Imperial College London

ProfessorRobinPhillips

Faculty of MedicineDepartment of Surgery & Cancer

Emeritus Professor of Colorectal Surgery
 
 
 
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Contact

 

+44 (0)1923 827 988robin.phillips

 
 
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Location

 

St Marks HospitalNorthwick Park and St Marks Site

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Summary

 

Publications

Publication Type
Year
to

305 results found

Adegbola SO, Dibley L, Sahnan K, Wade T, Verjee A, Sawyer R, Mannick S, McCluskey D, Bassett P, Yassin N, Warusavitarne J, Faiz O, Phillips R, Tozer PJ, Norton C, Hart ALet al., 2021, Development and initial psychometric validation of a patient-reported outcome measure for Crohn's perianal fistula: the Crohn's Anal Fistula Quality of Life (CAF-QoL) scale, Publisher: BMJ PUBLISHING GROUP, Pages: 1649-1656, ISSN: 0017-5749

Conference paper

Adegbola SO, Dibley L, Sahnan K, Wade T, Verjee A, Sawyer R, Mannick S, McCluskey D, Yassin N, Phillips RKS, Tozer PJ, Norton C, Hart ALet al., 2020, Burden of disease and adaptation to life in patients with Crohn's perianal fistula: a qualitative exploration, Health and Quality of Life Outcomes, Vol: 18, Pages: 1-13, ISSN: 1477-7525

BackgroundPerianal fistulas are a challenging manifestation of Crohn’s disease. Best medical and surgical therapy results in only about a third of patients remaining in remission at one year on maintenance treatment and sustained healing is often elusive. There is little published data on patient perspective of living with the condition or coping strategies in the face of non-curative/non-definitive treatment. We aimed to understand the experience of living with perianal fistula(s) and their impact on quality of life and routine functioning.MethodsThis exploratory qualitative study used purposive sampling to recruit participants with current / previous diagnosis of Crohn’s anal fistulas, from national IBD / bowel disease charities. The “standards for reporting qualitative research” (SRQR) recommendations were followed. Unstructured individual face-to-face interviews were audio recorded, transcribed and analysed thematically. Early themes were reviewed by the study team including patient advocates, clinicians and qualitative researchers.ResultsTwelve interviews were conducted, achieving apparent data saturation. Three broad themes were uncovered: Burden of symptoms; Burden of treatment; and Impact on emotional, physical and social well-being. Each included several sub-themes, with considerable interplay between these. The impact of perianal fistula(s) on patients with CD is intense and wide reaching, negatively affecting intimate, close and social relationships. Fistulas cause losses in life and work-related opportunities, and treatments can be difficult to tolerate.ConclusionCrohn’s perianal fistulas exert a heavy negative physical and emotional impact on patients. These findings will inform development of a patient reported outcome measure to assess treatment effectiveness and quality of life for patients living with this challenging condition.

Journal article

Adegbola SO, Sarafian M, Sahnan K, Ding NS, Faiz OD, Warusavitarne J, Phillips RKS, Tozer PJ, Holmes E, Hart ALet al., 2020, Differences in amino acid and lipid metabolism distinguish Crohn's from idiopathic/cryptoglandular perianal fistulas by tissue metabonomic profiling and may offer clues to underlying pathogenesis., Eur J Gastroenterol Hepatol, Vol: Publish Ahead of Print

INTRODUCTION: Few studies have investigated perianal fistula etiopathogenesis, and although the cryptoglandular theory is widely accepted in idiopathic cases, in Crohn's disease, it is thought to involve the interplay between microbiological, immunological and genetic factors. A pilot study was conducted to assess for metabolic variations in Crohn's perianal fistula tissue that might differ from that of idiopathic (cryptoglandular) perianal fistula tissue as a comparator. The goal was to identify any potential biomarkers of disease, which may improve the understanding of pathogenesis. AIMS AND METHODS: Fistula tract biopsies were obtained from 30 patients with idiopathic perianal fistula and 20 patients with Crohn's anal fistula. Two different assays were used in an ultra-high-performance liquid chromatography system coupled with a mass spectrometric detector to achieve broad metabolome coverage. Univariate and multivariate statistical data analyses were used to identify differentiating metabolic features corresponding to the perianal fistula phenotype (i.e. Crohn's disease vs. idiopathic). RESULTS: Significant orthogonal partial least squares discriminant analysis predictive models (validated with cross-validated-analysis of variance P value <0.05) differentiated metabolites from tissue samples from Crohn's vs. idiopathic anal fistula patients using both metabolic profiling platforms. A total of 41 metabolites were identified, suggesting alterations in pathways, including amino acid, carnitine and lipid metabolism. CONCLUSION: Metabonomics may reveal biomarkers of Crohn's perianal fistula. Further work in larger numbers is required to validate the findings of these studies as well as cross-correlation with microbiome work to better understand the impact of host-gut/environment interactions in the pathophysiology of Crohn's and idiopathic perianal fistulas and identify novel therapeutic targets.

Journal article

Adegbola S, Sarafian M, Sahnan K, Pechlivanis A, Phillips R, Knowles C, Haddow J, Warusavitarne J, Faiz O, Tozer P, Holmes E, Hart Aet al., 2020, Lack of anti-TNF drugs levels in fistula tissue: A reason for non-response in Crohn's perianal fistula?, Publisher: OXFORD UNIV PRESS, Pages: S330-S331, ISSN: 1873-9946

Conference paper

Sahnan K, Lung P, Adegbola S, Shaikh S, Iqbal N, Hart A, Warusavitarne J, Faiz O, Phillips R, Tozer Pet al., 2019, The use of 3D imaging to facilitate training during complex fistula surgery - a video vignette, COLORECTAL DISEASE, Vol: 21, Pages: 376-376, ISSN: 1462-8910

Journal article

Sahnan K, Askari A, Adegbola SO, Warusavitarne J, Lung PFC, Hart A, Faiz O, Phillips RKS, Tozer Pet al., 2019, Persistent fistula after anorectal abscess drainage: Local experience of 11 years, Diseases of the Colon and Rectum, Vol: 62, Pages: 327-332, ISSN: 0012-3706

BACKGROUND: The characteristics of patients who develop a fistula-in-ano after an anorectal abscess are unclear. OBJECTIVE: Our study explored this relationship and patient factors associated with fistula development. DESIGN: International Classification of Diseases, 10 Revision, and Classification of Interventions and Procedures, version 4, codes were used to identify all of the patients with a primary anorectal abscess. Multivariable analysis was used to identify factors predictive of fistula formation. SETTINGS: The study was conducted in a district general hospital. PATIENTS: Patients with anorectal abscess who were admitted to our institution (2004-2015) were included. MAIN OUTCOMES MEASURES: The rate of subsequent fistula formation was measured. RESULTS: A total of 1970 abscess patients were identified; 70.0% (n = 1379) were men, and 7.3% (n = 144) had Crohn's disease. Fistulas occurred in 16.2% (n = 319) at a median of 7 months (interquartile range, 3-7 mo). Patients with Crohn's disease were more than twice as likely to develop a fistula than patients without Crohn's disease (32.6% vs 14.9%; OR = 2.5 (95% CI, 1.7-3.7); p < 0.001). Patients with Crohn's disease with a fistula were more likely to be women (55.3% vs 34.6%; p = 0.007) and aged <30 years (51.1% vs 24.3%; p < 0.001) versus patients without Crohn's disease with a fistula. At multivariable analysis of the entire cohort, male sex (OR = 0.7 (95% CI, 0.5-0.9); p = 0.005) and diabetes mellitus (OR = 0.5 (95% CI, 0.3-0.9); p = 0.027) were associated with a reduced likelihood of developing a fistula after abscess formation. LIMITATIONS: The study was limited by its single-center scope, retrospective analysis, and lack of an established definition for Crohn's disease. CONCLUSIONS: Abscesses are more common in men, but progression to fistula is more likely in women. The rate of fistula progression in Crohn's disease is twice that in patients without Crohn's disease. Identification of patients at ri

Journal article

Sahnan K, Tozer PJ, Adegbola SO, Lee MJ, Heywood N, McNair AGK, Hind D, Yassin N, Lobo AJ, Brown SR, Sebastian S, Phillips RKS, Lung PFC, Faiz OD, Crook K, Blackwell S, Verjee A, Hart AL, Fearnhead NS, John A, Austin A, Simon A, Aidan A, James A, Katherine A, Sathish B, Ian B, Gauraang B, Stuart B, Dominic B, Matthew B, David B, Jeffrey B, Christopher C, Rachel C, Peter C, Thomas C, Tamzin C, Robert D, Walter D, Irene D, Jayne E, Jonathan E, Martyn E, Simon F, Beverley F, Catherine F, James G, Catherine G, Ben G, Arun G, Sanjay G, Richard G, Alex H, Diane H, Nigel H, Steve H, Laura H, Marcus H, Rachel H, Barney H, Bu H, Emma H, Paul H, Tim H, Stephen H, Rajapandian I, Matthew J, Cheryl K, Kennedy NA, Fevronia K, Charles K, Bee L, Wendy L, Jimmy L, Richard L, Peter M, Janis M, Steven M, John M, Michele M, Charles M-A, Alistair M, Jasbir N, Arvind P, Gareth P, Rajan P, Uday P, Leon P, Kathryn P, Thomas P, Katie P, Richard P, Niall P, Mark P, Abdul R, Kerry R, Dan R, Russell RK, Mathew R, Suzanne R, Judith S, John S, Christian S, Irshad S, Ian S, Baljit S, Ederis S, Christopher S, Neil S, Adam S, Ben S, Taylor SA, Julian T, Tham TC, Pradeep T, John T, Jared T, Simon T, Mark T, Tracey T, Christos T, Carolynne V, Oliver W, Janindra W, Emma W, Debbie W, Emma W, Graham W, Mark W, Graeme W, Eleanor W, Hannah Y, Lisa Yet al., 2019, Developing a core outcome set for fistulising perianal Crohn's disease, Gut, Vol: 68, Pages: 226-238, ISSN: 0017-5749

Objective Lack of standardised outcomes hamperseffective analysis and comparison of data whencomparing treatments in fistulising perianal Crohn’sdisease (pCD). Development of a standardised set ofoutcomes would resolve these issues. This study providesthe definitive core outcome set (COS) for fistulising pCD.Design Candidate outcomes were generated througha systematic review and patient interviews. Consensuswas established via a three-round Delphi process usinga 9-point Likert scale based on how important they feltit was in determining treatment success culminating ina final consensus meeting. Stakeholders were recruitednationally and grouped into three panels (surgeonsand radiologists, gastroenterologists and IBD specialistnurses, and patients). Participants received feedback fromtheir panel (in the second round) and all participants (inthe third round) to allow refinement of their scores.Results A total of 295 outcomes were identified fromsystematic reviews and interviews that were categorisedinto 92 domains. 187 stakeholders (response rate78.5%) prioritised 49 outcomes through a three-roundDelphi study. The final consensus meeting of 41 expertsand patients generated agreement on an eight domainCOS. The COS comprised three patient-reported outcomedomains (quality of life, incontinence and a combinedscore of patient priorities) and five clinician-reportedoutcome domains (perianal disease activity, developmentof new perianal abscess/sepsis, new/recurrent fistula,unplanned surgery and faecal diversion).Conclusion A fistulising pCD COS has been producedby all key stakeholders. Application of the COS willreduce heterogeneity in outcome reporting, therebyfacilitating more meaningful comparisons betweentreatments, data synthesis and ultimately benefit patientcare.

Journal article

Adegbola SO, Sahnan K, Tozer PJ, Strouhal R, Hart AL, Lung PFC, Phillips RKS, Faiz O, Warusavitarne Jet al., 2018, Symptom Amelioration in Crohn's Perianal Fistulas Using Video-Assisted Anal Fistula Treatment (VAAFT), JOURNAL OF CROHNS & COLITIS, Vol: 12, Pages: 1067-1072, ISSN: 1873-9946

Journal article

Lung PFC, Sahnan K, Burling D, Burn J, Tozer P, Yassin N, Adegbola SO, Baldwin-Cleland R, Warusavitarne J, Gupta A, Faiz O, Phillips RKS, Hart ALet al., 2018, Volume assessment magnetic resonance imaging technique for monitoring perianal Crohn's fistulas, Therapeutic Advances in Gastroenterology, Vol: 11, Pages: 1-8, ISSN: 1756-2848

Background:Perianal Crohn’s fistula and their response to anti-tumour necrosis factor (TNF) therapies are best assessed with magnetic resonance imaging (MRI), but radiologist reporting is subjective and variable. This study investigates whether segmentation software could provide precise and reproducible objective measurements of fistula volume.Methods:Retrospective analysis of patients with perianal Crohn’s fistula at our institution between 2007 and 2013. Pre- and post-biologic MRI scans were used with varying time intervals. A total of two radiologists recorded fistula volumes, mean signal intensity and time taken to measure fistula volumes using validated Open Source segmentation software. A total of three radiologists assessed fistula response to treatment (improved, worse or unchanged) by comparing MRI scans.Results:A total of 18 cases were reviewed for this pilot study. Inter-observer variability was very good for volume and mean signal intensity; intra-class correlation (ICC) 0.95 [95% confidence interval (CI) 0.91–0.98] and 0.95 (95% CI 0.90–0.97) respectively. Intra-observer variability was very good for volume and mean signal intensity; ICC 0.99 (95% CI 0.97–0.99) and 0.98 (95% CI 0.95–0.99) respectively. Average time taken to measure fistula volume was 202 s and 250 s for readers 1 and 2. Agreement between three specialist radiologists was good [kappa 0.69 (95% CI 0.49–0.90)] for the subjective assessment of fistula response. Significant association was found between objective percentage volume change and subjective consensus agreement of response (p = 0.001). Median volume change for improved, stable or worsening fistula response was −67% [interquartile range (IQR): −78, −47], 0% (IQR: −16, +17), and +487% (IQR: +217, +559) respectively.Conclusion:Quantification of fistula volumes and signal intensities is feasible and reliable, providing an objective measure of perianal Crohn’s fis

Journal article

Lung PFC, Sahnan K, Burling D, Burn J, Tozer P, Yassin N, Adegbola SO, Baldwin R, Warusavitarne J, Gupta A, Faiz O, Phillips RKS, Hart ALet al., 2018, Volume assessment MRI technique for monitoring perianal Crohn’s fistulas, Therapeutic Advances in Gastroenterology, Vol: 11, Pages: 1-8, ISSN: 1756-2848

BackgroundPerianal Crohn’s fistula and their response to anti-TNF therapies are best assessed with MRI, but radiologist reporting is subjective and variable. This study investigates whether segmentation software could provide precise and reproducible objective measurements of fistula volume. MethodsRetrospective analysis of patients with perianal Crohn’s fistula at our institution between 2007 and 2013. Pre- and post biologic MRI scans were used with varying time intervals. Two radiologists recorded fistula volumes, mean signal intensity and time taken to measure fistula volumes using validated open-source segmentation software. Three radiologists assessed fistula response to treatment (improved, worse or unchanged) by comparing MRI scans. ResultsEighteen cases were reviewed for this pilot study. Inter-observer variability was very good for volume and mean signal intensity; ICC 0.95 (95%CI 0.91-0.98) and 0.95 (95%CI 0.90-0.97) respectively. Intra-observer variability was very good for volume and mean signal intensity; ICC 0.99 (95%CI 0.97-0.99) and 0.98 (95%CI 0.95-0.99) respectively. Average time taken to measure fistula volume was 202s and 250s for readers 1 and 2. Agreement between 3 specialist radiologists was good (kappa 0.69 [95%CI 0.49-0.90]) for the subjective assessment of fistula response. Significant association was found between objective percentage volume change and subjective consensus agreement of response (p=0.001). Median volume change for improved, stable or worsening fistula response was -67% (IQR:-78,-47), 0% (IQR:-16,+17), and +487% (IQR:+217,+559) respectively. ConclusionQuantification of fistula volumes and signal intensities is feasible and reliable, providing an objective measure of perianal Crohn’s fistula and response to treatment.

Journal article

Sahnan K, Adegbola SO, Tozer PJ, Gupta A, Baldwin-Cleland R, Yassin N, Warusavitarne J, Faiz OD, Hart AL, Phillips RKS, Lung PFCet al., 2018, Improving the Understanding of Perianal Crohn Fistula Through 3D Modeling, ANNALS OF SURGERY, Vol: 267, Pages: E105-E107, ISSN: 0003-4932

Journal article

Sahnan K, Adegbola SO, Tozer PJ, Patel U, Ilangovan R, Warusavitarne J, Faiz OD, Hart AL, Phillips RKS, Lung PFCet al., 2018, Innovation in the imaging perianal fistula: a step towards personalised medicine, Therapeutic Advances in Gastroenterology, Vol: 11, ISSN: 1756-2848

Background: Perianal fistula is a topic both hard to understand and to teach. The key to understanding the treatment options and the likely success is deciphering the exact morphology of the tract(s) and the amount of sphincter involved. Our aim was to explore alternative platforms better to understand complex perianal fistulas through three-dimensional (3D) imaging and reconstruction. Methods: Digital imaging and communications in medicine images of spectral attenuated inversion recovery magnetic resonance imaging (MRI) sequences were imported onto validated open-source segmentation software. A specialist consultant gastrointestinal radiologist performed segmentation of the fistula, internal and external sphincter. Segmented files were exported as stereolithography files. Cura (Ultimaker Cura 3.0.4) was used to prepare the files for printing on an Ultimaker 3 Extended 3D printer. Animations were created in collaboration with Touch Surgery™. Results: Three examples of 3D printed models demonstrating complex perianal fistula were created. The anatomical components are displayed in different colours: red: fistula tract; green: external anal sphincter and levator plate; blue: internal anal sphincter and rectum. One of the models was created to be split in half, to display the internal opening and allow complexity in the intersphincteric space to better evaluated. An animation of MRI fistulography of a trans-sphincteric fistula tract with a cephalad extension in the intersphincteric space was also created. Conclusion: MRI is the reference standard for assessment of perianal fistula, defining anatomy and guiding surgery. However, communication of findings between radiologist and surgeon remains challenging. Feasibility of 3D reconstructions of complex perianal fistula is realized, with the potential to improve surgical planning, communication with patients, and augment training.

Journal article

Adegbola SO, Sahnan K, Pellino G, Tozer PJ, Hart A, Phillips RKS, Warusavitarne J, Faiz ODet al., 2017, Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review, TECHNIQUES IN COLOPROCTOLOGY, Vol: 21, Pages: 775-782, ISSN: 1123-6337

Journal article

Adegbola SO, Sahnan K, Tozer PJ, Phillips RKS, Faiz OD, Warusavitarne J, Hart Aet al., 2017, Review of local injection of anti-TNF for perianal fistulising Crohn's disease, International Journal of Colorectal Disease, Vol: 32, Pages: 1539-1544, ISSN: 0179-1958

BackgroundPerianal fistulising Crohn’s disease (PFCD) affects a third of Crohn’s disease patients and represents a disabling phenotype with poor outcome. The anti-tumour necrosis factor alpha (TNF) therapies have been shown to maintain clinical remission in a third of patients after 1 year of treatment. Maintenance therapy with systematic administration schedules confers greatest benefit, but exposes patients to risks/side effects of continued systemic use and led to consideration of local drug delivery (first described in 2000). In this review, we analyse all published articles on local anti-TNF therapy in the treatment of PFCD.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to systematically search Medline and Embase using the medical subject headings ‘fistula’, ‘anus’, ‘Crohn disease’, ‘infliximab’ and ‘adalimumab’. This was combined with free text searches, e.g. ‘local injection’ and ‘Crohn’s perianal disease’. Studies/abstracts describing local injection treatment with anti-TNF were included in this review.ResultsSix pilot studies including a total of 92 patients were included in this review. Outcomes reported were mostly clinical and included ‘complete/partial response’ to therapy and short-term results varied between 40 and 100%. There were no significant adverse events and the local injections were well tolerated.ConclusionsThere is paucity of data assessing this treatment modality. Local anti-TNF therapy appears safe, but outcome reporting is heterogeneous, subjective and long-term data are unavailable. Our review suggests a potential role may be in those in whom systemic treatment is contraindicated and calls for standardised reporting of outcomes in this field to enable better data interpretation.

Journal article

Sahnan K, Askari A, Adegbola S, Phillips RKS, Tozer P, Hart A, Faiz Oet al., 2017, The natural history of anorectal sepsis in England, British Journal of Surgery, Vol: 104, Pages: 1857-1865, ISSN: 1365-2168

Introduction Progression from anorectal abscess to fistula is poorly described and it remains unclear which patients develop a fistula following a preceding abscess. We aim to assess the burden of anorectal abscess and the risk factors of subsequent fistula formation. Methods The Hospital Episode Statistics database was used to identify all patients presenting with new anorectal abscesses. Cox regression analysis was undertaken to identify factors predictive of fistula formation. Results 159,052 patients in England with first-time abscesses presented from 1997-2012 with an incidence rate of 20.2/100,000. Subsequent fistula formation following an abscess was 16.0% (25,530/159,563) in idiopathic cases and 41.5% (4,407/10,613) in IBD cases (27% coded concurrently as ulcerative colitis (UC); 47.0% coded as Crohn’s disease (CD)). Of the total patients who developed a fistula, 67.0% did so within the first year. Independent predictors of fistula formation were; IBD, in particular CD (HR 3.51, p<0.001), UC (HR 1.82, p<0.001), female gender (HR 1.18, p<0.001), 41-60 years old (HR 1.85, p<0.001, compared to the <20 age group); and intersphincteric (HR 1.53, p<0.001) or ischiorectal (HR 1.48, p<0.001) abscess locations, compared to perianal. 2.8% of all patients presenting with a new abscess were subsequently diagnosed with CD (median 14 months). Conclusion This population study demonstrates that the burden of anorectal sepsis is high, with subsequent fistula formation nearly x3 times higher in CD than idiopathic disease. Female gender is a novel, independent predictor of fistula formation following abscess drainage and most fistulas form within the first year. Risk stratification can guide management and follow-up.

Journal article

Sahnan K, Adegbola SO, Tozer PJ, Watfah J, Phillips RKet al., 2017, Perianal abscess, BMJ, Vol: 356, ISSN: 0959-8138

The annual incidence of perianal abscess is estimated between 14 000 and 20 000 people in the UK, resulting in about 12 500 operations in the NHS each year.1 A recent Swedish cohort study estimated the incidence at 16.1 per 100 000.2 The true incidence may be higher, since many patients are treated with antibiotics in the community and some abscesses spontaneously regress or discharge.23 Patients usually present with an erythematous swelling near the anus and may be embarrassed or reluctant to seek treatment. They may present to a non-specialist in the first instance. This article provides information on the causes and different types of perianal abscess and an update on how they are best managed.

Journal article

Sahnan K, Adegbola SO, Tozer PJ, Burling D, Warusavitarne J, Faiz OD, Phillips RK, Hart AL, Lung PFet al., 2017, P126 Experience of 3D modelling in perianal fistula disease and survey of international surgical interest., J Crohns Colitis, Vol: 11, Pages: S140-S141

Journal article

Sahnan K, Adegbola SO, Tozer PJ, Allin BS, Lee MJ, Heywood N, McNair AG, Lobo AJ, Brown SR, Sebastian S, Phillips RK, Lung PF, Faiz OD, Blackwell S, Verjee A, Fearnhead NS, Hart ALet al., 2017, P245 A systematic review of outcomes reported in studies on fistulising perianal Crohn's disease., J Crohns Colitis, Vol: 11

Journal article

Sahnan K, Lung PF, Adegbola SO, Burling D, Burn J, Tozer PJ, Gupta A, Faiz OD, Phillips RK, Hart ALet al., 2017, P398 An objective measure of response to treatment for patients with Crohn's perianal fistulas on anti-TNF treatment., J Crohns Colitis, Vol: 11

Journal article

Hollingshead JR, Phillips RK, 2015, Haemorrhoids: modern diagnosis and treatment, Postgraduate Medical Journal, Vol: 92, Pages: 4-8, ISSN: 1469-0756

Haemorrhoids present often to primary and secondary care, and haemorrhoidal procedures are among the most common carried out. They may co-exist with more serious pathology, and correct evaluation is important. In most cases a one-off colonoscopy in patients aged 50 or above with flexible sigmoidoscopy in younger patients is reasonable. Many people with haemorrhoids do not require treatment. Topical remedies provide no more than symptomatic relief-and even evidence for this is poor. Bulk laxatives alone may improve symptoms of both bleeding and prolapse and seem as effective as injection sclerotherapy. Rubber band ligation is effective in 75% of patients in the short term, but does not treat prolapsed haemorrhoids or those with a significant external component. Conventional haemorrhoidectomy remains the most effective treatment in the long term, the main limitation being post-operative pain. Metronidazole, topical sphincter relaxants and operative technique have all been shown to reduce pain. Stapled haemorrhoidectomy and haemorrhoidal artery ligation techniques are probably less effective but less painful. Long-term data are poor for all procedures, with many studies reporting only 1-3 years of follow-up data. Haemorrhoids are common in pregnancy, occurring in 40% of women. They can usually be treated conservatively during pregnancy, with any treatment delayed until after delivery. Acutely strangulated haemorrhoids may be treated either conservatively or operatively. There is an increased risk of anal stenosis after acute surgery, but the risks of sepsis and sphincter damage are less significant than previously thought. The majority of patients who are treated conservatively will still require definitive treatment at a later date.

Journal article

Yassin NA, Dardanov D, Phillips RKS, 2015, Sepsis, CT, and the Deep Postanal Space: A Riddle, Wrapped in a Mystery, Inside an Enigma, DISEASES OF THE COLON & RECTUM, Vol: 58, Pages: 1111-1113, ISSN: 0012-3706

Journal article

Bernardo D, Mann ER, Montalvillo E, Bassity E, Bayiroglu F, Man R, Fernández-Salazar L, English NR, Peake STC, Landy J, Lee GH, Malietzis G, Siaw YH, Vora R, Murugananthan A, Sánchez-Recio E, Phillips RKS, Garrote JA, Scott P, Parkhill J, Hart AL, Omar HO, Arranz E, Walker AW, Carding SR, Knight SCet al., 2015, CCR2 mediates dendritic cell recruitment to the human colon but is not responsible for differences observed in dendritic cell subsets, phenotype and function between the proximal and distal colon, Cellular and Molecular Gastroenterology and Hepatology, Vol: 2, Pages: 22-39.e5, ISSN: 2352-345X

Background & aimsMost knowledge about gastrointestinal (GI)-tract dendritic cells (DC) relies on murine studies where CD103+ DC specialize in generating immune tolerance with the functionality of CD11b+/- subsets being unclear. Information about human GI-DC is scarce, especially regarding regional specifications. Here, we characterized human DC properties throughout the human colon.MethodsPaired proximal (right/ascending) and distal (left/descending) human colonic biopsies from 95 healthy subjects were taken; DC were assessed by flow cytometry and microbiota composition assessed by 16S rRNA gene sequencing.ResultsColonic DC identified were myeloid (mDC, CD11c+CD123-) and further divided based on CD103 and SIRPα (human analog of murine CD11b) expression. CD103-SIRPα+ DC were the major population and with CD103+SIRPα+ DC were CD1c+ILT3+CCR2+ (although CCR2 was not expressed on all CD103+SIRPα+ DC). CD103+SIRPα- DC constituted a minor subset that were CD141+ILT3-CCR2-. Proximal colon samples had higher total DC counts and fewer CD103+SIRPα+ cells. Proximal colon DC were more mature than distal DC with higher stimulatory capacity for CD4+CD45RA+ T-cells. However, DC and DC-invoked T-cell expression of mucosal homing markers (β7, CCR9) was lower for proximal DC. CCR2 was expressed on circulating CD1c+, but not CD141+ mDC, and mediated DC recruitment by colonic culture supernatants in transwell assays. Proximal colon DC produced higher levels of cytokines. Mucosal microbiota profiling showed a lower microbiota load in the proximal colon, but with no differences in microbiota composition between compartments.ConclusionsProximal colonic DC subsets differ from those in distal colon being more mature. Targeted immunotherapy using DC in T-cell mediated GI-tract inflammation may therefore need to reflect this immune compartmentalization.

Journal article

Yassin NA, Al-Hassi O, Ansari TI, Hart AL, Phillips RKSet al., 2015, The Interaction Between Bacterial Products and the Immune System as an Aetiological Factor for Idiopathic and Crohn's Anal Fistulae, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 7-7, ISSN: 0007-1323

Conference paper

Patsouras D, Pawa N, Osmani H, Phillips RKSet al., 2015, Management of tailgut cysts in a tertiary referral centre: a 10-year experience., Colorectal Dis, Vol: 17, Pages: 724-729

AIM: Tailgut cysts are rare congenital lesions typically presenting as presacral masses. A variable clinical presentation often leads to misdiagnosis and unsuccessful operations. METHOD: A retrospective analysis was performed of tailgut cysts presenting to one surgeon at St Mark's hospital between 2003 and 2013. The patient demographic data and clinicopathological and radiological features, together with perioperative details and recurrence, were reviewed. RESULTS: A total of 17 patients (15 women) with a median age of 35 (21-64) years were included in the study. The mean duration of symptoms before referral was 40 months, with sepsis predominating in 12 cases. Fifteen of the patients had previously undergone surgery (mean 2.9 procedures). A posterior surgical approach was adopted in all patients with a coccygectomy performed in 13. A loop colostomy was formed in three patients. Two of them went on to have a secondary pull-through operation after an initial failed local repair of rectal injury. One case was reported to show malignant degeneration on histological examination. There was one recurrence during a median follow-up period of 13 (3-36) months. CONCLUSION: Tailgut cysts are an uncommon yet important cause of chronic perianal sepsis. Suspicion should be raised in a patient, usually female, presenting with a history of unsuccessful procedures. Diagnosis can be made by clinical assessment and MRI. Complete excision usually resolves the problem.

Journal article

Yassin NA, Askari A, Ferrari L, Faiz O, Warusavitarne J, Gupta A, Phillips RK, Hart Aet al., 2015, Fistulising Perianal Crohn's Disease - Has Anti-TNF Therapy Improved Outcomes?, 46th Annual Digestive Disease Week (DDW), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S875-S875, ISSN: 0016-5085

Conference paper

Yassin NA, Askari A, Ferrari L, Warusavitarne J, Faiz O, Gupta A, Phillips RK, Hart Aet al., 2015, MRI Scans Should Be Used to Monitor the Effects of Anti-TNF Therapy When Treating Perianal Crohn's Fistulas, 46th Annual Digestive Disease Week (DDW), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S643-S643, ISSN: 0016-5085

Conference paper

Tozer PJ, Rayment N, Hart AL, Daulatzai N, Murugananthan AU, Whelan K, Phillips RKSet al., 2015, What role do bacteria play in persisting fistula formation in idiopathic and Crohn's anal fistula?, COLORECTAL DISEASE, Vol: 17, Pages: 235-241, ISSN: 1462-8910

Journal article

Daulatzai N, Hart AL, Phillips RKS, Knight SC, Mann ERet al., 2015, The Role of Dendritic and T-Cell Function and Migration in the Development of Cutaneous Wound Failure in Crohn's Disease, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 166-166, ISSN: 0007-1323

Conference paper

Yassin NA, Askari A, Warusavitarne J, Faiz OD, Athanasiou T, Phillips RKS, Hart ALet al., 2014, Systematic review: the combined surgical and medical treatment of fistulising perianal Crohn's disease, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 40, Pages: 741-749, ISSN: 0269-2813

Journal article

White I, Jenkins JT, Coomber R, Clark SK, Phillips RKS, Kennedy RHet al., 2014, Outcomes of laparoscopic and open restorative proctocolectomy., Br J Surg, Vol: 101, Pages: 1160-1165

BACKGROUND: The literature on laparoscopic restorative proctectomy (RP) and proctocolectomy (RPC) is limited. This study compared clinical outcomes of laparoscopic RP and RPC with those of conventional open surgery at one centre. METHODS: Data were analysed from consecutive patients undergoing RPC and RP between November 2006 and November 2011. A standard laparoscopic technique was developed during the first 2 years, performed by two laparoscopic surgeons, with selection of patients who had not previously undergone open colectomy. Study endpoints included postoperative length of stay, 30-day morbidity, readmission, reoperation, pouch function and failure. RESULTS: A total of 207 patients were included; open surgery was performed in 131 (63·3 per cent) and a laparoscopic procedure in 76 (36·7 per cent). There were no significant differences in patient demographics. The conversion rate was 9 per cent (7 of 76). The median (i.q.r.) duration of operation was shorter for open than for laparoscopic procedures: 208 (178-255) versus 285 (255-325) min respectively (P < 0·001). Laparoscopic RPC had a shorter length of stay: median (i.q.r.) 6 (4-8) versus 8 (7-12) days (P < 0·001). The rate of minor complications was lower in the laparoscopic group (33 versus 50·4 per cent; odds ratio (OR) 0·48, 95 per cent confidence interval 0·27 to 0·87).There were no significant differences in total complications (51 per cent after laparoscopy versus 61·5 per cent after open surgery; OR 0·66, 0·37 to 1·17), anastomotic leakage, major morbidity, 30-day readmission, reoperation and stoma closure rates. Pouch failure (including permanent stoma) occurred in 14 (7·7 per cent) of 181 patients. Three patients died, all in the open surgery group. CONCLUSION: Laparoscopic RPC is feasible with some short-term advantages.

Journal article

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