Gastroenterological surgery

Endoscopic Follow-up after Acute Diverticulitis (2025)

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Type of publication:

Conference abstract

Author(s):

*Sultana E.; *Chakrabarty A.; *Ball W.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii59), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Introduction: Acute diverticulitis is one of the most common causes for surgical emergency hospital admissions in the UK. The guidelines for endoscopic follow-up for patients with diverticulitis has changed over the last few years. This study aimed to assess the local follow-up of patients who present with diverticulitis. The objective was to identify the outcome of patients with diverticulitis and establish the new local guidelines for endoscopic follow-up. Method(s): A single-centre retrospective study was done for all patients who had CT proven diverticulitis at the Royal Shrewsbury Hospital in 2022. Data was collected about the patient demographics, vital statistics on presentation, Hinchey Classification, mode of management, previous admissions with diverticulitis, readmissions in one year, surgery in one year, and their follow-up results. Result(s): There were 193 patients in the study with a median age of 61 (IQR: 51-73) and 37.8% were male. Follow-up endoscopy was done in 45.6% (87/193) of the patients, amongst which 85.1% (74) had uncomplicated diverticulitis. There was one cancer detected in colonoscopy and one in flexible sigmoidoscopy both of which were suspicious on the initial CT scan. 13 patients had a follow-up CT scan within 1 year, of which 2 confirmed cancer. Median time for endoscopy and CT scan was 10 and 26 weeks from discharge, respectively. Conclusion(s): Diagnosis of cancer on an isolated follow-up colonoscopy or flexible sigmoidoscopy after uncomplicated diverticulitis is rare. These investigations should be reserved for patients with complicated diverticulitis or suspicious features of cancer on the initial CT scan.

DOI: 10.1093/bjs/znaf166.222

Factors associated with conversion from day-case to in-patient elective laparoscopic cholecystectomy across England: An observational study using administrative data (2025)

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Type of publication:

Conference abstract

Author(s):

*Olagunju N.; *Cheetham M.; Briggs T.; Gray W.K.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii25), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Aims: Day-case laparoscopic cholecystectomy is safe, cost-effective and patient friendly; however, some planned day case patients may convert to in-patient stay following an elective laparoscopic cholecystectomy. The aim of this study was to determine the rate of conversion from planned day-case to in-patient laparoscopic cholecystectomy across England and trends in same-day discharge over the study period. This study also aimed to evaluate factors contributing to these conversions. Method(s): This was an exploratory analysis of administrative data from the Hospital Episode Statistics (HES) database for England of planned day-case laparoscopic cholecystectomies from April 2017 to March 2024. Result(s): Of 286,754 planned day-case patients, the conversion rate to in-patient stay was 26.1% (74,957). Patients who converted to in-patient stay were older, more likely to be male and have open surgery, more comorbidities and were more likely to be operated on by a low annual volume surgeon. Post-procedural complications of haemorrhage, pain and venous thromboembolism were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 14.5% to 39.0%. Conversion to in-patient stay was associated with higher emergency hospital admissions within 30 days of discharge (4,290, 5.7%) when compared with same-day discharge (8,306 3.9%). Conclusion(s): The rate of conversion from planned day-case to in-patient laparoscopic cholecystectomy across England have declined over the past 7 years. Our study highlights patient selection, intra-operative haemostasis, and peri-operative pain management as target areas for centres hoping to improve day-case laparoscopic cholecystectomy rates.

DOI: 10.1093/bjs/znaf166.094

Assessment of Predictors of Recurrence, Surgical and Radiological Intervention in Acute Colonic Diverticulitis: A Multicentre Study with One-Year Follow-Up (2025)

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Type of publication:

Conference abstract

Author(s):

Mohamedahmed A.Y.; Albendary M.; Issa M.; *Sultana E.; Hamid M.; Zaman S.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii1), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Background: Recurrent acute diverticulitis (AD) significantly impacts patient's quality of life and increases morbidity and healthcare costs. This study aims to assess risk factors for recurrence and the need for surgical and radiological intervention during one year from index presentation. Method(s): This multicentre study was performed in four UK hospitals. All patients presented with a CT scan confirmed colonic AD during 12 months were included. Patients were followed up for one year from the index presentation. Outcomes of interest were the patient factors associated with recurrent episodes of diverticulitis and the requirement for a radiological or surgical intervention, using both univariate and multivariate logistic regression. Statistical analysis was performed using R version 4.4. Result(s): A total number of 542 patients were included; the median age was 62 (51-73) years, and 64.2% had Hinchey 1a AD. The recurrence rate over 1 year was 19.5%, with increased likelihood in patients with previous diverticulitis (P=0.006), Temperature >= 38degreeC on index admission (P=0.021), and LOS >= 3 days (P=0.009). Surgical and radiological intervention during follow-up was reported as 11.8% and 2%, respectively. Factors associated with increased likelihood of surgical intervention within 1 year were previous diagnosis of complicated diverticulitis (P=0.002), pyrexia(P=0.009) and hypotension(P=0.013) on index admission, CRP >300 (P=0.037), WCC >=15(P=0.007), and Hinchey grades >= 2 (P=0.001). Conclusion(s): High inflammatory markers, prolonged LOS and previous history of diverticulitis are associated with an increased risk of recurrence of diverticulitis. Treatment of acute diverticulitis must be tailored according to the patient's risk stratification.

DOI: 10.1093/bjs/znaf166.003

Robotic Versus Laparoscopic Approaches to Distal Pancreatectomy: Quality Assessment of the Current Evidence (2025)

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Type of publication:

Journal article

Author(s):

*Khan, Attam Ullah; Khan, Adan; Danial, Arbab.

Citation:

JCPSP, Journal of the College of Physicians & Surgeons – Pakistan. 35(5):628-635, 2025 May.

Abstract:

Pancreatic surgery, associated with technical difficulties and high complication rates, remains a challenge for surgeons. The laparoscopic approach has been shown to have benefits over the open approach; however laparoscopic distal pancreatectomy (LDP) still has its challenges. Robotic distal pancreatectomy (RDP) offers a technical edge over the laparoscopic approach in terms of superior imaging and ergonomics. Whether the technical advantages translate into improved outcomes is to be established. The aim of this study was to produce an overview of systematic reviews, summarising the evidence to date comparing RDP and LDP in terms of intraoperative, postoperative, and oncological outcomes and assessing the quality of the included reviews. Three electronic databases, PubMed, Embase, and Scopus, were searched to identify systematic reviews with meta-analyses comparing RDP with LDP. The AMSTAR-2 format was used to assess the quality of the studies. Fourteen systematic reviews were identified for inclusion. RDP had a significantly higher rate of spleen preservation, significantly shorter hospital stay, and a significantly lower rate of conversion to open surgery, whilst having higher total costs compared to LDP. The overall quality of the reviews was variable. The evidence suggests that RDP has potential advantages over LDP in terms of higher spleen preservation rate, shorter hospital stays, and lower conversion rate to open surgery, whilst maintaining comparability with most other outcomes. Based on the variable quality evidence, RDP is a safe alternative to LDP.

DOI: 10.29271/jcpsp.2025.05.628

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Hospital length of stay, 30-day emergency readmissions and the role of the DrEaMing enhanced recovery pathways in colonic and rectal surgery in England (2025)

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Type of publication:

Journal article

Author(s):

Dawes, Mindy; Packman, Zoe; McDonald, Ruth A; *Cheetham, Mark J; Gallagher-Ball, Nannette M T; Warwick, Eleanor; Oyston, Maria; McCone, Emma; Snowden, Chris; Swart, Michael; Briggs, Tim W R; Gray, William K.

Citation:

British Journal of Anaesthesia. 2025 Apr 22.

Abstract:

BACKGROUND: Enhanced recovery pathways (ERPs) are designed to improve patient outcomes after elective surgery. Our primary aim was to examine whether shorter hospital stay, as a surrogate ERP outcome, was associated with higher 30-day emergency readmission rates for colonic and rectal surgery in England. A secondary aim was to assess how hospital trust compliance with a specific postoperative care bundle, drinking, eating, and mobilising (DrEaMing) within 24 h, relates to outcomes.

METHODS: This was a retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged >=17 yr undergoing elective colonic or rectal surgery for cancer between April 1, 2014, and March 31, 2024, were included.

RESULTS: Shorter hospital stays were significantly associated with a lower rate of 30-day emergency readmission among 124 580 colonic and 87 036 rectal surgery patients. Comparing the first (reference) and fourth quartile of length of stay, the odds of 30-day emergency readmission increased by 2.16 (95% confidence interval [CI] 2.04-2.30) and 2.41 (95% CI 2.26-2.57) for colonic and rectal surgery, respectively. Increased hospital trust DrEaMing compliance was associated with a reduction in the number of patients with extended length of stay (colonic surgery: X2=24.885, P<0.001; rectal surgery: X2=61.670, P<0.001) and was not associated with 30-day emergency readmission.

CONCLUSIONS: We found no evidence that shorter length of stay, or greater DrEaMing compliance, were associated with higher emergency admission rates. These findings should not be interpreted as causal.

Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England (2025)

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Type of publication:
Journal article

Author(s):
Ayyaz, F M; Joyner, J; *Cheetham, M; Briggs, Twr; Gray, W K.

Citation:
Annals of the Royal College of Surgeons of England. 107(1):54-60, 2025

Abstract:
INTRODUCTION: The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. METHODS: This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic
cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. RESULTS: Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December
2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of
prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. CONCLUSIONS: Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.

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Intraoperative hypercarbia and massive surgical emphysema secondary to transanal endoscopic microsurgery (TEMS). (2014)

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Type of publication:
Journal article

Author(s):
*Chandra A, *Clarke R, *Shawkat H

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
We describe a case where full-thickness excision of a rectal lesion caused massive surgical emphysema and subsequent hypercarbia with associated difficulties with ventilation. This unique case highlights the risks of respiratory failure with extraperitoneal insufflation as in this case and as more commonly with intraperitoneal insufflation. Transanal endoscopic microsurgery (TEMS) is a technique that is being increasingly used in the management of large and early malignant rectal polyps. We reviewed the literature in order to understand the case and to highlight factors that should minimise any adverse sequelae. In the presence of ventilatory difficulties secondary to postoperative surgical emphysema, whether via extraperitoneal insufflation as described here or with intraperitoneal insufflation (as in laparoscopy), consider decreasing gas pressures, expediting the procedure, delaying extubation and prolonged close monitoring in recovery with possible admission to a high dependency unit (HDU) or intensive care unit (ICU).

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202864.abstract