Aisling Hogan | UCD Ireland (original) (raw)

Papers by Aisling Hogan

Research paper thumbnail of Covid 19 and Surgical training: Carpe Diem

British Journal of Surgery, Sep 14, 2020

Editor We read with interest recent articles on cancellation of elective surgery during the pande... more Editor We read with interest recent articles on cancellation of elective surgery during the pandemic1-3. This has greatly impacted surgical training. Irish trainees were surveyed on their experience of the COVID-19 era in an attempt to navigate the ‘new normal’ in surgery and to explore potential learning and personal opportunities. A survey was distributed to all surgical trainees in the Republic of Ireland (n = 340). Response rate was only 29% (n = 98). Of these, 44% (n = 43) were Core Surgical Trainees (CST) and the remainder (46%) were on the Higher Surgical Training (HST) pathway. Respondents were from 22 training sites and 8 specialties. As

Research paper thumbnail of A Twist in the Tale

Journal of Gastrointestinal Surgery, Apr 26, 2017

Research paper thumbnail of Management of the acute appendix mass: a survey of surgical practice

PubMed, Oct 1, 2012

Management of the appendix mass is controversial with no consensus in the literature. Traditional... more Management of the appendix mass is controversial with no consensus in the literature. Traditionally, the approach has been conservative followed by interval appendicectomy. A survey was distributed to 117 surgeons (100 consultants and 17 final year specialist registrars) to determine how the appendix mass is currently treated in Ireland. In total, 70 surgeons responded. 51 (73%) adopt a conservative approach initially. 48 (68%) favoured interval appendicectomy at six weeks after a period of successful conservative management. 34 (49%) gave risk of recurrence as the reason for performing interval appendicectomy and 16 (22%) would perform interval appendicectomy in order to obtain histological analysis to outrule caecal or appendiceal neoplasm. 44 (63%) opted for a laparoscopic rather than an open approach for interval appendicectomy. No consensus exists in Ireland for management of the appendix mass presenting acutely. The present series demonstrates a trend towards conservative approach initially followed by interval appendicectomy.

Research paper thumbnail of Day of surgery admission for the elective surgical in-patient: successful implementation of the Elective Surgery Programme

Irish Journal of Medical Science, Sep 11, 2012

Background & Aims: The aim of this prospective cross-sectional study was to determine the impact ... more Background & Aims: The aim of this prospective cross-sectional study was to determine the impact of 1) Ring fencing in-patient general surgical beds and 2) Introducing a pre-operative assessment clinic (PAC) on the Day of Surgery Admission rate (DOSA) in a single Irish institution. The secondary aim was to analyse the impact of an increased rate of DOSA on cost efficiency and patient satisfaction. Methods: An 18 month period was examined following ring-fencing of elective and emergency surgical beds. A PAC was established during the study period. Prospectively collected data pertaining to all surgical admissions was retrieved using patient administration system software (Powerterm Pro, Eircom Software) and a database of performance information from Irish Public Health Services (HealthStat). Results: Ring-fencing and PAC establishment was associated with a significant increase in the overall DOSA rate from 56% to 85%, surpassing the national target rate of DOSA (75%). Data relating specifically to General Surgery admissions mirrored this increase in DOSA rate from a median of 5 patients per month, before the advent of ring-fencing and PAC, to 42 patients per month (p<0.0387). 100 patient surveys demonstrated high levels of satisfaction with DOSA, with a preference compared to admission one night pre-operatively. Cost analysis demonstrated overall savings of 340,370 Euro from this change in practice. Conclusion: The present study supports the practice of DOSA through the introduction of ring fenced surgical beds and PAC. This has been shown to improve hospital resource utilisation and streamline surgical service provision in these economically challenging times.

Research paper thumbnail of CO2 embolus: an important complication of TaTME surgery

Techniques in Coloproctology, Dec 7, 2016

Research paper thumbnail of Evaluating the Surgical Management of Appendiceal Neoplasms Diagnosed following Appendicectomy

Research paper thumbnail of Pregnancy after laparoscopic ventral mesh rectopexy: implications and outcomes

Colorectal Disease, Sep 1, 2017

Surgical management of rectal prolapse varies considerably. Most surgeons are reluctant to use ve... more Surgical management of rectal prolapse varies considerably. Most surgeons are reluctant to use ventral mesh rectopexy in young women until they have completed their family. The aim of the present study was to review outcomes of pregnancy following laparoscopic ventral mesh rectopexy (LVMR) from a tertiary referral centre over a 10 year period (2006-2016) and to review the impact on pelvic floor symptoms. Method We undertook a retrospective review of a prospectively compiled database of patients who had undergone laparoscopic ventral rectopexy in a single centre over a 10 years period. Pelvic floor symptom scores (Vaizey for incontinence and Longo for Obstructive defaecation) were collected at initial presentation (pre-intervention), post-intervention and after child birth. Results 954 rectopexies were performed over this 10 year period. 225 (24%) patients were female and under 45 years of age (taken as arbitrary cutoff for decreased likelihood of pregnancy) Eight (4%) of these patients became pregnant following rectopexy. The interval between rectopexy and delivery was 42 months (21-50). Six patients delivered live babies by elective Lower Segment Caesarean Section (LSCS) and two by spontaneous vaginal delivery. Six were first babies and two were second. No mesh related adverse outcome was reported. No difference in pelvic floor symptoms was demonstrated on comparison of post-rectopexy and post-delivery scores. Conclusion This study provides the first description in the English Language literature of safe delivery by elective LSCS or SVD following laparoscopic ventral mesh rectopexy. No adverse impact on pelvic floor related quality of life was detected.

Research paper thumbnail of 1444 Targeting sialic acid on stromal cells reverses T cell suppression in the colorectal tumour microenvironment a new tumour stromal cell immune checkpoint

Regular and Young Investigator Award Abstracts, Nov 1, 2022

Ci and Di) one-way ANOVA with a Tukey post hoc test and (Cii, Ciii, Dii and Diii) a ratio paired ... more Ci and Di) one-way ANOVA with a Tukey post hoc test and (Cii, Ciii, Dii and Diii) a ratio paired t test. n = 3-4 biological replicates Abstract 1444 Figure 3 TCS-conditioned stromal cells inhibit T cell activation and cytotoxicity in vivo and these effects can be reversed by targeting stromal cell sialylation. 8-12 week old female Balb/c mice were injected subcutaneously with 5x105 CT26 colon cancer cells with or without 1.5x105 TCS MSCs or Siayltransferase inhibited TCS MSCs (SI-TCS) where indicated. 13 days post-injection, tumours, draining lymph nodes and spleens were harvested and analysed for the presence of specific immune cell markers by flow cytometry. Tumour conditioned stromal cells suppress T cell activation in the tumour, spleen and draining lymph node, as determined by CD4/CD8 CD25 expression, which is reversed by targeting stromal cell siaylation. Granzyme B expressing cytotoxic T cells are suppressed by stromal cells in the TME. The stromal mediated immunosuppressive effects on cytotoxic CD8 T cells are restored in the draining lymph and spleenand partially restored in the tumour. Data are mean ± SD; *p < 0.05, **p< 0.01, ***p< 0.001 and ****p, 0.0001 using one-way ANOVA with a Tukey post hoc test. n = 4-5 biological replicates.

Research paper thumbnail of AB182. SOH21AS207. Jejunal ischemia secondary to COVID-19 in an Irish male: case report

Mesentery and peritoneum, Apr 1, 2021

Background: Coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus ... more Background: Coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly transmittable virus that has recently emerged in Wuhan, China before rapidly spreading worldwide. Due to the lack of prior immunity, COVID-19 pandemic has been associated with a high morbidity and mortality worldwide. The main target were the lungs occasionally manifesting as acute respiratory failure. Multiple organ dysfunction was also reported in reverse transcription polymerase chain reaction (RT-PCR) positive COVID-19 patients. Despite ongoing research, information is still significantly lacking. Methods: In this case report, we will discuss a 74-year-old Irish male who tested RT-PCR covid-19 positive on hospital admission requiring a prolonged rocky intensive care unit (ICU) admission for 2 months due to acute respiratory distress syndrome (ARDS). Whilst in the intensive care unit (ICU), jejunal ischemia was diagnosed both clinically and was confirmed by computerised topography Angiography (CTA). A conservative approach was used in light of the COVID-19 diagnosis, existing comorbidities and ongoing global pandemic. This 74-year-old had a successful recovery and was discharged. Results: Approximately 3 months later, he presented again to the Accident and emergency department with overwhelming diffuse peritonitis. Emergency laparotomy revealed a perforated jejunum 50 cm from the duodenojejunal flexure. Segmental resection was performed with the formation of a double barrel stoma. Conclusions: This case report highlights the importance of early recognition of thromboembolic disorders in COVID-19 patients. It also emphasises the crucial role of early operative measures in improving patient's survival.

Research paper thumbnail of Primary omental infarction: a rare cause of acute abdominal pain

Clinical and Experimental Medical Sciences, 2013

Omental infarction is an uncommon but important cause of acute abdominal pain, which frequently m... more Omental infarction is an uncommon but important cause of acute abdominal pain, which frequently mimics other surgical presentations. The current series describes five cases of idiopathic omental torsion and infarction and provides a review of the literature. We discuss the diagnosis of primary omental infarction as well as the role of conservative and surgical management.

Research paper thumbnail of Does Practice Make Perfect?

Annals of Surgical Oncology, Jan 29, 2008

Extensive literature supports the correlation between surgical volume and improved clinical outco... more Extensive literature supports the correlation between surgical volume and improved clinical outcome in the management of various cancers. It is this evidence that has catalysed the creation of centres of excellence. However, on closer inspection, many of these studies are poor quality, low weight and use vastly heterogenous end points in assessment of both volume and outcome. We critically appraise the English language literature published over the last ten years pertaining to the volume outcome relationship in the context of cancer care. Future balanced unbiased studies may enable equipoise in planning international cancer management strategies.

Research paper thumbnail of Targeting stromal cell sialylation reverses T cell-mediated immunosuppression in the tumor microenvironment

Research paper thumbnail of General Surgery

Research paper thumbnail of Validation of the OAKS prognostic model for acute kidney injury after gastrointestinal surgery

BJS Open, 2022

BackgroundPostoperative acute kidney injury (AKI) is a common complication of major gastrointesti... more BackgroundPostoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two multicentre cohort studies.MethodsThe Outcomes After Kidney injury in Surgery (OAKS) prognostic model was developed to predict risk of AKI in the 7 days after surgery using six routine datapoints (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Validation was performed within two independent cohorts: a prospective multicentre, international study (‘IMAGINE’) of patients undergoing elective colorectal surgery (2018); and a retrospective regional cohort study (‘Tayside’) in major abdominal surg...

Research paper thumbnail of Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Anaesthesia, 2021

SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...

Research paper thumbnail of Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic

British Journal of Surgery, 2021

Background This study aimed to determine the impact of pulmonary complications on death after sur... more Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery be...

Research paper thumbnail of SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

Research paper thumbnail of 865 Sugar high: Does the sialic acid profile of cancer-associated fibroblasts induce a more tumour-permissive microenvironment?

Journal for ImmunoTherapy of Cancer, 2020

BackgroundImmunosuppressive tumour microenvironments (TME) inhibit the effectiveness of cancer im... more BackgroundImmunosuppressive tumour microenvironments (TME) inhibit the effectiveness of cancer immunotherapies. Sialic acids, which exist as terminal sugars of glyco-conjugates, are highly expressed on cancer cells and are involved in various pathological processes including increased immune evasion, tumour invasiveness and tumour cell metastasis.1 Siglecs (Sialic acid-binding immunoglobulin-type lectins) are expressed on immune cell surfaces and bind sialic acid. Siglec binding to hypersialylated tumour glycans blocks immune cell activation to promote immunosuppression.1 2Intestinal stromal cells (iSCs), precursors to cancer-associated fibroblasts (CAFs), are a key component of the TME and play a vital role in tumour progression by enhancing a tumour-promoting microenvironment. The aim of this study was therefore to investigate if iSC/CAF sialylation contributes to enhanced immunosuppression in the TME.Methods iSCs were isolated from colorectal cancer patient biopsies and cultured ...

Research paper thumbnail of Potential impact of text message reminders on non-attendance at outpatient clinics

Irish Journal of Medical Science, Jul 25, 2008

Background Non-attendance at outpatient clinic leads to significant time wasting and inefficient ... more Background Non-attendance at outpatient clinic leads to significant time wasting and inefficient use of resources. Aims To establish the magnitude of the problem of clinic non-attendance and to ascertain the potential impact of a simple strategy to reduce inefficiency in Irish healthcare. Methods The number of patients due to attend general surgical clinic in a single year was ascertained. Telephone questionnaire of 97 patients who failed to attend was performed. A survey of potential impact of text message reminder was conducted. Results Appointments were sent to 18,362 patients. Of these, 31% (n = 5692) were new to clinic. The rate of nonattendance was 16.8% (n = 3085). Varied reasons were given for non-attendance. Text message reminder would encourage 51% of those surveyed to attend or cancel in advance. Conclusion The rate of non-attendance is 17%. A reminder would eradicate more than half of non-attendance, allowing significantly more new patients to be seen, translating to more efficient use of clinic time.

Research paper thumbnail of Increased complexity of post-laparoscopic cholecystectomy bile duct injuries: 22 years experience from a national referral centre in Ireland

Hpb, Apr 1, 2016

Conclusions: In summary, we were able to demonstrate that ISS is accompanied by dynamic changes i... more Conclusions: In summary, we were able to demonstrate that ISS is accompanied by dynamic changes in gene expression. These changes can be used as prognostic biomarkers as well as to identify clinical complications in early stages, potentially allowing early clinical interventions.

Research paper thumbnail of Covid 19 and Surgical training: Carpe Diem

British Journal of Surgery, Sep 14, 2020

Editor We read with interest recent articles on cancellation of elective surgery during the pande... more Editor We read with interest recent articles on cancellation of elective surgery during the pandemic1-3. This has greatly impacted surgical training. Irish trainees were surveyed on their experience of the COVID-19 era in an attempt to navigate the ‘new normal’ in surgery and to explore potential learning and personal opportunities. A survey was distributed to all surgical trainees in the Republic of Ireland (n = 340). Response rate was only 29% (n = 98). Of these, 44% (n = 43) were Core Surgical Trainees (CST) and the remainder (46%) were on the Higher Surgical Training (HST) pathway. Respondents were from 22 training sites and 8 specialties. As

Research paper thumbnail of A Twist in the Tale

Journal of Gastrointestinal Surgery, Apr 26, 2017

Research paper thumbnail of Management of the acute appendix mass: a survey of surgical practice

PubMed, Oct 1, 2012

Management of the appendix mass is controversial with no consensus in the literature. Traditional... more Management of the appendix mass is controversial with no consensus in the literature. Traditionally, the approach has been conservative followed by interval appendicectomy. A survey was distributed to 117 surgeons (100 consultants and 17 final year specialist registrars) to determine how the appendix mass is currently treated in Ireland. In total, 70 surgeons responded. 51 (73%) adopt a conservative approach initially. 48 (68%) favoured interval appendicectomy at six weeks after a period of successful conservative management. 34 (49%) gave risk of recurrence as the reason for performing interval appendicectomy and 16 (22%) would perform interval appendicectomy in order to obtain histological analysis to outrule caecal or appendiceal neoplasm. 44 (63%) opted for a laparoscopic rather than an open approach for interval appendicectomy. No consensus exists in Ireland for management of the appendix mass presenting acutely. The present series demonstrates a trend towards conservative approach initially followed by interval appendicectomy.

Research paper thumbnail of Day of surgery admission for the elective surgical in-patient: successful implementation of the Elective Surgery Programme

Irish Journal of Medical Science, Sep 11, 2012

Background & Aims: The aim of this prospective cross-sectional study was to determine the impact ... more Background & Aims: The aim of this prospective cross-sectional study was to determine the impact of 1) Ring fencing in-patient general surgical beds and 2) Introducing a pre-operative assessment clinic (PAC) on the Day of Surgery Admission rate (DOSA) in a single Irish institution. The secondary aim was to analyse the impact of an increased rate of DOSA on cost efficiency and patient satisfaction. Methods: An 18 month period was examined following ring-fencing of elective and emergency surgical beds. A PAC was established during the study period. Prospectively collected data pertaining to all surgical admissions was retrieved using patient administration system software (Powerterm Pro, Eircom Software) and a database of performance information from Irish Public Health Services (HealthStat). Results: Ring-fencing and PAC establishment was associated with a significant increase in the overall DOSA rate from 56% to 85%, surpassing the national target rate of DOSA (75%). Data relating specifically to General Surgery admissions mirrored this increase in DOSA rate from a median of 5 patients per month, before the advent of ring-fencing and PAC, to 42 patients per month (p<0.0387). 100 patient surveys demonstrated high levels of satisfaction with DOSA, with a preference compared to admission one night pre-operatively. Cost analysis demonstrated overall savings of 340,370 Euro from this change in practice. Conclusion: The present study supports the practice of DOSA through the introduction of ring fenced surgical beds and PAC. This has been shown to improve hospital resource utilisation and streamline surgical service provision in these economically challenging times.

Research paper thumbnail of CO2 embolus: an important complication of TaTME surgery

Techniques in Coloproctology, Dec 7, 2016

Research paper thumbnail of Evaluating the Surgical Management of Appendiceal Neoplasms Diagnosed following Appendicectomy

Research paper thumbnail of Pregnancy after laparoscopic ventral mesh rectopexy: implications and outcomes

Colorectal Disease, Sep 1, 2017

Surgical management of rectal prolapse varies considerably. Most surgeons are reluctant to use ve... more Surgical management of rectal prolapse varies considerably. Most surgeons are reluctant to use ventral mesh rectopexy in young women until they have completed their family. The aim of the present study was to review outcomes of pregnancy following laparoscopic ventral mesh rectopexy (LVMR) from a tertiary referral centre over a 10 year period (2006-2016) and to review the impact on pelvic floor symptoms. Method We undertook a retrospective review of a prospectively compiled database of patients who had undergone laparoscopic ventral rectopexy in a single centre over a 10 years period. Pelvic floor symptom scores (Vaizey for incontinence and Longo for Obstructive defaecation) were collected at initial presentation (pre-intervention), post-intervention and after child birth. Results 954 rectopexies were performed over this 10 year period. 225 (24%) patients were female and under 45 years of age (taken as arbitrary cutoff for decreased likelihood of pregnancy) Eight (4%) of these patients became pregnant following rectopexy. The interval between rectopexy and delivery was 42 months (21-50). Six patients delivered live babies by elective Lower Segment Caesarean Section (LSCS) and two by spontaneous vaginal delivery. Six were first babies and two were second. No mesh related adverse outcome was reported. No difference in pelvic floor symptoms was demonstrated on comparison of post-rectopexy and post-delivery scores. Conclusion This study provides the first description in the English Language literature of safe delivery by elective LSCS or SVD following laparoscopic ventral mesh rectopexy. No adverse impact on pelvic floor related quality of life was detected.

Research paper thumbnail of 1444 Targeting sialic acid on stromal cells reverses T cell suppression in the colorectal tumour microenvironment a new tumour stromal cell immune checkpoint

Regular and Young Investigator Award Abstracts, Nov 1, 2022

Ci and Di) one-way ANOVA with a Tukey post hoc test and (Cii, Ciii, Dii and Diii) a ratio paired ... more Ci and Di) one-way ANOVA with a Tukey post hoc test and (Cii, Ciii, Dii and Diii) a ratio paired t test. n = 3-4 biological replicates Abstract 1444 Figure 3 TCS-conditioned stromal cells inhibit T cell activation and cytotoxicity in vivo and these effects can be reversed by targeting stromal cell sialylation. 8-12 week old female Balb/c mice were injected subcutaneously with 5x105 CT26 colon cancer cells with or without 1.5x105 TCS MSCs or Siayltransferase inhibited TCS MSCs (SI-TCS) where indicated. 13 days post-injection, tumours, draining lymph nodes and spleens were harvested and analysed for the presence of specific immune cell markers by flow cytometry. Tumour conditioned stromal cells suppress T cell activation in the tumour, spleen and draining lymph node, as determined by CD4/CD8 CD25 expression, which is reversed by targeting stromal cell siaylation. Granzyme B expressing cytotoxic T cells are suppressed by stromal cells in the TME. The stromal mediated immunosuppressive effects on cytotoxic CD8 T cells are restored in the draining lymph and spleenand partially restored in the tumour. Data are mean ± SD; *p < 0.05, **p< 0.01, ***p< 0.001 and ****p, 0.0001 using one-way ANOVA with a Tukey post hoc test. n = 4-5 biological replicates.

Research paper thumbnail of AB182. SOH21AS207. Jejunal ischemia secondary to COVID-19 in an Irish male: case report

Mesentery and peritoneum, Apr 1, 2021

Background: Coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus ... more Background: Coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly transmittable virus that has recently emerged in Wuhan, China before rapidly spreading worldwide. Due to the lack of prior immunity, COVID-19 pandemic has been associated with a high morbidity and mortality worldwide. The main target were the lungs occasionally manifesting as acute respiratory failure. Multiple organ dysfunction was also reported in reverse transcription polymerase chain reaction (RT-PCR) positive COVID-19 patients. Despite ongoing research, information is still significantly lacking. Methods: In this case report, we will discuss a 74-year-old Irish male who tested RT-PCR covid-19 positive on hospital admission requiring a prolonged rocky intensive care unit (ICU) admission for 2 months due to acute respiratory distress syndrome (ARDS). Whilst in the intensive care unit (ICU), jejunal ischemia was diagnosed both clinically and was confirmed by computerised topography Angiography (CTA). A conservative approach was used in light of the COVID-19 diagnosis, existing comorbidities and ongoing global pandemic. This 74-year-old had a successful recovery and was discharged. Results: Approximately 3 months later, he presented again to the Accident and emergency department with overwhelming diffuse peritonitis. Emergency laparotomy revealed a perforated jejunum 50 cm from the duodenojejunal flexure. Segmental resection was performed with the formation of a double barrel stoma. Conclusions: This case report highlights the importance of early recognition of thromboembolic disorders in COVID-19 patients. It also emphasises the crucial role of early operative measures in improving patient's survival.

Research paper thumbnail of Primary omental infarction: a rare cause of acute abdominal pain

Clinical and Experimental Medical Sciences, 2013

Omental infarction is an uncommon but important cause of acute abdominal pain, which frequently m... more Omental infarction is an uncommon but important cause of acute abdominal pain, which frequently mimics other surgical presentations. The current series describes five cases of idiopathic omental torsion and infarction and provides a review of the literature. We discuss the diagnosis of primary omental infarction as well as the role of conservative and surgical management.

Research paper thumbnail of Does Practice Make Perfect?

Annals of Surgical Oncology, Jan 29, 2008

Extensive literature supports the correlation between surgical volume and improved clinical outco... more Extensive literature supports the correlation between surgical volume and improved clinical outcome in the management of various cancers. It is this evidence that has catalysed the creation of centres of excellence. However, on closer inspection, many of these studies are poor quality, low weight and use vastly heterogenous end points in assessment of both volume and outcome. We critically appraise the English language literature published over the last ten years pertaining to the volume outcome relationship in the context of cancer care. Future balanced unbiased studies may enable equipoise in planning international cancer management strategies.

Research paper thumbnail of Targeting stromal cell sialylation reverses T cell-mediated immunosuppression in the tumor microenvironment

Research paper thumbnail of General Surgery

Research paper thumbnail of Validation of the OAKS prognostic model for acute kidney injury after gastrointestinal surgery

BJS Open, 2022

BackgroundPostoperative acute kidney injury (AKI) is a common complication of major gastrointesti... more BackgroundPostoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two multicentre cohort studies.MethodsThe Outcomes After Kidney injury in Surgery (OAKS) prognostic model was developed to predict risk of AKI in the 7 days after surgery using six routine datapoints (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Validation was performed within two independent cohorts: a prospective multicentre, international study (‘IMAGINE’) of patients undergoing elective colorectal surgery (2018); and a retrospective regional cohort study (‘Tayside’) in major abdominal surg...

Research paper thumbnail of Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Anaesthesia, 2021

SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...

Research paper thumbnail of Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic

British Journal of Surgery, 2021

Background This study aimed to determine the impact of pulmonary complications on death after sur... more Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery be...

Research paper thumbnail of SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

Research paper thumbnail of 865 Sugar high: Does the sialic acid profile of cancer-associated fibroblasts induce a more tumour-permissive microenvironment?

Journal for ImmunoTherapy of Cancer, 2020

BackgroundImmunosuppressive tumour microenvironments (TME) inhibit the effectiveness of cancer im... more BackgroundImmunosuppressive tumour microenvironments (TME) inhibit the effectiveness of cancer immunotherapies. Sialic acids, which exist as terminal sugars of glyco-conjugates, are highly expressed on cancer cells and are involved in various pathological processes including increased immune evasion, tumour invasiveness and tumour cell metastasis.1 Siglecs (Sialic acid-binding immunoglobulin-type lectins) are expressed on immune cell surfaces and bind sialic acid. Siglec binding to hypersialylated tumour glycans blocks immune cell activation to promote immunosuppression.1 2Intestinal stromal cells (iSCs), precursors to cancer-associated fibroblasts (CAFs), are a key component of the TME and play a vital role in tumour progression by enhancing a tumour-promoting microenvironment. The aim of this study was therefore to investigate if iSC/CAF sialylation contributes to enhanced immunosuppression in the TME.Methods iSCs were isolated from colorectal cancer patient biopsies and cultured ...

Research paper thumbnail of Potential impact of text message reminders on non-attendance at outpatient clinics

Irish Journal of Medical Science, Jul 25, 2008

Background Non-attendance at outpatient clinic leads to significant time wasting and inefficient ... more Background Non-attendance at outpatient clinic leads to significant time wasting and inefficient use of resources. Aims To establish the magnitude of the problem of clinic non-attendance and to ascertain the potential impact of a simple strategy to reduce inefficiency in Irish healthcare. Methods The number of patients due to attend general surgical clinic in a single year was ascertained. Telephone questionnaire of 97 patients who failed to attend was performed. A survey of potential impact of text message reminder was conducted. Results Appointments were sent to 18,362 patients. Of these, 31% (n = 5692) were new to clinic. The rate of nonattendance was 16.8% (n = 3085). Varied reasons were given for non-attendance. Text message reminder would encourage 51% of those surveyed to attend or cancel in advance. Conclusion The rate of non-attendance is 17%. A reminder would eradicate more than half of non-attendance, allowing significantly more new patients to be seen, translating to more efficient use of clinic time.

Research paper thumbnail of Increased complexity of post-laparoscopic cholecystectomy bile duct injuries: 22 years experience from a national referral centre in Ireland

Hpb, Apr 1, 2016

Conclusions: In summary, we were able to demonstrate that ISS is accompanied by dynamic changes i... more Conclusions: In summary, we were able to demonstrate that ISS is accompanied by dynamic changes in gene expression. These changes can be used as prognostic biomarkers as well as to identify clinical complications in early stages, potentially allowing early clinical interventions.