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Article ; Online: Contemporary management of parastomal hernia.

Mohamed, Imran / Harries, Rhiannon L

2022 Volume 110, Issue 3, Page(s) 299–301

MeSH term(s)	Humans ; Incisional Hernia/etiology ; Incisional Hernia/surgery ; Hernia, Ventral/etiology ; Hernia, Ventral/surgery ; Surgical Mesh ; Surgical Stomas/adverse effects ; Herniorrhaphy
Language	English
Publishing date	2022-12-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znac448
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Article ; Online: Faecal immunochemical testing in symptomatic lower gastrointestinal triage: cohort study of patient acceptability and impact of social deprivation.

Cripps, Peter / Scott, Kelly / Sekhar, Hema / Harries, Rhiannon L / Taylor, Gregory W

The British journal of surgery

2023 Volume 110, Issue 4, Page(s) 511–512

MeSH term(s)	Humans ; Cohort Studies ; Triage ; Gastrointestinal Tract ; Mass Screening ; Social Deprivation ; Colorectal Neoplasms ; Occult Blood ; Early Detection of Cancer ; Feces/chemistry ; Colonoscopy ; Sensitivity and Specificity ; Hemoglobins/analysis
Chemical Substances	Hemoglobins
Language	English
Publishing date	2023-03-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znad036
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Article: Stomal Closure: Strategies to Prevent Incisional Hernia.

Harries, Rhiannon L / Torkington, Jared

Frontiers in surgery

2018 Volume 5, Page(s) 28

Abstract: Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result ...

Abstract	Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or "purse-string" closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias.
Language	English
Publishing date	2018-04-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2018.00028
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Article ; Online: Supporting laparoscopic general surgery training with digital technology: The United Kingdom and Ireland paradigm.

Humm, Gemma / Harries, Rhiannon L / Stoyanov, Danail / Lovat, Laurence B

BMC surgery

2021 Volume 21, Issue 1, Page(s) 123

Abstract: Surgical training in the UK and Ireland has faced challenges following the implementation of the European Working Time Directive and postgraduate training reform. The health services are undergoing a digital transformation; digital technology is ... ...

Abstract	Surgical training in the UK and Ireland has faced challenges following the implementation of the European Working Time Directive and postgraduate training reform. The health services are undergoing a digital transformation; digital technology is remodelling the delivery of surgical care and surgical training. This review aims to critically evaluate key issues in laparoscopic general surgical training and the digital technology such as virtual and augmented reality, telementoring and automated workflow analysis and surgical skills assessment. We include pre-clinical, proof of concept research and commercial systems that are being developed to provide solutions. Digital surgical technology is evolving through interdisciplinary collaboration to provide widespread access to high-quality laparoscopic general surgery training and assessment. In the future this could lead to integrated, context-aware systems that support surgical teams in providing safer surgical care.
MeSH term(s)	Digital Technology ; General Surgery/education ; Humans ; Ireland ; Laparoscopy/education ; United Kingdom
Language	English
Publishing date	2021-03-08
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2050442-1
ISSN	1471-2482 ; 1471-2482
ISSN (online)	1471-2482
ISSN	1471-2482
DOI	10.1186/s12893-021-01123-4
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Article ; Online: Botulinum Toxin A infiltration in conjunction with negative-pressure wound dressing and mesh-mediated traction in management of the open abdomen.

Mohamed, Imran / Egeler, Christian / Ford, Simon / White, Thomas / Harris, Dean A / Harries, Rhiannon L

The British journal of surgery

2022 Volume 109, Issue 8, Page(s) 780–781

MeSH term(s)	Abdomen ; Abdominal Wound Closure Techniques ; Bandages ; Botulinum Toxins, Type A/therapeutic use ; Humans ; Negative-Pressure Wound Therapy ; Surgical Mesh ; Traction
Chemical Substances	Botulinum Toxins, Type A (EC 3.4.24.69)
Language	English
Publishing date	2022-05-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znac150
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Article ; Online: Diagnosis of colorectal and emergency surgical site infections in the era of enhanced recovery: an all-Wales prospective study.

Reeves, Nicola / Cuff, Simone / Boyce, Kathryn / Harries, Rhiannon / Roberts, Christopher / Harrison, Wendy / Torkington, Jared

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2021 Volume 23, Issue 5, Page(s) 1239–1247

Abstract: Aim: Surgical site infections (SSIs) are associated with increased morbidity, hospital stay and cost. The literature reports that 25% of patients who undergo colorectal surgical procedures develop a SSI. Due to the enhanced recovery programme, patients ... ...

Abstract	Aim: Surgical site infections (SSIs) are associated with increased morbidity, hospital stay and cost. The literature reports that 25% of patients who undergo colorectal surgical procedures develop a SSI. Due to the enhanced recovery programme, patients are being discharged earlier with some SSIs presenting in primary care, making accurate recording of SSIs difficult. The aim of this study was to accurately record the 30-day SSI rate after surgery performed by colorectal surgeons nationally within Wales. Method: During March 2019, a national prospective snapshot study of all patients undergoing elective or emergency colorectal and general surgical procedures under the care of a colorectal consultant at 12 Welsh hospitals was completed. There was a multimodal 30-day follow-up using electronic records, clinic visits and/or telephone calls. Diagnosis of SSI was based on Centers for Disease Control and Prevention diagnostic criteria. Results: Within Wales, of the 545 patients included, 13% developed a SSI within 30 days, with SSI rates of 14.3% for elective surgery and 11.7% for emergency surgery. Of these SSIs, 49.3% were diagnosed in primary care, with 28.2% of patients being managed exclusively in the community. There were two peaks of diagnosis at days 5-7 and days 22-28. SSI rates between laparoscopic (8.6%) and open (16.2%) surgeries were significantly different (p = 0.028), and there was also a significantly different rate of SSI between procedure groups (p = 0.001), with high SSI rates for colon (22%) and rectal (18.9%) surgery compared with general surgical procedures. Conclusion: This first all-Wales prospective study demonstrated an overall SSI rate of 13%. By incorporating accurate primary care follow-up it was found that 49.3% of these SSIs were diagnosed in primary care.
MeSH term(s)	Colorectal Neoplasms ; Colorectal Surgery ; Humans ; Prospective Studies ; Rectum ; Risk Factors ; Surgical Wound Infection/diagnosis ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/etiology
Language	English
Publishing date	2021-02-18
Publishing country	England
Document type	Journal Article
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.15569
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Article ; Online: Author response to: The impact of virtual-reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials.

Humm, Gemma / Mohan, Helen / Fleming, Christina / Harries, Rhiannon / Wood, Christopher / Dawas, Khaled / Stoyanov, Danail / Lovat, Laurence B

BJS open

2022 Volume 6, Issue 6

MeSH term(s)	Humans ; Cholecystectomy, Laparoscopic ; Randomized Controlled Trials as Topic ; Simulation Training ; Virtual Reality
Language	English
Publishing date	2022-11-18
Publishing country	England
Document type	Journal Article ; Comment
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrac136
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Article ; Online: The impact of virtual reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials.

Humm, Gemma / Mohan, Helen / Fleming, Christina / Harries, Rhiannon / Wood, Christopher / Dawas, Khaled / Stoyanov, Danail / Lovat, Laurence B

BJS open

2022 Volume 6, Issue 4

Abstract: Background: Simulation training can improve the learning curve of surgical trainees. This research aimed to systematically review randomized clinical trials (RCT) evaluating the performance of junior surgical trainees following virtual reality training ( ...

Abstract	Background: Simulation training can improve the learning curve of surgical trainees. This research aimed to systematically review randomized clinical trials (RCT) evaluating the performance of junior surgical trainees following virtual reality training (VRT) and other training methods in laparoscopic cholecystectomy. Methods: MEDLINE (PubMed), Embase (Ovid SP), Web of Science, Scopus and LILACS were searched for trials randomizing participants to VRT or no additional training (NAT) or simulation training (ST). Outcomes of interest were the reported performance using global rating scores (GRS), the Objective Structured Assessment of Technical Skill (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS), error counts and time to completion of task during laparoscopic cholecystectomy on either porcine models or humans. Study quality was assessed using the Cochrane Risk of Bias Tool. PROSPERO ID: CRD42020208499. Results: A total of 351 titles/abstracts were screened and 96 full texts were reviewed. Eighteen RCT were included and 15 manuscripts had data available for meta-analysis. Thirteen studies compared VRT and NAT, and 4 studies compared VRT and ST. One study compared VRT with NAT and ST and reported GRS only. Meta-analysis showed OSATS score (mean difference (MD) 6.22, 95%CI 3.81 to 8.36, P < 0.001) and time to completion of task (MD -8.35 min, 95%CI 13.10 to 3.60, P = <0.001) significantly improved after VRT compared with NAT. No significant difference was found in GOALS score. No significant differences were found between VRT and ST groups. Intraoperative errors were reported as reduced in VRT groups compared with NAT but were not suitable for meta-analysis. Conclusion: Meta-analysis suggests that performance measured by OSATS and time to completion of task is improved with VRT compared with NAT for junior trainee in laparoscopic cholecystectomy. However, conclusions are limited by methodological heterogeneity and more research is needed to quantify the potential benefit to surgical training.
MeSH term(s)	Animals ; Cholecystectomy, Laparoscopic ; Humans ; Laparoscopy/education ; Randomized Controlled Trials as Topic ; Simulation Training/methods ; Swine ; Virtual Reality
Language	English
Publishing date	2022-08-03
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review ; Research Support, Non-U.S. Gov't
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrac086
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Article ; Online: Radiological incidence of donor-site incisional hernia and parastomal hernia after vertical rectus abdominus myocutaneous flap-based reconstruction following colorectal surgery.

Tang, Alethea M / Spencer, Naomi / Parkins, Kristie / Bevan, Victoria / Taylor, Gregory / Markham, Derrian / Drew, Peter / Harries, Rhiannon L

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2022 Volume 25, Issue 4, Page(s) 738–746

Abstract: Aim: A vertical rectus abdominis myocutaneous (VRAM) flap is commonly used to reconstruct perineal defects for low rectal and anal cancer. The incidence of midline incisional hernias after VRAM reconstruction varies from 3.6% when detected clinically to ...

Abstract	Aim: A vertical rectus abdominis myocutaneous (VRAM) flap is commonly used to reconstruct perineal defects for low rectal and anal cancer. The incidence of midline incisional hernias after VRAM reconstruction varies from 3.6% when detected clinically to 50% when detected radiologically. The aim of this study is to accurately determine the radiological incidence of donor-site incisional and parastomal hernia following VRAM reconstruction. Method: This was a retrospective cohort study of patients undergoing colorectal surgery requiring VRAM reconstruction over 10 years. Data were collected on patient demographics, indication for surgery and surgical procedure, including details of any hernia repair. Images from surveillance CTs were reviewed for the presence and size of midline incisional and/or parastomal hernias. Parastomal hernias were classified based on the European Hernia Society (EHS) classification. Results: One hundred and seventy three patients were included in the analysis. The median age was 67 years (range 29-88 years) and the median length of follow-up was 49 months (interquartile range 24.3-71.0 months). The cumulative incidence of donor-site incisional hernia after VRAM at 1, 2 and 5 years was 15.1%, 25.4% and 29.1%, respectively. The cumulative incidence for PSH at 1, 2 and 5 years was 33.1%, 46.6% and 53.3%, respectively (95% CI 45.4%-60.5%). Conclusion: Most patients who develop donor-site incisional hernia and parastomal herniation following VRAM tend to do so within the first 2 years. Although the use of CT imaging improves the diagnosis of donor-site incisional and parastomal hernias, the clinical significance of this is unknown.
MeSH term(s)	Humans ; Child, Preschool ; Child ; Incisional Hernia/diagnostic imaging ; Incisional Hernia/epidemiology ; Incisional Hernia/etiology ; Myocutaneous Flap/transplantation ; Rectus Abdominis/diagnostic imaging ; Rectus Abdominis/transplantation ; Incidence ; Colorectal Surgery ; Retrospective Studies ; Hernia
Language	English
Publishing date	2022-11-20
Publishing country	England
Document type	Journal Article
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.16400
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Article ; Online: 40-4-40: educational and economic outcomes of a free, international surgical training event.

Glasbey, James / Sinclair, Piriyah / Mohan, Helen / Harries, Rhiannon

Postgraduate medical journal

2017 Volume 93, Issue 1106, Page(s) 730–735

Abstract: Purpose of study: To demonstrate a model for delivery of an international surgical training event, and demonstrate its educational and economic outcomes.: Study design: The Association of Surgeons in Training (ASiT) ran a course series on 16 January ... ...

Abstract	Purpose of study: To demonstrate a model for delivery of an international surgical training event, and demonstrate its educational and economic outcomes. Study design: The Association of Surgeons in Training (ASiT) ran a course series on 16 January 2016 across the UK and Ireland. A mandatory, self-reported, online questionnaire collected delegate feedback, using 5-point Likert Scales, and a NetPromoter feedback tool. Precourse and postcourse matched questionnaires were collected for 'Foundation Skills in Surgery' (FSS) courses. Paired economic analysis was performed. Statistical analysis was carried out using RStudio (V.3.1.1 Boston, Massachusetts, USA). Results: Forty courses were held across the UK and Ireland (65.0% technical, 35.0% non-technical), with 184 faculty members. Of 570 delegates, 529 fully completed the feedback survey (92.8% response rate); 56.5% were male. The median age was 26 years (range: 18-67 years). The mean overall course NetPromoter Score was 8.7 out of 10. On logistic regression high NetPromoter Score was associated with completing a Foundation Skills in Surgery course (R=0.44, OR: 1.49, p=0.025) and having clear learning outcomes (R=0.72, OR: 2.04, p=0.029) but not associated with specialty, course style or teaching style. For Foundation Skills in Surgery courses, delegates reported increased commitment to a career in surgery (p<0.001), confidence with basic surgical skills (p<0.001) and confidence with assisting in theatre (p<0.001). A comparable cost saving of £231,462.37 was calculated across the 40 courses. Conclusion: The ASiT '40-4-40' event demonstrated the diversity and depth of surgical training, with 40 synchronous technical and non-technical courses, demonstrable educational benefit and a significant cost saving to surgical trainees.
MeSH term(s)	Adolescent ; Adult ; Aged ; Career Choice ; Clinical Competence/economics ; Curriculum ; Education, Medical/economics ; Education, Medical/organization & administration ; Educational Measurement ; General Surgery/education ; Humans ; Internationality ; Ireland ; Middle Aged ; Models, Educational ; Surveys and Questionnaires ; United Kingdom
Keywords	covid19
Language	English
Publishing date	2017-07-12
Publishing country	England
Document type	Journal Article
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/postgradmedj-2017-134874
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