RSS 1.0General Surgery
Recent Submissions
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Our experience with colorectal cancer rate, Three years post colonoscopyPoster abstract P475 from the 13th Scientific and Annual Meeting of the European Society of Coloproctology, Nice, France, 26-28 September 2018.
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Acute complicated diverticulitis—opportunity for conservative treatmentPoster abstract P102 from the 14th Scientific and Annual Meeting of the European Society of Coloproctology, Austria Centre, 25-27 September 2019.
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Risk of colorectal cancer and advanced adenomas in complicated diverticulitis – is there a concern?Poster abstract P110 from the 14th Scientific and Annual Meeting of the European Society of Coloproctology, Austria Centre, 25-27 September 2019.
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Colonoscopy requests and follow-up appointments – evolving practicePoster abstract P087 from the 14th Scientific and Annual Meeting of the European Society of Coloproctology, Vienna, Austria, 25–27 September 2019.
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Restrospective review of post colonoscopy colorectal cancer rates at the George Eliot Hospital Endoscopy UnitPoster presentation abstract 429 from the Association of Surgeons in Training (ASiT) Annual Conference 6th-8th March 2020, Birmingham International Convention Centre.
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Accuracy of intraoperative diagnosis of appendicitis in laparoscopy. Should this affect decision for appendicectomyPoster presentation abstract 942 from the Association of Surgeons in Training (ASiT) Annual Conference 6th-8th March 2020, Birmingham International Convention Centre.
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A pandemic recap : lessons we have learnedOn January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.
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Percutaneous retroperitoneoscopic drainage of complex extraperitoneal abscesses using flexible endoscopy: description of technique and perioperative careThe treatment of primary psoas abscesses usually is performed by a combination of prolongued antiobiotic therapy and drainage with interventional radiology techniques. However, although this combination is usually adequate for the treatment of solitary extraperitoneal collections, the presence of multi-loculated complex abscesses requires usually multiple procedures and feruently mandates open surgery. Herein, we describe an alternative tehnique of percutaneous retroperitoneoscopic drainage of multiple extensive primary psoas abscesses using flexible endoscopy, which can enable treatment these cases as one-stop proedure in a minimally invasive manner.
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Acute appendicitis in the context of undescended cecum: laparoscopic management with restoration of the orthotopic anatomyUndescended cecum is a rare congenital abnormality; upon development of acute appendicitis though, the high position of the cecum results in atypical clinical symptomatology. We present a rare case of appendicitis in a patient with undescended cecum, which we managed laparoscopically, combining the appendicectomy with orthotopic repositioning of the cecum. Key words: laparoscopy, malrotation, undescended cecum, emergency, surgery
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Laparoscopic management of acutely symptomatic chylous mesenteric cystAcutely symptomatic chylous mesenteric cyst is a very rare cause of acute abdomen. We report a case of acutely inflamed chyle-containing benign mesenteric cyst, highlighting the role of laparoscopy as a safe diagnostic and therapeutic modality.
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Should hospital readmissions be a key performance indicator in assessing a colorectal unit?Abstract P561 of the European Society of Colproctology 17th Scientific & Annual Meeting, 21 - 23 September 2022, Dublin, Ireland.
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How well do endoscopic morphological and histopathological characteristics correlate in colonic polypectomy reporting?Abstract P384 of the ESCP 17th Scientific & Annual Meeting, 21-23 September 2022, Dublin, Ireland.
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Ruscus extract, hesperidin methyl-chalcone and vitamin C, constituents of Cyclo 3 fort® in symptomatic chronic venous insufficiency: initial tertiary experience from southwestern GreeceLetter to the Editor regarding an initial tertiary experience from southwestern Greece of ruscus extract, hesperidin methyl-chalcone and vitamin C, constituents of Cyclo 3 fort® in symptomatic chronic venous insufficiency.
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Hyperthermic intraperitoneal chemotherapy with mitomycin C versus oxaliplatin after cytoreductive surgery for the treatment of peritoneal metastases of colorectal cancer originBackground: Mitomycin C and oxaliplatin are considered the main chemotherapeutic agents used in the context of hyperthermic intraperitoneal chemotherapy (HIPEC) after the performance of cytoreductive surgery for peritoneal metastases of colorectal cancer origin. However, there is lack of a generally accepted consensus regarding the optimal choice between them as upfront chemo-therapetic agent. Our paper aims to summarize in a comprehensive manner the available evidence, while individualised schemes with targeted therapies are under development. Methods: We conducted a comprehensive, narrative review of the literature including all previous studies until 03/2022, which reported perioperative and/ or oncological outcomes after the use of mitomycin C and/ or oxaliplatin as main hyperthermic chemotherapy agents after cytoreductive surgery for colorectal peritoneal metastatic disease. Results: Data from a total of 23 single-agent and 13 comparative studies were included in our review. Despite the demonstrated safety profile of both chemotherapeutics, the heterogeneity of the included studies, their retrospective nature and the absence of relevant randomized trials prohibits the drawing of safe conclusions regarding the superiority of one of the two agents. However, it seems that perioperative morbidity is less with oxaliplatin-based HIPEC, while mitomycin C appears as a more cost-effective option. Conclusions: Selection of the optimal intraperitoneal chemotherapy agent for peritoneal metastases of colorectal cancer origin after the completion of cytoreductive surgery is still a matter of debate, with significant institutional variation. Further randomized clinical trials between the two commonest HIPEC agents are required, assessing the differences in perioperative outcomes, oncological outcomes, healthcare-associated costs and patients' quality of life. Keywords: chemotherapy; cytoreduction; hyperthermia; mitomycin; oxaliplatin.
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Is the increase in emergency colorectal cancer presentation directly related to the after effects of the pandemic?Poster abstract from the ESCP 17th Scientific & Annual Meeting, 21 - 23 September 2022, Dublin, Ireland.
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Multiple synchronous intestinal tumorsLetter to the Editor reporting the case of an 83-year-old woman with synchronous primary cancers of terminal ileum, sigmoid and upper rectum.
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Auditing the routine microbiological examination of pus swabs from uncomplicated perianal abscesses: clinical necessity or old habit?Background: Obtaining pus swabs from perianal abscesses after incision and drainage for subsequent microbiological analysis is traditionally performed by general surgeons. Our aim is to assess the current practice in our institution, emphasizing on whether pus swabs were sent or not, as well as to identify any associations between the revealed microbiology and the occurrence of immediate post-operative complications and re-admission rates with fistula-in-ano up to 12 months post the emergency drainage. Finally, we aimed to identify if the any members of the surgical team reviewed at any stage post-operatively the results of the microbiological examination of the obtained pus swabs and if that resulted in changes of the patient management. Methods: We reviewed the operative findings and perioperative antimicrobial management of all patients within our institution that required surgical treatment of perianal abscesses over a 6-week period and re-assessed them after 12 months from the performed drainage, with respect to re-admission and identification of occurred fistula-in-ano. Results: A total of 24 patients met our inclusion criteria. Pus swabs were sent in 66.7% of cases and only a third of the requested microbiology reports were reviewed by a part of the surgical team. All patients were discharged prior to the release of the microbiology results with no subsequent change in the management plan. We did not find any consistent association between the microbiology results and re-admission with perianal abscess, with or without fistula-in-ano. Conclusions: We do not recommend routine use of pus swabs when draining perianal abscesses unless clinical concerns arise, including recurrent perianal sepsis, immuno-compromised status or extensive soft tissue necrosis, especially when these features are associated with systemic sepsis.
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Benign multicystic peritoneal mesothelioma presenting as appendiceal abscess: a diagnostic and therapeutic challengePrimary peritoneal tumors are rarely encountered and their management is usually challenging for the clinicians. Especially when the patients with advanced peritoneal malignancy present as surgical emergencies, usually with symptoms of obstruction, perforation or gross space-occupying lesions, the on-call surgical team has to weigh the pros and cons of urgent versus delayed treatment and plans a safe and simultaneously oncologically beneficial therapeutic approach. Herein, we present a case of a Caucasian man who was referred as suspected complicated appendicitis by his primary care physician, with the final diagnosis being benign multicystic mesothelioma. We describe the challenges of the clinical decision making for the emergency general surgeon and relevant diagnostic and therapeutic pitfalls, which can be potentially minimized by early liaison with tertiary units specializing in the treatment of disseminated peritoneal malignancy.
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Low preoperative serum albumin levels are associated with impaired outcome after cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignanciesPreoperative hypoalbuminemia is known to be associated with postoperative morbidity and mortality, as well as with poor survival after gastrointestinal cancer surgery. However, limited data exist regarding the prognostic significance of hypoalbuminemia in patients with peritoneal metastases undergoing cytoreductive surgery, combined with perioperative intraperitoneal chemotherapy. We performed a systematic literature review of the previously published studies addressing the potential association between preoperative albumin levels and overall surgical outcomes after the performance of cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancies. Our research yielded a total of nine retrospective studies which met our inclusion criteria, and despite their heterogeneity; and we can conclude that preoperatively low albumin levels are associated with greater likelihood of overall and major morbidity, as well as less favorable oncological outcome after the performance of cytoreductive surgery and perioperative intraperitoneal chemotherapy.
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Surveillance colonoscopy after appendicectomy in patients over the age of 40: targeted audit of outcomes and variability in practiceIntroduction: Recent evidence suggests the need to proceed with a surveillance colonoscopy in patients above the age of 40 years who undergo appendicectomy for acute appendicitis, given the higher risk of an underlying colonic tumor. After anecdotally observing a substantial variability in terms of adaptation of these recommendations by the on-call surgical teams, we performed a clinical audit regarding our relevant endoscopic follow-up compliance rates to identify areas for improvement of our practise. Materials Methods: We performed a retrospective review of the electronic records of all patients above 40 years who had appendicectomy for acute appendicitis within a 3-year period in our institution, assessing as primary outcome the actual performance of a follow-up colonoscopy and the detected endoscopic findings. Results: Our results demonstrated that more than 80% of our patients did not have an endoscopic follow-up, as suggested by the current evidence. In addition, with respect to the subspecialisation of the parent surgical team, it seems that non-colorectal teams had lower compliance regarding the arrangement of endoscopic surveillance, when compared to specialist colorectal team. Conclusions: Emergency surgical teams need to be further educated with respect to the current practise recommendations concerning the appropriate endoscopic follow-up after the performance of appendicectomy for acute appendicitis. Establishment of dedicated bundles of postoperative care, as well as clear relevant guidance from the gastrointestinal/emergency surgery societies would be of great value in this direction.