Search

Aim: The management of anal fissure: ACPGBI position statement was written 15 years ago. [KLR Cross et al., Colorectal Dis, 2008]. Our aim was to update the guideline and provide recommendations on the most effective treatment for patients with anal fissures utilising a multidisciplinary, rigorous guideline methodology. Methods: The development process consisted of six phases. In phase 1 we defined the scope of the guideline. The patient population included patients with acute and chronic anal fissure. The target group was all practitioners (primary and secondary care) treating patients with fissures and, in addition, healthcare workers and patients who desired information regarding fissure management. In phase 2 we formed a guideline development group (GDG) including a methodologist. In phase 3 review questions were formulated, using a reversed PICO process, starting with possible recommendations based on the GDG's knowledge. In phase 4 a comprehensive literature search focused on existing systematic reviews addressing each review question, supplemented by more recent studies if appropriate. In phase 5 data were extracted from the included papers and checked by the GDG. If indicated, meta‐analysis of systematic review data was updated by the GDG. During phase 6 the GDG members decided what recommendations could be made based on the evidence in the literature and strength of the recommendation was assessed using 'grade'. Results: This guideline is divided into two sections: Primary care which includes (i) diagnosis; (ii) basic treatment; (iii) topical treatment; and secondary care which includes (iv) botulinum toxin therapy; (v) surgical intervention and (vi) special situations (including pregnancy and breast‐feeding patients, children, receptive anal intercourse and low‐pressure fissures). A total of 23 recommendations were formulated. A new term clinically healed was described by the GDG. Conclusion: This guideline provides an up‐to‐date evidence‐based summary of the current knowledge of the management of anal fissure and may serve as a useful guide for clinicians as well as a potential reference for patients. [ABSTRACT FROM AUTHOR]

Aim: Use of open abdomen (OA) remains an important life‐saving manoeuvre in the management of trauma and the abdominal catastrophe. The National Open Abdomen Audit (NOAA) is an audit project investigating the indications, management, and subsequent outcomes of OA treatment throughout the UK. The aim is to generate a snapshot of practice which will inform the management of future patients and potentially reduce the significant harm that can be associated with OA. Methods and analysis: NOAA is a collaborative, prospective observational audit recruiting patients from across Great Britain and Ireland. The study will open from July 2023 with rolling recruitment across participating sites. All adult patients who leave theatre with an OA will be included and followed‐up for 90 days. The primary objective is to prospectively audit the national variability in the management of the OA. Secondary outcomes include the treatment modality used for OA, indication, outcome of treatment and complications, including mortality and development of intestinal failure. All data will be recorded and managed using the secure REDCap electronic data capture and analysed using Stata (version 16.1). Results will be reported in accordance with the STROBE statement. Conclusion: Results will be used to formulate a practical clinical guideline on when to implement an OA along with a stepwise management plan once initiated to reduce the associated morbidity and mortality. It is hoped that participation in this study will facilitate education of surgeons with a "trickle down" effect on all members of the surgical team and remove variability in the management. [ABSTRACT FROM AUTHOR]

Aim: Patients diagnosed with a malignant polyp generally have favourable overall survival (OS) and cancer‐specific survival (CSS). However, it is unclear how choice in management for malignant polyps may affect survival. Methods: Data from the Queensland Oncology Repository was analysed to derive a population wide assessment of the impact of management strategy on OS and CSS for patients diagnosed with malignant polyps. Log‐rank testing, Kaplan–Meier and Cox‐regression models were performed. Patients were matched using propensity score and Mahalanobis distance matching. Results: A total of 1,646 patients were included with 240 deaths and 52 colorectal cancer related deaths until censor date. Following propensity score and Mahalanobis distance matching of patients undergoing polypectomy alone versus colorectal resection, there was no significant difference in the age groups (<60 years of age or ≥60 years of age), American Society of Anesthesiology score, comorbidity count or Association of ColoProctology of Great Britain and Ireland risk category. However, of note Log‐rank testing demonstrated a significant difference in OS (p < 0.001) and CSS (p = 0.0061) between management strategies. Multivariable Cox‐regression models in matched and un‐matched patient cohorts demonstrated significantly lower hazards of death for OS with resection (p < 0.001). However, CSS was no longer significantly different between management groups in multivariable Cox‐regression analysis (p = 0.073). Conclusion: Patients who underwent colorectal resection had significantly improved OS and CSS compared with polypectomy alone. Improved OS was furthermore seen on multivariable analysis, and in matched cohorts. Future research should investigate why this unexpected finding may be the case and whether updates to guidelines should be considered. [ABSTRACT FROM AUTHOR]

Aim: There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods: Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results: All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion: These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting. [ABSTRACT FROM AUTHOR]

This article discusses the Association of Coloproctology of Great Britain and Ireland's guideline on the management of anal fissure. The guideline emphasizes the need for high-quality research, education, and training in proctology, which has been a neglected area in colorectal surgery. The management of anal fissure is of interest to various healthcare professionals and stakeholders, and the guideline has been developed with broad stakeholder engagement, including patients. While there have been some refinements in pharmacological therapies and patient selection for operations, the guideline highlights the disappointingly low quality of evidence for most treatment options and calls for better research in this field. [Extracted from the article]

This is a summary of the history of the Association of Coloproctology of Great Britain and Ireland from its inception in the late 1980s to the present day. [ABSTRACT FROM AUTHOR]

Aim: The aim was to explore whether people with an ileostomy in the UK and Ireland receive the dietary advice they require. Method: An online survey with multiple‐choice questions asked people with an ileostomy about the dietary advice they received and would have preferred to receive. Participants were recruited via websites of the Ileostomy and Internal Pouch Association and Crohn's and Colitis UK and via social media. People with a current ileostomy, age 16 years or over, and living in the UK or Ireland were eligible for inclusion. Responses were analysed using descriptive statistics. Results: In all, 291 eligible responses were received and included in the analysis; 201 (69%) received advice on diet for their ileostomy from a healthcare professional or the internet. Of the 90 who did not receive dietary advice, 82 (91%) would have liked advice. Stoma nurses were the most common source of dietary advice (55%), but many other sources were frequently reported. Most (62%) felt that at least some dietary advice they received was conflicting. Over half (55%) felt anxious about managing their diet with a new ileostomy, 39% were confused, and 31% frustrated. Of 291 respondents, 29% received advice from a dietitian compared to 60% who would have preferred advice from a dietitian. Conclusion: Many people undergoing ileostomy surgery do not receive the dietary advice and support they require. Healthcare professionals working with people with an ileostomy should be mindful they are often anxious about their diet and require clear and consistent dietary advice and support. [ABSTRACT FROM AUTHOR]

The following position statement forms part of a response to the current concerns regarding use of mesh to perform rectal prolapse surgery. It highlights the actions being pursued by the Pelvic Floor Society (TPFS) regarding clinical governance in relation to ventral mesh rectopexy (VMR). The following are summary recommendations. Available evidence suggests that mesh morbidity for VMR is far lower than that seen in transvaginal procedures (the main subject of current concern) and lower than that observed following other abdomino‐pelvic procedures for urogenital prolapse, e.g. laparoscopic sacrocolpopexy.VMR should be performed by adequately trained surgeons who work within a multidisciplinary team (MDT) framework. Within this, it is mandatory to discuss all patients considered for surgery at an MDT meeting.Clinical outcomes of surgery and any complications resulting from surgery should be recorded in the TPFS‐hosted national database (registry) available for this purpose; in addition, all patients should be considered for entry into ongoing and planned UK/European randomized studies where this is feasible.A move towards accreditation of UK units performing VMR will improve performance and outcomes in the long term.An enhanced programme of training including staged porcine, cadaveric and preceptorship sessions will ensure the competence of surgeons undertaking VMR.Enhanced consent forms and patient information booklets are being developed, and these will help both surgeons and patients.There is weak observational evidence that technical aspects of the procedure can be optimized to reduce morbidity rates. Suture material choice may contribute towards morbidity. The available evidence is insufficient to support the use of one mesh over another (biologic vs synthetic); however, the use of polyester mesh is associated with increased morbidity. [ABSTRACT FROM AUTHOR]

Aim: The involvement of surgeons in major adverse outcomes can have a negative impact on their personal and professional lives, as well as on patient outcomes. Healthcare professionals involved in such incidents have been referred to as 'second victims'. We designed an online survey to study the impact of operative complications on surgeons' professional and personal lives. Method: An online survey of general, gastrointestinal, hepato‐pancreato‐biliary and vascular surgeons was conducted using the Twitter feed of the Association of Coloproctology of Great Britain and Ireland, the Association of Surgeons of Great Britain and Ireland and the European Society of Coloproctology over an 8‐week period. Results: Questionnaires were completed by 82 participants. Ninety‐one per cent of respondents were consultant surgeons, 37% with more than 15 years' experience. Eighty‐three per cent were colorectal surgeons. The majority of surgeons (95%) reported that their practice had been affected as a result of serious complications and 54% suggested that it had had a negative impact on their family life. Fifty‐five per cent of respondents mentioned lack of support in their institution for healthcare professionals involved in adverse outcomes and an existing blame culture. Suggestions for improvement included mentoring (41%), counselling (38%), openness (66%), peer support groups (52%) and human factors training (32%). Conclusion: This survey highlights that the majority of surgeons involved in serious complications are adversely affected. Those involved in the running of surgical services need to improve support for surgeons in the aftermath of such events. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The Association of Coloproctology of Great Britain and Ireland (ACPGBI) Delphi process identified prevention and treatment of parastomal hernia (PSH) as the second highest priority non‐cancer related colorectal pathology. This position statement aims to summarize the current evidence base. Methods: Four broad themes were identified (prevention, diagnosis/classification, management and operative repair). Guidelines are based on evidence from an extensive literature review using organized searches on the PubMed, MEDLINE, Embase and Cochrane databases. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adhered to for classifying the quality of evidence and reporting the strength of recommendations. Results: The suture repair of PSH other than for patients in extremis is not recommended. Synthetic non‐absorbable mesh can be used safely in the short term in the construction of colostomies post rectal surgery, but longer‐term follow‐up is needed. Other broad recommendations are made around access to stoma care nurses, prevention classification and management. Conclusion: There is a lack of high quality evidence for many domains in the prevention and treatment of PSH but the results of several studies are awaited. What does this paper add to the literature?: Parastomal hernias are a common and debilitating condition following stoma formation. This position statement from ACPGBI details the current evidence base and ongoing research for the prevention, diagnosis and management of parastomal hernias. [ABSTRACT FROM AUTHOR]

I represent the Patient Liaison Group working with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) particularly on the topic of inflammatory bowel disease (IBD). The IBD Surgical Guidelines have been commissioned by ACPGBI to sit alongside the review by the British Society of Gastroenterology of the medical guidelines for the measurement of IBD [2]. They look at Crohn's disease; pouch surgery, intestinal failure; surgery for IBD in pregnancy; right through to the impact of medications on surgery. [Extracted from the article]