Charles Evans - Academia.edu (original) (raw)

Papers by Charles Evans

Research paper thumbnail of PTU-059 Novel urinary and blood peptide markers for detection of colorectal cancer – early results

Colon and Anorectum, 2018

Research paper thumbnail of Faecal immunochemical testing (FIT) in symptomatic patients: what are we missing?

Frontline Gastroenterology, 2019

ObjectiveFaecal immunochemical test (FIT) shows promise as a non-invasive triage test for colorec... more ObjectiveFaecal immunochemical test (FIT) shows promise as a non-invasive triage test for colorectal cancer (CRC) in the symptomatic population. The aim of this study was to assess the use of FIT within the recent NG12 and DG30 National Institute for Health and Care Excellence (NICE) guidelines.DesignA single-centre prospective study of patients referred to University Hospitals Coventry and Warwickshire NHS Trust via the 2-week wait (TWW) pathway between January 2015 and March 2016 was conducted. 612 patients were reviewed, of which 519 were found to meet the NG12 criteria and 79 met the DG30 criteria. Data included age, sex, symptoms, colonoscopy or CT colonography, histology and FIT results.Main outcome measuresFIT was performed in all patients and sensitivity, specificity, positive predictive value and negative predictive value, with 95% CI, for cancers and adenomas within each pathway (TWW, NG12 and DG30) was calculated.ResultsCRC sensitivity in TWW pathway patients, NG12 and DG...

Research paper thumbnail of Risk stratification of Symptomatic Patients Suspected of Colorectal Cancer using Faecal and Urinary Markers

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 24, 2018

Faecal markers such as faecal immunochemical test for haemoglobin (FIT) and faecal calprotectin (... more Faecal markers such as faecal immunochemical test for haemoglobin (FIT) and faecal calprotectin (FCP) have been increasingly used to exclude colorectal cancer (CRC) and colonic inflammation. However, in those with lower gastrointestinal symptoms, there are considerable numbers with cancer but have a negative FIT test (false negative), which, has impeded its use in clinical practice. We undertook a diagnostic accuracy study of CRC using faecal immunochemical test for haemoglobin (FIT), faecal calprotectin (FCP) and urinary volatile organic compounds (VOCs) in patients with lower gastrointestinal symptoms. 1016 symptomatic patients with suspected CRC referred by family physicians were recruited prospectively in accordance with national referring protocol. A total of 562 patients, who completed colonic investigations, in addition to providing stool for FIT, FCP as well as urine samples for urinary VOC measurements, were included in the final outcome measures. The sensitivity and specif...

Research paper thumbnail of Does Hyoscine improve polyp detection rate during colonoscopy? Systematic Review & meta-analysis of randomized clinical trials

Annals of Medicine and Surgery, 2018

Background/objective: Published studies have shown conflicting results regarding the benefit of H... more Background/objective: Published studies have shown conflicting results regarding the benefit of Hyoscine Butylbrmoide use during colonoscopy in polyp and adenoma detection rates. This meta-analysis was conducted with the aim to summarize all available evidence. Methods: A literature search was carried out using PubMed, Ovid MEDLINE and the Cochrane Library database from inception to December 2017. Studies that compared the use of Hyoscine Butylbrmoide compared to placebo during colonoscopy were included. Pooled odds ratio and 95% confidence interval were calculated using Mantel-Haenszel fixed-effects model when there was no heterogeneity identified. Results: Of the 423 retrieved studies, eight met the eligibility criteria and were included in the analysis. There was no significant difference between the groups in terms of polyp and adenoma detection rates. There was no significant difference between the Hyoscine and placebo groups in polyp detection rate (49.3% vs 48%, OR = 1.06, 95% CI: 0.90-1.23, P = 0.50). Adenoma detection rate was also not significantly different between the 2 groups 33.7% vs, 31%; OR = 1.13; 95%CI: 0.95-1.35; P = 0.16). No heterogeneity was observed (P = 0.65, I 2 = 0%). Conclusion: This meta-analysis found no significant impact of Hyoscine on polyp and adenoma detection when used during colonoscopy.

Research paper thumbnail of Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery

British Journal of Surgery, 2011

Background Epidural analgesia is considered fundamental in enhanced recovery protocols (ERPs). Ho... more Background Epidural analgesia is considered fundamental in enhanced recovery protocols (ERPs). However, its value in laparoscopic colorectal surgery is unclear. The aim of this study was to examine the effects of different analgesic regimens on outcomes following laparoscopic colorectal surgery in fluid-optimized patients treated within an ERP. Methods Ninety-nine patients were randomized to receive epidural, spinal or patient-controlled (PCA) analgesia. The primary endpoints were time until medically fit for discharge and length of hospital stay. Secondary endpoints included return of bowel function, pain scores, and changes in pulmonary function and quality of life. Results Ninety-one patients completed the study. The median length of hospital stay was 3·7 days following epidural analgesia, significantly longer than that of 2·7 and 2·8 days for spinal analgesia and PCA respectively (P = 0·002 and P < 0·001). There was also a slower return of bowel function with epidural analges...

Research paper thumbnail of A Multicenter Collaboration to Assess the Safety of Laparoscopic Ventral Rectopexy

Diseases of the colon and rectum, 2015

Concerns have been raised regarding the potential risk of mesh complications after laparoscopic v... more Concerns have been raised regarding the potential risk of mesh complications after laparoscopic ventral rectopexy. This study aimed to determine the risk of mesh and nonmesh morbidity after laparoscopic ventral rectopexy and to compare the safety of synthetic meshes with biological grafts. This was a retrospective review. The study used data collated from prospective pelvic floor databases in 5 centers (3 in the United Kingdom, 1 in Australia, and 1 in Italy). All of the patients undergoing laparoscopic ventral rectopexy over a 14-year period (1999-2013) at these centers were included in the study. The primary outcome was mesh morbidity, classified as vaginal erosion, rectal erosion, rectovaginal fistula, or perineal erosion. Secondary outcomes were nonmesh morbidity. A total of 2203 patients underwent surgery; 1764 (80.1%) used synthetic mesh and 439 (19.9%) used biological grafts. There were 2 postoperative deaths (0.1%). Forty-five patients (2.0%) had mesh erosion, including 20 v...

Research paper thumbnail of The correlation between colorectal cancer rates of proliferation and apoptosis and systemic cytokine levels; plus their influence upon survival

British Journal of Cancer, 2006

Research paper thumbnail of Splenic abscess rupture postappendicectomy

BMJ case reports, 2012

The authors present a case of splenic abscess rupture postappendicectomy. Splenic abscess is rare... more The authors present a case of splenic abscess rupture postappendicectomy. Splenic abscess is rare with a reported incidence of 0.05%-0.7%. It is extremely unusual for a splenic abscess to result in splenic rupture. Contiguous spread, in this case from postappendix perforation, can cause splenic abscess formation. Postemergency splenectomy, the patient required admission to intensive therapy unit for 5 days but made a good postoperative recovery. This case is important to report as this is a rare postoperative complication of generalised peritonitis and this case highlights that astute diagnosis and management of the deteriorating surgical patient and rapid mobilisation of theatre are lifesaving.

Research paper thumbnail of Impact of surgery on immunologic function: comparison between minimally invasive techniques and conventional laparotomy for surgical resection of colorectal tumors

The American Journal of Surgery, 2009

BACKGROUND: Surgical trauma suppresses host immune function, potentially creating an environment ... more BACKGROUND: Surgical trauma suppresses host immune function, potentially creating an environment vulnerable to tumor cell growth. This study compared immune function after laparoscopy, minilaparotomy, and conventional colorectal tumor resections.

Research paper thumbnail of Factors Influencing Laparoscopic Colorectal Operative Duration and its Effect on Clinical Outcome

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2012

This study aimed to identify factors affecting laparoscopic colorectal operative duration and det... more This study aimed to identify factors affecting laparoscopic colorectal operative duration and determine the impact of prolonged operative time. Data were collected prospectively on all laparoscopic colorectal operations performed within 1 institution over a period of 4 years. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; demographics, CR-POSSUM scores, intraoperative details, surgeon experience, and postoperative outcomes were recorded and assessed in relation to operative duration. Two hundred laparoscopic colorectal operations were performed (137 cancers, 63 benign). Operation duration correlated to operation type (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and CR-POSSUM mortality risk (P = 0.03). Operative duration positively correlated with incidence of postoperative complications (P = 0.02) and length of stay (P = 0.05). Operation time &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;180 minutes was associated with increased incidence of postoperative complications (P = 0.006). The type of laparoscopic colorectal surgical operation performed has a significantly greater impact upon operative duration than individual patient parameters, pathology, or surgical experience. Operative time is associated with a greater risk of complications and longer hospital stay.

Research paper thumbnail of Outcomes following emergency general surgery in nonagenarians

International Journal of Surgery, 2012

Aims: To assess outcomes of inpatient stay in patients referred to acute surgical unit from resid... more Aims: To assess outcomes of inpatient stay in patients referred to acute surgical unit from residential homes, comparing with non-institutionalised patients with similar presenting complaints. Methods: 40 patients admitted from homes over six months were matched with following emergency surgical admission living independently aged >70. Data gathered via 'take' lists and discharge summaries. Results: Dementia was more prevalent in the residential care (45 vs. 28%), who also had more co-morbidities (4.4 vs. 2.6). Presenting complaints between groups were similar, abdominal pain and haematemesis being leading causes. Larger proportion of community residents underwent surgery during admission (28 vs. 5%) whilst greater proportion of residential care died during admission (15 vs. 2.5%). Residential care patients had a slightly longer average duration of stay in this study (5.5 vs 4.2 days). Conclusions: Whilst presenting with similar complaints, residential care patients are less often surgical candidates; fewer undergo surgery and a larger proportion die during admission. This supports value of geriatric liaison, particularly discharge planning, including in those patients palliative needs, as well as medical optimisation of co-morbidities when surgery is considered. Presented to the surgical and elderly care department: a new admission pathway for this group of patients was proposed to the trust, suggesting refferal via the geriatric team.

Research paper thumbnail of Doppler-guided haemorrhoidal artery ligation with recto anal repair: a new technique for the treatment of symptomatic haemorrhoids

International Journal of Colorectal Disease, 2010

Doppler-guided haemorrhoidal artery ligation (DGHAL) is a minimally invasive surgical technique u... more Doppler-guided haemorrhoidal artery ligation (DGHAL) is a minimally invasive surgical technique used to treat symptomatic haemorrhoids. In 2005, the DGHAL proctoscope was redesigned to incorporate a window through which a recto anal repair (RAR) could be performed to improve the outcome in patients with significant prolapse symptoms. The aim of this study was to observe the outcome of a series of consecutive DGHAL-RAR procedures. Seventy-seven consecutive patients (49 male) underwent DGHAL-RAR for symptomatic haemorrhoids and were reviewed for a minimum of 6 months post-surgery. Fifty-seven (74%) of patients presented with both prolapse and bleeding symptoms. The median number of DGHALs performed was six, and the median number of RARs was two. Most (96%) patients were discharged the same day. At follow-up, 11 patients complained of recurrent symptoms, five of prolapse, four of bleeding and two of pruritus. Eight patients suffered with post-operative anal fissures. The procedure is recommended by 84.4% of patients 6 weeks post-surgery. DGHAL-RAR is safe, effective and well tolerated. It reduces the need for potentially dangerous excisional procedures. The RAR component is an effective addition to DGHAL in the short term for the treatment of prolapse, but longer follow-up will be required to demonstrate durability of the technique.

Research paper thumbnail of Overlapping anal sphincter repair and anterior levatorplasty: effect of patient’s age and duration of follow-up

International Journal of Colorectal Disease, 2006

tient age does not correlate with outcome, and symptoms do not deteriorate over time. Anorectal p... more tient age does not correlate with outcome, and symptoms do not deteriorate over time. Anorectal physiology results don't predict for symptomatic improvement in patients with faecal incontinence.

Research paper thumbnail of Emergency Surgery Handover: Are We Breaching the Data Protection Act?

Bulletin of The Royal College of Surgeons of England, 2012

Research paper thumbnail of A Multicenter Collaboration to Assess the Safety of Laparoscopic Ventral Rectopexy

Diseases of the colon and rectum, 2015

Concerns have been raised regarding the potential risk of mesh complications after laparoscopic v... more Concerns have been raised regarding the potential risk of mesh complications after laparoscopic ventral rectopexy. This study aimed to determine the risk of mesh and nonmesh morbidity after laparoscopic ventral rectopexy and to compare the safety of synthetic meshes with biological grafts. This was a retrospective review. The study used data collated from prospective pelvic floor databases in 5 centers (3 in the United Kingdom, 1 in Australia, and 1 in Italy). All of the patients undergoing laparoscopic ventral rectopexy over a 14-year period (1999-2013) at these centers were included in the study. The primary outcome was mesh morbidity, classified as vaginal erosion, rectal erosion, rectovaginal fistula, or perineal erosion. Secondary outcomes were nonmesh morbidity. A total of 2203 patients underwent surgery; 1764 (80.1%) used synthetic mesh and 439 (19.9%) used biological grafts. There were 2 postoperative deaths (0.1%). Forty-five patients (2.0%) had mesh erosion, including 20 v...

Research paper thumbnail of PTU-059 Novel urinary and blood peptide markers for detection of colorectal cancer – early results

Colon and Anorectum, 2018

Research paper thumbnail of Faecal immunochemical testing (FIT) in symptomatic patients: what are we missing?

Frontline Gastroenterology, 2019

ObjectiveFaecal immunochemical test (FIT) shows promise as a non-invasive triage test for colorec... more ObjectiveFaecal immunochemical test (FIT) shows promise as a non-invasive triage test for colorectal cancer (CRC) in the symptomatic population. The aim of this study was to assess the use of FIT within the recent NG12 and DG30 National Institute for Health and Care Excellence (NICE) guidelines.DesignA single-centre prospective study of patients referred to University Hospitals Coventry and Warwickshire NHS Trust via the 2-week wait (TWW) pathway between January 2015 and March 2016 was conducted. 612 patients were reviewed, of which 519 were found to meet the NG12 criteria and 79 met the DG30 criteria. Data included age, sex, symptoms, colonoscopy or CT colonography, histology and FIT results.Main outcome measuresFIT was performed in all patients and sensitivity, specificity, positive predictive value and negative predictive value, with 95% CI, for cancers and adenomas within each pathway (TWW, NG12 and DG30) was calculated.ResultsCRC sensitivity in TWW pathway patients, NG12 and DG...

Research paper thumbnail of Risk stratification of Symptomatic Patients Suspected of Colorectal Cancer using Faecal and Urinary Markers

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 24, 2018

Faecal markers such as faecal immunochemical test for haemoglobin (FIT) and faecal calprotectin (... more Faecal markers such as faecal immunochemical test for haemoglobin (FIT) and faecal calprotectin (FCP) have been increasingly used to exclude colorectal cancer (CRC) and colonic inflammation. However, in those with lower gastrointestinal symptoms, there are considerable numbers with cancer but have a negative FIT test (false negative), which, has impeded its use in clinical practice. We undertook a diagnostic accuracy study of CRC using faecal immunochemical test for haemoglobin (FIT), faecal calprotectin (FCP) and urinary volatile organic compounds (VOCs) in patients with lower gastrointestinal symptoms. 1016 symptomatic patients with suspected CRC referred by family physicians were recruited prospectively in accordance with national referring protocol. A total of 562 patients, who completed colonic investigations, in addition to providing stool for FIT, FCP as well as urine samples for urinary VOC measurements, were included in the final outcome measures. The sensitivity and specif...

Research paper thumbnail of Does Hyoscine improve polyp detection rate during colonoscopy? Systematic Review & meta-analysis of randomized clinical trials

Annals of Medicine and Surgery, 2018

Background/objective: Published studies have shown conflicting results regarding the benefit of H... more Background/objective: Published studies have shown conflicting results regarding the benefit of Hyoscine Butylbrmoide use during colonoscopy in polyp and adenoma detection rates. This meta-analysis was conducted with the aim to summarize all available evidence. Methods: A literature search was carried out using PubMed, Ovid MEDLINE and the Cochrane Library database from inception to December 2017. Studies that compared the use of Hyoscine Butylbrmoide compared to placebo during colonoscopy were included. Pooled odds ratio and 95% confidence interval were calculated using Mantel-Haenszel fixed-effects model when there was no heterogeneity identified. Results: Of the 423 retrieved studies, eight met the eligibility criteria and were included in the analysis. There was no significant difference between the groups in terms of polyp and adenoma detection rates. There was no significant difference between the Hyoscine and placebo groups in polyp detection rate (49.3% vs 48%, OR = 1.06, 95% CI: 0.90-1.23, P = 0.50). Adenoma detection rate was also not significantly different between the 2 groups 33.7% vs, 31%; OR = 1.13; 95%CI: 0.95-1.35; P = 0.16). No heterogeneity was observed (P = 0.65, I 2 = 0%). Conclusion: This meta-analysis found no significant impact of Hyoscine on polyp and adenoma detection when used during colonoscopy.

Research paper thumbnail of Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery

British Journal of Surgery, 2011

Background Epidural analgesia is considered fundamental in enhanced recovery protocols (ERPs). Ho... more Background Epidural analgesia is considered fundamental in enhanced recovery protocols (ERPs). However, its value in laparoscopic colorectal surgery is unclear. The aim of this study was to examine the effects of different analgesic regimens on outcomes following laparoscopic colorectal surgery in fluid-optimized patients treated within an ERP. Methods Ninety-nine patients were randomized to receive epidural, spinal or patient-controlled (PCA) analgesia. The primary endpoints were time until medically fit for discharge and length of hospital stay. Secondary endpoints included return of bowel function, pain scores, and changes in pulmonary function and quality of life. Results Ninety-one patients completed the study. The median length of hospital stay was 3·7 days following epidural analgesia, significantly longer than that of 2·7 and 2·8 days for spinal analgesia and PCA respectively (P = 0·002 and P < 0·001). There was also a slower return of bowel function with epidural analges...

Research paper thumbnail of A Multicenter Collaboration to Assess the Safety of Laparoscopic Ventral Rectopexy

Diseases of the colon and rectum, 2015

Concerns have been raised regarding the potential risk of mesh complications after laparoscopic v... more Concerns have been raised regarding the potential risk of mesh complications after laparoscopic ventral rectopexy. This study aimed to determine the risk of mesh and nonmesh morbidity after laparoscopic ventral rectopexy and to compare the safety of synthetic meshes with biological grafts. This was a retrospective review. The study used data collated from prospective pelvic floor databases in 5 centers (3 in the United Kingdom, 1 in Australia, and 1 in Italy). All of the patients undergoing laparoscopic ventral rectopexy over a 14-year period (1999-2013) at these centers were included in the study. The primary outcome was mesh morbidity, classified as vaginal erosion, rectal erosion, rectovaginal fistula, or perineal erosion. Secondary outcomes were nonmesh morbidity. A total of 2203 patients underwent surgery; 1764 (80.1%) used synthetic mesh and 439 (19.9%) used biological grafts. There were 2 postoperative deaths (0.1%). Forty-five patients (2.0%) had mesh erosion, including 20 v...

Research paper thumbnail of The correlation between colorectal cancer rates of proliferation and apoptosis and systemic cytokine levels; plus their influence upon survival

British Journal of Cancer, 2006

Research paper thumbnail of Splenic abscess rupture postappendicectomy

BMJ case reports, 2012

The authors present a case of splenic abscess rupture postappendicectomy. Splenic abscess is rare... more The authors present a case of splenic abscess rupture postappendicectomy. Splenic abscess is rare with a reported incidence of 0.05%-0.7%. It is extremely unusual for a splenic abscess to result in splenic rupture. Contiguous spread, in this case from postappendix perforation, can cause splenic abscess formation. Postemergency splenectomy, the patient required admission to intensive therapy unit for 5 days but made a good postoperative recovery. This case is important to report as this is a rare postoperative complication of generalised peritonitis and this case highlights that astute diagnosis and management of the deteriorating surgical patient and rapid mobilisation of theatre are lifesaving.

Research paper thumbnail of Impact of surgery on immunologic function: comparison between minimally invasive techniques and conventional laparotomy for surgical resection of colorectal tumors

The American Journal of Surgery, 2009

BACKGROUND: Surgical trauma suppresses host immune function, potentially creating an environment ... more BACKGROUND: Surgical trauma suppresses host immune function, potentially creating an environment vulnerable to tumor cell growth. This study compared immune function after laparoscopy, minilaparotomy, and conventional colorectal tumor resections.

Research paper thumbnail of Factors Influencing Laparoscopic Colorectal Operative Duration and its Effect on Clinical Outcome

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2012

This study aimed to identify factors affecting laparoscopic colorectal operative duration and det... more This study aimed to identify factors affecting laparoscopic colorectal operative duration and determine the impact of prolonged operative time. Data were collected prospectively on all laparoscopic colorectal operations performed within 1 institution over a period of 4 years. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; demographics, CR-POSSUM scores, intraoperative details, surgeon experience, and postoperative outcomes were recorded and assessed in relation to operative duration. Two hundred laparoscopic colorectal operations were performed (137 cancers, 63 benign). Operation duration correlated to operation type (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and CR-POSSUM mortality risk (P = 0.03). Operative duration positively correlated with incidence of postoperative complications (P = 0.02) and length of stay (P = 0.05). Operation time &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;180 minutes was associated with increased incidence of postoperative complications (P = 0.006). The type of laparoscopic colorectal surgical operation performed has a significantly greater impact upon operative duration than individual patient parameters, pathology, or surgical experience. Operative time is associated with a greater risk of complications and longer hospital stay.

Research paper thumbnail of Outcomes following emergency general surgery in nonagenarians

International Journal of Surgery, 2012

Aims: To assess outcomes of inpatient stay in patients referred to acute surgical unit from resid... more Aims: To assess outcomes of inpatient stay in patients referred to acute surgical unit from residential homes, comparing with non-institutionalised patients with similar presenting complaints. Methods: 40 patients admitted from homes over six months were matched with following emergency surgical admission living independently aged >70. Data gathered via 'take' lists and discharge summaries. Results: Dementia was more prevalent in the residential care (45 vs. 28%), who also had more co-morbidities (4.4 vs. 2.6). Presenting complaints between groups were similar, abdominal pain and haematemesis being leading causes. Larger proportion of community residents underwent surgery during admission (28 vs. 5%) whilst greater proportion of residential care died during admission (15 vs. 2.5%). Residential care patients had a slightly longer average duration of stay in this study (5.5 vs 4.2 days). Conclusions: Whilst presenting with similar complaints, residential care patients are less often surgical candidates; fewer undergo surgery and a larger proportion die during admission. This supports value of geriatric liaison, particularly discharge planning, including in those patients palliative needs, as well as medical optimisation of co-morbidities when surgery is considered. Presented to the surgical and elderly care department: a new admission pathway for this group of patients was proposed to the trust, suggesting refferal via the geriatric team.

Research paper thumbnail of Doppler-guided haemorrhoidal artery ligation with recto anal repair: a new technique for the treatment of symptomatic haemorrhoids

International Journal of Colorectal Disease, 2010

Doppler-guided haemorrhoidal artery ligation (DGHAL) is a minimally invasive surgical technique u... more Doppler-guided haemorrhoidal artery ligation (DGHAL) is a minimally invasive surgical technique used to treat symptomatic haemorrhoids. In 2005, the DGHAL proctoscope was redesigned to incorporate a window through which a recto anal repair (RAR) could be performed to improve the outcome in patients with significant prolapse symptoms. The aim of this study was to observe the outcome of a series of consecutive DGHAL-RAR procedures. Seventy-seven consecutive patients (49 male) underwent DGHAL-RAR for symptomatic haemorrhoids and were reviewed for a minimum of 6 months post-surgery. Fifty-seven (74%) of patients presented with both prolapse and bleeding symptoms. The median number of DGHALs performed was six, and the median number of RARs was two. Most (96%) patients were discharged the same day. At follow-up, 11 patients complained of recurrent symptoms, five of prolapse, four of bleeding and two of pruritus. Eight patients suffered with post-operative anal fissures. The procedure is recommended by 84.4% of patients 6 weeks post-surgery. DGHAL-RAR is safe, effective and well tolerated. It reduces the need for potentially dangerous excisional procedures. The RAR component is an effective addition to DGHAL in the short term for the treatment of prolapse, but longer follow-up will be required to demonstrate durability of the technique.

Research paper thumbnail of Overlapping anal sphincter repair and anterior levatorplasty: effect of patient’s age and duration of follow-up

International Journal of Colorectal Disease, 2006

tient age does not correlate with outcome, and symptoms do not deteriorate over time. Anorectal p... more tient age does not correlate with outcome, and symptoms do not deteriorate over time. Anorectal physiology results don't predict for symptomatic improvement in patients with faecal incontinence.

Research paper thumbnail of Emergency Surgery Handover: Are We Breaching the Data Protection Act?

Bulletin of The Royal College of Surgeons of England, 2012

Research paper thumbnail of A Multicenter Collaboration to Assess the Safety of Laparoscopic Ventral Rectopexy

Diseases of the colon and rectum, 2015

Concerns have been raised regarding the potential risk of mesh complications after laparoscopic v... more Concerns have been raised regarding the potential risk of mesh complications after laparoscopic ventral rectopexy. This study aimed to determine the risk of mesh and nonmesh morbidity after laparoscopic ventral rectopexy and to compare the safety of synthetic meshes with biological grafts. This was a retrospective review. The study used data collated from prospective pelvic floor databases in 5 centers (3 in the United Kingdom, 1 in Australia, and 1 in Italy). All of the patients undergoing laparoscopic ventral rectopexy over a 14-year period (1999-2013) at these centers were included in the study. The primary outcome was mesh morbidity, classified as vaginal erosion, rectal erosion, rectovaginal fistula, or perineal erosion. Secondary outcomes were nonmesh morbidity. A total of 2203 patients underwent surgery; 1764 (80.1%) used synthetic mesh and 439 (19.9%) used biological grafts. There were 2 postoperative deaths (0.1%). Forty-five patients (2.0%) had mesh erosion, including 20 v...