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Article ; Online: Surgical management of ulcerative colitis.

Worley, Guy H T / Vaughan-Shaw, Peter / Sahnan, Kapil

2023 Volume 110, Issue 8, Page(s) 885–887

MeSH term(s)	Humans ; Colitis, Ulcerative/surgery ; Colectomy ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Colitis/surgery
Language	English
Publishing date	2023-06-27
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/znad020
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Article ; Online: Robotic Total Mesorectal Excision With Transanal Transection and Single-Stapled Anastomosis: A Step-By-Step Video Demonstration.

Mata, Rodrigo / Sahnan, Kapil / Pellino, Gianluca / Spinelli, Antonino / Espín-Basany, Eloy

Diseases of the colon and rectum

2024 Volume 67, Issue 5, Page(s) e289–e290

MeSH term(s)	Humans ; Robotic Surgical Procedures ; Rectal Neoplasms/surgery ; Rectum/surgery ; Anastomosis, Surgical ; Transanal Endoscopic Surgery ; Laparoscopy
Language	English
Publishing date	2024-01-31
Publishing country	United States
Document type	Video-Audio Media ; Journal Article
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000003243
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Article ; Online: An early experience in robotic ileoanal pouch surgery with robotic intracorporeal single-stapled anastomosis (RiSSA) at a tertiary referral centre.

Deputy, Mohammed / Pitman, Francesca / Sahnan, Kapil / Miskovic, Danilo / Faiz, Omar

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

2023 Volume 25, Issue 6, Page(s) 1169–1175

Abstract: Aim: A robotic approach to ileal pouch-anal anastomosis (IPAA) surgery offers advantages over other approaches in terms of precision, improved access to the pelvis and less muscular fatigue for the surgeon. The integrity of the anastomosis is also ... ...

Abstract	Aim: A robotic approach to ileal pouch-anal anastomosis (IPAA) surgery offers advantages over other approaches in terms of precision, improved access to the pelvis and less muscular fatigue for the surgeon. The integrity of the anastomosis is also fundamental to successful IPAA surgery. The robotic platform can permit intracorporeal suturing deep within the pelvis to create a single-stapled, double purse-string anastomosis, which may reduce the risk of anastomotic complications. This study describes the safety and early outcomes of robotic intracorporeal single-stapled anastomosis (RiSSA) amongst patients operated consecutively at a tertiary centre immediately before and following the pandemic. Method: A retrospective study of prospectively collected data analysing the outcome of patients undergoing robotic IPAA between 2019 and 2022 was conducted. All procedures were performed with the da Vinci Xi Surgical System (with a hand-assisted suprapubic incision to fashion the pouch). All pouch-anal anastomoses were performed using a double purse-string, single-stapled (RiSSA) method. Demographic, clinical and outcome data were collected. Results: Twenty consecutive patients (nine with ulcerative colitis and 11 with familial adenomatous polyposis) were included with a median age of 25 years (range 16-52); 18 had American Society of Anesthesiologists classification II, and mean body mass index was 24 kg/m Discussion: RiSSA offers a safe and feasible alternative technique to other minimally invasive approaches with low rates of anastomosis-related complications.
MeSH term(s)	Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Robotic Surgical Procedures/methods ; Colitis, Ulcerative/surgery ; Colitis, Ulcerative/complications ; Retrospective Studies ; Tertiary Care Centers ; Treatment Outcome ; Anastomosis, Surgical/methods ; Proctocolectomy, Restorative/methods ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Adenomatous Polyposis Coli/surgery ; Intestinal Obstruction/etiology ; Colonic Pouches
Language	English
Publishing date	2023-03-11
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.16528
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Article: Emerging Data on Fistula Laser Closure (FiLaC) for the Treatment of Perianal Fistulas; Patient Selection and Outcomes.

Adegbola, Samuel O / Sahnan, Kapil / Tozer, Phillip / Warusavitarne, Janindra

Clinical and experimental gastroenterology

2021 Volume 14, Page(s) 467–475

Abstract: Fistula laser closure (FiLaC) is a relatively new sphincter-sparing technique in fistula surgery that was initially reported in 2011. It involves the radial dissipation of laser energy in the fistula tract and, through a combination of coagulation and ... ...

Abstract	Fistula laser closure (FiLaC) is a relatively new sphincter-sparing technique in fistula surgery that was initially reported in 2011. It involves the radial dissipation of laser energy in the fistula tract and, through a combination of coagulation and shrinkage of the tract, is proposed to result in progressive sealing of fistulas. Early studies have suggested minimal impact on continence and touted the advantage of minimal morbidity with potential of repeat procedures if the technique fails initially. Despite early promising results, ten years on, questions remain on the technique, patient selection and long-term outcomes. This narrative review assesses the evidence reported to-date of radially emitting laser fistula surgery in the treatment of perianal fistulas.
Language	English
Publishing date	2021-12-06
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2520690-4
ISSN	1178-7023
ISSN	1178-7023
DOI	10.2147/CEG.S269464
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Article ; Online: Factors associated with stoma formation in ileocolic resection for Crohn's disease and the development of a predictive scoring system.

Wickramasinghe, Dakshitha / Carvello, Michele / Di Candido, Francesca / Maroli, Annalisa / Adegbola, Samuel / Sahnan, Kapil / Morar, Pritesh / Spinelli, Antonino / Warusavitarne, Janindra

Langenbeck's archives of surgery

2022 Volume 407, Issue 7, Page(s) 2997–3003

Abstract: Purpose: The likelihood of a stoma following ileocolic resection (ICR) for Crohn's disease (CD) is an important consideration. This study aims to identify the factors associated with an increased likelihood of a stoma and develop a predictive scoring ... ...

Abstract	Purpose: The likelihood of a stoma following ileocolic resection (ICR) for Crohn's disease (CD) is an important consideration. This study aims to identify the factors associated with an increased likelihood of a stoma and develop a predictive scoring system (SS). Methods: Patient data were collected from St. Marks Hospital, London, UK and Humanitas Clinical and Research Center, Milan, Italy, on all patients who underwent an ICR for CD from 2005 to 2017. A logistic regression analysis was used for multivariate analysis. The SS was developed from the logistic regression model. The performance of the SS was evaluated using receiver operating characteristics area under the curve (AUROC). Results: A total of 628 surgeries were included in the analysis. Sixty-nine surgeries were excluded due to missing data. The remaining 559 were divided into two cohorts for the scoring system's development (n = 434) and validation (n = 125). The regression model was statistically significant (p < 0.0001). The statistically significant independent variables included sex, preoperative albumin and haemoglobin levels, surgical access and simultaneous colonic resection. The AUROC for the development and validation cohorts were 0.803 and 0.905, respectively (p < 0.0001). Youden's index suggested the cut-off score of - 95.9, with a sensitivity of 87.6% and a specificity of 62.9%. Conclusions: Male sex, low preoperative albumin, anaemia, laparoscopic conversion and simultaneous colonic resection were associated with an increased likelihood of requiring a stoma and were used to develop an SS. The calculator is available online at https://rebrand.ly/CrohnsStoma .
MeSH term(s)	Humans ; Male ; Crohn Disease/surgery ; Colectomy ; Anastomosis, Surgical ; Colon/surgery ; Albumins ; Retrospective Studies
Chemical Substances	Albumins
Language	English
Publishing date	2022-07-29
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-022-02626-1
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Article: Creation of an institutional preoperative checklist to support clinical risk assessment in patients with ulcerative colitis (UC) considering ileoanal pouch surgery.

Alves Martins, Bruno Augusto / Shamsiddinova, Amira / Alquaimi, Manal Mubarak / Worley, Guy / Tozer, Phil / Sahnan, Kapil / Perry-Woodford, Zarah / Hart, Ailsa / Arebi, Naila / Matharoo, Manmeet / Warusavitarne, Janindra / Faiz, Omar

Frontline gastroenterology

2023 Volume 15, Issue 3, Page(s) 203–213

Abstract: Background: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the most established restorative operative approach for patients with ulcerative colitis. It has associated morbidity and the potential for major repercussions on quality of ... ...

Abstract	Background: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the most established restorative operative approach for patients with ulcerative colitis. It has associated morbidity and the potential for major repercussions on quality of life. As such, patient selection is crucial to its success. The main aim of this paper is to present an institutional preoperative checklist to support clinical risk assessment and patient selection in those considering IPAA. Methods: A literature review was performed to identify the risk factors associated with surgical complications, decreased functional outcomes/quality of life, and pouch failure after IPAA. Based on this, a preliminary checklist was devised and modified through an iterative process. This was then evaluated by a consensus group comprising the pouch multidisciplinary team (MDT) core members. Results: The final preoperative checklist includes assessment for risk factors such as gender, advanced age, obesity, comorbidities, sphincteric impairment, Crohn's disease and pelvic radiation therapy. In addition, essential steps in the decision-making process, such as pouch nurse counselling and discussion regarding surgical alternatives, are also included. The last step of the checklist is discussion at a dedicated pouch-MDT. Discussion: A preoperative checklist may support clinicians with the selection of patients that are suitable for pouch surgery. It also serves as a useful tool to inform the discussion of cases at the MDT meeting.
Language	English
Publishing date	2023-12-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2521857-8
ISSN	2041-4137
ISSN	2041-4137
DOI	10.1136/flgastro-2023-102503
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Article ; Online: Perioperative safety of tofacitinib in surgical ulcerative colitis patients.

Lightner, Amy L / Vaidya, Prashansha / Holubar, Stefan / Warusavitarne, Janindra / Sahnan, Kapil / Carrano, Francesco Maria / Spinelli, Antonino / Zaghiyan, Karen / Fleshner, Phillip R

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

2021 Volume 23, Issue 8, Page(s) 2085–2090

Abstract: Aim: The literature regarding monoclonal antibodies and increased postoperative complications in inflammatory bowel disease remains controversial. There have been no studies investigating tofacitinib. The aim of this work was to determine preoperative ... ...

Abstract	Aim: The literature regarding monoclonal antibodies and increased postoperative complications in inflammatory bowel disease remains controversial. There have been no studies investigating tofacitinib. The aim of this work was to determine preoperative exposure to the small-molecule inhibitor tofacitinib and postoperative outcomes. Method: We conducted a retrospective review of all adult patients exposed to tofacitinib within 4 weeks of total abdominal colectomy for medically refractory ulcerative colitis between 1 January 2018 and 1 September 2020 at four inflammatory bowel disease referral centres. Data collected included patient demographics and 90-day postoperative morbidity, readmission and reoperation rates. Results: Fifty-three patients (32 men, 60%) with ulcerative colitis underwent a total abdominal colectomy (n = 50 laparoscopic, 94%) for medically refractory disease. Previous exposure to monoclonal antibodies included infliximab (n = 34), adalimumab (n = 35), certolizumab pegol (n = 5), vedolizumab (n = 33) and ustekinumab (n = 10). Twenty-seven (51%) patients were on concurrent prednisone at a median daily dose of 30 mg by mouth (range 5-60 mg). There were no postoperative deaths. Ninety-day postoperative complications included ileus (n = 7, 13.2%), superficial surgical site infection (n = 4, 7.5%), intra-abdominal abscess (n = 2, 3.8%) and venous thromboembolism (VTE) (n = 7, 13.2%). Locations of VTE included portomesenteric venous thrombus (n = 4), internal iliac vein (n = 2) and pulmonary embolism (n = 1). Nine (17%) patients were readmitted to hospital and five (9%) patients had a reoperation. Conclusion: Mirroring the recently issued US Food and Drug Administration black box warning of an increased risk of VTE in medically treated ulcerative colitis patients taking tofacitinib, preoperative tofacitinib exposure may present an increased risk of postoperative VTE events. Consideration should be given for prolonged VTE prophylaxis on hospital discharge.
MeSH term(s)	Adult ; Colitis, Ulcerative/drug therapy ; Colitis, Ulcerative/surgery ; Humans ; Male ; Piperidines/adverse effects ; Postoperative Complications/epidemiology ; Pyrimidines ; Retrospective Studies
Chemical Substances	Piperidines ; Pyrimidines ; tofacitinib (87LA6FU830)
Language	English
Publishing date	2021-05-24
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.15702
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Article ; Online: Is fistulotomy with immediate sphincter reconstruction (FISR) a sphincter preserving procedure for high anal fistula? A systematic review and meta-analysis.

Iqbal, Nusrat / Dilke, Stella Maye / Geldof, Jeroen / Sahnan, Kapil / Adegbola, Samuel / Bassett, Paul / Tozer, Philip

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

2021 Volume 23, Issue 12, Page(s) 3073–3089

Abstract: Aim: This systematic review aimed to assess the outcomes of fistulotomy or fistulectomy and immediate sphincter repair (FISR) in relation to healing, incontinence and sphincter dehiscence both overall and in patients with high anal fistulae.: Methods!# ...

Abstract	Aim: This systematic review aimed to assess the outcomes of fistulotomy or fistulectomy and immediate sphincter repair (FISR) in relation to healing, incontinence and sphincter dehiscence both overall and in patients with high anal fistulae. Methods: Medline, Embase and The Cochrane library were searched for studies of patients undergoing FISR for anal fistula. Data regarding healing, continence and sphincter dehiscence were extracted overall and for high anal fistulae. The DerSimonian-Laird random-effects method was used for pooled analysis, heterogeneity between studies was assessed based on the significance of between-study heterogeneity, and on the size of the I Results: We identified 21 studies evaluating 1700 patients. Pooled analysis of healing reached 93% (95% CI: 91%-95%, I Conclusion: The evidence suggests FISR is a safe, effective procedure. However, data are limited by inconsistencies in reporting of continence and definition of fistula height, particularly high anal fistulae. Significant heterogeneity means that outcomes in high fistulae remain uncertain.
MeSH term(s)	Anal Canal/surgery ; Fecal Incontinence/etiology ; Humans ; Organ Sparing Treatments ; Rectal Fistula/etiology ; Rectal Fistula/surgery ; Treatment Outcome ; Urinary Incontinence
Language	English
Publishing date	2021-10-22
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.15945
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Article ; Online: A scoring system to predict a prolonged length of stay after surgery for Crohn's disease.

Wickramasinghe, Dakshitha / Adegbola, Samuel / Sahnan, Kapil / Morar, Pritesh / Carvello, Michele / Di Candido, Francesca / Maroli, Annalisa / Spinelli, Antonino / Warusavitarne, Janindra

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

2021 Volume 23, Issue 5, Page(s) 1205–1212

Abstract: Aim: Many factors influence the postoperative length of stay (LOS) in Crohn's disease (CD). This study aims to identify the factors associated with a prolonged LOS after ileocolic resection (ICR) for CD and to develop a scoring system to predict the ... ...

Abstract	Aim: Many factors influence the postoperative length of stay (LOS) in Crohn's disease (CD). This study aims to identify the factors associated with a prolonged LOS after ileocolic resection (ICR) for CD and to develop a scoring system to predict the postoperative LOS in CD. Method: Patient data were collected from St Marks Hospital, London, UK, and the Humanitas Clinical and Research Center Milan, Italy, for all patients who underwent an ICR for CD from 2005 to 2017. Logistic regression was used for multivariate analysis. The scoring system was developed from the logistic regression model. The performance of the scoring system was evaluated using the area under the receiver operating characteristic curve (AUROC). Results: A total of 628 surgeries were included in the analysis. Eighty eight surgeries were excluded due to missing data. The remaining 543 were divided into two cohorts for the development (n = 418) and validation (n = 125) of the scoring system. The regression model was statistically significant (p < 0.0001). The statistically significant independent variables included the time since diagnosis, American Society of Anesthesiologists (ASA) grade, perioperative use of steroids, surgical access, strictureplasty and platelet count. The AUROCs for the development and validation cohorts were 0.732 and 0.7, respectively (p < 0.0001). The cut-off score suggested by Youden's index was 50, with a sensitivity of 65.6% and a specificity of 73.3%. Conclusion: The time since diagnosis, ASA grade, steroid use, surgical access, strictureplasty and platelet count were associated with a prolonged LOS and were used to develop a scoring system. The calculator is available online at https://rebrand.ly/Crohnscal.
MeSH term(s)	Anastomosis, Surgical ; Colectomy ; Crohn Disease/surgery ; Humans ; Length of Stay ; Postoperative Period ; Retrospective Studies
Language	English
Publishing date	2021-02-20
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.15567
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Article ; Online: Anal itching.

Sahnan, Kapil / Lever, Laurence / Philips, Robin K S

BMJ (Clinical research ed.)

2016 Volume 355, Page(s) i4931

MeSH term(s)	Humans ; Medical History Taking ; Physical Examination ; Pruritus Ani/etiology ; Pruritus Ani/therapy
Language	English
Publishing date	2016-11-04
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.i4931
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