Lillian Reza - Academia.edu (original) (raw)
Papers by Lillian Reza
British Journal of Healthcare Management, 2021
Joint medical-surgical inflammatory bowel disease clinics allow simultaneous patient assessment b... more Joint medical-surgical inflammatory bowel disease clinics allow simultaneous patient assessment by both a gastroenterologist and surgeon. However, patient perceptions of dual clinician presence have not been adequately assessed. Therefore, this study aimed to evaluate the patient's view of receiving multidisciplinary care in this clinic. Patients attending the medical-surgical inflammatory bowel disease clinic completed questionnaires assessing their attitudes towards the clinic, their overall satisfaction and desired frequency of appointments. Responses were received from 44 patients, the majority of whom indicated that attendance at the joint medical-surgical clinical made them feel less anxious about their disease, provided consistent messages regarding their care and minimised the number of trips made to hospital. High levels of satisfaction were reported, with 43% stating they preferred joint clinic attendance for every appointment. Effective inflammatory bowel disease mana...
Frontline Gastroenterology, 2020
Perianal manifestations of Crohn’s disease constitute a distinct disease phenotype commonly affec... more Perianal manifestations of Crohn’s disease constitute a distinct disease phenotype commonly affecting patients and conferring an increased risk of disability and disease burden. Much research has gone into management of fistulising manifestations, with biological therapy changing the landscape of treatment. In this article, we discuss the up-to-date surgical and medical management of perianal fistulas, highlighting current consensus management guidelines and the evidence behind them, as well as future directions in management.
Colorectal Disease, 2021
Ileal pouch–anal anastomosis (IPAA), or a ‘pouch’, allows restoration of intestinal continuity af... more Ileal pouch–anal anastomosis (IPAA), or a ‘pouch’, allows restoration of intestinal continuity after proctocolectomy for ulcerative colitis or familial adenomatous polyposis. Most patients have a good long‐term outcome after IPAA, but in a significant proportion the functional outcome and quality of life are unsatisfactory. We term this outcome ‘the pouch behaving badly’. Managing this, especially one is when unfamiliar with the possible underlying pathologies, is a challenge for both patient and clinician. We aim to outline the clinical approach to the pouch behaving badly, highlighting key aspects of investigation and management.
Current Problems in Surgery, 2020
Frontline Gastroenterology, 2020
As well as inflammatory bowel disease, there are a number of other conditions which either predis... more As well as inflammatory bowel disease, there are a number of other conditions which either predispose to or cause perianal disease. For the most part, these are relatively simple and can be managed by a local specialist but there are cases where more nuanced approach is needed and where tertiary referral maybe more appropriate. In particular, rarer forms of perianal disease such as complex cryptoglandular fistula, rectovaginal fistula (RVF) and those associated with ileoanal pouches are associated with high levels of morbidity, risk and treatment failure. Experience in patient selection, multiple reparative techniques and identifying rare causes are crucial, and where evidence is lacking, this experience is the surgeon’s only weapon. The Association of Coloproctology of Great Britain and Ireland have recently released an updated position statement on anal fistula, once again recognising its complexity and often a lack of high-level evidence for treatment.1 A greater proportion of men suffer from anorectal abscess than women and these occur at a mean age of 40 in both sexes.2–4 Known risk factors associated with developing an abscess include inflammatory bowel disease (IBD), smoking and HIV.5 The most commonly reported symptoms are pain and discharge, causing social embarrassment and loss of quality of life (QoL).6–9 It is thought that approximately 90% of abscesses occur due to cryptoglandular suppuration, with infection of the intersphincteric anal glands which lubricate the passage of stool.10 11 The remaining ~10% of cases are caused by Crohn’s disease (CD), abdominal infections tracking caudally (eg, diverticulitis), penetrative causes (eg, animal bones or by anal digitation),12 perforated cancers (eg, rectal or anal) or post radiotherapy, penetrating ulcers,13 tuberculosis (TB),14 actinomycosis15 or from a complication of local surgical procedures (eg, haemorrhoidectomy, episiotomy) or medical treatment (with nicorandil, which causes perianal or peristomal ulceration …
Colorectal Disease, 2020
Restorative proctocolectomy has been widely adopted as the procedure of choice for restoring gast... more Restorative proctocolectomy has been widely adopted as the procedure of choice for restoring gastrointestinal continuity following proctocolectomy. It is often associated with improved quality of life and high patient satisfaction; however, the development of a pouch anal fistula can cause significant morbidity. Pouch fistulas are notoriously difficult to treat and there is great heterogeneity in the management reported of these fistulas. A lack of classification, and the assumption that fistulas originating from completely different aetiologies will behave and respond similarly to a particular treatment strategy, precludes meaningful comparison of management outcomes. We aim to introduce consistency in the reporting of pouch fistulas using a novel classification system.
British Journal of Surgery, 2019
Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practi... more Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle...
Journal of Clinical Gastroenterology and Treatment, 2016
Diagnosis of complicated jejunal diverticulosis is difficult due to its atypical and non-specific... more Diagnosis of complicated jejunal diverticulosis is difficult due to its atypical and non-specific clinical presentation hence the diagnosis is often made at laparotomy.
Colorectal Disease, 2021
It is now over 40 years since restorative proctocolectomy (RPC) with formation of ileoanal pouch ... more It is now over 40 years since restorative proctocolectomy (RPC) with formation of ileoanal pouch was pioneered by Parks and Nicholls [1]. During that time the operative technique has evolved, in particular the reservoir configuration (S, W, J and H) and the method of pouchanal anastomosis. Initially the anastomotic technique involved mucosectomy and handsewn anastomosis, which was largely superseded by the use of circular staplers. Both techniques leave behind residual rectal tissue which is susceptible to the original pathology;
British Journal of Healthcare Management, 2021
Joint medical-surgical inflammatory bowel disease clinics allow simultaneous patient assessment b... more Joint medical-surgical inflammatory bowel disease clinics allow simultaneous patient assessment by both a gastroenterologist and surgeon. However, patient perceptions of dual clinician presence have not been adequately assessed. Therefore, this study aimed to evaluate the patient's view of receiving multidisciplinary care in this clinic. Patients attending the medical-surgical inflammatory bowel disease clinic completed questionnaires assessing their attitudes towards the clinic, their overall satisfaction and desired frequency of appointments. Responses were received from 44 patients, the majority of whom indicated that attendance at the joint medical-surgical clinical made them feel less anxious about their disease, provided consistent messages regarding their care and minimised the number of trips made to hospital. High levels of satisfaction were reported, with 43% stating they preferred joint clinic attendance for every appointment. Effective inflammatory bowel disease mana...
Frontline Gastroenterology, 2020
Perianal manifestations of Crohn’s disease constitute a distinct disease phenotype commonly affec... more Perianal manifestations of Crohn’s disease constitute a distinct disease phenotype commonly affecting patients and conferring an increased risk of disability and disease burden. Much research has gone into management of fistulising manifestations, with biological therapy changing the landscape of treatment. In this article, we discuss the up-to-date surgical and medical management of perianal fistulas, highlighting current consensus management guidelines and the evidence behind them, as well as future directions in management.
Colorectal Disease, 2021
Ileal pouch–anal anastomosis (IPAA), or a ‘pouch’, allows restoration of intestinal continuity af... more Ileal pouch–anal anastomosis (IPAA), or a ‘pouch’, allows restoration of intestinal continuity after proctocolectomy for ulcerative colitis or familial adenomatous polyposis. Most patients have a good long‐term outcome after IPAA, but in a significant proportion the functional outcome and quality of life are unsatisfactory. We term this outcome ‘the pouch behaving badly’. Managing this, especially one is when unfamiliar with the possible underlying pathologies, is a challenge for both patient and clinician. We aim to outline the clinical approach to the pouch behaving badly, highlighting key aspects of investigation and management.
Current Problems in Surgery, 2020
Frontline Gastroenterology, 2020
As well as inflammatory bowel disease, there are a number of other conditions which either predis... more As well as inflammatory bowel disease, there are a number of other conditions which either predispose to or cause perianal disease. For the most part, these are relatively simple and can be managed by a local specialist but there are cases where more nuanced approach is needed and where tertiary referral maybe more appropriate. In particular, rarer forms of perianal disease such as complex cryptoglandular fistula, rectovaginal fistula (RVF) and those associated with ileoanal pouches are associated with high levels of morbidity, risk and treatment failure. Experience in patient selection, multiple reparative techniques and identifying rare causes are crucial, and where evidence is lacking, this experience is the surgeon’s only weapon. The Association of Coloproctology of Great Britain and Ireland have recently released an updated position statement on anal fistula, once again recognising its complexity and often a lack of high-level evidence for treatment.1 A greater proportion of men suffer from anorectal abscess than women and these occur at a mean age of 40 in both sexes.2–4 Known risk factors associated with developing an abscess include inflammatory bowel disease (IBD), smoking and HIV.5 The most commonly reported symptoms are pain and discharge, causing social embarrassment and loss of quality of life (QoL).6–9 It is thought that approximately 90% of abscesses occur due to cryptoglandular suppuration, with infection of the intersphincteric anal glands which lubricate the passage of stool.10 11 The remaining ~10% of cases are caused by Crohn’s disease (CD), abdominal infections tracking caudally (eg, diverticulitis), penetrative causes (eg, animal bones or by anal digitation),12 perforated cancers (eg, rectal or anal) or post radiotherapy, penetrating ulcers,13 tuberculosis (TB),14 actinomycosis15 or from a complication of local surgical procedures (eg, haemorrhoidectomy, episiotomy) or medical treatment (with nicorandil, which causes perianal or peristomal ulceration …
Colorectal Disease, 2020
Restorative proctocolectomy has been widely adopted as the procedure of choice for restoring gast... more Restorative proctocolectomy has been widely adopted as the procedure of choice for restoring gastrointestinal continuity following proctocolectomy. It is often associated with improved quality of life and high patient satisfaction; however, the development of a pouch anal fistula can cause significant morbidity. Pouch fistulas are notoriously difficult to treat and there is great heterogeneity in the management reported of these fistulas. A lack of classification, and the assumption that fistulas originating from completely different aetiologies will behave and respond similarly to a particular treatment strategy, precludes meaningful comparison of management outcomes. We aim to introduce consistency in the reporting of pouch fistulas using a novel classification system.
British Journal of Surgery, 2019
Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practi... more Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle...
Journal of Clinical Gastroenterology and Treatment, 2016
Diagnosis of complicated jejunal diverticulosis is difficult due to its atypical and non-specific... more Diagnosis of complicated jejunal diverticulosis is difficult due to its atypical and non-specific clinical presentation hence the diagnosis is often made at laparotomy.
Colorectal Disease, 2021
It is now over 40 years since restorative proctocolectomy (RPC) with formation of ileoanal pouch ... more It is now over 40 years since restorative proctocolectomy (RPC) with formation of ileoanal pouch was pioneered by Parks and Nicholls [1]. During that time the operative technique has evolved, in particular the reservoir configuration (S, W, J and H) and the method of pouchanal anastomosis. Initially the anastomotic technique involved mucosectomy and handsewn anastomosis, which was largely superseded by the use of circular staplers. Both techniques leave behind residual rectal tissue which is susceptible to the original pathology;