Andrew Cockbain | Leeds Teaching Hospitals Trust (original) (raw)

Papers by Andrew Cockbain

Annals of Surgery, Feb 1, 2016

Purpose: Radical cystectomy is inherently associated with morbidity. We assess the timing and inc... more Purpose: Radical cystectomy is inherently associated with morbidity. We assess the timing and incidence of venous thromboembolism, review current guideline recommendations and provide evidence for considering extended venous thromboembolism prophylaxis in all patients undergoing radical cystectomy. Materials and Methods: We searched PubMedÒ for available literature on radical cystectomy and venous thromboembolism, focusing on incidence and timing, evidence supporting extended venous thromboembolism prophylaxis in patients undergoing radical cystectomy or abdominal oncologic surgery, current guideline recommendations, safety considerations and direct oral anticoagulants. Search terms included "radical cystectomy," "venous thromboembolism," "prophylaxis," and "extended oral anticoagulants" and "direct oral anticoagulants" alone and in combination. Relevant articles were reviewed, including original research, reviews and clinical guidelines. References from review articles and guidelines were also assessed to develop a narrative review. Results: The incidence of symptomatic venous thromboembolism in short-term followup after radical cystectomy is 3% to 11.6%, of which more than 50% of cases will occur after hospital discharge. Meta-analyses of clinical trials in patients undergoing major abdominal oncologic operations suggest a decreased risk of venous thromboembolisms for patients receiving extended (4 weeks) venous thromboembolism prophylaxis. Extended prophylaxis should be considered for all radical cystectomy patients. Although the relative risk of bleeding also increases, the overall net benefit of extended prophylaxis clearly favors use for at least 28 days postoperatively. Extrarenal eliminated prophylaxis agents are preferred given the risk of renal insufficiency in radical cystectomy patients, with newer oral anticoagulants providing an alternative route of administration. Conclusions: Patients undergoing radical cystectomy are at high risk for venous thromboembolism after hospital discharge. There is strong evidence that

The journal of bone and joint surgery, Mar 1, 2009

Failure of fixation is a common problem in the treatment of osteoporotic fractures around the hip... more Failure of fixation is a common problem in the treatment of osteoporotic fractures around the hip. The reinforcement of bone stock or of fixation of the implant may be a solution. Our study assesses the existing evidence for the use of bone substitutes in the management of these fractures in osteoporotic patients. Relevant publications were retrieved through Medline research and further scrutinised. Of 411 studies identified, 22 met the inclusion criteria, comprising 12 experimental and ten clinical reports. The clinical studies were evaluated with regard to their level of evidence. Only four were prospective and randomised. Polymethylmethacrylate and calcium-phosphate cements increased the primary stability of the implant-bone construct in all experimental and clinical studies, although there was considerable variation in the design of the studies. In randomised, controlled studies, augmentation of intracapsular fractures of the neck of the femur with calcium-phosphate cement was associated with poor long-term results. There was a lack of data on the longterm outcome for trochanteric fractures. Because there were only a few, randomised, controlled studies, there is currently poor evidence for the use of bone cement in the treatment of fractures of the hip.

Transplantation Proceedings, Dec 1, 2010

Introduction. Postoperative infection (POI) prolongs inpatient stay, delays return to normal acti... more Introduction. Postoperative infection (POI) prolongs inpatient stay, delays return to normal activity, and may be detrimental to long-term survival after cancer resections. This study sought to identify the impact of postoperative infection on liver transplantation outcomes. Methods. We analyzed our prospective database of 910 adult patients who underwent liver transplantation between 2000 and 2010 in a single UK center. POI was defined as pyrexia plus positive cultures from blood, sputum, urine, wound, or ascitic fluid. Patient demographic features and perioperative variables were analyzed for their effects on POI. The impacts of POI on overall survival (OS) and graft survival were analyzed using Kaplan-Meier curves with log-rank tests for significance, before entry into a multivariate regression analysis. We analyzed the effects of POI on the length of hospital stay (LOS) and the incidence of acute rejection episodes and readmissions within 1 year as secondary outcomes. Results. Patients who developed a postoperative chest or wound infection showed poorer OS at a mean of 7.0 versus 8.8 years (P ϭ .009) and 7.0 versus 8.8 years (P ϭ .003), respectively. Infection in blood, ascitic fluid, or urine showed no significant impact on survival. LOS was significantly increased among patients with a wound (median 21 vs 17 days, P ϭ .011), a sputum (median 24 vs 17 days, P Ͻ .001), or a blood infection (median 32 vs 17 days, P Ͻ .001). Higher rates of intraoperative blood transfusion were observed among subjects who developed a chest or a wound infection. There was no difference in other variables between those who did versus did not develop an infection. Upon multivariate analysis, wound infection was the strongest independent predictor of OS (P ϭ .007). Conclusion. We demonstrated that wound or chest infections were associated with poorer OS. More aggressive prophylactic and/or therapeutic interventions targeting specific sites of infection may represent a simple and cost-effective measure to reduce hospital stay and improve OS.

Hpb, Apr 1, 2016

Methods: Eighty-one patients underwent surgery for HCC on normal liver between 1967 and 2010 at o... more Methods: Eighty-one patients underwent surgery for HCC on normal liver between 1967 and 2010 at our center. An uni and multivariate analysis have been realized in order to identify clinical, biological and pathological factors that could predict the 5 and 10 years disease-free survival (DFS). Results: Median tumour size was 10 AE 5,3 cm, median alpha fetoprotein (mg/L) was 9,5 (1-1138070). Sixty-three patients (77%) had a single tumour and macrovascular invasion was present in 18% of the patients. Chemoembolisation was used as a first-line treatment in 37% of the cases. 90-days mortality was 1%. Thirty-one patients (38%) had an adjuvant treatment. Median follow-up was 58 AE 74,4 months, 5e10 years DFS was 51% and 41% respectively. Micro and macrovascular invasion were the only recurrence predictive factors (OR 3.4 95%IC 1,53e5,88; p = 0,001). Five patients (6%) had a recurrence after 5 years. No positive predictive factors have been identified in patients who had a follow-up of more than 10 years. Conclusions: Micro and macrovascular invasion are the only recurrence predictive factors. Post-operative followup should not be stopped after 5 years in patients who underwent resection for HCC on normal liver.

British Journal of Surgery, Apr 1, 2011

Background: A randomized clinical trial was undertaken to assess the utility of routine on-table ... more Background: A randomized clinical trial was undertaken to assess the utility of routine on-table cholangiography (OTC) during laparoscopic cholecystectomy for gallstone disease. Methods: Some 190 patients with a history of biliary colic or cholecystitis and a low predictive risk for choledocholithiasis were randomized to undergo elective laparoscopic cholecystectomy alone (99 patients) or elective laparoscopic cholecystectomy with OTC (91). Intraoperative findings and postoperative outcomes for the two groups were compared. The primary outcome measure was the incidence of common bile duct (CBD) stones. Results: Of the patients undergoing OTC, ten had abnormal cholangiograms; three had CBD stones and seven had abnormalities without stones. OTC was associated with a significantly longer mean(s.e.m.) operating time (66(2) versus 54(3) min; P < 0•001), but there was no association between performance of OTC and postoperative morbidity. During a 1-year follow-up, no patient in the OTC group represented to hospital with recurrent biliary symptoms. In contrast, four of the patients allocated to surgery alone represented with symptoms suggestive of CBD obstruction; all settled with conservative treatment and the difference in readmission rate was not significant (P = 0•122). Conclusion: Routine cholangiography in patients with a low risk for CBD stones does not seem justified from the results of this trial. Registration number: NCT00806780 (http://www.clinicaltrials.gov).

Annals of Surgery, Mar 1, 2011

The Spine Journal, Jul 1, 2011

AIM: To evaluate the pelvic incidence (PI) of coccydynia patients treated by different methods an... more AIM: To evaluate the pelvic incidence (PI) of coccydynia patients treated by different methods and to determine whether it is a risk factor or a prognostic factor. MATERIAL and METHODS: Patients who were treated for coccydynia were evaluated retrospectively, and 110 patients were enrolled. Spinopelvic parameters were measured by using Surgimap software, and the position of the coccyx was evaluated according to the Postacchini classification. The results were compared to spinopelvic parameters of healthy population. RESULTS: The mean PI of the coccydynia patients did not differ from the healthy population, and there were no differences between treatment subgroups. The Postacchini classification showed that patients with type-3 and type-4 configurations had higher PI. When treatment groups were evaluated according to Postacchini classification, 80% of the surgery group had type-3 and type-4 configurations (50%, 30% respectively). CONCLUSION: This is the first study to evaluate the PI of coccydynia patients. Patients with higher PI were prone to having type-3 of type-4 coccyx configurations and undergoing surgical treatment.

Gut, Apr 13, 2011

Omega (u)-3 polyunsaturated fatty acids (PUFAs) are naturally occurring substances that are well ... more Omega (u)-3 polyunsaturated fatty acids (PUFAs) are naturally occurring substances that are well tolerated and have been used extensively for the prevention of cardiovascular disease. More recently, u-3 PUFAs have been recognised to have anticancer activity. There is also evidence suggesting improved efficacy and/or tolerability of conventional cancer chemotherapy when administered with u-3 PUFAs. The purpose of this review is to (i) describe the mechanisms by which u-3 PUFAs are thought to have antineoplastic activity, (ii) review published preclinical and clinical studies that support anti-colorectal cancer activity and (iii) summarise current clinical trials investigating the potential therapeutic role(s) of u-3 PUFAs at different stages of colorectal carcinogenesis, from adenoma (polyp) prevention to treatment of established malignant disease and prevention of cancer recurrence.

Gut, May 28, 2012

Conclusion While the presence of infected necrosis or persistent organ failure in SAP (group III)... more Conclusion While the presence of infected necrosis or persistent organ failure in SAP (group III) is associated with high mortality, the combination of "infected necrosis and persistent organ failure" (group IV) is uniformly fatal. Further research is necessary to confirm the findings in our study and to explore ways of optimising patients in group III to improve survival.

Transplantation Proceedings, Dec 1, 2010

Donation after cardiac death (DCD) donors provide a valuable source of grafts for renal transplan... more Donation after cardiac death (DCD) donors provide a valuable source of grafts for renal transplantation. They are exposed to an initial warm ischemic insult, which can affect early function. We sought to compare our initial DCD experience in renal transplantation with a case-matched donation after brain death (DBD) cohort from the same period. We included all DCD transplantations in the first 5 years of the program. A control DBD group was matched with a variety of donor and recipient factors. We demonstrated a significantly increased early dysfunction (DGF and primary nonfunction). DCD graft function was poorer than the DBD equivalent at 1-and 3-years. However, medium-term recipient and graft outcomes were comparable. DCD grafts continue to play a vital role in renal transplantation despite evidence of early graft dysfunction.

Journal of Chromatography B, Jun 1, 2017

Transplantation, Jul 1, 2010

European Surgery, 2015

Long-term follow-up of patients diagnosed with nonspecific abdominal pain (NSAP) 1 1 3 Summary Ba... more Long-term follow-up of patients diagnosed with nonspecific abdominal pain (NSAP) 1 1 3 Summary Background Nonspecific abdominal pain (NSAP) accounts for 40 % of all general surgical admissions. Data suggest that conditions such as irritable bowel syndrome and gynaecological pathologies can be misdiagnosed as NSAP. Delayed diagnosis and management can cause increased morbidity. Our aim was to follow-up a cohort of patients with an initial diagnosis of NSAP to determine their eventual diagnosis. Method Hospital episode statistic (HES) data were reviewed to identify 100 acute surgical admissions coded as NSAP at discharge between January and December 2008. Medical records were systematically reviewed over a 3-year follow-up period to identify further investigations, operations and any eventual diagnoses in patients who fulfilled NSAP criteria. General practitioners were contacted to evaluate any further GP surgery visits and hospital referrals for this cohort of patients. Results A total of 59 were incorrectly coded as NSAP; only 41 fulfilled the criteria of NSAP at discharge from the initial acute admission. The majority of patients correctly diagnosed as NSAP were female (71 %) individuals. Median age across both genders was 25.7 years (interquartile range 19.4-37.7 years). At three yearly followup, 54 % of patients appropriately labelled as NSAP were diagnosed with a specific pathology. Conclusion This study highlights that around half of patients correctly labelled with NSAP were subsequently diagnosed with a specific pathology. Our results suggest that patients diagnosed with NSAP should be followed up to avoid additional morbidity from misdiagnosis. Furthermore, the current coding system for NSAP needs to be modified.

British Journal of Surgery, 2016

BackgroundThe optimal timing of cholecystectomy for patients admitted with acute gallbladder path... more BackgroundThe optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a ‘delayed’ operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease.MethodsUsing data from a prospective population-based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost–utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impac...

The American Surgeon, 2020

Background Enhanced recovery protocols after esophagectomy aim to discharge patients by day 7. A ... more Background Enhanced recovery protocols after esophagectomy aim to discharge patients by day 7. A small risk of delayed complications exists. We aimed to assess whether C-reactive protein (CRP) levels on day 7 could help predict delayed complications and assist safe discharge. Methods All consecutive esophagectomies over 3 years were retrospectively reviewed. Patients were categorized on day 7 into (1) those clinically unsafe for discharge; (2) those clinically safe for discharge; and (3) those considered safe for discharge but develop a delayed complication. CRP level on day 7 and the trend in CRP levels between days 3 and 7 were compared. Results A total of 140 patients underwent esophagectomy, of which 64 patients (46%) had at least one complication. On day 7, 62 (44%) patients were considered clinically unsafe for discharge; 74 (53%) were considered safe for discharge; and 4 (3%) were safe but developed a delayed complication. No patient with delayed complication had a day 7 CRP ...

Bulletin of The Royal College of Surgeons of England, 2011

Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for... more Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for patients presenting with acute cholecystitis as supported by a recent meta-analysis 1 and Cochrane review. 2 Although the benefit of ALC is less clear in patients with biliary colic,few would disagree that earlier cholecystectomy is preferable for most patients with symptomatic gallstone disease. 3 ALC has similar complication rates to elective laparoscopic cholecystectomy (ELC) and a reduced total length of hospital stay. 1,2,4-6 Recurrent symptoms from untreated gallstone disease are common, with the risk of developing more severe complications such as acute cholecystitis, acute pancreatitis or cholangitis while waiting for an operation. 7 It has been reported that patients awaiting ELC after an acute admission have significantly more general practitioner (GP) attendances than those who receive ALC, 8 that they have an average of one emergency department attendance for symptom recurrence 9 and that one in six requires hospital admission due to the severity of recurrent symptoms. 10

Gut, 2022

Data from experimental studies have demonstrated that marine omega-3 polyunsaturated fatty acids ... more Data from experimental studies have demonstrated that marine omega-3 polyunsaturated fatty acids (O3FAs) have anti-inflammatory and anticancer properties. In the last decade, large-scale randomised controlled trials of pharmacological delivery of O3FAs and prospective cohort studies of dietary O3FA intake have continued to investigate the relationship between O3FA intake and colorectal cancer (CRC) risk and mortality. Clinical data suggest that O3FAs have differential anti-CRC activity depending on several host factors (including pretreatment blood O3FA level, ethnicity and systemic inflammatory response) and tumour characteristics (including location in the colorectum, histological phenotype (eg, conventional adenoma or serrated polyp) and molecular features (eg, microsatellite instability, cyclooxygenase expression)). Recent data also highlight the need for further investigation of the effect of O3FAs on the gut microbiota as a possible anti-CRC mechanism, when used either alone o...

Surgical Endoscopy, 2018

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy wou... more Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consi...

HPB, 2016

Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the ... more Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice. Patients and methods: Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach. Results: Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p < 0.001), indication for surgery (p < 0.001), ASA (p < 0.001), thickwalled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p < 0.001), and a score >6 identified patients at high risk of conversion (7.1% vs. 1.2%). Conclusion: This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy.

Annals of Surgery, Feb 1, 2016

Purpose: Radical cystectomy is inherently associated with morbidity. We assess the timing and inc... more Purpose: Radical cystectomy is inherently associated with morbidity. We assess the timing and incidence of venous thromboembolism, review current guideline recommendations and provide evidence for considering extended venous thromboembolism prophylaxis in all patients undergoing radical cystectomy. Materials and Methods: We searched PubMedÒ for available literature on radical cystectomy and venous thromboembolism, focusing on incidence and timing, evidence supporting extended venous thromboembolism prophylaxis in patients undergoing radical cystectomy or abdominal oncologic surgery, current guideline recommendations, safety considerations and direct oral anticoagulants. Search terms included "radical cystectomy," "venous thromboembolism," "prophylaxis," and "extended oral anticoagulants" and "direct oral anticoagulants" alone and in combination. Relevant articles were reviewed, including original research, reviews and clinical guidelines. References from review articles and guidelines were also assessed to develop a narrative review. Results: The incidence of symptomatic venous thromboembolism in short-term followup after radical cystectomy is 3% to 11.6%, of which more than 50% of cases will occur after hospital discharge. Meta-analyses of clinical trials in patients undergoing major abdominal oncologic operations suggest a decreased risk of venous thromboembolisms for patients receiving extended (4 weeks) venous thromboembolism prophylaxis. Extended prophylaxis should be considered for all radical cystectomy patients. Although the relative risk of bleeding also increases, the overall net benefit of extended prophylaxis clearly favors use for at least 28 days postoperatively. Extrarenal eliminated prophylaxis agents are preferred given the risk of renal insufficiency in radical cystectomy patients, with newer oral anticoagulants providing an alternative route of administration. Conclusions: Patients undergoing radical cystectomy are at high risk for venous thromboembolism after hospital discharge. There is strong evidence that

The journal of bone and joint surgery, Mar 1, 2009

Failure of fixation is a common problem in the treatment of osteoporotic fractures around the hip... more Failure of fixation is a common problem in the treatment of osteoporotic fractures around the hip. The reinforcement of bone stock or of fixation of the implant may be a solution. Our study assesses the existing evidence for the use of bone substitutes in the management of these fractures in osteoporotic patients. Relevant publications were retrieved through Medline research and further scrutinised. Of 411 studies identified, 22 met the inclusion criteria, comprising 12 experimental and ten clinical reports. The clinical studies were evaluated with regard to their level of evidence. Only four were prospective and randomised. Polymethylmethacrylate and calcium-phosphate cements increased the primary stability of the implant-bone construct in all experimental and clinical studies, although there was considerable variation in the design of the studies. In randomised, controlled studies, augmentation of intracapsular fractures of the neck of the femur with calcium-phosphate cement was associated with poor long-term results. There was a lack of data on the longterm outcome for trochanteric fractures. Because there were only a few, randomised, controlled studies, there is currently poor evidence for the use of bone cement in the treatment of fractures of the hip.

Transplantation Proceedings, Dec 1, 2010

Introduction. Postoperative infection (POI) prolongs inpatient stay, delays return to normal acti... more Introduction. Postoperative infection (POI) prolongs inpatient stay, delays return to normal activity, and may be detrimental to long-term survival after cancer resections. This study sought to identify the impact of postoperative infection on liver transplantation outcomes. Methods. We analyzed our prospective database of 910 adult patients who underwent liver transplantation between 2000 and 2010 in a single UK center. POI was defined as pyrexia plus positive cultures from blood, sputum, urine, wound, or ascitic fluid. Patient demographic features and perioperative variables were analyzed for their effects on POI. The impacts of POI on overall survival (OS) and graft survival were analyzed using Kaplan-Meier curves with log-rank tests for significance, before entry into a multivariate regression analysis. We analyzed the effects of POI on the length of hospital stay (LOS) and the incidence of acute rejection episodes and readmissions within 1 year as secondary outcomes. Results. Patients who developed a postoperative chest or wound infection showed poorer OS at a mean of 7.0 versus 8.8 years (P ϭ .009) and 7.0 versus 8.8 years (P ϭ .003), respectively. Infection in blood, ascitic fluid, or urine showed no significant impact on survival. LOS was significantly increased among patients with a wound (median 21 vs 17 days, P ϭ .011), a sputum (median 24 vs 17 days, P Ͻ .001), or a blood infection (median 32 vs 17 days, P Ͻ .001). Higher rates of intraoperative blood transfusion were observed among subjects who developed a chest or a wound infection. There was no difference in other variables between those who did versus did not develop an infection. Upon multivariate analysis, wound infection was the strongest independent predictor of OS (P ϭ .007). Conclusion. We demonstrated that wound or chest infections were associated with poorer OS. More aggressive prophylactic and/or therapeutic interventions targeting specific sites of infection may represent a simple and cost-effective measure to reduce hospital stay and improve OS.

Hpb, Apr 1, 2016

Methods: Eighty-one patients underwent surgery for HCC on normal liver between 1967 and 2010 at o... more Methods: Eighty-one patients underwent surgery for HCC on normal liver between 1967 and 2010 at our center. An uni and multivariate analysis have been realized in order to identify clinical, biological and pathological factors that could predict the 5 and 10 years disease-free survival (DFS). Results: Median tumour size was 10 AE 5,3 cm, median alpha fetoprotein (mg/L) was 9,5 (1-1138070). Sixty-three patients (77%) had a single tumour and macrovascular invasion was present in 18% of the patients. Chemoembolisation was used as a first-line treatment in 37% of the cases. 90-days mortality was 1%. Thirty-one patients (38%) had an adjuvant treatment. Median follow-up was 58 AE 74,4 months, 5e10 years DFS was 51% and 41% respectively. Micro and macrovascular invasion were the only recurrence predictive factors (OR 3.4 95%IC 1,53e5,88; p = 0,001). Five patients (6%) had a recurrence after 5 years. No positive predictive factors have been identified in patients who had a follow-up of more than 10 years. Conclusions: Micro and macrovascular invasion are the only recurrence predictive factors. Post-operative followup should not be stopped after 5 years in patients who underwent resection for HCC on normal liver.

British Journal of Surgery, Apr 1, 2011

Background: A randomized clinical trial was undertaken to assess the utility of routine on-table ... more Background: A randomized clinical trial was undertaken to assess the utility of routine on-table cholangiography (OTC) during laparoscopic cholecystectomy for gallstone disease. Methods: Some 190 patients with a history of biliary colic or cholecystitis and a low predictive risk for choledocholithiasis were randomized to undergo elective laparoscopic cholecystectomy alone (99 patients) or elective laparoscopic cholecystectomy with OTC (91). Intraoperative findings and postoperative outcomes for the two groups were compared. The primary outcome measure was the incidence of common bile duct (CBD) stones. Results: Of the patients undergoing OTC, ten had abnormal cholangiograms; three had CBD stones and seven had abnormalities without stones. OTC was associated with a significantly longer mean(s.e.m.) operating time (66(2) versus 54(3) min; P < 0•001), but there was no association between performance of OTC and postoperative morbidity. During a 1-year follow-up, no patient in the OTC group represented to hospital with recurrent biliary symptoms. In contrast, four of the patients allocated to surgery alone represented with symptoms suggestive of CBD obstruction; all settled with conservative treatment and the difference in readmission rate was not significant (P = 0•122). Conclusion: Routine cholangiography in patients with a low risk for CBD stones does not seem justified from the results of this trial. Registration number: NCT00806780 (http://www.clinicaltrials.gov).

Annals of Surgery, Mar 1, 2011

The Spine Journal, Jul 1, 2011

AIM: To evaluate the pelvic incidence (PI) of coccydynia patients treated by different methods an... more AIM: To evaluate the pelvic incidence (PI) of coccydynia patients treated by different methods and to determine whether it is a risk factor or a prognostic factor. MATERIAL and METHODS: Patients who were treated for coccydynia were evaluated retrospectively, and 110 patients were enrolled. Spinopelvic parameters were measured by using Surgimap software, and the position of the coccyx was evaluated according to the Postacchini classification. The results were compared to spinopelvic parameters of healthy population. RESULTS: The mean PI of the coccydynia patients did not differ from the healthy population, and there were no differences between treatment subgroups. The Postacchini classification showed that patients with type-3 and type-4 configurations had higher PI. When treatment groups were evaluated according to Postacchini classification, 80% of the surgery group had type-3 and type-4 configurations (50%, 30% respectively). CONCLUSION: This is the first study to evaluate the PI of coccydynia patients. Patients with higher PI were prone to having type-3 of type-4 coccyx configurations and undergoing surgical treatment.

Gut, Apr 13, 2011

Omega (u)-3 polyunsaturated fatty acids (PUFAs) are naturally occurring substances that are well ... more Omega (u)-3 polyunsaturated fatty acids (PUFAs) are naturally occurring substances that are well tolerated and have been used extensively for the prevention of cardiovascular disease. More recently, u-3 PUFAs have been recognised to have anticancer activity. There is also evidence suggesting improved efficacy and/or tolerability of conventional cancer chemotherapy when administered with u-3 PUFAs. The purpose of this review is to (i) describe the mechanisms by which u-3 PUFAs are thought to have antineoplastic activity, (ii) review published preclinical and clinical studies that support anti-colorectal cancer activity and (iii) summarise current clinical trials investigating the potential therapeutic role(s) of u-3 PUFAs at different stages of colorectal carcinogenesis, from adenoma (polyp) prevention to treatment of established malignant disease and prevention of cancer recurrence.

Gut, May 28, 2012

Conclusion While the presence of infected necrosis or persistent organ failure in SAP (group III)... more Conclusion While the presence of infected necrosis or persistent organ failure in SAP (group III) is associated with high mortality, the combination of "infected necrosis and persistent organ failure" (group IV) is uniformly fatal. Further research is necessary to confirm the findings in our study and to explore ways of optimising patients in group III to improve survival.

Transplantation Proceedings, Dec 1, 2010

Donation after cardiac death (DCD) donors provide a valuable source of grafts for renal transplan... more Donation after cardiac death (DCD) donors provide a valuable source of grafts for renal transplantation. They are exposed to an initial warm ischemic insult, which can affect early function. We sought to compare our initial DCD experience in renal transplantation with a case-matched donation after brain death (DBD) cohort from the same period. We included all DCD transplantations in the first 5 years of the program. A control DBD group was matched with a variety of donor and recipient factors. We demonstrated a significantly increased early dysfunction (DGF and primary nonfunction). DCD graft function was poorer than the DBD equivalent at 1-and 3-years. However, medium-term recipient and graft outcomes were comparable. DCD grafts continue to play a vital role in renal transplantation despite evidence of early graft dysfunction.

Journal of Chromatography B, Jun 1, 2017

Transplantation, Jul 1, 2010

European Surgery, 2015

Long-term follow-up of patients diagnosed with nonspecific abdominal pain (NSAP) 1 1 3 Summary Ba... more Long-term follow-up of patients diagnosed with nonspecific abdominal pain (NSAP) 1 1 3 Summary Background Nonspecific abdominal pain (NSAP) accounts for 40 % of all general surgical admissions. Data suggest that conditions such as irritable bowel syndrome and gynaecological pathologies can be misdiagnosed as NSAP. Delayed diagnosis and management can cause increased morbidity. Our aim was to follow-up a cohort of patients with an initial diagnosis of NSAP to determine their eventual diagnosis. Method Hospital episode statistic (HES) data were reviewed to identify 100 acute surgical admissions coded as NSAP at discharge between January and December 2008. Medical records were systematically reviewed over a 3-year follow-up period to identify further investigations, operations and any eventual diagnoses in patients who fulfilled NSAP criteria. General practitioners were contacted to evaluate any further GP surgery visits and hospital referrals for this cohort of patients. Results A total of 59 were incorrectly coded as NSAP; only 41 fulfilled the criteria of NSAP at discharge from the initial acute admission. The majority of patients correctly diagnosed as NSAP were female (71 %) individuals. Median age across both genders was 25.7 years (interquartile range 19.4-37.7 years). At three yearly followup, 54 % of patients appropriately labelled as NSAP were diagnosed with a specific pathology. Conclusion This study highlights that around half of patients correctly labelled with NSAP were subsequently diagnosed with a specific pathology. Our results suggest that patients diagnosed with NSAP should be followed up to avoid additional morbidity from misdiagnosis. Furthermore, the current coding system for NSAP needs to be modified.

British Journal of Surgery, 2016

BackgroundThe optimal timing of cholecystectomy for patients admitted with acute gallbladder path... more BackgroundThe optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a ‘delayed’ operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease.MethodsUsing data from a prospective population-based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost–utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impac...

The American Surgeon, 2020

Background Enhanced recovery protocols after esophagectomy aim to discharge patients by day 7. A ... more Background Enhanced recovery protocols after esophagectomy aim to discharge patients by day 7. A small risk of delayed complications exists. We aimed to assess whether C-reactive protein (CRP) levels on day 7 could help predict delayed complications and assist safe discharge. Methods All consecutive esophagectomies over 3 years were retrospectively reviewed. Patients were categorized on day 7 into (1) those clinically unsafe for discharge; (2) those clinically safe for discharge; and (3) those considered safe for discharge but develop a delayed complication. CRP level on day 7 and the trend in CRP levels between days 3 and 7 were compared. Results A total of 140 patients underwent esophagectomy, of which 64 patients (46%) had at least one complication. On day 7, 62 (44%) patients were considered clinically unsafe for discharge; 74 (53%) were considered safe for discharge; and 4 (3%) were safe but developed a delayed complication. No patient with delayed complication had a day 7 CRP ...

Bulletin of The Royal College of Surgeons of England, 2011

Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for... more Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for patients presenting with acute cholecystitis as supported by a recent meta-analysis 1 and Cochrane review. 2 Although the benefit of ALC is less clear in patients with biliary colic,few would disagree that earlier cholecystectomy is preferable for most patients with symptomatic gallstone disease. 3 ALC has similar complication rates to elective laparoscopic cholecystectomy (ELC) and a reduced total length of hospital stay. 1,2,4-6 Recurrent symptoms from untreated gallstone disease are common, with the risk of developing more severe complications such as acute cholecystitis, acute pancreatitis or cholangitis while waiting for an operation. 7 It has been reported that patients awaiting ELC after an acute admission have significantly more general practitioner (GP) attendances than those who receive ALC, 8 that they have an average of one emergency department attendance for symptom recurrence 9 and that one in six requires hospital admission due to the severity of recurrent symptoms. 10

Gut, 2022

Data from experimental studies have demonstrated that marine omega-3 polyunsaturated fatty acids ... more Data from experimental studies have demonstrated that marine omega-3 polyunsaturated fatty acids (O3FAs) have anti-inflammatory and anticancer properties. In the last decade, large-scale randomised controlled trials of pharmacological delivery of O3FAs and prospective cohort studies of dietary O3FA intake have continued to investigate the relationship between O3FA intake and colorectal cancer (CRC) risk and mortality. Clinical data suggest that O3FAs have differential anti-CRC activity depending on several host factors (including pretreatment blood O3FA level, ethnicity and systemic inflammatory response) and tumour characteristics (including location in the colorectum, histological phenotype (eg, conventional adenoma or serrated polyp) and molecular features (eg, microsatellite instability, cyclooxygenase expression)). Recent data also highlight the need for further investigation of the effect of O3FAs on the gut microbiota as a possible anti-CRC mechanism, when used either alone o...

Surgical Endoscopy, 2018

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy wou... more Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consi...

HPB, 2016

Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the ... more Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice. Patients and methods: Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach. Results: Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p < 0.001), indication for surgery (p < 0.001), ASA (p < 0.001), thickwalled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p < 0.001), and a score >6 identified patients at high risk of conversion (7.1% vs. 1.2%). Conclusion: This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy.