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  1. Article ; Online: Gross small bowel sacculation from chronic stricturing in Crohn's disease - a video vignette.

    Hardy, A J / McEntee, P / Kearney, D E / Kevans, D / Larkin, J O

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

    2020  Volume 22, Issue 11, Page(s) 1759

    MeSH term(s) Constriction, Pathologic ; Crohn Disease/complications ; Diverticulum ; Humans ; Intestine, Small/surgery
    Language English
    Publishing date 2020-05-25
    Publishing country England
    Document type Letter ; Video-Audio Media
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15115
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    Zs.A 5799: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Laparoscopic Meckel's diverticulectomy for small bowel volvulus - a video vignette.

    Narouz, F / Manzoor, T / Larkin, J O

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

    2016  Volume 18, Issue 11, Page(s) 1109–1110

    MeSH term(s) Adult ; Endoscopy, Gastrointestinal/methods ; Humans ; Intestinal Volvulus/surgery ; Intestine, Small/surgery ; Laparoscopy/methods ; Male ; Meckel Diverticulum/surgery
    Language English
    Publishing date 2016-11
    Publishing country England
    Document type Case Reports ; Letter ; Video-Audio Media
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.13519
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    Zs.A 5799: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: Early vs. standard reversal ileostomy: a systematic review and meta-analysis.

    O'Sullivan, N J / Temperley, H C / Nugent, T S / Low, E Z / Kavanagh, D O / Larkin, J O / Mehigan, B J / McCormick, P H / Kelly, M E

    Techniques in coloproctology

    2022  Volume 26, Issue 11, Page(s) 851–862

    Abstract: Background: Formation of a defunctioning loop ileostomy is common after mid and low rectal resection. Historically, they were reversed between 3 and 6 months after initial resection. Recently, earlier closure (< 14 days) has been suggested by some ... ...

    Abstract Background: Formation of a defunctioning loop ileostomy is common after mid and low rectal resection. Historically, they were reversed between 3 and 6 months after initial resection. Recently, earlier closure (< 14 days) has been suggested by some current randomised controlled trials. The aim of this study was to investigate the effect of early stoma closure on surgical and patient outcomes.
    Methods: A systematic review of the current randomised controlled trial literature comparing early and standard ileostomy closure after rectal surgery was performed. Specifically, we examined surgical outcomes including; morbidity, mortality and quality of life.
    Results: Six studies met the predefined criteria and were included in our analysis. 275 patients underwent early stoma closure compared with 259 patients having standard closure. Overall morbidity was similar between both groups (25.5% vs. 21.6%) (OR, 1.47; 95% CI 0.75-2.87). However, there tended to be more reoperations (8.4 vs. 4.2%) (OR, 2.02, 95% CI 0.99-4.14) and small bowel obstructions/postoperative ileus (9.3% vs. 4.4%) (OR 0.44, 95% CI 0.22-0.90) in the early closure group, but no difference across the other domains.
    Conclusions: Early closure appears to be a feasible in highly selective cases after good perioperative counselling and shared decision-making. Further research on quality of life outcomes and long term benefits is necessary to help define which patients are suitable candidates for early closure.
    MeSH term(s) Humans ; Ileostomy/adverse effects ; Ileostomy/methods ; Ileus ; Postoperative Complications/epidemiology ; Quality of Life ; Randomized Controlled Trials as Topic ; Rectal Neoplasms/surgery
    Language English
    Publishing date 2022-05-21
    Publishing country Italy
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-022-02629-6
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    Zs.A 5842: Show issues Location:
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  4. Article ; Online: Management options for chronic anal fissure: a systematic review of randomised controlled trials.

    Boland, P A / Kelly, M E / Donlon, N E / Bolger, J C / Larkin, J O / Mehigan, B J / McCormick, P H

    International journal of colorectal disease

    2020  Volume 35, Issue 10, Page(s) 1807–1815

    Abstract: Introduction: Anal fissure is the most common cause of severe anorectal pain in adults, contributing significantly to coloproctology workloads. There are a wide variety of management options available, including topical nitrites, calcium channel ... ...

    Abstract Introduction: Anal fissure is the most common cause of severe anorectal pain in adults, contributing significantly to coloproctology workloads. There are a wide variety of management options available, including topical nitrites, calcium channel blockers, botulinum toxin injection and sphincterotomy. The aim of this study was to review current options for the treatment of chronic anal fissure.
    Methods: A comprehensive search identifying randomized controlled trials comparing treatment options for anal fissure published between January 2000 and February 2020 was performed. The primary outcome assessed was healing at 8 weeks post commencing treatment. Secondary outcomes included recurrence, intolerance of treatment and complications.
    Results: A total of 2822 studies were identified. After removal of duplicates and non-relevant studies, we identified nine randomized controlled trials which met pre-defined criteria. There was a total of 775 patients. At 8 weeks, healing rates were 95.13% in those treated with sphincterotomy, 66.7% in the botulinum toxin group, 63.8% in the nitrate group, 52.3% for topical diltiazem and 50% for topical minoxidil. Recurrence was highest amongst those treated with botulinum toxin injection (41.7%) and lowest for sphincterotomy (6.9%). Although the absolute number is low, there was a risk of permanent incontinence with sphincterotomy.
    Conclusion: This review of the randomized control data demonstrates that healing was significantly higher amongst those treated with sphincterotomy versus more conservative modalities. Topical nitrites had similar outcomes to botulinum toxin injection but were poorly tolerated in comparison to other treatments. The benefit of sphincterotomy was at a cost of increased complications, notably permanent incontinence.
    MeSH term(s) Adult ; Anal Canal/surgery ; Botulinum Toxins, Type A/therapeutic use ; Chronic Disease ; Fissure in Ano/drug therapy ; Humans ; Neoplasm Recurrence, Local ; Randomized Controlled Trials as Topic ; Treatment Outcome
    Chemical Substances Botulinum Toxins, Type A (EC 3.4.24.69)
    Language English
    Publishing date 2020-07-25
    Publishing country Germany
    Document type Journal Article ; Systematic Review
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-020-03699-4
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  5. Article ; Online: Colonic stenting as a bridge to surgery in malignant large bowel obstruction: oncological outcomes.

    Donlon, N E / Kelly, M E / Narouz, F / McCormick, P H / Larkin, J O / Mehigan, B J

    International journal of colorectal disease

    2019  Volume 34, Issue 4, Page(s) 613–619

    Abstract: Introduction: Stenting of obstructing colorectal cancers obviates the need for emergency surgery, reducing initial morbidity and mortality rate associated with emergency surgery and facilitates full staging of the neoplastic process with an opportunity ... ...

    Abstract Introduction: Stenting of obstructing colorectal cancers obviates the need for emergency surgery, reducing initial morbidity and mortality rate associated with emergency surgery and facilitates full staging of the neoplastic process with an opportunity to optimize the patient for surgery. Some recent publications have suggested however that this approach may be associated with higher local recurrence rates. We examined our outcomes following colonic stenting as a bridge to resection.
    Methods: A database was reviewed (2006-2018) of patients presenting with acute colorectal obstruction that proceeded to endoscopic stenting. We assessed the bridge to surgery strategy, its success, complication rate, and impact on recurrence and survival.
    Results: Of a total of 103 patients who presented with acute malignant large bowel obstruction over this time period, 26 patients had potentially curable disease at presentation and underwent stenting as a bridge to surgery. The technical success rate for stenting in those managed as a bridge to surgery was 92% (n = 24/26) with 7.69% (n = 2/26) having a complication. There was one stent-related perforation. Median follow-up of this cohort was 31 months, with a 5-year overall survival of 53.5%.
    Conclusion: Colorectal stenting as a bridge to resection is a successful management strategy for those presenting with obstructing colorectal obstruction. Selective use is associated with lower rates of stoma formation, greater rates of laparoscopic resections with low complication rates, and acceptable oncological outcomes.
    MeSH term(s) Aged ; Aged, 80 and over ; Cohort Studies ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/surgery ; Female ; Humans ; Intestinal Obstruction/mortality ; Intestinal Obstruction/surgery ; Male ; Middle Aged ; Palliative Care ; Postoperative Complications/etiology ; Stents ; Treatment Outcome
    Language English
    Publishing date 2019-01-16
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-019-03239-9
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    Zs.A 2121: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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  6. Article ; Online: Multivisceral resection for T4 or recurrent colorectal cancer.

    Larkin, J O / O'Connell, P R

    Digestive diseases (Basel, Switzerland)

    2012  Volume 30 Suppl 2, Page(s) 96–101

    Abstract: Background: Approximately 10% of patients with colorectal cancer have locally advanced disease with peritoneal involvement (T4a) or invasion of adjacent organs (T4b) at the time of diagnosis. Of patients who undergo resection with curative intent, ... ...

    Abstract Background: Approximately 10% of patients with colorectal cancer have locally advanced disease with peritoneal involvement (T4a) or invasion of adjacent organs (T4b) at the time of diagnosis. Of patients who undergo resection with curative intent, between 7 and 33% develop isolated locoregional recurrences. R0 surgical excision is potentially curative.
    Methods: We reviewed the literature relating to multivisceral resection for T4 or recurrent colorectal cancer.
    Results: Comprehensive staging to identify the local and systemic extent of disease is essential to determine resectability and patient suitability for a curative approach. PET scans and pelvic MRI (rectal) staging and a coordinated multispecialty input to neoadjuvant treatment, multivisceral surgical resection, reconstruction and adjuvant chemotherapy are essential. Intraoperative radiotherapy and hyperthermic intraperitoneal chemotherapy may have a role in selected patients. R0 resection can achieve 5-year local control rates for primary locally advanced and recurrent colorectal cancer of up to 89 and 38%, respectively, and overall 5-year survival up to 66 and 25%, respectively.
    Conclusion: An aggressive surgical strategy as part of a multimodal strategy in the treatment of locally advanced or recurrent colorectal cancer in the absence of incurable metastatic disease affords the best prospect for long-term survival in selected patients.
    MeSH term(s) Colonic Neoplasms/pathology ; Colonic Neoplasms/surgery ; Colonic Neoplasms/therapy ; Humans ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local/surgery ; Neoplasm Recurrence, Local/therapy ; Neoplasm Staging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Rectal Neoplasms/therapy
    Language English
    Publishing date 2012
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 632798-9
    ISSN 1421-9875 ; 0257-2753
    ISSN (online) 1421-9875
    ISSN 0257-2753
    DOI 10.1159/000342037
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    Zs.A 1853: Show issues Location:
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  7. Article ; Online: Management of anal intraepithelial neoplasia and anal squamous cell carcinoma at a tertiary referral centre with a dedicated infectious diseases unit: an 18-year review.

    Power Foley, M / Kelly, M E / Kerr, C / Kennedy, C / Gallagher, D / Gillham, C / Mehigan, B J / McCormick, P H / Bergin, C / Larkin, J O

    International journal of colorectal disease

    2020  Volume 35, Issue 10, Page(s) 1855–1864

    Abstract: Introduction: Anal squamous cell carcinoma (ASCC) is a rare malignancy with rising incidence rates. Risk factors include human immunodeficiency virus (HIV) infection, high-risk sexual activity and HPV-related genitourinary dysplasia/neoplasia. There is ... ...

    Abstract Introduction: Anal squamous cell carcinoma (ASCC) is a rare malignancy with rising incidence rates. Risk factors include human immunodeficiency virus (HIV) infection, high-risk sexual activity and HPV-related genitourinary dysplasia/neoplasia. There is an overlap between high-risk patients and those attending HIV Medicine/Sexual Health (HMSH) services. We hypothesised that HMSH involvement may facilitate earlier referral to colorectal surgeons, with better outcomes.
    Methods: Retrospective review of all ASCC and anal intraepithelial neoplasia (AIN) treated at a tertiary-referral hospital with a dedicated HMSH clinic between 2000 and 2018. Comparative analysis was performed of demographics, management and outcomes between HMSH and non-HMSH patients.
    Results: One hundred and nine patients had anal pathology, eighty-five with ASCC (78%) and twenty-four with AIN (22%). Seventy (64%) were male. Median (range) age at ASCC diagnosis was 51 years (26-88). Thirty-six percent of all patients attended HMSH services, 28% were HIV positive, and 41% of males were men-who-have-sex-with-men (MSM). Eighty-one ASCC patients (97.5%) were treated with curative intent. Sixty-seven (80%) had primary chemoradiation therapy. Fifteen (17.5%) had primary surgical excision. Twelve (14%) developed recurrent disease. Ultimately, seven required salvage APR. Overall 3-year survival (3YS) was 76%. HMSH patients were significantly younger at ASCC diagnosis (p < 0.001), with a higher prevalence of HIV, HPV and MSM. HMSH attenders also tended to be diagnosed at earlier stages, were less likely to develop recurrence and achieved better overall outcomes, with a superior overall 3YS than non-HMSH patients (92% vs 72%, p = 0.037).
    Conclusion: ASCC incidence is increasing worldwide. The HMSH cohort has emerged as a distinct subpopulation of younger, high-risk, male patients. Collaboration between HMSH and colorectal surgeons offers an opportunity for risk reduction strategies and earlier intervention.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Anus Neoplasms/diagnosis ; Anus Neoplasms/epidemiology ; Anus Neoplasms/therapy ; Carcinoma in Situ/epidemiology ; Carcinoma in Situ/therapy ; Carcinoma, Squamous Cell/epidemiology ; Carcinoma, Squamous Cell/therapy ; Communicable Diseases ; Female ; HIV Infections/complications ; HIV Infections/epidemiology ; Homosexuality, Male ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Papillomavirus Infections/complications ; Papillomavirus Infections/epidemiology ; Papillomavirus Infections/therapy ; Retrospective Studies ; Sexual and Gender Minorities ; Tertiary Care Centers ; Young Adult
    Language English
    Publishing date 2020-06-04
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-020-03640-9
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    Zs.A 2121: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  8. Article: Seppuku: a modern approach to an ancient injury.

    Richardson, A J / Tevlin, R / Larkin, J O / Beddy, D

    Irish medical journal

    2013  Volume 106, Issue 7, Page(s) 211–212

    Abstract: A 67 year-old man with paraplegia and depression presented with self-inflicted evisceration and small bowel injury. Damage control surgery was undertaken at emergency laparotomy with definitive anastomosis performed at second-look laparotomy following 24 ...

    Abstract A 67 year-old man with paraplegia and depression presented with self-inflicted evisceration and small bowel injury. Damage control surgery was undertaken at emergency laparotomy with definitive anastomosis performed at second-look laparotomy following 24 hours resuscitation in ICU. He had an uncomplicated post-operative course and was discharged to an inpatient psychiatric unit.
    MeSH term(s) Abdominal Injuries/surgery ; Aged ; Colon/injuries ; Colon/surgery ; Humans ; Intestine, Small/injuries ; Intestine, Small/surgery ; Male ; Suicide, Attempted ; Wounds, Stab/surgery
    Language English
    Publishing date 2013-07
    Publishing country Ireland
    Document type Case Reports ; Journal Article
    ZDB-ID 193134-9
    ISSN 0332-3102 ; 0021-129X
    ISSN 0332-3102 ; 0021-129X
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    Zs.B 148: Show issues Location:
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  9. Article ; Online: Brain metastasis from colorectal carcinoma: a single cancer centre experience.

    Tevlin, R / Larkin, J O / Hyland, J M / O'Connell, P R / Winter, D C

    Irish journal of medical science

    2015  Volume 184, Issue 3, Page(s) 673–675

    Abstract: Purpose: Brain metastases (BM) from colorectal cancer (CRC) are rare. As survival increases in patients with metastatic CRC, it is hypothesised that new metastatic patterns will emerge: for instance, as CRC with limited metastatic involvement of the ... ...

    Abstract Purpose: Brain metastases (BM) from colorectal cancer (CRC) are rare. As survival increases in patients with metastatic CRC, it is hypothesised that new metastatic patterns will emerge: for instance, as CRC with limited metastatic involvement of the liver and lung can now be successfully resected, we propose that sites, previously rarely involved in metastatic spread, will become more common. The objective of this study was to describe the experience with BM from CRC in a single cancer centre.
    Methods: A prospectively compiled database (1988-2012) of patients with CRC treated in a tertiary referral hospital was retrospectively examined. Patients with a histological diagnosis of CRC and radiologically documented BM were included. Clinical information (including patient demographics, primary and metastatic disease factors) was obtained from medical records.
    Results: Eleven patients (0.3 % of 4219 patients) were identified (8 male, 3 female). The median age at CRC diagnosis was 70 years (range 55-80 years) while the median age at diagnosis of BM was 73 years (range 56-83 years). Three patients diagnosed with synchronous metastases underwent palliative treatment while eight patients had undergone surgical resection of the primary tumour with curative intent a median of 24 months (range 0-48 months) prior to diagnosis of BM. 10/11 patients were symptomatic at diagnosis of BM. All were diagnosed using computed tomography and managed palliatively. The cerebellum was most the frequently involved site. The median overall survival time following diagnosis of BM was 2.5 months (range 2-9 months). Notably, 8/11 patients were diagnosed in the latter 8 years of the study period (between 2004 and 2012).
    Conclusion: With increased survival, improved systemic therapy and aggressive approaches to surgical management of "classical" metastases from CRC, it is likely that a changing pattern of metastases will emerge. As survival rates increase, we propose that metastatic sites, which were previously considered rare (e.g. brain), will now become more common and thus, surgeons must recognise pertinent symptomatology.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Animals ; Brain/pathology ; Brain Neoplasms/mortality ; Brain Neoplasms/secondary ; Brain Neoplasms/therapy ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/therapy ; Female ; Humans ; Ireland/epidemiology ; Male ; Middle Aged ; Palliative Care/statistics & numerical data ; Prognosis ; Retrospective Studies ; Survival Rate
    Language English
    Publishing date 2015-09
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 390895-1
    ISSN 1863-4362 ; 0021-1265
    ISSN (online) 1863-4362
    ISSN 0021-1265
    DOI 10.1007/s11845-015-1272-y
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  10. Article: Primary colorectal lymphoma - A single centre experience.

    Tevlin, R / Larkin, J O / Hyland, J M P / O'Connell, P R / Winter, D C

    The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

    2015  Volume 13, Issue 3, Page(s) 151–155

    Abstract: Purpose: The incidence of primary colorectal lymphoma (PCL) is rare (0.2-0.6% of large bowel malignancy). Up to one third of Non-Hodgkin's lymphoma will present with extra-nodal manifestations only. Extra-nodal lymphomas arise from tissues other than ... ...

    Abstract Purpose: The incidence of primary colorectal lymphoma (PCL) is rare (0.2-0.6% of large bowel malignancy). Up to one third of Non-Hodgkin's lymphoma will present with extra-nodal manifestations only. Extra-nodal lymphomas arise from tissues other than the lymph nodes and even from sites, which contain no lymphoid tissue. The incidence of Non-Hodgkin's lymphoma has increased over the past fifty years. The objective of this study was to examine our experience of PCL.
    Methods: A prospectively-compiled database (1988-2012) of patients with colorectal cancer was retrospectively examined for cases of colorectal lymphoma. A retrospective chart review identified cases of PCL based on Dawson's criteria. Clinical information was obtained from case notes.
    Results: Eleven patients (0.3% of 4219 patients) were identified (6 male, 5 female). The median age at diagnosis was 63 years. Mode of presentation varied; abdominal pain, a palpable mass and per rectal bleeding being the most frequent. The caecum was the most frequently involved site (5/11). Nine patients underwent surgical management, one had chemotherapy alone and one had radiotherapy alone. All cases were non-Hodgkin's lymphoma, with diffuse large B-cell lymphoma in majority. The median event-free survival of those treated with surgery and post-operative chemotherapy was 10 months (range 5-120 months).
    Conclusion: Primary colorectal lymphoma is rare. Management is multidisciplinary and dependent on the subtype of lymphoma. Due to the rarity of diagnosis, there is a paucity of randomised control trials. Most information published is based on individual case reports and there is, thus, no clear treatment algorithm for these cases.
    MeSH term(s) Adult ; Aged ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/therapy ; Female ; Humans ; Lymphoma, Large B-Cell, Diffuse/diagnosis ; Lymphoma, Large B-Cell, Diffuse/therapy ; Lymphoma, Non-Hodgkin/diagnosis ; Lymphoma, Non-Hodgkin/therapy ; Male ; Middle Aged ; Retrospective Studies
    Language English
    Publishing date 2015-06
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 2102927-1
    ISSN 1479-666X
    ISSN 1479-666X
    DOI 10.1016/j.surge.2014.01.002
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