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  1. Article: A systematic review of the role of re-laparoscopy in the management of complications following laparoscopic colorectal surgery.

    Chang, K H / Bourke, M G / Kavanagh, D O / Neary, P C / O'Riordan, J M

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

    2016  Volume 14, Issue 5, Page(s) 287–293

    Abstract: The benefits of laparoscopic versus open surgery for patients with both benign and malignant colorectal disease have been well established. Re-laparoscopy in patients who develop complications following laparoscopic colorectal surgery has recently been ... ...

    Abstract The benefits of laparoscopic versus open surgery for patients with both benign and malignant colorectal disease have been well established. Re-laparoscopy in patients who develop complications following laparoscopic colorectal surgery has recently been reported by some groups and the aim of this systematic review was to summarise this literature. A literature search of PubMed, Medline and EMBASE identified a total of 11 studies that reported laparoscopic re-intervention for complications in 187 patients following laparoscopic colorectal surgery. The majority of these patients required re-intervention in the immediate postoperative period (i.e. less than seven days). Anastomotic leakage was the commonest complication requiring re-laparoscopy reported (n = 139). Other complications included postoperative hernia (n = 12), bleeding (n = 9), adhesions (n = 7), small bowel obstruction (n = 4), colonic ischaemia (n = 4), bowel and ureteric injury (n = 3 respectively) and colocutaneous fistula (n = 1). Ninety-seven percent of patients (n = 182) who underwent re-laparoscopy had their complications successfully managed by re-laparoscopy, maintaining the benefits of the laparoscopic approach and avoiding a laparotomy. We conclude that re-laparoscopy for managing complications following laparoscopic colorectal surgery appears to be safe and effective in highly selected patients.
    MeSH term(s) Colonic Diseases/surgery ; Colorectal Surgery/adverse effects ; Evidence-Based Medicine ; Humans ; Laparoscopy/adverse effects ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Postoperative Period ; Rectal Diseases/surgery ; Reoperation ; Risk Factors ; Treatment Outcome
    Language English
    Publishing date 2016-10
    Publishing country Scotland
    Document type Journal Article ; Review
    ZDB-ID 2102927-1
    ISSN 1479-666X
    ISSN 1479-666X
    DOI 10.1016/j.surge.2015.12.003
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  2. Article: Long-term follow up for colon cancer in a minimally invasive, colorectal unit.

    Nason, G J / Barry, B D / Rajaretnam, N S / Neary, P C

    Irish medical journal

    2013  Volume 106, Issue 7, Page(s) 204–207

    Abstract: Our aim was to assess the long-term survival advantage associated with the laparoscopic approach for colon cancer resection in an Irish minimally invasive unit. Between January 2005 and December 2006, 154 patients underwent resection for colon cancer. ... ...

    Abstract Our aim was to assess the long-term survival advantage associated with the laparoscopic approach for colon cancer resection in an Irish minimally invasive unit. Between January 2005 and December 2006, 154 patients underwent resection for colon cancer. 108 underwent a laparoscopic resection, with a conversion rate of 11%. The overall 5 year survival was 71.4%. The overall 5 year survival rate for laparoscopic resections was 80.6% where as the overall survival for open resection was 50%. Laparoscopic surgery had a significant 5 year overall survival advantage compared to open in both non metastatic disease (Stage I and II) (92.2% vs. 69.6%, p = 0.0288) and metastatic disease (Stage III and IV), (68.4% vs. 30.4%, p = 0.0026). Laparoscopic surgery in a dedicated minimally invasive unit with verifiable low conversion rates is feasible and in our experience associated with a long-term survival advantage for colon cancer.
    MeSH term(s) Adenocarcinoma/mortality ; Adenocarcinoma/secondary ; Adenocarcinoma/surgery ; Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms/mortality ; Colonic Neoplasms/pathology ; Colonic Neoplasms/surgery ; Colorectal Surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Surgery Department, Hospital ; Survival Rate ; Time Factors ; Young Adult
    Language English
    Publishing date 2013-07
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 193134-9
    ISSN 0332-3102 ; 0021-129X
    ISSN 0332-3102 ; 0021-129X
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  3. Article ; Online: Incidence of early symptomatic port-site hernia: a case series from a department where laparoscopy is the preferred surgical approach.

    Moran, D C / Kavanagh, D O / Sahebally, S / Neary, P C

    Irish journal of medical science

    2012  Volume 181, Issue 4, Page(s) 463–466

    Abstract: Introduction: Potential benefits of laparoscopic surgery include decreased post-operative pain, improved cosmesis and a shorter hospital stay. However as the volume and complexity of laparoscopic procedures increase, there appears to be a simultaneous ... ...

    Abstract Introduction: Potential benefits of laparoscopic surgery include decreased post-operative pain, improved cosmesis and a shorter hospital stay. However as the volume and complexity of laparoscopic procedures increase, there appears to be a simultaneous increase in complications relating to laparoscopic access. Development of a port-site hernia is one such complication.
    Aims: The aim of this study was to evaluate our experience relating to the incidence, presentation and interventions for early, symptomatic port-site hernias following laparoscopic surgery in a unit where minimal access surgery is the preferred approach.
    Materials and methods: A retrospective review of the medical records of all patients who underwent laparoscopic procedures performed by the colorectal service over a 3-year period was conducted. Patients who developed port-site hernias were identified. Additional information on patient demographics, patient co-morbidities, the length and nature of the laparoscopic procedure, the presenting symptoms, the timing of these symptoms as well as the relative investigations and interventions were recorded. All trocars used in this series were bladed.
    Results: A total of 647 patients underwent laparoscopic procedures over a 3-year period. Eight (1.23%) hernias were identified as occurring at the trocar entry site. All were symptomatic and all required surgical intervention.
    Conclusions: Development of a port-site hernia in the early post-operative period can be associated with significant morbidity. This complication should be considered in patients presenting with post-operative bowel obstruction. With meticulous closure of port sites 10 mm and bigger, the incidence of hernia may be reduced.
    MeSH term(s) Aged ; Aged, 80 and over ; Female ; Hernia, Abdominal/epidemiology ; Hernia, Abdominal/etiology ; Hernia, Abdominal/surgery ; Humans ; Incidence ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Retrospective Studies ; Time Factors
    Language English
    Publishing date 2012-01-08
    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/s11845-011-0799-9
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  4. Article ; Online: Meta-analysis of the effect of extending the interval after long-course chemoradiotherapy before surgery in locally advanced rectal cancer.

    Ryan, É J / O'Sullivan, D P / Kelly, M E / Syed, A Z / Neary, P C / O'Connell, P R / Kavanagh, D O / Winter, D C / O'Riordan, J M

    The British journal of surgery

    2019  Volume 106, Issue 10, Page(s) 1298–1310

    Abstract: Background: The current standard of care in locally advanced rectal cancer (LARC) is neoadjuvant long-course chemoradiotherapy (nCRT) followed by total mesorectal excision (TME). Surgery is conventionally performed approximately 6-8 weeks after nCRT. ... ...

    Abstract Background: The current standard of care in locally advanced rectal cancer (LARC) is neoadjuvant long-course chemoradiotherapy (nCRT) followed by total mesorectal excision (TME). Surgery is conventionally performed approximately 6-8 weeks after nCRT. This study aimed to determine the effect on outcomes of extending this interval.
    Methods: A systematic search was performed for studies reporting oncological results that compared the classical interval (less than 8 weeks) from the end of nCRT to TME with a minimum 8-week interval in patients with LARC. The primary endpoint was the rate of pathological complete response (pCR). Secondary endpoints were recurrence-free survival, local recurrence and distant metastasis rates, R0 resection rates, completeness of TME, margin positivity, sphincter preservation, stoma formation, anastomotic leak and other complications. A meta-analysis was performed using the Mantel-Haenszel method.
    Results: Twenty-six publications, including four RCTs, with 25 445 patients were identified. A minimum 8-week interval was associated with increased odds of pCR (odds ratio (OR) 1·41, 95 per cent c.i. 1·30 to 1·52; P < 0·001) and tumour downstaging (OR 1·18, 1·05 to 1·32; P = 0·004). R0 resection rates, TME completeness, lymph node yield, sphincter preservation, stoma formation and complication rates were similar between the two groups. The increased rate of pCR translated to reduced distant metastasis (OR 0·71, 0·54 to 0·93; P = 0·01) and overall recurrence (OR 0·76, 0·58 to 0·98; P = 0·04), but not local recurrence (OR 0·83, 0·49 to 1·42; P = 0·50).
    Conclusion: A minimum 8-week interval from the end of nCRT to TME increases pCR and downstaging rates, and improves recurrence-free survival without compromising surgical morbidity.
    MeSH term(s) Blood Loss, Surgical/statistics & numerical data ; Chemoradiotherapy, Adjuvant/methods ; Clinical Trials as Topic ; Disease-Free Survival ; Humans ; Observational Studies as Topic ; Operative Time ; Organ Sparing Treatments/methods ; Postoperative Complications/etiology ; Rectal Neoplasms/mortality ; Rectal Neoplasms/surgery ; Rectal Neoplasms/therapy ; Rectum/surgery ; Reoperation/statistics & numerical data ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2019-06-19
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    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 10.1002/bjs.11220
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  5. Article ; Online: Laparoscopic surgery for complicated diverticular disease: a single-centre experience.

    Royds, J / O'Riordan, J M / Eguare, E / O'Riordan, D / Neary, P C

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

    2012  Volume 14, Issue 10, Page(s) 1248–1254

    Abstract: Aim: The role of laparoscopic surgery in the management of patients with diverticular disease is still not universally accepted. The aim of our study was to evaluate the results of laparoscopic surgery for diverticular disease in a centre with a ... ...

    Abstract Aim: The role of laparoscopic surgery in the management of patients with diverticular disease is still not universally accepted. The aim of our study was to evaluate the results of laparoscopic surgery for diverticular disease in a centre with a specialist interest in minimally invasive surgery.
    Method: All diverticular resections carried out between 2006 and 2010 were reviewed. Data recorded included baseline demographics, indication for surgery, operative details, length of hospital stay and complications. Complicated diverticular disease was defined as diverticulitis with associated abscess, phlegmon, fistula, stricture, obstruction, bleeding or perforation.
    Results: One hundred and two patients (58 men) who had surgery for diverticular disease were identified (median age 59 years, range 49-70 years). Sixty-four patients (64%) had surgery for complicated diverticular disease. The indications were recurrent acute diverticulitis (37%), colovesical fistula (21%), stricture formation (17%) and colonic perforation (16%). Sixty-nine cases (88%) were completed by elective laparoscopy. Postoperative mortality was 0%. For elective cases there was no difference in morbidity rates between patients with complicated and uncomplicated diverticular disease. The overall anastomotic leakage rate was 1% and the wound infection rate 7%. There was a nonsignificant trend to higher conversion to open surgery in the elective group in complicated (11.4%) compared with uncomplicated patients (5.2%) (P=0.67). Electively, the rate of stoma formation was higher in the complicated (31.6%) than the uncomplicated group (5.2%) (P<0.02).
    Conclusion: Laparoscopic surgery for both complicated and uncomplicated diverticular disease is associated with low rates of postoperative morbidity and relatively low conversion rates. Laparoscopic surgery is now the standard of care for complicated and uncomplicated diverticular disease in our institution.
    MeSH term(s) Aged ; Anastomosis, Surgical ; Colectomy ; Colon/surgery ; Conversion to Open Surgery/statistics & numerical data ; Diverticulitis, Colonic/complications ; Diverticulitis, Colonic/surgery ; Diverticulum, Colon/surgery ; Elective Surgical Procedures ; Female ; Humans ; Laparoscopy ; Length of Stay/statistics & numerical data ; Male ; Medical Audit ; Middle Aged ; Postoperative Complications/epidemiology ; Practice Guidelines as Topic ; Rectum/surgery ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2012-10
    Publishing country England
    Document type Evaluation Studies ; Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/j.1463-1318.2011.02924.x
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  6. Article ; Online: Assessment of comparative skills between hand-assisted and straight laparoscopic colorectal training on an augmented reality simulator.

    Leblanc, F / Delaney, C P / Neary, P C / Rose, J / Augestad, K M / Senagore, A J / Ellis, C N / Champagne, B J

    Diseases of the colon and rectum

    2010  Volume 53, Issue 9, Page(s) 1323–1327

    Abstract: Purpose: The aim of this study was to compare skills sets during a hand-assisted and straight laparoscopic colectomy on an augmented reality simulator.: Methods: Twenty-nine surgeons, assigned randomly in 2 groups, performed laparoscopic sigmoid ... ...

    Abstract Purpose: The aim of this study was to compare skills sets during a hand-assisted and straight laparoscopic colectomy on an augmented reality simulator.
    Methods: Twenty-nine surgeons, assigned randomly in 2 groups, performed laparoscopic sigmoid colectomies on a simulator: group A (n = 15) performed hand-assisted then straight procedures; group B (n = 14) performed straight then hand-assisted procedures. Groups were compared according to prior laparoscopic colorectal experience, performance (time, instrument path length, and instrument velocity changes), technical skills, and operative error.
    Results: Prior laparoscopic colorectal experience was similar in both groups. Both groups had better performances with the hand-assisted approach, although technical skill scores were similar between approaches. The error rate was higher with the hand-assisted approach in group A, but similar between both approaches in group B.
    Conclusions: These data define the metrics of performance for hand-assisted and straight laparoscopic colectomy on an augmented reality simulator. The improved scores with the hand-assisted approach suggest that with this simulator a hand-assisted model may be technically easier to perform, although it is associated with increased intraoperative errors.
    MeSH term(s) Clinical Competence ; Colectomy/standards ; Colorectal Surgery/education ; Colorectal Surgery/standards ; Computer Simulation ; Computer-Assisted Instruction ; Humans ; Laparoscopy/standards ; Psychomotor Performance ; Statistics, Nonparametric ; Task Performance and Analysis ; User-Computer Interface
    Language English
    Publishing date 2010-09
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1007/DCR.0b013e3181e263f1
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  7. Article: Carcinoid disease: review of the literature.

    Neary, P C / Redmond, P H / Houghton, T / Watson, G R / Bouchier-Hayes, D

    Diseases of the colon and rectum

    1997  Volume 40, Issue 3, Page(s) 349–362

    Abstract: Carcinoid syndrome is the product of a rare but fascinating malignant neoplasm. Carcinoid syndrome was described more than 100 years ago, and recent advances in diagnostic localization, elucidation of the mechanisms of oncogenesis, treatment options, and, ...

    Abstract Carcinoid syndrome is the product of a rare but fascinating malignant neoplasm. Carcinoid syndrome was described more than 100 years ago, and recent advances in diagnostic localization, elucidation of the mechanisms of oncogenesis, treatment options, and, consequently, patient prognosis have been made. Current modalities of treatment, possible therapeutic implications of new avenues of research, and current literature on the chemotherapeutic combinations used are reviewed.
    MeSH term(s) Carcinoid Tumor/diagnosis ; Carcinoid Tumor/epidemiology ; Carcinoid Tumor/etiology ; Carcinoid Tumor/physiopathology ; Carcinoid Tumor/therapy ; Humans ; Incidence ; Prognosis ; Risk Factors ; Treatment Outcome
    Language English
    Publishing date 1997-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1007/bf02050428
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  8. Article ; Online: Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection

    Nepogodiev D. / Bhangu A. / Glasbey J.C. / Li E. / Omar O.M. / Simoes J.F. / Abbott T.E. / Alser O. / Arnaud A.P. / Bankhead-Kendall B.K. / Breen K.A. / Cunha M.F. / Davidson G.H. / Di Saverio S. / Gallo G. / Griffiths E.A. / Gujjuri R.R. / Hutchinson P.J. / Kaafarani H.M. /
    Lederhuber H. / Loffler M.W. / Mashbari H.N. / Minaya-Bravo A. / Morton D.G. / Moszkowicz D. / Pata F. / Tsoulfas G. / Venn M.L. / Cox D. / Roslani A.C. / Alakaloko F. / de Vries J.-P.P. / Aaraj M.A. / Abbott S.J. / Abdalla M.O. / Abdelaal A.S. / Ademuyiwa A.O. / Aherne T.M. / Ali O.M. / Alkadeeki G.Z. / Almeida A.C. / Alrahawy M.M. / Ambler G.K. / Alameer E. / Andreani S.M. / De Andres-Asenjo B. / Antonanzas L.L. / Aoun S.G. / Ashoush F.M. / Augestad K.M. / Avellana R.B. / Ayeni F.A. / Ayorinde J.O. / Babu B.H. / Baig M.M. / Bajomo O.M. / Baker O.J. / Baker M.P. / Baldwin A.J. / Ban V.S. / Baron R.D. / Barranquero A.G. / Barry C.P. / DI Bartolomeo A. / Bass G.A. / Bath M.F. / Batjer H.H. / Beamish A.J. / Belgaumkar A.P. / Bence M.N. / Benson R.A. / Bernal-Sprekelsen J.C. / Bhama A.R. / Bhavaraju A.V. / Biffl W.L. / Blundell C.M. / Boddy A.P. / Borgstein A.B. / Bosanquet D.C. / Bosch K.D. / Bouhuwaish A.E. / Bozkurt M.A. / Brathwaite C.E. / Brown B.C. / Brown O.D. / Brown A.K. / Buarque I.L. / Bueno-Canones A.D. / Bulugma M.R. / Burke J.R. / Byrne M.H. / Cagigal-Ortega E.P. / Callcut R.A. / DI Candido F. / Canova M.E. / Carlos W.J. / Caruana E.J. / Cato L.D. / Catton A.B. / Ceretti A.P. / Chase T.J. / Chiara F.D. / Chowdhury A.H. / Chung E.A. / Cicerchia P.M. / Clough E.C. / Coleman N.L. / Collins C.G. / Collins M.L. / Colonna E.T. / Comini L.V. / Coughlin P.A. / Cruzado L.F.-G. / Davidson B.R. / Davies R.J. / Davies E.J. / Davis N.F. / Dawson B.E. / Dean B.J. / Delgado M.G.-C. / Diaz J.J. / Dickson K.E. / Diez-Alonso M.M. / Dixon J.R. / Doe M.J. / Drake T.D. / Drake F.T. / Duffy J.P. / Dunne D.F. / Dunne N.J. / Duran-Munoz-Cruzado V.M. / Durst A.Z. / Eardley N.J. / Edwards J.G. / Elfallal A.H. / Elfiky M.M. / Elliott J.A. / Emile S.H. / Emslie K.M. / Endorf F.W. / Engel J.L. / Enjuto D.T. / Etchill E.W. / Evans J.P. / Fahey B.A. / Faria C.S. / Feo C.V. / Ferguson H.J. / Fernandez B.D. / Fernandez A.G. / Fernandez A.J. / Fernandez-Pacheco B.C. / Fitzgerald 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G.S. / Mateo-Sierra O. / Martinez-Perez C. / Serrano Gonzalez J. / Hernandez Bartolome M.A. / Diaz Perez D. / Gutierrez Samaniego M. / Galindo Jara P. / Sharma N. / Smart N.J. / Keller D.S.

    an international cohort study

    2020  

    Abstract: Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and ... ...

    Abstract Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p<0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
    Keywords Adult ; Aged ; Betacoronavirus ; Coronavirus Infections ; Elective Surgical Procedures ; Emergency Medical Services ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia ; Viral ; Postoperative Complications ; Respiratory Tract Diseases ; Retrospective Studies ; Surgical Procedures ; Operative ; Young Adult ; covid19
    Subject code 610 ; 616
    Language English
    Publishing country it
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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