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  1. Article ; Online: Anal fistulas are not all the same.

    Sahnan, K / Warusavitarne, J

    Techniques in coloproctology

    2022  Volume 26, Issue 10, Page(s) 773–774

    MeSH term(s) Humans ; Rectal Fistula/etiology ; Rectal Fistula/surgery
    Language English
    Publishing date 2022-08-09
    Publishing country Italy
    Document type Editorial ; Comment
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-022-02674-1
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  2. Article ; Online: Surgical management of ulcerative colitis.

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

    The British journal of surgery

    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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  3. 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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  4. 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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  5. Article ; Online: Video-assisted anal fistula treatment (VAAFT) assisted seton placement - a video vignette.

    Tozer, P / Sahnan, K / Adegbola, S / Shaikh, S / Lung, P

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

    2019  Volume 21, Issue 12, Page(s) 1462

    MeSH term(s) Humans ; Prosthesis Implantation/methods ; Rectal Fistula/surgery ; Transanal Endoscopic Surgery/methods ; Treatment Outcome ; Video-Assisted Surgery/methods
    Language English
    Publishing date 2019-09-03
    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.14823
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  6. 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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  7. 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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  8. Article: Darvadstrocel for the treatment of patients with perianal fistulas in Crohn's disease.

    Kotze, P G / Spinelli, A / Warusavitarne, J / Di Candido, F / Sahnan, K / Adegbola, S O / Danese, S

    Drugs of today (Barcelona, Spain : 1998)

    2019  Volume 55, Issue 2, Page(s) 95–105

    Abstract: Despite significant advances in medical and surgical therapy for perianal fistulas in Crohn's disease (CD), treatment results are still modest, and a specific need for more effective therapies is a reality. Darvadstrocel is composed of expanded human ... ...

    Abstract Despite significant advances in medical and surgical therapy for perianal fistulas in Crohn's disease (CD), treatment results are still modest, and a specific need for more effective therapies is a reality. Darvadstrocel is composed of expanded human allogeneic mesenchymal adult stem cells extracted from adipose tissue and constitutes the first stem cell therapy for perianal fistulizing CD to receive approval from the European Medicines Agency (EMA). This therapy is injected in both internal and external openings, as well as inside the fistula tracks, to induce fistula healing. In this monograph, the authors review the preclinical pharmacology of darvadstrocel, as well as pharmacokinetics and metabolism, and cover the main indications and detailed information on the efficacy and safety profile of the agent. Possible interactions with other agents used to treat CD are also explored. Darvadstrocel is a safe and effective therapy for perianal complex fistulas in CD, and represents the beginning of a new era of mesenchymal stem cell therapy in this difficult phenotype of the disease.
    MeSH term(s) Adipose Tissue/cytology ; Adult ; Crohn Disease/complications ; Crohn Disease/therapy ; Humans ; Rectal Fistula/etiology ; Rectal Fistula/therapy ; Stem Cell Transplantation ; Treatment Outcome
    Language English
    Publishing date 2019-04-10
    Publishing country Spain
    Document type Journal Article ; Review
    ISSN 1699-3993
    ISSN 1699-3993
    DOI 10.1358/dot.2019.55.2.2914336
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  9. Article ; Online: Heterogeneity in outcome selection, definition and measurement in studies assessing the treatment of cryptoglandular anal fistula: findings from a systematic review.

    Machielsen, A J H M / Iqbal, N / Kimman, M L / Sahnan, K / Adegbola, S O / Kane, G / Woodcock, R / Kleijnen, J / Grossi, U / Breukink, S O / Tozer, P J

    Techniques in coloproctology

    2021  Volume 25, Issue 7, Page(s) 761–830

    Abstract: Background: Treatment for cryptoglandular anal fistula (AF) is challenging and a lack of uniform outcomes in the literature prevents direct comparison of treatments. This can be addressed by developing a core outcome set, a standardised set of outcomes ... ...

    Abstract Background: Treatment for cryptoglandular anal fistula (AF) is challenging and a lack of uniform outcomes in the literature prevents direct comparison of treatments. This can be addressed by developing a core outcome set, a standardised set of outcomes reported in all interventional studies for a specific condition. The aim of this systematic review is to assess the range of outcomes, their definitions, and the measurement instruments currently utilised in interventional studies for adult patients with AF. This will inform the development of an AF core outcome set.
    Methods: Medline, Embase and The Cochrane Library were searched to identify all patient- and clinician-reported outcomes in studies assessing medical, surgical or combination treatment of adult patients with AF published from January 2008 to May 2020. The resulting outcomes were categorized according to the Core Outcome Measurement in Effectiveness Trials (COMET) taxonomy to better understand their distribution.
    Results: In total, 155 studies were included, 552 outcomes were extracted, with a median of three outcomes (interquartile range 2-5) per study. Only 25% of studies demonstrated high-quality outcome reporting. The outcomes were merged into 52 unique outcomes and structured into four core areas and 14 domains, with the majority in the domain of physiological or clinical (gastrointestinal) outcomes. The most commonly reported outcomes were healing (77%), incontinence (63%), and recurrence (40%), with no single outcome assessed across all studies. There was a wide variation in outcome definitions and measurement instruments used.
    Conclusions: There is substantial heterogeneity in outcomes, definitions, and measurement instruments reported in interventional studies for cryptoglandular anal fistula. This emphasises the need for standardised outcome reporting and measurement.
    MeSH term(s) Adult ; Humans ; Rectal Fistula ; Recurrence ; Treatment Outcome
    Language English
    Publishing date 2021-05-08
    Publishing country Italy
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-021-02452-5
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  10. Article ; Online: The use of 3D imaging to facilitate training during complex fistula surgery - a video vignette.

    Sahnan, K / Lung, P / Adegbola, S / Shaikh, S / Iqbal, N / Hart, A / Warusavitarne, J / Faiz, O / Phillips, R / Tozer, P

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

    2019  Volume 21, Issue 3, Page(s) 376

    MeSH term(s) Diffusion Magnetic Resonance Imaging/methods ; Humans ; Imaging, Three-Dimensional/methods ; Proctectomy/education ; Proctectomy/methods ; Rectal Fistula/diagnostic imaging ; Rectal Fistula/surgery ; Teaching
    Language English
    Publishing date 2019-01-30
    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.14551
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