bluuebunny/crossref_metadata_2025_split huggingface dataset:
CR27P LAPAROSCOPIC TOTAL COLECTOMY FOR SLOW TRANSIT CONSTIPATION
Authors: Chow C. F. , Brockman S. , Stevenson A. R. , Lumley J. , Stitz R. 
Published: April 2009

Purpose:   Slow transit constipation (STC) is a debilitating condition mainly affecting young women. Total colectomy (TC) is an option for patients with severe symptoms who are unresponsive to conservative measures. Open TC has been the procedure of choice but is associated with long term SBO and ongoing symptoms. It is difficult to determine if these ongoing symptoms are related to gut dysmotility or to post operative adhesions. Laparoscopic TC appears equivalent open TC with the advantage of being able to perform a diagnostic laparoscopy at a later stage to divide or exclude adhesions as a cause of chronic obstructive symptoms or pain.Methods:   All consecutive patients undergoing a laparoscopic TC ± rectopexy for STC from 1991–2007 were reviewed.Results:   84 patients (81 female, 3 male) were included. Average operating time was 188 min, average LOS 8 days. Conversion rate was 1.2%. There were no post op mortalities. Anastomotic leaks occurred in 2.4%, pelvic collections in 2.4%, intra‐abdominal bleeds in 4.7% and 3.5% developed wound infections. Bowel frequency was significantly improved however, 31% had at least 1 episode of obstructive symptoms. Ongoing pain was experienced by 38%. 57% underwent a further procedure a majority of which was a laparoscopy ± division of adhesions.Conclusion:   Lap TC is a feasible and acceptable option for patients with STC with reasonable operating times, low conversion rates and acceptable mortality and morbidity. Bowel frequency is significantly improved however long term chronic pain and SBO are common. Lap TC allows for a minimally invasive laparoscopy to be performed to divide or exclude adhesions as a cause for obstructive symptoms or ongoing pain.
CR28P LIVER FUNCTION TESTS AS A BIOMARKER FOR COLORECTAL ANASTOMOTIC LEAKS
Authors: Cao C. Q. , Smith S. , Draganic B. 
Published: April 2009

Purpose:   Anastomotic leak (AL) from colorectal surgery is a common and potentially fatal complication that is currently diagnosed clinically with the aid of imaging studies. It has been hypothesized that portal sepsis occurs earlier than clinical signs of peritonism. The present study analysed liver function tests (LFTs) and white cell count (WCC) in patients with AL from colorectal procedures involving primary anastomosis, with the aim of identifying serum parameters that could provide an early indication of AL to allow timely surgical intervention.Materials and Methods:   Between November 2003 and December 2008, 1243 consecutive colorectal procedures involving primary anastomosis from our institution were retrospectively screened for AL. LFTs and WCC of the identified patients were extracted from a central database for analysis.Results:   From our database, we found thirty‐four patients who required operative intervention and had confirmed AL according to their operation reports. Elevated levels of GGT above 115 and ALP above 55 were found in 71% and 61% of patients, respectively, prior to clinical anastomotic leakage. WCC appeared to remain on the upper border of the normal range in the majority of patients.Conclusion:   Elevated median levels of GGT and ALP in this group of patients after the initial colorectal procedure is suggestive that LFTs may be a useful biomarker for anastomotic leaks. Further research in prospective trials should be performed to evaluate its usefulness.
CR03 *ILEOCOLIC RESECTIONS FOR CROHN'S DISEASE: IMPACT OF MEDICAL THERAPY
Authors: Bernardi M.‐P. , Heriot A. G. , Sutherland A. , Woods R. , Keck J. , Johnston M. 
Published: April 2009

Purpose:   Ileocolic resection is the commonest surgical resection performed for Crohn's disease. The aim of the study was to review outcomes of primary ileocolic resections for Crohn's disease with particular emphasis on complications, recurrence and impact of prophylactic medication.Methodology:   Retrospective chart review was undertaken on all patients undergoing ileocolic resection for Crohn's disease between July 1998 and June 2008 at a tertiary centre. Data collected included patient demographics, pre‐operative medication, technical aspects of surgery, complications, prophylactic medical therapy and recurrence of disease.Results:   There were 64 patients (28 male, 36 female), mean age 30.2 years (SD 10.6). Surgery was elective in 49 patients (76.6 %) and urgent in 15 (23.4%). Laparoscopic surgery was undertaken in 31 (48.4%) with 3 converted to open (9.7 %). High anterior resection was performed in addition in 9.4% for contiguous disease. Post‐operative complication rate was 17.2% (anastomotic leak 6.3%; intra‐abdominal abscess 4.7%; pulmonary embolus 3.1%; other 3.1%). Endoscopic disease recurrence occurred in 27 (42.2%) of patients with mean time to recurrence 1.8 years (SD 1.3). Surgical intervention for recurrent disease was required in 5 (7.8%) and 40% of these developed further recurrence on imaging after repeat surgery. Prophylactic medications following primary resection did not reduce risk of recurrence (recurrence [prophylaxis/no prophylaxis], 21 vs. 6; no recurrence, 26 vs. 11; p = NS).Conclusion:   Almost half of patients who have an ileocolic resection for Crohn's disease will develop recurrence though less than 10% require further surgery. Prophylactic medical therapy does not reduce recurrence.
CR30P METACHRONOUS COLORECTAL CANCER
Authors: Carmichael R. W. , Siu S. , Ho Y.‐H. 
Published: April 2009

Purpose:   The purpose of this article is to review the current knowledge relating to risk factors, tumorigenesis and survival of patients with metachronous colorectal cancer to address potential advances in surveillance and management of patients with colorectal cancer.Methodology:   The Cochrane Library, PubMed, EMBASE and Ovid databases were searched from 1966 to December 2008 for both published reviews and published articles on metachronous colorectal cancer regarding incidence, carcinoma sequence, clinical characteristics, risk factors, detection, treatment, surveillance and survival. Further articles were obtained by a manual review of the reference lists of all retrieved articles. All publications relevant to this study were included.Results:   Factors likely to increase the risk of developing metachronous colorectal cancer include; age, personal and family history of multiple malignancies, synchronous polyps, hereditary non‐polyposis colorectal cancer and microsatellite instability.Conclusion:   Pre‐operative colonoscopic polyp status and biopsy analysis regarding microsatellite instability are essential in identifying patients at risk of metachronous colorectal cancer. A rapid adenoma‐carcinoma sequence less than the accepted 2 to 5 years would warrant stringent colonoscopic surveillance. Thus, frequent colonoscopic surveillance is recommended, within the first 5 years post‐operatively, for the detection of metachronous colorectal cancer.
CR32P PREDICTORS OF DAY STAY AFTER COLONIC SURGERY IN A STRUCTURED MULTI‐MODAL CARE PROGRAM
Authors: Kahokehr A. A. , Sammour T. , Sahakian V. , Zargar‐Shoshtari K. , Hill A. G. 
Published: April 2009

Background:   Enhanced Recovery After Surgery (ERAS) programs have gained popularity in colonic surgery. Hospital stay has been reduced dramatically as a result, but remains varied in the published literature. We were interested in investigating the factors that influence hospital stay in an ERAS setting.Methods:   Between October 2005 and November 2008 prospective data were collected on consecutive patients undergoing elective colonic resection, without a stoma, at a single site. Patients were managed within an ERAS program. Patients unable to communicate in English, with dementia or ASA >4 were excluded. Variables were tested using the Mann‐Whitney U and Spearman's two tailed correlation table for continuous data. Cox regression analysis was used for modelling.Results:   102 patients were included. There were 57 right sided, 43 left sided and 2 total colectomies. Mean age was 66 years (95% CI, 40–88). Median day stay was 4 days (range 3–46). Indications for surgery were: malignancy (80%), diverticular disease (13%) and other (7%). Age, operation site, ASA, indication for surgery and BMI were not significant predictors of hospital stay. Factors with the strongest correlation for reduced day stay were Cr‐Possum score (p = 0.006), female sex (p = 0.013), laparoscopic (n = 6) and transverse (n = 32) incisions (p < 0.001), and the operating surgeon (p < 0.001). Using Cox regression modeling, surgeon and patient gender could be eliminated as independent predictors of day stay. The other two factors added significant strength to the model.Conclusion:   Choice of incision and Cr‐POSSUM score are independent predictors of day stay in the ERAS setting.
CR34P STOMAS ARE STILL USED IN COLORECTAL TRAUMA
Authors: Nguyen T. C. , Shedda S. , Jones I. T. , Judson R. , Hayes I. , Hastie I. 
Published: April 2009

Purpose:   We aimed to assess the management of colorectal and anal injuries in trauma patients at a single major metropolitan trauma hospital in Australia.Methods:   A prospectively collected database at a major metropolitan trauma centre was assessed to retrieve consecutive patients who had colorectal and anal injuries over a 12 year period.Results:   185 patients were identified with colorectal or anal injuries from February 1996 to June 2008. The mechanism of injury was blunt in 145 (78%) with 134 (72%) related to motor vehicle trauma. The remaining 40 (22%) were due to penetrating injuries. There were 165 (89%) colonic injuries, 5 (3%) rectal injuries and 15 (8%) perineal injuries. 106 (57%) patients had multiple site of colonic or multiple organ injuries. 46 (25%) patients had full thickness tear of the colon with only 2 having full transection of the colon. The rest had contusions, serosal tears or mesocolon injury. The median injury severity score was 27 (range 4–75). 134 (72%) patients had surgical intervention including 61 repairs, 30 resections and 12 stomas, 3 of which occurred in major perineal injuries. The in hospital mortality rate was 5.4% with major or minor morbidity occurring in 52%. This included 3 anastomotic leaks and 2 missed injuries requiring a second laparotomy. 12 (6%) patients were subsequently readmitted after the initial management.Conclusion:   Colorectal injuries are usually due to road trauma with the majority occurring in the colon and over half these patients have multiple injuries. The complication rate is significant but relatively few of these are related to anastomotic leak when primary anastomosis is undertaken. Stomas however continue to be used.
CR36P TREATMENT OF ANAL FISTULA WITH THE COLLAGEN FISTULA PLUG
Authors: Hore T. , Hammodat H. 
Published: April 2009

Purpose:   We investigated the use of ‘Surgisis’ anorectal fistula plug in the treatment of anorectal fistula. Success rates quoted have been variable. There is no known data regarding when to reattempt the ‘Surgisis’ plug if failure occurs. We assessed our success rate and looked at any pattern for reinsertion of the ‘Surgisis’ anorectal plug.Methodology:   We retrospectively collected patient/fistula characteristics, procedure details, and follow‐up information for all patients treated with the anal fistula plug at our institution over the past 5 years. The outcome was considered successful if the external and internal opening were closed and if the patient had no drainage at the last follow‐up.Results:   Of 16 patients, 21 fistulae were treated with the ‘Surgisis’ anorectal fistula plug. 28.5% had complete healing after the first attempt at insertion of the ‘Surgisis’ plug, while 28.5% required a reinsertion of the ‘Surgisis’ plug for complete healing to occur. 43% failed to heal with the insertion of the ‘Surgisis’ plug or were awaiting follow‐up. The period of time between insertion of seton, subsequent failure and insertion of ‘Surgisis’ plug was extremely variable. Median time taken was 220 (41–553) days. Following this the median time taken for reinsertion was 303 (151–495) days.Conclusion:   Collectively our success rate for ‘Surgisis’ plug insertion is 57% however only 28.5% after first insertion. There is no clear relationship between the time period and the success of reinsertion of the ‘Surgisis’ plug. More data is required to give clear guidelines for timing of ‘Surgisis’ plug reinsertion.
CR05 *POSTERIOR TIBIAL NERVE STIMULATION: A TREATMENT FOR FAECAL INCONTINENCE?
Authors: Yeung J. M. , Findlay J. , Maxwell‐Armstrong C. 
Published: April 2009

Purpose:   Faecal incontinence (FI) is a prevalent and important multifactorial condition. Neuromodulation via implanted sacral nerve stimulators is efficacious, but as with other invasive treatment modalities is expensive and associated with significant complications. Peripheral neuromodulation of sacral nerve roots via posterior tibial nerve stimulation (PTNS) is effective in urinary incontinence, but there is minimal evidence for its use in FI. This study aimed to assess the efficacy of PTNS in FI.Methodology:   12 patients with FI of various causes (8 idiopathic, 3 obstetric, 1 previous anorectal surgery) underwent PTNS at a UK hospital. All were investigated with colonic imaging, anorectal physiological studies and endoanal ultrasound. Prior treatments comprised physiotherapy (12), sphincter repairs (3 biofeedback (3) and implants (1). PTNS was performed for 30 minutes, weekly for 12 weeks. Outcome measures were episodes of incontinence, the Hospital Anxiety and Depression Scale and Rockwood Faecal Incontinence Quality of Life score.Results:   Mean monthly episodes of incontinence of wind, liquid and solid before treatment were 18.77, 21.77 and 22.15 respectively. After 12 weeks’ treatment this had reduced to 0.92, 0.83 and 0.83 respectively (p < 0.05). Sphincter integrity, physiology and aetiology were not shown to affect efficacy. No patient's incontinence worsened. Non‐significant improvements in Anxiety and Depression and quality of life scores were also seen.Conclusions:   This is the first UK study to demonstrate PTNS as a potentially efficacious and minimally invasive alternative treatment modality for faecal incontinence. These early results are encouraging, but we await medium and long term follow up.
CR06 *LAPAROSCOPIC ANTERIOR RECTOPEXY FOR EXTERNAL PROLAPSE IS SAFE IN THE ELDERLY AND MAKES PERINEAL PROCEDURES ALMOST OBSOLETE
Authors: Akbar A. , Wijffels N. , Cunningham C. , Dixon A. , Lindsey I. 
Published: April 2009

Purpose:   Perineal procedures, despite high recurrence (pooled published series 18%) and poor function, are gold standard for external rectal prolapse (ERP) in the elderly for safety. Abdominal rectopexy has lower recurrence (<5%), but performed posteriorly induces constipation in 50% and open has higher morbidity. Laparoscopic anterior rectopexy (LAR) overcomes these limitations, improving constipation with low recurrence. We aimed to assess efficacy and safety of LAR for ERP in the elderly.Methodology:   Data on LAR for ERP >80 from 2 tertiary colorectal pelvic floor services in Oxford and Bristol were collected prospectively and analysed. End‐points were mortality, morbidity, length of stay (LOS). A subgroup was analysed for change in bowel function (Wexner constipation score and Faecal Incontinence Severity Index [FISI]). A comparison was made with a cohort of patients <80 years.Results:   81 patients (1 Delorme's in this period) 80 years or more (28% of total) were compared with 149 patients under 80 (98% vs. 86% female, age median 84 vs. 60 years, range 80–97 vs. 16–79 years). 30‐day mortality (0% vs. 0%), morbidity (11% vs. 3%+), LOS (2 vs. 2 days) and recurrence (2% vs. 0%) was acceptably low and similar in both age cohorts. Functional results were excellent, both cohorts showing improvement in constipation (median Wexner pre‐op 10 to post‐op 3 vs. 10 to 4, new‐onset constipation negligible) and incontinence (median FISI 31 to 0 vs. 34 to 8, resp.).Conclusions:   LAR is safe and can be offered to all fit elderly ERP patients. Perineal procedures should be restricted to the very frail.
CR07 *IMMUNOHISTOCHEMISTRY FOR LOSS OF EXPRESSION OF MISMATCH REPAIR GENE PROTEINS IN YOUNG PATIENTS WITH COLORECTAL CANCER: THE AUCKLAND EXPERIENCE
Authors: Wright D. M. , Parry S. , Arnold J. , Bissett I. , Hulme‐Moir M. , Parry B. 
Published: April 2009

Recently, in Australasia, a plea to screen all young patients with colorectal cancer (CRC) for Lynch syndrome has been advanced1.Since 2001 the three public hospitals in Auckland have had the policy of undertaking immunohistochemical (IHC) testing on the tumours of patients aged 50 years and under to detect loss of expression (LOE) of protein products for the mismatch repair (MMR) genes MLH1, MSH2, MSH6 and PMS2.Purpose:   To determine (1) the completeness of patient capture, (2) the incidence of LOE by IHC of the 4 gene proteins, and (3) to correlate IHC results with those of subsequent genetic testing for the corresponding germline mutations.Methodology:   Retrospective review of the prospectively gathered clinical, pathological, and genetic records of all patients diagnosed with CRC aged 50 years and below between January 2001 and December 2007.Results:   244 patients aged 50 years or below with CRC were diagnosed in this period. 212 (86.9%) patients’ tumours underwent IHC, 147 of which had all 4 gene products studied. 30 (14.2%) tumours had LOE for one or more MMR proteins. 25/30 patients were offered genetic testing of whom 3 declined. So far 8 out of 16 patients tested have a confirmed germline mutation. Only 3/8 patients report a family history of CRC.Conclusion:   Tumour IHC reveals LOE for one of the four MMR gene proteins in approximately 14% of young patients developing CRC and in half subsequent genetic testing will identify Lynch syndrome. A policy of mandatory testing is confirmed but audit of performance and appropriate referral is required.
CR08 *PARASTOMAL HERNIA PREVENTION USING A NOVEL COLLAGEN IMPLANT: A RANDOMISED CONTROLLED PHASE 1 STUDY
Authors: Frye J. N. , Hammond T. M. , Prosser K. , Huang A. , Williams N. S. 
Published: April 2009

Background:   Parastomal hernias can be prevented or repaired using synthetic mesh; however, reported complications include infection, fibrosis and potential bowel erosion. The study aim was to assess the safety, feasibility and potential efficacy of using a prophylactic collagen implant.Methods:   Twenty patients undergoing defunctioning stomas were randomised to a conventional procedure or reinforcement with the implant. Follow‐up included regular symptom questionnaires, clinical examination, stoma site ultrasound, and serum inflammatory markers.Results:   Ten patients (four males; mean BMI 26.3) had a conventional stoma, and ten (three males; mean BMI 26.3) received the implant. At a median of 6.5 months follow‐up, a parastomal hernia was clinically evident in three of ten patients without the implant, and in none of ten patients with the implant. There were no clinical complications, ultrasound evidence of chronic seromas or serological evidence of a systemic inflammatory response.Conclusions:   Xenogeneic collagen has been demonstrated to aid soft tissue reinforcement. In this study, in contrast to published data relating to the use of conventional synthetic mesh, there were no complications related to infection or the implant's proximity to the bowel. This trial demonstrates that the implant is safe, feasible to use and has the potential to prevent parastomal herniation.
ES13 *SURGEON PERFORMED, ULTRASOUND GUIDED, FINE NEEDLE ASPIRATION BIOPSY OF THYROID: A SAFE, CONVENIENT AND EFFECTIVE DIAGNOSTIC TECHNIQUE
Authors: Law M. T. , Bennett I. C. 
Published: April 2009

Purpose:   Office‐based ultrasound is becoming increasingly popular and is a great adjunct to conventional diagnostic techniques such as thyroid FNAB. We aim to evaluate the performance of surgeon performed ultrasound (US) guided FNAB of thyroid, focusing on its accuracy, and safety.Method:   Performance of US guided FNAB performed in a single surgeon practice between 2006 and 2008 was retrospectively reviewed, with emphasis on non‐diagnostic and complication rates. Factors affecting FNAB outcome were tested using Chi‐square test and significance defined as p < 0.05Results:   128 FNABs were performed on 100 patients. Mean lesion size was 22 mm, majority were solid on US. US FNAB had sensitivity of 85%, accuracy 75%. Non‐diagnostic rate was only 5.5% with no complications. Malignant or atypical findings accounted for 12%. 22% of cases proceeded to thyroidectomy, 46% of which yielded malignancy. Lesions which were solid and <2 cm in size were associated with significantly higher non‐diagnostic rate (p = 0.04). Most patients had their consultations and US FNABs in the same sitting.Conclusion:   Performance of surgeon performed thyroid US guided FNAB compares favourably to radiologist performed series. It is superior to FNABs by palpation and is associated with low complication. Consideration should be given to using on‐site cytology assessment for smaller solid lesions to reduce non‐diagnostic rate. US FNAB is easily learned through structured training, imparts great convenience to both surgeons and patients and is cost effective.
ES14 *CAN CYTOLOGY EXCLUDE THYROGLOSSAL DUCT CYST PAPILLARY CARCINOMA?
Authors: Eteuati J. , Serpell J. W. 
Published: April 2009

Background:   Thyroglossal duct cysts (TDC) are the commonest midline neck mass. They occur in approximately 7% of the population. Thyroglossal duct carcinoma is uncommon but is reported in 1% of all thyroglossal cysts. Sistrunk's procedure is the accepted treatment for TDC.Aims:   The aims of this study were: to determine the incidence of Papillary Thyroid Cancer in TDC; to compare cytology from the cyst and final histopathology; and to assess the adequacy of Sistrunk's procedure.Method:   A retrospective analysis of prospectively collected data of all TDC operations performed by the unit within a 15 year period, 1993–2008, was undertaken.Results:   There were 39 patients; 14 males and 25 females, of median age 40 (range 17–79) years. The main presenting symptom was a neck lump, ranging from 1 week to 17 years and mainly in the midline (33/39). The imaging modality of choice was ultrasound of the neck which correctly identified a cystic structure likely to be a TDC in the neck in 31/33 cases (94%). Fine needle aspirate cytology (FNAC) in 24 patients predicted a benign TDC with a sensitivity of 95.6% and a specificity of 100%. Papillary Thyroid Cancer occurred in four TDC, an incidence of 10%. All patients had a Sistrunk's procedure, from which there were no recurrences. Two of the Papillary Thyroid Cancer patients underwent total thyroidectomy. There were six minor complications, a rate of 15%.Conclusion:   The incidence of Papillary Thyroid Cancer in TDC was 10% in this series. The remaining lesions were benign and FNAC correctly predicted this with a sensitivity of 95.6%. Sistrunk's procedure is adequate treatment with minimal complications and no recurrences.