Staff Publication

IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles (2026)

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Type of publication:

Journal article

Author(s):

*Rachaneni, Suneetha; Dietz, Hans Peter; Latthe, Pallavi; Sirany, Annie; Spivak, Anna; Dua, Anupreet.

Citation:

International Urogynecology Journal. 37(1):75-85, 2026 Jan.

Abstract:

INTRODUCTION AND HYPOTHESIS: Obstructed defecation syndrome (ODS) is a defecatory abnormality with a sensation of incomplete evacuation, the need to strain at stool, the need for digitation in the vagina, the anus, or the perineum. Anterior rectocele and rectal intussusception are the frequent pathologies behind ODS. The review focuses on the assessment and treatment of obstructed defecation in women with rectocele, recto-enterocele and rectal intussusception in the remit of a urogynecologist.

METHODS: A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed with colorectal surgeons from the American Society of Colon & Rectal Surgeons (ASCRS). An initial document was drafted based on a literature review. The review focused on the treatment options of women with presenting with obstructed defecation and posterior compartment prolapse either on clinical examination or on imaging. After evaluation by the entire IUGA R&D Committee revisions were made. The quality of the evidence was graded and used to form consensus recommendations.

RESULTS: Ultrasound and dynamic MRI are helpful imaging modalities in triaging patients. A defecating proctogram to evaluate the size of rectal intussusception and enterocele is the standard investigation. Conservative therapies are effective first-line management options. The transvaginal native tissue rectocele repair is a safe and effective first-line surgical treatment in women with obstructed defecation.

CONCLUSIONS: When evaluating patients with obstructive defecation, it is important to address anatomy as well as function. In the absence of a clinically significant rectocele or enterocele during vaginal examination, in women with obstructed defecation, referral to a gastroenterologist or colorectal surgeon for further evaluation and management is recommended.

DOI: 10.1007/s00192-025-06288-7

A worldwide perspective on chronic Achilles tendon rupture: An ESSKA AFAS survey initiative (2026)

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Type of publication:

Journal article

Author(s):

Vide, Joao; Santos, Francisco; Dantas, Sofia; Seica, Emanuel; Caetano, Joao; Mendes, Daniel; Sousa, Manuel Resende; Anderson, Mette; Guelfi, Matteo; Hong, Choon Chiet; van Dijk, Pim; Spennacchio, Pietro; Cordier, Guillaume; van Dijk, Niek; Ling, Samuel; Hua, Yinghui; Vega, Jordi; Fernandes, Pedro; *Carmont, Michael.

Citation:

Knee Surgery, Sports Traumatology, Arthroscopy. 2026 Feb 06.

Abstract:

PURPOSE: Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR.

METHODS: A web-based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A 'main tendency' was considered when 75% of the participants chose the same treatment method, a 'tendency' for 50%-75%, and 'no tendency' when less than 50% choose the same method.

RESULTS: A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End-to-end repair for defects <2 cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight-bearing (90%), and physiotherapy initiation at 4-6 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%).

CONCLUSION: This study confirms significant variation in CATR management internationally. While end-to-end repair is a consistent choice for gaps smaller than 2 cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms.

LEVEL OF EVIDENCE: Level IV.

DOI: 10.1002/ksa.70327

An Electromyographic Study Comparing Muscle Function During Supination and Pronation of the Forearm (2025)

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Type of publication:

Journal article

Author(s):

Kondi, Suresh; *Murugesan, Thivagar; Postans, Neil; Thumri, Paavana; Kantamaneni, Ketan; Ansari, Shahbaz; Pickard, Simon.

Citation:

Cureus. 18(1):e101255, 2026 Jan.

Abstract:

BACKGROUND: Forearm pronation and supination are fundamental movements essential for daily activities and clinical applications. While supinator and biceps brachii contribute to supination, and pronator quadratus and pronator teres facilitate pronation, the precise activation patterns and torque-dependent recruitment strategies of these muscles remain incompletely understood. Conflicting evidence exists regarding muscle contribution at varying load conditions, with implications for rehabilitation protocols, surgical planning, and prosthetic design.

PURPOSE: This study aimed to quantify and compare the electromyographic (EMG) activity of forearm rotator muscles during isometric contraction under progressively increasing torque loads during both supination and pronation movements.

METHODS: Four healthy right-handed subjects (3 males, 1 female; mean age 32.5 years) underwent simultaneous EMG and motion capture recording. Surface electrodes captured activity from biceps brachii, triceps, pronator teres, and pronator quadratus, while fine-wire electrodes measured supinator muscle activity. Participants maintained a neutral forearm position against applied loads of 1 kilogram positioned at increasing distances (10-35 cm) from the supination axis, creating progressively higher torques. EMG signals were filtered, rectified, normalized, and analyzed using root mean square values across three trials per loading condition.

RESULTS: During supination resistance, the supinator demonstrated higher activation at lower torques compared to the biceps brachii. As applied torque increased, the biceps brachii activity increased proportionally more than the supinator, indicating load-dependent recruitment. Triceps showed increased co-activation for joint stability. During pronation resistance, the pronator quadratus exhibited greater activity at lower torques relative to the pronator teres. With increasing torque, the pronator teres demonstrated relatively greater activation increases than the pronator quadratus. Both movement patterns demonstrated progressive recruitment of multi-joint muscles as torque demands increased.

CONCLUSIONS: This pilot EMG study (n=4) provides preliminary descriptive evidence suggesting that supinator and pronator quadratus primarily govern low-torque forearm rotation, while biceps brachii and pronator teres become increasingly dominant during high-torque demands. These observed patterns are consistent with a hierarchical muscle recruitment strategy optimized for mechanical efficiency and joint stability. Understanding these activation patterns may have potential clinical applications for rehabilitation protocol design following nerve injury or tendon rupture, surgical planning for nerve transfer procedures, and development of myoelectric prosthetic control algorithms.

DOI: 10.7759/cureus.101255

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Investigating the course of atopic eczema up to 1 year following completion of Narrowband UVB (NBUVB) phototherapy (2026)

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Type of publication:

Journal article

Author(s):

Bajaj, Sonali; Desai, Prachi; Singh, Akanksha; *Jain, Dimple; Wahie, Shyamal.

Citation:

Clinical & Experimental Dermatology. 2026 Feb 10. [epub ahead of print]

Abstract:

BACKGROUND: Narrowband UVB (NBUVB) is a second-line treatment for chronic moderate-to-severe atopic eczema unresponsive to adequate topical therapy, and is known to induce good short-term improvement of eczema severity. However, it is unclear how adult patients fare with their eczema severity long after completion of a course of NBUVB.

OBJECTIVES: We aimed to investigate the severity of atopic eczema in adults, 1 year following completion of NBUVB, using validated clinical activity measures.

METHODS: We undertook a multi-centre prospective observational study of adults with moderate-to-severe atopic eczema who were prescribed NBUVB as part of their standard clinical care. Assessments were made at baseline prior to starting NBUVB, at the end of NBUVB and at 4, 8 and 12 months after completion of NBUVB.

RESULTS: Eighty participants with moderate-to-severe atopic eczema (mean SCORAD 39.2, POEM 18.5, IGA 3.2) underwent NBUVB therapy. Significant reductions were observed post-treatment: SCORAD decreased to 17.8, POEM to 8.2, and IGA to 1.7 (p<0.001 achieved for all time points). These therapeutic effects were sustained at 4, 8, and 12 months post-treatment (n=27 at 12 months). Loss of follow-up was attributed to non-attendance exacerbated by the COVID-19 pandemic and patient relocation. Mild adverse events (n=5), including erythema and eczema flares, were reported, with no serious events.

CONCLUSIONS: These findings indicate that NBUVB may provide a long-lasting effect for patients who complete a course, helping to diminish their eczema severity to a more manageable level.

DOI: 10.1093/ced/llag066

Emergency hospital admissions while on an elective waiting list in England: an observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

James, Anthony P; Gray, William K; *Cheetham, Mark J; Eardley, Ian; Lansdown, Mark.

Citation:

British Journal of Surgery. 113(2), 2026 Feb 11.

Abstract:

INTRODUCTION: Patients awaiting elective procedures often have conditions that carry a risk of medical emergencies. This study quantifies the extent and variation of emergency hospital admissions during the waiting period across selected specialties and procedures.

METHODS: Data from the NHS England Waiting List Minimum Dataset linked to the Secondary Uses Service hospital admissions data set from 1 January 2022 to 31 December 2023 was analysed. Emergency admissions occurring while patients awaited treatment were identified and categorized from 'very likely' related to the index condition or its recognized co-morbid risks-and potentially avoidable through definitive treatment-through to 'unrelated'.

RESULTS: In 2023 some 2 093 789 waits (both incomplete and complete) were recorded across 41 selected procedures spanning 11 specialties. Over a combined waiting time of 33 832 790 days, 69 322 emergency admissions occurred, accounting for 535 806 bed days. The highest emergency admission rates per 52 weeks waiting were observed for urinary stent procedures (0.71), endoscopic retrograde cholangiopancreatography (0.63), and urinary catheter care (0.55). Nine procedures had more emergency bed days during the wait than elective bed days post-treatment, with the highest emergency/elective bed day ratios for ureteric stones (4.59), colonoscopy (2.80), and ablation/cardioversion (2.05).

CONCLUSION: A substantial number of patients on elective waiting lists are being admitted as emergencies during their wait, placing a burden on emergency care that would be avoided through more timely treatment. The variation in risk between specialties and pathways requires further prioritization strategies that mitigate patients' risk of associated harm, acting both within and across waiting lists, specialties, and organizations.

DOI: 10.1093/bjs/znaf292

Audit of Laparoscopic Cholecystectomy Operative Notes in a DGH (2025)

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Type of publication:

Conference abstract

Author(s):

*Ramesh S.; *Magalong J.A.; *Parampalli U.

Citation:

British Journal of Surgery. Conference: AUGIS Annual Scientific Meeting. Glasgow United Kingdom. 112(Supplement17) (pp xvii60), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Introduction: Operation notes are essential documents in patient care. The use of standardized guidelines, such as those endorsed by recognized organizations, is crucial to ensure consistent and detailed record-keeping. Documenting parameters specific to laparoscopic cholecystectomy provides valuable information for management in the event of complications and it also provides direction for follow-up care. Aim(s): This audit aims to assess the quality of laparoscopic cholecystectomy operative notes in our trust by comparing them against NHS England's GIRFT (Getting It Right Rirst-Time) recommendations. It also aims to Identify areas for improvement and implement targeted interventions. Method(s): A retrospective audit of 78 laparoscopic cholecystectomy operative notes conducted in 2024 were selected by systematic random sampling. Data were compared against GIRFT recommendations. After intervention, a re-audit of 78 laparoscopic cholecystectomy operative notes from 2025 was done using the same methodology and compared against initial audit. Result(s): Significant improvement was observed in the re-audit compared to the initial audit, after intervention in the form of surgeon education and use of modified operation note proforma specific to laparoscopic cholecystectomy was implemented. Documenting significant steps involved in Laparoscopic cholecystectomy for example, details of calot's triangle dissection, details of bile/gallstone spill and its management and mention of port used to extract gallbladder increased by 13%, 42%, and 48%, respectively. Conclusion(s): This audit demonstrates a significant improvement in operative note quality by implementing interventions from an initial audit, emphasising the importance of use of recommendations issued by GIRFT. Audits should be conducted at regular intervals to sustain improvements.

DOI: 10.1093/bjs/znaf270.230

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Lesser Omental Infarction: A Rare Cause of Intraperitoneal Focal Fat Infarction (IFFI) (2025)

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Type of publication:

Conference abstract

Author(s):

*Ramesh S.; *Jayaramegowda A.K.

Citation:

British Journal of Surgery. Conference: AUGIS Annual Scientific Meeting. Glasgow United Kingdom. 112(Supplement17) (pp xvii18), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Lesser Omental Infarction is a rare type of Intraperitoneal Focal Fat Infarction (IFFI) caused by the cut-off of blood supply to the fat tissue in the lesser omentum. Patients typically present with symptoms and signs mimicking more serious conditions such as perforated gastric ulcer, pancreatitis, or cholecystitis. This report aims to share insights into the clinical presentation, diagnostic challenges, and management strategies for patients with this condition. A 29-year-old gentleman presented with complaints of upper abdominal pain for two days, radiating to the right side. On abdominal examination, there was a soft but tender right hypochondrium. The patient was admitted with a provisional diagnosis of cholecystitis. Blood investigations were unremarkable, except for an elevated C-reactive protein (CRP). Ultrasound abdomen study was normal and ruled out gallbladder pathology. A CT scan of the abdomen suggested lesser omental infarction secondary to torsion. The patient was managed conservatively with analgesics and discharged after resolution of symptoms. Radiological imaging plays a crucial role in diagnosing lesser omental infarction. If missed, the patient may undergo unnecessary investigations and Interventions. When accurately diagnosed, most cases can be managed conservatively with analgesia. Surgical intervention is rarely required and is reserved for cases where devitalized tissue forms an abscess that does not resolve with conservative management.

DOI: 10.1093/bjs/znaf270.065

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Impact of the new UK guidelines on the emergency management of anaphylaxis at two hospitals (2024)

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Type of publication:

Conference abstract

Author(s):

*Elshahawy M.; *Kadambi M.; *Inani M.; Hughes D.; Clarke D.; Cooper A.; Goddard S.; Diwakar L.

Citation:

Allergy: European Journal of Allergy and Clinical Immunology. Conference: European Academy of Allergy and Clinical Immunology Hybrid Congress. Virtual. 79(Supplement 113) (pp 328-329), 2024. Date of Publication: 01 Oct 2024.

Abstract:

Background: In 2021, the UK Resuscitation Council made changes to the guidance on the management of acute anaphylaxis. The most significant of these included a) removal of antihistamine (chlorpheniramine) and steroid (hydrocortisone) from the algorithm b) Advise to administer repeated doses of IM adrenaline every 5 minutes until there has been an improvement in breathing and circulation. We carried out an audit to understand how the change in guideline has impacted patient care. Other aspects audited include measurement of serum tryptase and referral to specialist clinic. Method(s): This was a retrospective study using Ambulance Service and hospital notes to assess management of all patients presenting to the accident and emergency department at the university hospital of North Midlands (UHNM) and Shrewsbury and Telford hospitals (SaTH) with anaphylaxis in the years 2018 and 2022. ICD 10 codes were used to identify patients. Result(s): A total of 103 and 109 patients presented in 2018 and 2022 respectively with anaphylaxis. A&E and ambulance notes were available for 100 patients in 2018 (97%) and 103 (95%) patients in 2022. There were no deaths. Patient groups similar in age (range: 1-90 yrs) and gender (60% female) for both years across both sites. Less than half had tryptase measured. A significant number of patients with only skin symptoms were classified as having anaphylaxis. There was a significant reduction in the use of steroids and antihistamines between 2018 and 2022. Use of adrenaline was lower in 2022. Very few patients were referred to specialist clinics in both years, particularly from SaTH hospital. Conclusion(s): Anaphylaxis maybe over diagnosed in the emergency department. There has been some adherence to the new UK guideline for anaphylaxis management. Most patients still do not have serum tryptase checked. Referral rates are low.

DOI: 10.1111/all.16299

Use of GLP-1 analogues in Prader-Willi syndrome with type 2 diabetes: Tackling the underlying pathogenetic mechanism (2025)

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Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Jones A.; *Wilkes V.; *Singh P.; *Moulik P.

Citation:

Diabetic Medicine. Conference: Diabetes UK Professional Conference 2025. Glasgow . 42(Supplement 1) (no pagination), 2025. Date of Publication: 01 Feb 2025.

Abstract:

Background and Aims: Prader-Willi syndrome (PWS) is a rare genetic neurodevelopmental disorder causing hypothalamic-pituitary dysfunction, hyperphagia resulting in weight gain, short stature and mild cognitive impairment. We present two cases of PWS and role of GLP-1 analogues. Material(s) and Method(s): Retrospective review of two cases. Case 1: A 31-year-old female with PWS at the age of 7 years, learning difficulty, type 2 diabetes at 28 years, treated with metformin, linagliptin. She continued to gain weight despite calorie restriction, commenced on Semaglutide. Case 2: A 25-year-old female with PWS at age of 4 years, type 2 diabetes at 18 years, treated with metformin. Due to suboptimal glycaemic control, empagliflozin and liraglutide started. Result(s): Case 1: At initiation of Semaglutide, weight 93 kg, BMI 43.6 kg/m2, glycated haemoglobin (HbA1c) 106 mmol/mol (ref: 20-41). Twenty months on GLP-1 analogue, weight reduced by 21 kg, and HbA1c was 38 mmol/mol with reduction in appetite and positive change in eating habits. Case 2: At initiation of liraglutide, weight 91 kg, BMI 35 kg/ m2, HbA1c 72 mmol/mol. Six months later appetite, food cravings reduced; HbA1c 65 mmol/mol, weight stable. Conclusion(s): PWS is associated with high ghrelin, low insulin levels, visceral adiposity resulting in hyperphagia causing altered glucose metabolism predisposing to cardiovascular complications. Mainstay of treatment is behavioural modifications posing stress to patient and caregiver. There is no approved pharmacological management for this aspect of PWS. Systematic review on use of GLP-1 analogues with PWS showed improved glycaemic control, reduced appetite, without any significant side effects. Our patients showed improvements with metabolic control of type 2 diabetes, reducing food cravings. Further studies are required to explore exact mechanism of ghrelin suppression by GLP-1 analogues in PWS.

DOI: 10.1111/dme.15498

Outcomes of TEMS (Trans-anal Endoscopic Micro-Surgery) for early rectal cancer in a DGH - 10 years' experience (2024)

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Type of publication:

Conference abstract

Author(s):

Kumar S.; *Rehman S.; *McCloud J.; *Clarke R.G.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Wales United Kingdom. 26(Supplement 1) (pp 71-72), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Introduction: Trans-anal Endoscopic excision for Early Rectal Cancer (ERC) is low risk with excellent outcomes. Strict patient selection with discussion in an ERC MDT identifies appropriate patients for local excision. Trans-anal Endoscopic microsurgery (TEMS) with full-thickness excision is suitable for T1 rectal cancers as well as more advanced cancers in patients with significant comorbidity not fit for major surgery. We present results over a 10-year period. Method(s): We reviewed outcomes of patients undergoing TEMS for ERC, staged on MRI scans between March 2012 and Jan 2022 with follow up to Dec 2023. We included all patients withpotentially curable tumours and excluded patients deemed palliative at presentation. Result(s): 241 TEMS cases were performed with 73 for ERC with T1, T2 and T3 cancers being 70% (51/73), 24% (17/73) and 6% (5/73) respectively. Recurrence rates for T1 Cancer (Sm1, Haggit 1) was 0%. T1/2 with adverse histology was 18.7% to 41.7% and T3 was 80%. Resection margin R0 for T1 lesions was 86%-100% and for T2-T3 lesions was 20-60%. Correlation of T stage, resection margin and adverse histology to recurrence rates was significant. There were no major complications or deaths with 90 days. Conclusion(s): TEMS is a curative option for patients with ERC offering organ preservation and significantly less comorbidity than major resection. This is particularly important in the comorbid patient. Combination treatments with oncology can optimise outcomes in cancers with poor prognostic features and close surveillance will identify any local recurrence requiring salvage surgery.

DOI: 10.1111/codi.17066