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Leo CA, Maeda Y, Collins B, et 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.
Abeles A, Kwasnicki RM, Pettengell C, et 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.
Sasikumar A, Bhan C, Jenkins JT, et 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.
Tincknell L, Avila Rencoret F, Murphy J, et al., 2017, Intraoperative hyperspectral circumferential resection margin assessment for gastrointestinal cancer surgery, London Surgery Symposium
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.
Murphy J, Kalkbrenner KA, Blas JV, et 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.
Hotouras A, Ribas Y, Zakeri SA, et 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.
Hotouras A, Desai D, Bhan C, et 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
Leo AC, Maeda Y, Murphy J, et al., 2016, FECAL INCONTINENCE ON FACEBOOK, GOOGLE, AND TWITTER., ASCRS Annual Meeting 2016
Leo A, Maeda Y, Collins B, et al., 2016, Current practice of continence advisors in the UK: results from an online survey, The 11th Annual Meeting of European Society of Coloproctology
Docimo S, Pauli EM, 2016, Comment to: 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. Williams NS, Hotouras A, Bhan C, Murphy J, Chan CL. Hernia. 2015;19:949-54., Hernia, Vol: 20, Pages: 341-342
Hotouras A, Ribas Y, Allison M, et al., 2016, The CONFIDeNT trial, Lancet, Vol: 387, Pages: 643-644, ISSN: 1474-547X
Williams NS, Hotouras A, Bhan C, et 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
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- Citations: 28
Hotouras A, Ribas Y, Zakeri S, et al., 2015, A systematic review of the literature on the surgical management of recurrent rectal prolapse, COLORECTAL DISEASE, Vol: 17, Pages: 657-664, ISSN: 1462-8910
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- Citations: 33
Askari A, Nachiappan S, Murphy J, et al., 2015, Colorectal cancer (CRC) patients with inflammatory bowel disease (IBD) are at increased risk of poor outcomes post surgery in england, 2nd Digestive Disorders Federation Conference, Publisher: BMJ Publishing Group, Pages: A326-A326, ISSN: 0017-5749
Askari A, Nachiappan S, Murphy J, et al., 2015, Patients in England with inflammatory bowel disease (IBD) who develop colorectal cancer (CRC) have shortened survival when compared with patients with sporadic CRC, 2nd Digestive Disorders Federation Conference, Publisher: BMJ Publishing Group, Pages: A327-A328, ISSN: 0017-5749
Yongue G, Hotouras A, Murphy J, et al., 2015, The diagnostic yield of preoperative staging computed tomography of the thorax in colorectal cancer patients without hepatic metastases, EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, Vol: 27, Pages: 467-470, ISSN: 0954-691X
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- Citations: 8
Hotouras A, Murphy J, Chan CL, 2015, Segmental reversal of the small bowel can end permanent parenteral nutrition dependency., Ann Surg, Vol: 261
Hotouras A, Ribas Y, Zakeri S, et al., 2015, Gracilis muscle interposition for rectovaginal and anovaginal fistula repair: a systematic literature review, COLORECTAL DISEASE, Vol: 17, Pages: 104-110, ISSN: 1462-8910
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- Citations: 26
Askari A, Nachiappan S, Murphy J, et al., 2015, Survival in inflammatory bowel disease related colorectal cancer, JOURNAL OF CROHNS & COLITIS, Vol: 9, Pages: S35-S36, ISSN: 1873-9946
Bustin SA, Murphy J, 2015, Genetic and Epigenetic Biomarkers of Colorectal Cancer, MOLECULAR DIAGNOSTICS: CURRENT RESEARCH AND APPLICATIONS, Editors: Huggett, OGrady, Publisher: CAISTER ACADEMIC PRESS, Pages: 37-65, ISBN: 978-1-908230-41-6
Hotouras A, Bhan C, Murphy J, et al., 2014, Parastomal hernia prevention: is it all about mesh reinforcement?, Dis Colon Rectum, Vol: 57, Pages: e443-e444
Hotouras A, Murphy J, Allison M, et al., 2014, Prospective clinical audit of two neuromodulatory treatments for fecal incontinence: sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS)., Surg Today, Vol: 44, Pages: 2124-2130
BACKGROUND AND PURPOSE: Two types of neuromodulation are currently practised for the treatment of fecal incontinence (FI): sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS). This study compares these therapies, as no data exist to prospectively assess their relative efficacy and costs. METHODS: The subjects of this study were two distinct cohorts undergoing SNS (between 2003 and 2008) or PTNS (2008-onwards) for FI. Clinical outcomes assessed at 3 months included incontinence scores and the number of weekly incontinence episodes. The direct medical costs for each procedure were calculated from the audited expenditure of our unit. RESULTS: Thirty-seven patients (94.6 % women) underwent permanent SNS and 146 (87.7 % women) underwent PTNS. The mean pre-treatment incontinence score (± SD) was greater in the SNS cohort (14 ± 4 vs. 12 ± 4) and the mean post-treatment incontinence scores were similar for the two therapies (9 ± 5 vs. 10 ± 4), with a greater effect size evident in the SNS patients. In a 'pseudo case-control' analysis with 37 "matched" patients, the effect of both treatments was similar. The cost of treating a patient for 1 year was £ 11,374 ($ 18,223) for permanent SNS vs. £ 1740 ($ 2784) for PTNS. CONCLUSION: Given the lesser cost and invasive nature of PTNS, where both techniques are available, a trial of PTNS could be considered for all patients.
Ribas Y, Hotouras A, Munoz-Duyos A, et al., 2014, Sphincterotomy in women with chronic anal fissure? Are we asking for trouble?, Dis Colon Rectum, Vol: 57
Rychlik IJ, Davey P, Murphy J, et al., 2014, A meta-analysis to compare Dacron versus polytetrafluroethylene grafts for above-knee femoropopliteal artery bypass, JOURNAL OF VASCULAR SURGERY, Vol: 60, Pages: 506-515, ISSN: 0741-5214
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- Citations: 36
Murphy J, Kalkbrenner KA, Pemberton JH, et al., 2014, Dysplasia in Ulcerative Colitis as a Predictor of Unsuspected Synchronous Colorectal Cancer, DISEASES OF THE COLON & RECTUM, Vol: 57, Pages: 993-998, ISSN: 0012-3706
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- Citations: 22
Hotouras A, Murphy J, Walsh U, et al., 2014, Outcome of percutaneous tibial nerve stimulation (PTNS) for fecal incontinence: a prospective cohort study, Annals of Surgery, Vol: 259, Pages: 939-943, ISSN: 0003-4932
OBJECTIVES: The aim of this study was to assess the long-term efficacy of percutaneous tibial nerve stimulation (PTNS) in fecal incontinence (FI). BACKGROUND: There is extensive evidence regarding the efficacy of PTNS in urinary incontinence. Data on the efficacy of PTNS for FI are limited to a few small case series with relatively short-follow up. METHODS: A prospective cohort of patients with FI was studied. Incontinence scores were measured using a validated questionnaire (Cleveland Clinic Florida-FI score) at specific time points: before treatment, after completion of a treatment course (12 PTNS sessions), and before the last maintenance ("top-up") therapy. Deferment time and average number of weekly incontinence episodes were also estimated from a prospective bowel dairy kept by the patient at these time points. Quality of life was assessed with the Rockwood Fecal Incontinence Quality of Life questionnaire. RESULTS: A total of 150 patients were recruited to the study between January 2008 and June 2012. Analysis was performed on 115 patients who continued to receive PTNS after a median follow-up of 26 (range, 12-42) months. The baseline Cleveland Clinic Florida-FI score ±SD (12.0 ± 3.9) improved after 12 PTNS sessions (9.4 ± 4.6, P < 0.0001) and after "top-up" treatments (10.0 ± 4.3, P < 0.0001). The increase in the Cleveland Clinic Florida-FI score between the end of the 12th session and the last "top-up" therapy was also significant (P = 0.04). A similar pattern was seen for the deferment time and the quality of life scores. The median time between "top-up" sessions was 12 months (range, 1-40 months), significantly longer than the recommended interval of 6 months. CONCLUSIONS: PTNS is a well-tolerated treatment with high acceptability in the majority of patients. It provides a sustained improvement in FI up to 42 months in a relatively noninvasive manner. The effect of PTNS diminishes wi
Hotouras A, Murphy J, Abeles A, et al., 2014, Symptom distribution and anorectal physiology results in male patients with rectal intussusception and prolapse, JOURNAL OF SURGICAL RESEARCH, Vol: 188, Pages: 298-302, ISSN: 0022-4804
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- Citations: 8
Fitzmaurice GJ, McKenna AJ, Murphy J, et al., 2014, Streptococcus bovis bacteraemia: an evaluation of the long-term effect on cardiac outcomes., Gen Thorac Cardiovasc Surg, Vol: 62, Pages: 142-148
INTRODUCTION: Streptococcus bovis can lead to bacteraemia, septicaemia, and ultimately endocarditis. The objective of this study was to evaluate the long-term implications of S. bovis endocarditis on cardiac morbidity and mortality. METHODS: A retrospective cohort study was performed between January 2000 and March 2009 to assess all patients diagnosed with S. bovis bacteraemia from the Belfast Health and Social Care Trust. The primary end-point for cardiac investigations was the presence of endocarditis. Secondary end-points included referral for cardiac surgery and overall mortality. RESULTS: Sixty-one positive S. bovis blood cultures from 43 patients were included. Following echocardiography, seven patients were diagnosed with infective endocarditis (16.3 % of total patients); four patients (9.3 %) had native valve involvement while three (7.0 %) had prosthetic valve infection. Five of these seven patients had more than one positive S. bovis culture (71.4 %). Three had significant valve dysfunction that warranted surgical repair/replacement, one of whom was unfit for surgery. There was a 100 % recurrence rate amongst the valve replacement patients (n = 2) and six patients with endocarditis had colorectal pathology. Patients with endocarditis had similar long-term survival as those with non-endocarditic bacteraemia (57.1 % alive vs. 50 % of non-endocarditis patients, p = 0.73). CONCLUSION: Streptococcus bovis endocarditis patients tended to have pre-existing valvular heart disease and those with prosthetic heart valves had higher surgical intervention and relapse rates. These patients experienced a higher rate of co-existing colorectal pathology but currently have reasonable long-term outcomes. This may suggest that they represent a patient population that merits consideration for an early surgical strategy to maximise long-term results, however, further evaluation is warranted.
Hotouras A, Murphy J, Chan C, 2014, Response to Loganathan <i>et</i> <i>al</i>. (2013): Prolonged pudendal nerve terminal motor latency is associated with decreased resting and squeeze pressures in the intact anal sphincter, COLORECTAL DISEASE, Vol: 16, Pages: 219-219, ISSN: 1462-8910
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