 7). Three patients reported a deterioration in symptoms, seven (23%) no change and twenty (67%) a significant improvement. Six patients (20%) did not like this device while 24 (80%) liked them. Seventeen patients (57%) wanted to continue this treatment in long-term. CONCLUSION: The Renew device seems to be an acceptable and effective therapeutic option for passive FI. Further work is needed to compare it to other treatments and establish its position in the treatment pathway. This article is protected by copyright. All rights reserved.

Journal article

Thomas HS, Weiser TG, Drake TM, Knight SR, Fairfield C, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, Costas-Chavarri A, Ntirenganya F, Fitzgerald JE, Fergusson SJ, Glasbey J, Ingabire JCA, Ismail L, Salem HK, Kojo ATT, Lapitan MC, Lilford R, Mihaljevic AL, Morton D, Mutabazi AZ, Nepogodiev D, Adisa AO, Ots R, Pata F, Pinkney T, Poskus T, Qureshi AU, Ramos-De la Medina A, Rayne S, Shaw CA, Shu S, Spence R, Smart N, Tabiri S, Bhangu A, Harrison EM, Verjee A, Runigamugabo E, Ademuyiwa AO, Adisa AO, Aguilera ML, Altamini A, Alexander P, Al-Saqqa SW, Borda-Luque G, Cornick J, Costas-Chavarri A, Drake TM, Fergusson SJ, Fitzgerald JE, Glasbey J, Ingabire JCA, Ismail L, Jaffry Z, Salem HK, Khatri C, Kirby A, Kojo ATT, Lapitan MC, Lilford R, Mihaljevic AL, Mohan M, Morton D, Mutabazi AZ, Nepogodiev D, Ntirenganya F, Ots R, Pata F, Pinkney T, Poskus T, Qureshi AU, Ramos-De la Medina A, Rayne S, Recinos G, Soreide K, Shaw CA, Shu S, Spence R, Smart N, Tabiri S, Harrison EM, Bhang A, Khatri C, Gobin N, Freitas AV, Hall N, Kim S-H, Negida A, Khairy H, Jaffry Z, Chapman SJ, Arnaud AP, Tabiri S, Recinos G, Manipal CE, Mohan M, Amandito R, Shawki M, Hanrahan M, Pata F, Zilinskas J, Roslani AC, Goh CC, Ademuyiwa AO, Irwin G, Shu S, Luque L, Shiwani H, Altamimi A, Alsaggaf MU, Fergusson SJ, Spence R, Rayne S, Jeyakumar J, Cengiz Y, Raptis DA, Glasbey JC, Modolo MM, Iyer D, King S, Arthur T, Nahar SN, Waterman A, Ismail L, Walsh M, Agarwal A, Zani A, Firdouse M, Rouse T, Liu Q, Camilo Correa J, Salem HK, Talving P, Worku M, Arnaud A, Tabiri S, Kalles V, Aguilera ML, Recinos G, Kumar B, Kumar S, Amandito R, Quek R, Pata F, Ansaloni L, Altibi A, Venskutonis D, Zilinskas J, Poskus T, Whitaker J, Msosa V, Tew YY, Farrugia A, Borg E, Ramos-De la Medina A, Bentounsi Z, Ademuyiwa AO, Soreide K, Gala T, Al-Slaibi I, Tahboub H, Alser OH, Romani D, Shu S, Major P, Mironescu A, Bratu M, Kourdouli A, Ndajiwo A, Altwijri A, Alsaggaf MU, Gudal A, Jubran AF, Seisay S, Lieske Bet al., 2019, Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy, British Journal of Surgery, Vol: 106, Pages: E103-E112, ISSN: 1365-2168

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safepractice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aimof this study was to evaluate reported checklist use in emergency settings and examine the relationshipwith perioperative mortality in patients who had emergency laparotomy.Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were comparedwith those having elective gastrointestinal surgery. Relationships between reported checklist use andmortality were determined using multivariable logistic regression and bootstrapped simulation.Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. Afteradjusting for patient and disease factors, checklist use before emergency laparotomy was more commonin countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) comparedwith that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14to 0⋅21, P < 0⋅001) or low (363 of 860, 42⋅2 per cent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklistuse was less common in elective surgery than for emergency laparotomy in high-HDI countries (riskdifference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed inlow-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use wasassociated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P < 0⋅001). The greatestabsolute benefit was seen for emergency surgery in low- and middle-HDI countries.Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.

Journal article

Waldock WJ, Avila-Rencoret FB, Tincknell LG, Murphy J, Elson DS, Peters CJet al., 2018, Augmented intraoperative surgical vision for the assessment of gastrointestinal cancer resection margins, 21st Annual Meeting of the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS), Publisher: Wiley, Pages: 15-16, ISSN: 1365-2168

Conference paper

Iqbal F, van der Ploeg V, Adaba F, Askari A, Murphy J, Nicholls RJ, Vaizey Cet al., 2018, Patient-Reported Outcome After Ostomy Surgery for Chronic Constipation, JOURNAL OF WOUND OSTOMY AND CONTINENCE NURSING, Vol: 45, Pages: 319-325, ISSN: 1071-5754

Journal article

Leo CA, Cavazzoni E, Thomas GP, Hodgkison J, Murphy J, Vaizey CJet al., 2018, Evaluation of 153 Asymptomatic Subjects Using the Anopress Portable Anal Manometry Device, JOURNAL OF NEUROGASTROENTEROLOGY AND MOTILITY, Vol: 24, Pages: 431-436, ISSN: 2093-0879

Background/Aims The Anopress device is a new portable manometry system. The aim of this study is to formulate normative data using this new device by recording the anorectal function of asymptomatic subjects. Patient comfort was also assessed. Methods Anorectal function was assessed in asymptomatic volunteers using the Anopress. All volunteers were examined in a standardized way in accordance with the study protocol. Normative values for the Anopress were obtained from the recorded data and patient comfort was assessed using a visual analogue scale. Results We recruited 153 healthy volunteers. Eighty were female (23 parous; median age 39.5 [interquartile range {IQR}, 28.75–53.00]) and 73 were male (median age 40.5 [IQR, 29.00–52.25]). For the female cohort, the following normal range (2.5–97.5 percentile) values were recorded across the whole anal canal: resting pressure 40.0–103.0 mmHg; squeeze increment 35.0–140.6 mmHg; endurance 1.3–9.0 seconds; involuntary squeeze 41.1–120.8 mmHg; and strain pressure 22.1–77.9 mmHg. Similarly, the following male normal range (2.5–97.5 percentile) values were recorded across the whole anal canal: resting pressure 38.3–99.6 mmHg; squeeze increment 42.5–154.8 mmHg; involuntary squeeze 40.0–123.6 mmHg; endurance 2.0–10.0 seconds; and strain pressure 11.0–72.1 mmHg. The median visual analogue scale scores for discomfort during the measurement was 0.0 (IQR, 0.00–0.00). Conclusions Normative values for the Anopress device have been calculated by this study. The Anopress appears to be a safe and well tolerated way of measuring pressures from the entire anal canal. Further comparisons with other standard and commonly used manometry tests are, however, required to verify its reliability.

Journal article

Renshaw S, Silva IL, Hotouras A, Wexner SD, Murphy J, Bhan Cet al., 2018, Perioperative outcomes and adverse events of robotic colorectal resections for inflammatory bowel disease: a systematic literature review, TECHNIQUES IN COLOPROCTOLOGY, Vol: 22, Pages: 161-177, ISSN: 1123-6337

The purpose of this study was to assess outcome measures and cost-effectiveness of robotic colorectal resections in adult patients with inflammatory bowel disease. The Cochrane Library, PubMed/Medline and Embase databases were reviewed, using the text “robotic(s)” AND (“inflammatory bowel disease” OR “Crohn’s” OR “Ulcerative Colitis”). Two investigators screened abstracts for eligibility. All English language full-text articles were reviewed for specified outcomes. Data were pre-sented in a summarised and aggregate form, since the lack of higher-level evidence studies precluded meta-analysis. Primary outcomes included mortality and postoperative complications. Secondary outcomes included readmission rate, length of stay, conversion rate, procedure time, estimated blood loss and functional outcome. The tertiary outcome was cost-effectiveness. Eight studies (3 case-matched observational studies, 4 case series and 1 case report) met the inclusion criteria. There was no reported mortality. Overall, complications occurred in 81 patients (54%) including 30 (20%) Clavien-Dindo III–IV complica-tions. Mean length of stay was 8.6 days. Eleven cases (7.3%) were converted to open. The mean robotic operating time was 99 min out of a mean total operating time of 298.6 min. Thirty-two patients (24.7%) were readmitted. Functional outcomes were comparable among robotic, laparoscopic and open approaches. Case-matched observational studies comparing robotic to laparoscopic surgery revealed a significantly longer procedure time; however, conversion, complication, length of stay and readmission rates were similar. The case-matched observational study comparing robotic to open surgery also revealed a longer procedure time and a higher readmission rate; postoperative complication rates and length of stay were similar. No studies compared cost-effectiveness between robotic and traditional approaches. Although robotic resections fo

Journal article

Leo CA, Murphy J, Hodgkinson JD, Vaizey CJ, Maeda Yet al., 2018, Does the Internet provide patients or clinicians with useful information regarding faecal incontinence? An observational study., G Chir, Vol: 39, Pages: 71-76, ISSN: 0391-9005

BACKGROUND: The Internet has become an important platform for information communication. This study aim to investigate the utility of social media and search engines to disseminate faecal incontinence information. METHODS: We looked into Social media platforms and search engines. There was not a direct patient recruitment and any available information from patients was already on public domain at the time of search. A quantitative analysis of types and volumes of information regarding faecal incontinence was made. RESULTS: Twelve valid pages were identified on Facebook: 5 (41%) pages were advertising commercial incontinence products, 4 (33%) pages were dedicated to patients support groups and 3 (25%) pages provided healthcare information. Also we found 192 Facebook posts. On Twitter, 2890 tweets were found of which 51% tweets provided healthcare information; 675 (45%) were sent by healthcare professionals to patients, 530 tweets (35.3%) were between healthcare professionals, 201 tweets (13.4%) were from medical journals or scientific books and 103 tweets (7%) were from hospitals or clinics with information about events and meetings. The second commonest type of tweets was advertising commercial incontinence products 27%. Patients tweeted to exchange information and advice between themselves (20.5%). In contrast, search engines as Google/Yahoo/Bing had a higher proportion of healthcare information (over 70%). CONCLUSION: Internet appears to have potential to be a useful platform for patients to learn about faecal incontinence and share information; however, given one lack of focus of available data, patients may struggle to identify valid and useful information.

Journal article

Elson D, Tincknell L, Avila Rencoret F, Murphy J, Peters Cet al., 2018, Intraoperative hyperspectral circumferential resection margin assessment for gastrointestinal cancer surgery (second prize), Career in Surgery

Conference paper

Waldock W, Avila Rencoret F, Tincknell L, Murphy J, Elson D, Peters Cet al., 2018, Augmented intraoperative surgical vision for the assessment of gastrointestinal cancer resection margins, London Surgery Symposium

Conference paper

Murphy J, 2018, Clinical Features of Colorectal Cancer, Surgery of Anus Rectum and Colon, Editors: Post, Keighley

Book chapter

de Bruijn H, Maeda Y, Murphy J, Warusavitarne J, Vaizey CJet al., 2018, Combined Laparoscopic and Perineal Approach to Omental Interposition Repair of Complex Rectovaginal Fistula, Diseases of the Colon and Rectum, Vol: 61, Pages: 140-143, ISSN: 0012-3706

INTRODUCTION:Surgical repair of rectovaginal fistula remains a challenge. Complex and recurrent rectovaginal fistula repairs often fail because of scarring and devascularization of the surrounding tissue. Omental interposition may promote healing by introducing bulky vascularized tissue into the rectovaginal septum.TECHNIQUE:With the patient in the lithotomy position, the rectovaginal septum was dissected transperineally up to the fistula tract and the openings on both vaginal and rectal sides were closed using interrupted, absorbable sutures. The dissection was continued cranially to meet the laparoscopic dissection from above. The laparoscopic surgeon detached the omentum from the colon, then the anastomotic arterial branches between the Barlow’s arcade and the gastroepiploic arcade were divided and the greater omentum was mobilized, retaining blood supply from the left gastroepiploic artery. The rectum was then mobilized commencing on the right lateral side of the mesorectum and then proceeding anteriorly. The peritoneum between the rectum and the vagina was incised and the anterior mobilization was continued to connect with the perineal dissection. The mobilized omentum was pulled down between the rectum and the vagina.TECHNIQUE:The perineal operator secured the omentum around the rectal closure and at skin level with absorbable sutures. All of the patients had a defunctioning ileostomy or colostomy before omental repair.RESULTS:Patients underwent repair for complex or recurrent rectovaginal fistulas with this novel approach. Fistula healing was evaluated during examination under anaesthesia. All of the patients had completely healed at the latest follow-up (median = 15 mo; range, 8–41 mo). Postoperative complications included 1 superficial wound infection that was treated conservatively and 1 rectovaginal hematoma, which required CT-guided aspiration.CONCLUSIONS:Combined laparoscopic omental interposition with perineal rectovaginal fistula repair is

Journal article

Silva IL, Iskandarani M, Hotouras A, Murphy J, Bhan C, Adada B, Wexner SDet al., 2017, A systematic review to assess the management of patients with cerebral metastases secondary to colorectal cancer, TECHNIQUES IN COLOPROCTOLOGY, Vol: 21, Pages: 847-852, ISSN: 1123-6337

Journal article

Leo CA, Maeda Y, Collins B, Thomas GP, Hodgkinson JD, Murphy J, Vaizey CJet al., 2017, Current practice of continence advisors in managing faecal incontinence in the United Kingdom: results of an online survey, Colorectal Disease, Vol: 19, Pages: O339-O344, ISSN: 1462-8910

AimTo investigate the current practice of continence advisors in the United Kingdom.MethodContinence advisors were contacted by email or letter to participate in a survey. The survey contained 27 questions which addressed the practice of each continence advisor, their knowledge of continence management and the adequacy of their training.ResultsTwo hundred and twenty-six out of a total of 448 continence advisors (50.4%), responded. One hundred and seventy (76.9%) advisors treated both faecal and urinary incontinence, 51 (23.1%) treated urinary incontinence. Thirty-six advisors (16.1%) were lone workers and 130 (58.6%) had more than 10 years’ experience. The majority of the advisors (75.6%) performed a digital rectal examination as part of their assessment. Regarding the management of faecal incontinence, 148 prescribed suppositories, 127 offered enemas and 147 advised on rectal irrigation. Most of the advisors taught pelvic floor exercises (n = 207) and urge resistance techniques (n = 188). One hundred and fifty-nine (87.4%) prescribed the Peristeen Coloplast® anal plug and 78 (47.6%) prescribed the Renew® anal insert. Eighty-nine advisors (42.6%) felt they had not been adequately trained to provide a bowel continence service.ConclusionThe majority of continence advisors in the UK manage faecal incontinence. They are able to initiate a broad range of conservative treatment options; however, almost half of the advisors who answered the survey felt inadequately trained and may be better supported by further training.

Journal article

Abeles A, Kwasnicki RM, Pettengell C, Murphy J, Darzi Aet al., 2017, The relationship between physical activity and post-operative length of hospital stay: A systematic review, INTERNATIONAL JOURNAL OF SURGERY, Vol: 44, Pages: 295-302, ISSN: 1743-9191

BackgroundRecovery from surgery has traditionally been measured using specific outcome measures, such as length of hospital stay. However, advances in technology have enabled the measurement of continuous, objective physical activity data in the perioperative period. The aim of this systematic review was to determine the relationship between length of hospital stay and physical activity data for patients undergoing surgery.MethodsA systematic search of EMBASE, Medline and the Cochrane Library, from inception until January 2017, was performed to identify all study designs that evaluated physical activity after surgery. Studies were included if a wearable sensor measured patient activity as an in-patient and the length of hospital stay was reported. Only English articles were included.ResultsSix studies with a total of 343 participants were included in this review. All the studies were prospective observational studies. Each study used a different sensor, with the commonest being a tri-axial accelerometer, and multiple different physical activity outcome measures were used, thereby prohibiting meta-analysis. Four of the studies demonstrated a relationship between physical activity levels and length of hospital stay, while two studies did not show any significant relationship.ConclusionThe amount of physical activity performed post-operatively negatively correlates with the length of hospital stay. This suggests that objective physical activity data collected by body worn sensors may be capable of predicting functional recovery post-operatively.

Journal article

Sasikumar A, Bhan C, Jenkins JT, Antoniou A, Murphy Jet al., 2017, Systematic review of pelvic exenteration with en bloc sacrectomy for recurrent rectal adenocarcinoma – R0 resection predicts disease free survival, Diseases of the Colon & Rectum, Vol: 60, Pages: 346-352, ISSN: 1530-0358

Background: The management of recurrent rectal cancer is challenging. At the present time pelvic exenteration with en bloc sacrectomy offers the only hope of lasting cure. Objective: The purpose of this study was to evaluate clinical outcome measures and complication rates following sacrectomy for recurrent rectal cancer.Data Sources: Search conducted on ‘Pub Med’ for English language articles relevant to sacrectomy for recurrent rectal cancer with no time limitations.Study Selection: Studies reported sacrectomy with survival data for recurrent rectal adenocarcinoma. Main outcome measure: Disease free survival following sacrectomy for recurrent rectal cancer. Results: A total of 220 recurrent rectal cancer patients were included from 7 studies, of which 160 were male and 60 were female. Overall median operative time was 717 (570-992) minutes and blood loss was 3.7 (1.7-6.2) litres. An R0 (>1mm resection margin) resection was achieved in 78% of patients. Disease free survival associated with R0 resection was 55% at a median follow up period of 33 (17-60) months; however, none of the patients with R1 (<1mm resection margin) survived this period. Postoperative complication rates and median length of stay were found to decrease with more distal sacral transection levels. In contrast, R1 resection rates increased with more distal transection.Limitation: The studies assessed by this review were retrospective case series and thus are subject to significant bias. Conclusion: Sacrectomy performed for patients with recurrent rectal cancer is associated with significant postoperative morbidity. Morbidity and post-operative length of stay increase with the level of sacral transection. Nevertheless, approximately half of patients eligible for rectal excision with en bloc sacrectomy may benefit from disease free survival for up to 33 months, with R0 resection predicting disease free survival in the medium term.

Journal article

Tincknell L, Avila Rencoret F, Murphy J, Peters C, Elson Det al., 2017, Intraoperative hyperspectral circumferential resection margin assessment for gastrointestinal cancer surgery, London Surgery Symposium

Conference paper

Abeles A, Murphy J, 2016, Appendicitis and lower gastrointestinal emergencies, Surgery (Oxford), Vol: 34, Pages: 550-557, ISSN: 0263-9319

Appendicitis and lower gastrointestinal emergencies represent the majority of emergency presentations to acute general surgical on-call teams. Early recognition and resuscitation of the patient as well as prompt investigation allow appropriate management plans to be initiated in a timely manner. Those patients requiring operative intervention should be managed within a multidisciplinary team to achieve optimal outcomes. Current surgical approaches favour minimally invasive techniques, where appropriate, with decreased pain and shorter length of stay being major advantages.

Journal article

Murphy J, Kalkbrenner KA, Blas JV, Pemberton JH, Landmann RG, Young-Fadok TM, Etzioni DAet al., 2016, What is the likelihood of colorectal cancer when surgery for ulcerative-colitis-associated dysplasia is deferred?, Colorectal Disease, Vol: 18, Pages: 703-709, ISSN: 1463-1318

AIM: Surgery aims to prevent cancer-related morbidity for patients with ulcerative colitis (UC) associated dysplasia. The literature varies widely regarding the likelihood of dysplastic progression to higher grades of dysplasia or cancer. The aim of this study was to characterize the likelihood of the development of colorectal cancer (CRC) of patients with UC-associated dysplasia who chose to defer surgery. METHOD: A retrospective review was carried out of patients undergoing surgery for UC at the Mayo Clinic, who were diagnosed to have dysplasia between August 1993 and July 2012. The relationships between grade of dysplasia, time to surgery and the detection of unsuspected carcinoma were investigated. RESULTS: In all, 175 patients underwent surgery at a median of 4.9 (interquartile range 2.5-8.9) months after a diagnosis of dysplasia. Their median age was 52 (interquartile range 43-59) years. An initial diagnosis of indeterminate dysplasia was not associated with CRC [0/23; 17.7 (8.1-29.6) months]. Thirty-six patients who had an initial diagnosis of dysplasia progressed from indeterminate to low-grade dysplasia [24.2 (11.0-30.4) months]. Low-grade dysplasia was associated with a 2% (1/56; T2N0M0) risk of CRC when present in random surveillance biopsies and a 3% (2/61; T1N0M0, T4N0M0) risk if detected in endoscopically visible lesions [7.4 (5.2-33.3) months]. Eighteen patients progressed from indeterminate to high-grade dysplasia [19.1 (9.2-133.9) months]. Seventeen patients progressed from low to high-grade dysplasia [11.0 (5.8-30.1) months]. None of the patients with high-grade dysplasia (0/35) progressed to CRC [4.5 (1.7-9.9) months]. CONCLUSION: Dysplasia was associated with a low incidence of node negative CRC if surgery was deferred for up to 5 years. These findings may help inform the decision-making process for asymptomatic patients who are having to decide between intensive surveillance or surgery for UC-associated dysplasia.

Journal article

Hotouras A, Ribas Y, Zakeri SA, Nunes QM, Murphy J, Bhan C, Wexner SDet al., 2016, The influence of obesity and body mass index on the outcome of laparoscopic colorectal surgery: a systematic literature review, Colorectal Disease, Vol: 18, Pages: O337-O366, ISSN: 1463-1318

AIM: The relationship between obesity, body-mass index (BMI) and laparoscopic colorectal resection is unclear. Our object was to assess systematically the available evidence to establish the influence of obesity and BMI on the outcome of laparoscopic colorectal resection. METHOD: A search of PubMed/Medline databases was performed in May 2015 to identify all studies investigating the impact of BMI and obesity on elective laparoscopic colorectal resection performed for benign or malignant bowel disease. Clinical end points examined included operation time, conversion rate to open surgery, post-operative complications including anastomotic leakage, length of hospital stay, readmission rate, reoperation rate and mortality. For patients who underwent an operation for cancer, the harvested number of lymph nodes and long-term oncological data were also examined. RESULTS: 45 studies were analysed, the majority of which were Level IV with only four level III case-controlled studies. Thirty comparative studies containing 23649 patients including 17895 non-obese and 5754 obese showed no significant differences between the two groups with respect to intraoperative blood loss, overall postoperative morbidity, anastomotic leakage, reoperation rate, mortality and the number of retrieved lymph nodes in patients operated on for malignancy. Most studies, including 15 non-comparative studies, reported a longer operation time in patients who underwent a laparoscopic procedure with the BMI being an independent predictor in multivariate analyses for the operation time. CONCLUSION: Laparoscopic colorectal resection is safe and technically and oncologically feasible in obese patients. These results, however, may be different outside high volume centres of expertise. This article is protected by copyright. All rights reserved.

Journal article

Hotouras A, Desai D, Bhan C, Murphy J, Lampe B, Sugarbaker PHet al., 2016, Heated IntraPEritoneal Chemotherapy (HIPEC) for Patients With Recurrent Ovarian Cancer A Systematic Literature Review, International Journal of Gynecological Cancer, Vol: 26, Pages: 661-670, ISSN: 1525-1438

Background: Despite advances in surgical oncology, most patients with primary ovarian cancer develop a recurrence that is associated with a poor prognosis. The aim of this review was to establish the impact of Heated IntraPEritoneal Chemotherapy (HIPEC) in the overall survival of patients with recurrent ovarian cancer.Methods: A search of PubMed/MEDLINE databases was performed in February 2015 using the terms “recurrent ovarian cancer,” “cytoreductive surgery/cytoreduction,” and “heated/hyperthermic intraperitoneal chemotherapy.” Only English articles with available abstracts assessing the impact of HIPEC in patients with recurrent ovarian cancer were examined. The primary outcome measure was overall survival, whereas secondary outcomes included disease-free survival and HIPEC-related morbidity.Results: Sixteen studies with 1168 patients were analyzed. Most studies were Level IV, with 4 studies graded as Level III and 1 Level II. Cisplatin was the main chemotherapeutic agent used, but variations were observed in the actual technique, temperature of perfusate, and duration of treatment. In patients undergoing cytoreductive surgery and HIPEC, the overall survival ranged between 26.7 and 35 months, with disease-free survival varying between 8.5 and 48 months. Heated IntraPEritoneal Chemotherapy seems to confer survival benefits to patients with recurrent disease, with a randomized controlled study reporting that the overall survival is doubled when cytoreductive surgery is compared with cytoreductive surgery and chemotherapy (13. 4 vs 26.7 months). Heated IntraPEritoneal Chemotherapy–related morbidity ranged between 13.6% and 100%, but it was mainly minor and not significantly different from that experienced by patients who only underwent cytoreduction.Conclusions: Cytoreductive surgery and HIPEC seem to be associated with promising results in patients with recurrent ovarian cancer. Large international prospective studies are r

Journal article

Leo AC, Maeda Y, Murphy J, Vaizey Cet al., 2016, FECAL INCONTINENCE ON FACEBOOK, GOOGLE, AND TWITTER., ASCRS Annual Meeting 2016

Conference paper

Leo A, Maeda Y, Collins B, Hodgkinson JD, Murphy J, Vaizey Cet al., 2016, Current practice of continence advisors in the UK: results from an online survey, The 11th Annual Meeting of European Society of Coloproctology

Conference paper

Hotouras A, Ribas Y, Allison M, Murphy Jet al., 2016, The CONFIDeNT trial, Lancet, Vol: 387, Pages: 643-644, ISSN: 1474-547X

Journal article

Williams NS, Hotouras A, Bhan C, Murphy J, Chan CLet al., 2015, A case-controlled pilot study assessing the safety and efficacy of the Stapled Mesh stomA Reinforcement Technique (SMART) in reducing the incidence of parastomal herniation, HERNIA, Vol: 19, Pages: 949-954, ISSN: 1265-4906

Journal article

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