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1. The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

Author

S.K. Kamarajah, R.P.T. Evans, D. Nepogodiev, J. Hodson, J.R. Bundred, I. Gockel, J.A. Gossage, A. Isik, B. Kidane, H.A. Mahendran, I. Negoi, K.E. Okonta, R. Sayyed, R. van Hillegersberg, R.S. Vohra, B.P.L. Wijnhoven, P. Singh, E.A. Griffiths, D. Alderson, J. Bundred, J. Gossage, B. Jefferies, S. McKay, I. Mohamed, K. Siaw-Acheampong, R. Vohra, K. Wanigasooriya, T. Whitehouse, A. Gjata, J.I. Moreno, F.R. Takeda, R. Guevara Castro, T. Harustiak, A. Bekele, A. Kechagias, A. Kennedy, A. Da Roit, A. Bagajevas, J.S. Azagra, L. Mejía-Fernández, J. El Kafsi, R.H. Sayyed, M. Sousa, A.S. Sampaio, R. Blanco, B. Wallner, P.M. Schneider, P.K. Hsu, S. Gananadha, V. Wills, M. Devadas, C. Duong, M. Talbot, M.W. Hii, R. Jacobs, N.A. Andreollo, B. Johnston, G. Darling, A. Isaza-Restrepo, G. Rosero, F. Arias-Amézquita, D. Raptis, J. Gaedcke, D. Reim, J. Izbicki, J.H. Egberts, S. Dikinis, D.W. Kjaer, M.H. Larsen, M.P. Achiam, J. Saarnio, D. Theodorou, T. Liakakos, D.P. Korkolis, W.B. Robb, C. Collins, T. Murphy, J. Reynolds, V. Tonini, M. Migliore, L. Bonavina, M. Valmasoni, R. Bardini, J. Weindelmayer, M. Terashima, R.E. White, E. Alghunaim, M. Elhadi, A.M. Leon-Takahashi, H. Medina-Franco, P.C. Lau, J. Heisterkamp, C. Rosman, G. Beban, R. Babor, A. Gordon, J.I. Rossaak, K.M.I. Pal, A.U. Qureshi, S.A. Naqi, A.A. Syed, J. Barbosa, C.S. Vicente, J. Leite, J. Freire, R. Casaca, R.C.T. Costa, R.R. Scurtu, S.S. Mogoanta, C. Bolca, S. Constantinoiu, D. Sekhniaidze, M. Bjelović, J.B.Y. So, G. Gačevski, C. Loureiro, M. Pera, A. Bianchi, M. Moreno Gijón, J. Martín Fernández, M.S. Trugeda Carrera, M. Vallve-Bernal, M.A. Cítores Pascual, S. Elmahi, I. Halldestam, J. Hedberg, S. Mönig, S. Gutknecht, M. Tez, A. Guner, M.B. Tirnaksiz, E. Colak, B. Sevinç, A. Hindmarsh, I. Khan, D. Khoo, R. Byrom, J. Gokhale, P. Wilkerson, P. Jain, D. Chan, K. Robertson, S. Iftikhar, R. Skipworth, M. Forshaw, S. Higgs, R. Nijjar, Y.K.S. Viswanath, P. Turner, S. Dexter, A. Boddy, W.H. Allum, S. Oglesby, E. Cheong, D. Beardsmore, N. Maynard, R. Berrisford, S. Mercer, S. Puig, R. Melhado, C. Kelty, T. Underwood, K. Dawas, W. Lewis, A. Al-Bahrani, G. Bryce, M. Thomas, A.T. Arndt, F. Palazzo, R.A. Meguid, J. Fergusson, E. Beenen, C. Mosse, J. Salim, S. Cheah, T. Wright, M.P. Cerdeira, P. McQuillan, M. Richardson, H. Liem, J. Spillane, M. Yacob, F. Albadawi, T. Thorpe, A. Dingle, C. Cabalag, K. Loi, O.M. Fisher, S. Ward, M. Read, M. Johnson, R. Bassari, H. Bui, I. Cecconello, R.A.A. Sallum, J.R.M. da Rocha, L.R. Lopes, V. Tercioti, J.D.S. Coelho, J.A.P. Ferrer, G. Buduhan, L. Tan, S. Srinathan, P. Shea, J. Yeung, F. Allison, P. Carroll, F. Vargas-Barato, F. Gonzalez, J. Ortega, L. Nino-Torres, T.C. Beltrán-García, L. Castilla, M. Pineda, A. Bastidas, J. Gómez-Mayorga, N. Cortés, C. Cetares, S. Caceres, S. Duarte, A. Pazdro, M. Snajdauf, H. Faltova, M. Sevcikova, P.B. Mortensen, N. Katballe, T. Ingemann, B. Morten, I. Kruhlikava, A.P. Ainswort, N.M. Stilling, J. Eckardt, J. Holm, M. Thorsteinsson, M. Siemsen, B. Brandt, B. Nega, E. Teferra, A. Tizazu, J.H. Kauppila, V. Koivukangas, S. Meriläinen, R. Gruetzmann, C. Krautz, G. Weber, H. Golcher, G. Emons, A. Azizian, M. Ebeling, S. Niebisch, N. Kreuser, G. Albanese, J. Hesse, L. Volovnik, U. Boecher, M. Reeh, S. Triantafyllou, D. Schizas, A. Michalinos, E. Balli, M. Mpoura, A. Charalabopoulos, D.K. Manatakis, D. Balalis, J. Bolger, C. Baban, A. Mastrosimone, O. McAnena, A. Quinn, C.B. Ó Súilleabháin, M.M. Hennessy, I. Ivanovski, H. Khizer, N. Ravi, N. Donlon, M. Cervellera, S. Vaccari, S. Bianchini, l. Sartarelli, E. Asti, D. Bernardi, S. Merigliano, L. Provenzano, M. Scarpa, L. Saadeh, B. Salmaso, G. De Manzoni, S. Giacopuzzi, R. La Mendola, C.A. De Pasqual, Y. Tsubosa, M. Niihara, T. Irino, R. Makuuchi, K. Ishii, M. Mwachiro, A. Fekadu, A. Odera, E. Mwachiro, D. AlShehab, H.A. Ahmed, A.O. Shebani, A. Elhadi, F.A. Elnagar, H.F. Elnagar, S.T. Makkai-Popa, L.F. Wong, Y.R. Tan, S. Thannimalai, C.A. Ho, W.S. Pang, J.H. Tan, H.N.L. Basave, R. Cortés-González, S.M. Lagarde, J.J.B. van Lanschot, C. Cords, W.A. Jansen, I. Martijnse, R. Matthijsen, S. Bouwense, B. Klarenbeek, M. Verstegen, F. van Workum, J.P. Ruurda, P.C. van der Sluis, M. de Maat, N. Evenett, P. Johnston, R. Patel, A. MacCormick, M. Young, B. Smith, C. Ekwunife, A.H. Memon, K. Shaikh, A. Wajid, N. Khalil, M. Haris, Z.U. Mirza, S.B.A. Qudus, M.Z. Sarwar, A. Shehzadi, A. Raza, M.H. Jhanzaib, J. Farmanali, Z. Zakir, O. Shakeel, I. Nasir, S. Khattak, M. Baig, Noor MA, H.H. Ahmed, A. Naeem, A.C. Pinho, R. da Silva, A. Bernardes, J.C. Campos, H. Matos, T. Braga, C. Monteiro, P. Ramos, F. Cabral, M.P. Gomes, P.C. Martins, A.M. Correia, J.F. Videira, C. Ciuce, R. Drasovean, R. Apostu, S. Paitici, A.E. Racu, C.V. Obleaga, M. Beuran, B. Stoica, C. Ciubotaru, V. Negoita, I. Cordos, R.D. Birla, D. Predescu, P.A. Hoara, R. Tomsa, V. Shneider, M. Agasiev, I. Ganjara, D. Gunjić, M. Veselinović, T. Babič, T.S. Chin, A. Shabbir, G. Kim, A. Crnjac, H. Samo, I. Díez del Val, S. Leturio, J.M. Ramón, M. Dal Cero, S. Rifá, M. Rico, A. Pagan Pomar, J.A. Martinez Corcoles, J.L. Rodicio Miravalles, S.A. Pais, S.A. Turienzo, L.S. Alvarez, P.V. Campos, A.G. Rendo, S.S. García, E.P.G. Santos, E.T. Martínez, M.J. Fernández Díaz, C. Magadán Álvarez, V. Concepción Martín, C. Díaz López, A. Rosat Rodrigo, L.E. Pérez Sánchez, M. Bailón Cuadrado, C. Tinoco Carrasco, E. Choolani Bhojwani, D.P. Sánchez, M.E. Ahmed, T. Dzhendov, F. Lindberg, M. Rutegård, M. Sundbom, C. Mickael, N. Colucci, A. Schnider, S. Er, E. Kurnaz, S. Turkyilmaz, A. Turkyilmaz, R. Yildirim, B.E. Baki, N. Akkapulu, O. Karahan, N. Damburaci, R. Hardwick, P. Safranek, V. Sujendran, J. Bennett, Z. Afzal, M. Shrotri, B. Chan, K. Exarchou, T. Gilbert, T. Amalesh, D. Mukherjee, S. Mukherjee, T.H. Wiggins, R. Kennedy, S. McCain, A. Harris, G. Dobson, N. Davies, I. Wilson, D. Mayo, D. Bennett, R. Young, P. Manby, N. Blencowe, M. Schiller, B. Byrne, D. Mitton, V. Wong, A. Elshaer, M. Cowen, V. Menon, L.C. Tan, E. McLaughlin, R. Koshy, C. Sharp, H. Brewer, N. Das, M. Cox, W. Al Khyatt, D. Worku, R. Iqbal, L. Walls, R. McGregor, G. Fullarton, A. Macdonald, C. MacKay, C. Craig, S. Dwerryhouse, S. Hornby, S. Jaunoo, M. Wadley, C. Baker, M. Saad, M. Kelly, A. Davies, F. Di Maggio, P. Mistry, R. Singhal, O. Tucker, S. Kapoulas, S. Powell-Brett, P. Davis, G. Bromley, L. Watson, R. Verma, J. Ward, V. Shetty, C. Ball, K. Pursnani, A. Sarela, H. Sue Ling, S. Mehta, J. Hayden, N. To, T. Palser, D. Hunter, K. Supramaniam, Z. Butt, A. Ahmed, S. Kumar, A. Chaudry, O. Moussa, A. Kordzadeh, B. Lorenzi, M. Wilson, P. Patil, I. Noaman, J. Willem, G. Bouras, R. Evans, M. Singh, H. Warrilow, A. Ahmad, N. Tewari, F. Yanni, J. Couch, E. Theophilidou, J.J. Reilly, null van Boxel Gijs, K. Akbari, D. Zanotti, B. Sgromo, G. Sanders, T. Wheatley, A. Ariyarathenam, A. Reece-Smith, L. Humphreys, C. Choh, N. Carter, B. Knight, P. Pucher, A. Athanasiou, B. Tan, M. Abdulrahman, J. Vickers, K. Akhtar, R. Chaparala, R. Brown, M.M.A. Alasmar, R. Ackroyd, K. Patel, A. Tamhankar, A. Wyman, R. Walker, B. Grace, N. Abbassi, N. Slim, L. Ioannidi, G. Blackshaw, T. Havard, X. Escofet, A. Powell, A. Owera, F. Rashid, P. Jambulingam, J. Padickakudi, H. Ben-Younes, K. Mccormack, I.A. Makey, M.K. Karush, C.W. Seder, M.J. Liptay, G. Chmielewski, E.L. Rosato, A.C. Berger, R. Zheng, E. Okolo, A. Singh, C.D. Scott, M.J. Weyant, J.D. Mitchell, Surgery, Intensive Care, Radiotherapy, Oral and Maxillofacial Surgery, Rheumatology, Medical Microbiology & Infectious Diseases, Erasmus MC other, Hematology, Gastroenterology & Hepatology, Public Health, Medical Informatics, Internal Medicine, Public Administration, Epidemiology, Erasmus School of Economics, Cell biology, Pathology, Health Services Management & Organisation (HSMO), and Molecular Genetics

Subjects
Pulmonary and Respiratory Medicine, Esophageal Neoplasms, Anastomosis, Anastomotic Leak, outcomes, Esophageal Neoplasms/surgery, surgical techniques, Cohort Studies, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Necrosis, Postoperative Complications, Esophagectomy/adverse effects, SDG 3 - Good Health and Well-being, Surgical, Surgical Stapling, anastomotic leak, esophageal cancer, esophagectomy, Anastomosis, Surgical, Esophagectomy, Humans, Suture Techniques, Anastomosis, Surgical/adverse effects, Suture Techniques/adverse effects, Surgical Stapling/adverse effects, Surgery, Postoperative Complications/etiology, Necrosis/surgery, Cardiology and Cardiovascular Medicine, Anastomotic Leak/etiology
Abstract

BACKGROUND: The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.METHODS: This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.RESULTS: Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.CONCLUSIONS: Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

Published
2022
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2. Patient-reported outcomes after oesophagectomy in the multicentre LASER study

Author

Conor F. Murphy, J Roigg, Marco Scarpa, Bas P. L. Wijnhoven, Carlo Castoro, Jeremy R Huddy, Christine Greene, Giovanni Zaninotto, O McCormack, Nick Maynard, S S Gisbertz, Miguel Pera, John V. Reynolds, B. Sunde, Fredrik Klevebro, Edward Cheong, R Matthijsen, Viknesh Sounderajah, Christophe Mariette, George B. Hanna, Magnus Nilsson, Pernilla Lagergren, Sjoerd M. Lagarde, Sheraz R. Markar, Asif Johar, M. I. van Berge Henegouwen, Guillaume Piessen, Arun Ariyarathenam, H Brenkman, John M. Findlay, Jelle P. Ruurda, Jessie A Elliott, J. J. B. van Lanschot, Rita Alfieri, Eleonora Pinto, S Jaunoo, S Antonowicz, William H. Allum, Grant Sanders, S Castro, R. van Hillegersberg, N Ravi, Surgery, CCA - Cancer biology and immunology, CCA - Cancer Treatment and Quality of Life, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Male, medicine.medical_specialty, Time Factors, Esophageal Neoplasms, medicine.medical_treatment, 030230 surgery, 03 medical and health sciences, Lethargy, Postoperative Complications, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Swallowing, Quality of life, Internal medicine, Humans, Medicine, Patient Reported Outcome Measures, Aged, Retrospective Studies, business.industry, Incidence, Heartburn, Middle Aged, Esophageal cancer, medicine.disease, Esophagectomy, Europe, Cross-Sectional Studies, Treatment Outcome, 030220 oncology & carcinogenesis, Quality of Life, Vomiting, Female, Surgery, medicine.symptom, business, Follow-Up Studies, Cohort study
Abstract

Background Data on the long-term symptom burden in patients surviving oesophageal cancer surgery are scarce. The aim of this study was to identify the most prevalent symptoms and their interactions with health-related quality of life. Methods This was a cross-sectional cohort study of patients who underwent oesophageal cancer surgery in 20 European centres between 2010 and 2016. Patients had to be disease-free for at least 1 year. They were asked to complete a 28-symptom questionnaire at a single time point, at least 1 year after surgery. Principal component analysis was used to assess for clustering and association of symptoms. Risk factors associated with the development of severe symptoms were identified by multivariable logistic regression models. Results Of 1081 invited patients, 876 (81.0 per cent) responded. Symptoms in the preceding 6 months associated with previous surgery were experienced by 586 patients (66.9 per cent). The most common severe symptoms included reduced energy or activity tolerance (30.7 per cent), feeling of early fullness after eating (30.0 per cent), tiredness (28.7 per cent), and heartburn/acid or bile regurgitation (19.6 per cent). Clustering analysis showed that symptoms clustered into six domains: lethargy, musculoskeletal pain, dumping, lower gastrointestinal symptoms, regurgitation/reflux, and swallowing/conduit problems; the latter two were the most closely associated. Surgical approach, neoadjuvant therapy, patient age, and sex were factors associated with severe symptoms. Conclusion A long-term symptom burden is common after oesophageal cancer surgery.

Published
2021
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3. The management of chyle leak post-oesophagectomy for oesophageal carcinoma: a systematic review

Author

A V Robinson, T Roper, M Khan, L Kennedy, and S Jaunoo

Subjects
medicine.medical_specialty, Leak, Chyle, Esophageal Neoplasms, business.industry, General surgery, Incidence (epidemiology), MEDLINE, Chylothorax, General Medicine, Review, medicine.disease, Thoracic duct, Esophagectomy, medicine.anatomical_structure, Radiological weapon, medicine, Humans, Surgery, Prospective Studies, Complication, business
Abstract

Introduction Chyle leak is an uncommon yet potentially fatal complication of oesophagectomy for oesophageal cancer. The management of chyle leak is a debated, controversial topic and to date there is no standardised approach or validated algorithm for its management. This review aims to summarise current treatment algorithms for chyle leak post-oesophagectomy and their outcomes. Methods A systematic search of Embase, MEDLINE, UpToDate and Cochrane was conducted to identify studies reporting on the management of chyle leak following oesophagectomy for oesophageal cancer. Data on interventional success rate and mortality are reported. Findings Twenty-one studies met the inclusion criteria including over 23,254 oesophagectomies and identifying 838 chyle leaks (incidence Conclusions Owing to the heterogeneity of treatment algorithms, timings and indications for interventions, the optimal strategy for managing chyle leak remains unclear. This review has identified an unmet need for prospective multicentre studies assessing the efficacy of predefined algorithms.

Published
2021

4. 1553 Non-Operative Management of Acute Appendicitis at A Major Trauma Centre – A Retrospective Case Series

Author

S J K Chong, M Kaur, C Palmer, and S Jaunoo

Subjects
Series (stratigraphy), medicine.medical_specialty, business.industry, General surgery, Major trauma, Acute appendicitis, Medicine, Surgery, business, medicine.disease
Abstract

Aim The recent CODA trial concluded that appendicitis patients with confirmed faecolith are at higher risk of appendicectomy and complications than those without faecolith. A retrospective case series of patients undergoing non-operative management of appendicitis at a major trauma centre was conducted to determine the success of non-operative management, defined as lack of operative management within 30 and 90 days of diagnosis, and the impact of presence of faecolith on outcomes. Method All patients who received a working diagnosis of appendicitis over a 16-week period between March and June 2020 were identified and their electronic records interrogated for: preliminary and final diagnoses; imaging modality and result; operative or non-operative initial treatment strategy; final treatment strategy; and histopathology results where applicable. Patients who received an initial operative treatment strategy were excluded. Patients for whom appendicitis was not confirmed on either imaging or histopathology were excluded. Results 24 patients received an initial non-operative treatment strategy and were eligible for inclusion. 15 patients (62.5%) underwent successful non-operative management. The remaining 9 patients (37.5%) required operative management within 30 days. Presence of faecolith was confirmed in 9 patients (37.5%). 3 patients (33%) with presence of faecolith required operative management, while 3 patients (25%) without presence of faecolith required operative management. 1 patient with confirmed faecolith developed a large intra-abdominal abscess while undergoing a non-operative treatment strategy and subsequently required right hemicolectomy. Conclusions The majority of our eligible appendicitis patients were successfully managed non-operatively. Presence of faecolith in acute appendicitis is associated with increased risk of requiring operative management.

Published
2021
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5. Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study

Author

Kamarajah, S. K. Nepogodiev, D. Bekele, A. Cecconello, I. and Evans, R. P. T. Guner, A. Gossage, J. A. Harustiak, T. and Hodson, J. Isik, A. Kidane, B. Leon-Takahashi, A. M. and Mahendran, H. A. Negoi, I. Okonta, K. E. Rosero, G. and Sayyed, R. H. Singh, P. Takeda, F. R. van Hillegersberg, R. and Vohra, R. S. White, R. E. Griffiths, E. A. Alderson, D. and Bundred, J. Evans, R. P. T. Gossage, J. Griffiths, E. A. and Jefferies, B. Kamarajah, S. K. McKay, S. Mohamed, I. and Nepogodiev, D. Siaw-Acheampong, K. Singh, P. van Hillegersberg, R. Vohra, R. Wanigasooriya, K. Whitehouse, T. and Gjata, A. Moreno, J. I. Takeda, F. R. Kidane, B. and Guevara, Castro R. Harustiak, T. Bekele, A. Kechagias, A. and Gockel, I. Kennedy, A. Da Roit, A. Bagajevas, A. and Azagra, J. S. Mahendran, H. A. Mejia-Fernandez, L. and Wijnhoven, B. P. L. El Kafsi, J. Sayyed, R. H. Sousa, M. and Sampaio, A. S. Negoi, I. Blanco, R. Wallner, B. and Schneider, P. M. Hsu, P. K. Isik, A. Gananadha, S. and Wills, V. Devadas, M. Duong, C. Talbot, M. Hii, M. W. and Jacobs, R. Andreollo, N. A. Johnston, B. Darling, G. and Isaza-Restrepo, A. Rosero, G. Arias-Amezquita, F. Raptis, D. and Gaedcke, J. Reim, D. Izbicki, J. Egberts, J. H. and Dikinis, S. Kjaer, D. W. Larsen, M. H. Achiam, M. P. and Saarnio, J. Theodorou, D. Liakakos, T. Korkolis, D. P. and Robb, W. B. Collins, C. Murphy, T. Reynolds, J. Tonini, V. Migliore, M. Bonavina, L. Valmasoni, M. Bardini, R. and Weindelmayer, J. Terashima, M. White, R. E. Alghunaim, E. Elhadi, M. Leon-Takahashi, A. M. Medina-Franco, H. and Lau, P. C. Okonta, K. E. Heisterkamp, J. Rosman, C. van Hillegersberg, R. Beban, G. Babor, R. Gordon, A. and Rossaak, J. I. Pal, K. M. I. Qureshi, A. U. Naqi, S. A. and Syed, A. A. Barbosa, J. Vicente, C. S. Leite, J. Freire, J. Casaca, R. Costa, R. C. T. Scurtu, R. R. Mogoanta, S. S. Bolca, C. Constantinoiu, S. Sekhniaidze, D. Bjelovic, M. So, J. B. Y. Gacevski, G. Loureiro, C. Pera, M. and Bianchi, A. Moreno, Gijon M. Martin Fernandez, J. Carrera, M. S. Trugeda Vallve-Bernal, M. Pascual, M. A. Citores and Elmahi, S. Halldestam, I. Hedberg, J. Monig, S. and Gutknecht, S. Tez, M. Guner, A. Tirnaksiz, M. B. Colak, E. Sevinc, B. Hindmarsh, A. Khan, I. Khoo, D. Byrom, R. Gokhale, J. Wilkerson, P. Jain, P. Chan, D. and Robertson, K. Iftikhar, S. Skipworth, R. Forshaw, M. and Higgs, S. Gossage, J. Nijjar, R. Viswanath, Y. K. S. and Turner, P. Dexter, S. Boddy, A. Allum, W. H. Oglesby, S. and Cheong, E. Beardsmore, D. Vohra, R. Maynard, N. and Berrisford, R. Mercer, S. Puigt, S. Melhadot, R. Kelty, C. Underwood, T. Dawas, K. Lewis, W. Al-Bahrani, A. and Bryce, G. Thomas, M. Arndt, A. T. Palazzo, F. Meguid, R. A. Fergusson, J. Beenen, E. Mosse, C. Salim, J. and Cheah, S. Wright, T. Cerdeira, M. P. McQuillan, P. and Richardson, M. Liem, H. Spillane, J. Yacob, M. Albadawi, F. Thorpe, T. Dingle, A. Cabalag, C. Loi, K. Fisher, O. M. Ward, S. Read, M. Johnson, M. Bassari, R. Bui, H. Cecconello, I. Sallum, R. A. A. da Rocha, J. R. M. and Lopes, L. R. Tercioti, Jr., V. Coelho, J. D. Ferrer, J. A. P. Buduhan, G. Tan, L. Srinathan, S. Shea, P. Yeung, J. Allison, F. Carroll, P. Vargas-Barato, F. Gonzalez, F. Ortega, J. Nino-Torres, L. Beltran-Garcia, T. C. and Castilla, L. Pineda, M. Bastidas, A. Gomez-Mayorga, J. and Cortes, N. Cetares, C. Caceres, S. Duarte, S. Pazdro, A. and Snajdauf, M. Faltova, H. Sevcikova, M. Mortensen, P. B. and Katballe, N. Ingemann, T. Morten, B. Kruhlikava, I. and Ainswort, A. P. Stilling, N. M. Eckardt, J. Holm, J. and Thorsteinsson, M. Siemsen, M. Brandt, B. Nega, B. and Teferra, E. Tizazu, A. Kauppila, J. H. Koivukangas, V. and Merilainen, S. Gruetzmann, R. Krautz, C. Weber, G. and Golcher, H. Emons, G. Azizian, A. Ebeling, M. Niebisch, S. Kreuser, N. Albanese, G. Hesse, J. Volovnik, L. and Boecher, U. Reeh, M. Triantafyllou, S. Schizas, D. and Michalinos, A. Mpali, E. Mpoura, M. Charalabopoulos, A. and Manatakis, D. K. Balalis, D. Bolger, J. Baban, C. and Mastrosimone, A. McAnena, O. Quinn, A. Suilleabhain, C. B. O. Hennessy, M. M. Ivanovski, I. Khizer, H. Ravi, N. and Donlon, N. Cervellera, M. Vaccari, S. Bianchini, S. and Sartarelli, L. Asti, E. Bernardi, D. Merigliano, S. and Provenzano, L. Scarpa, M. Saadeh, L. Salmaso, B. De Manzoni, G. Giacopuzzi, S. La Mendola, R. De Pasqual, C. A. and Tsubosa, Y. Niihara, M. Irino, T. Makuuchi, R. and Ishii, K. Mwachiro, M. Fekadu, A. Odera, A. Mwachiro, E. and AlShehab, D. Ahmed, H. A. Shebani, A. O. Elhadi, A. and Elnagar, F. A. Elnagar, H. F. Makkai-Popa, S. T. Wong, L. F. and Tan, Y. R. Thannimalai, S. Ho, C. A. Pang, W. S. and Tan, J. H. Basave, H. N. L. Cortes-Gonzalez, R. Lagarde, S. M. van Lanschot, J. J. B. Cords, C. Jansen, W. A. and Martijnse, I. Matthijsen, R. Bouwense, S. Klarenbeek, B. and Verstegen, M. van Workum, F. Ruurda, J. P. van der Sluis, P. C. de Maat, M. Evenett, N. Johnston, P. Patel, R. and MacCormick, A. Young, M. Smith, B. Ekwunife, C. Memon, A. H. Shaikh, K. Wajid, A. Khalil, N. Haris, M. and Mirza, Z. U. Qudus, S. B. A. Sarwar, M. Z. Shehzadi, A. and Raza, A. Jhanzaib, M. H. Farmanali, J. Zakir, Z. and Shakeel, O. Nasir, I. Khattak, S. Baig, M. Noor, M. A. and Ahmed, H. H. Naeem, A. Pinho, A. C. da Silva, R. and Bernardes, A. Campos, J. C. Matos, H. Braga, T. and Monteiro, C. Ramos, P. Cabral, F. Gomes, M. P. Martins, P. C. Correia, A. M. Videira, J. F. Ciuce, C. Drasovean, R. Apostu, R. Ciuce, C. Paitici, S. Racu, A. E. and Obleaga, C. V. Beuran, M. Stoica, B. Ciubotaru, C. and Negoita, V. Cordos, I. Birla, R. D. Predescu, D. Hoara, P. A. Tomsa, R. Shneider, V. Agasiev, M. Ganjara, I. and Gunjic, D. Veselinovic, M. Babic, T. Chin, T. S. and Shabbir, A. Kim, G. Crnjac, A. Samo, H. Del Val, I. Diez and Leturio, S. Ramon, J. M. Dal Cero, M. Rifa, S. Rico, M. Pomar, A. Pagan Corcoles, J. A. Martinez Miravalles, J. L. Rodicio Pais, S. A. Turienzo, S. A. Alvarezt, L. S. and Alvarez, L. S. Campos, P. V. Rendo, A. G. Garcia, S. S. and Santos, E. P. G. Martinez, E. T. Fernandez, Diaz Mj Magadan, Alvarez C. Concepcion, Martin V. Diaz, Lopez C. Rosat, Rodrigo A. Perez, Sanchez L. E. Bailon, Cuadrado M. Tinoco, Carrasco C. Bhojwani, E. Choolani Sanchez, D. P. Ahmed, M. E. Dzhendov, T. Lindberg, F. Rutegard, M. Sundbom, M. and Mickael, C. Colucci, N. Schnider, A. Er, S. Kurnaz, E. Turkyilmaz, S. Turkyilmaz, A. Yildirim, R. Baki, B. E. Akkapulu, N. Karahan, O. Damburaci, N. Hardwickt, R. and Safranek, P. Sujendran, V. Bennett, J. Afzal, Z. and Shrotri, M. Chan, B. Exarchou, K. Gilbert, T. Amalesh, T. Mukherjee, D. Mukherjee, S. Wiggins, T. H. Kennedy, R. McCain, S. Harris, A. Dobson, G. Davies, N. and Wilson, I. Mayo, D. Bennett, D. Young, R. Manby, P. and Blencowe, N. Schiller, M. Byrne, B. Mitton, D. Wong, V. and Elshaer, A. Cowen, M. Menon, V. Tan, L. C. and McLaughlin, E. Koshy, R. Sharp, C. Brewer, H. Das, N. and Cox, M. Al Khyatt, W. Worku, D. Iqbal, R. Walls, L. and McGregor, R. Fullarton, G. Macdonald, A. MacKay, C. and Craig, C. Dwerryhouse, S. Hornby, S. Jaunoo, S. Wadley, M. Baker, C. Saad, M. Kelly, M. Davies, A. Di Maggio, F. McKay, S. Mistry, P. Singhal, R. Tucker, O. and Kapoulas, S. Powell-Brett, S. Davis, P. Bromley, G. and Watson, L. Verma, R. Ward, J. Shetty, V. Ball, C. and Pursnani, K. Sarela, A. Sue, Ling H. Mehta, S. Hayden, J. To, N. Palser, T. Hunter, D. Supramaniam, K. and Butt, Z. Ahmed, A. Kumar, S. Chaudry, A. Moussa, O. and Kordzadeh, A. Lorenzi, B. Wilson, M. Patil, P. Noaman, I. Willem, J. Bouras, G. Evans, R. Singh, M. and Warrilow, H. Ahmad, A. Tewari, N. Yanni, F. Couch, J. and Theophilidou, E. Reilly, J. J. Singh, P. van Boxel, Gijs and Akbari, K. Zanotti, D. Sgromo, B. Sanders, G. and Wheatley, T. Ariyarathenam, A. Reece-Smith, A. Humphreys, L. and Choh, C. Carter, N. Knight, B. Pucher, P. and Athanasiou, A. Mohamed, I. Tan, B. Abdulrahman, M. and Vickers, J. Akhtar, K. Chaparala, R. Brown, R. Alasmar, M. M. A. Ackroyd, R. Patel, K. Tamhankar, A. Wyman, A. and Walker, R. Grace, B. Abbassi, N. Slim, N. Ioannidi, L. Blackshaw, G. Havard, T. Escofet, X. Powell, A. and Owera, A. Rashid, F. Jambulingam, P. Padickakudi, J. and Ben-Younes, H. Mccormack, K. Makey, I. A. Karush, M. K. and Seder, C. W. Liptay, M. J. Chmielewski, G. Rosato, E. L. and Berger, A. C. Zheng, R. Okolo, E. Singh, A. Scott, C. D. and Weyant, M. J. Mitchell, J. D. Oesophago-Gastric Anastomotic

Abstract

Background: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III-V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC. Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Published
2021

6. Postoperative outcomes in oesophagectomy with trainee involvement

Author

Evans, R. P. T. Hodson, J. Kamarajah, S. K. Griffiths, E. A. and Singh, P. Alderson, D. Bundred, J. Gossage, J. and Jefferies, B. McKay, S. Mohamed, I Nepogodiev, D. and Siaw-Acheampong, K. van Hillegersberg, R. Vohra, R. and Wanigasooriya, K. Whitehouse, T. Gjata, A. Moreno, I, J. and Takeda, F. R. Kidane, B. Castro, R. Guevara Harustiak, T. and Bekele, A. Kechagias, A. Gockel, I Kennedy, A. Da Roit, A. Bagajevas, A. Azagra, J. S. Mahendran, H. A. and Mejia-Fernandez, L. Wijnhoven, B. P. L. El Kafsi, J. Sayyed, R. H. Sousa, M. Sampaio, A. S. Negoi, I Blanco, R. and Wallner, B. Schneider, P. M. Hsu, P. K. Isik, A. and Gananadha, S. Wills, V Devadas, M. Duong, C. Talbot, M. and Hii, M. W. Jacobs, R. Andreollo, N. A. Johnston, B. and Darling, G. Isaza-Restrepo, A. Rosero, G. Arias-Amezquita, F. Raptis, D. Gaedcke, J. Reim, D. Izbicki, J. and Egberts, J. H. Dikinis, S. Kjaer, D. W. Larsen, M. H. and Achiam, M. P. Saarnio, J. Theodorou, D. Liakakos, T. and Korkolis, D. P. Robb, W. B. Collins, C. Murphy, T. and Reynolds, J. Tonini, V Migliore, M. Bonavina, L. and Valmasoni, M. Bardini, R. Weindelmayer, J. Terashima, M. and White, R. E. Alghunaim, E. Elhadi, M. Leon-Takahashi, A. M. and Medina-Franco, H. Lau, P. C. Okonta, K. E. Heisterkamp, J. Rosman, C. Beban, G. Babor, R. Gordon, A. and Rossaak, I, J. Pal, I, K. M. Qureshi, A. U. Naqi, S. A. and Syed, A. A. Barbosa, J. Vicente, C. S. Leite, J. Freire, J. Casaca, R. Costa, R. C. T. Scurtu, R. R. Mogoanta, S. S. Bolca, C. Constantinoiu, S. Sekhniaidze, D. So, J. B. Y. Gacvski, G. Loureiro, C. Pera, M. Bianchi, A. and Gijon, M. Moreno Fernandez, J. Martin Carrera, M. S. Trugeda and Vallve-Bernal, M. Pascual, M. A. Citores Elmahi, S. and Halldestam, I Hedberg, J. Monig, S. Gutknecht, S. Tez, M. Guner, A. Tirnaksiz, T. B. Colak, E. Sevinc, B. and Hindmarsh, A. Khan, I Khoo, D. Byrom, R. Gokhale, J. and Wilkerson, P. Jain, P. Chan, D. Robertson, K. Iftikhar, S. Skipworth, R. Forshaw, M. Higgs, S. Nijjar, R. and Viswanath, Y. K. S. Turner, P. Dexter, S. Boddy, A. and Allum, W. H. Oglesby, S. Cheong, E. Beardsmore, D. and Maynard, N. Berrisford, R. Mercer, S. Puig, S. Melhado, R. Kelty, C. Underwood, T. Dawas, K. Lewis, W. and Al-Bahrani, A. Bryce, G. Thomas, M. Arndt, A. T. and Palazzo, F. Meguid, R. A. Fergusson, J. Beenen, E. and Mosse, C. Salim, J. Cheah, S. Wright, T. Cerdeira, M. P. and McQuillan, P. Richardson, M. Liem, H. Spillane, J. and Yacob, M. Albadawi, F. Thorpe, T. Dingle, A. Cabalag, C. and Loi, K. Fisher, O. M. Ward, S. Read, M. Johnson, M. and Bassari, R. Bui, H. Cecconello, I Sallum, R. A. A. and da Rocha, J. R. M. Lopes, L. R. Tercioti, Jr., V. Coelho, J. D. S. Ferrer, J. A. P. Buduhan, G. Tan, L. Srinathan, S. and Shea, P. Yeung, J. Allison, F. Carroll, P. and Vargas-Barato, F. Gonzalez, F. Ortega, J. Nino-Torres, L. and Beltran-Garcia, T. C. Castilla, L. Pineda, M. Bastidas, A. Gomez-Mayorga, J. Cortes, N. Cetares, C. Caceres, S. and Duarte, S. Pazdro, A. Snajdauf, M. Faltova, H. and Sevcikova, M. Mortensen, P. B. Katballe, N. Ingemann, T. and Morten, B. Kruhlikava, I Ainswort, A. P. Stilling, N. M. and Eckardt, J. Holm, J. Thorsteinsson, M. Siemsen, M. and Brandt, B. Nega, B. Teferra, E. Tizazu, A. Kauppila, J. S. Koivukangas, V Merilainen, S. Gruetzmann, R. Krautz, C. Weber, G. Golcher, H. Emons, G. Azizian, A. and Ebeling, M. Niebisch, S. Kreuser, N. Albanese, G. Hesse, J. Volovnik, L. Boecher, U. Reeh, M. Triantafyllou, S. and Schizas, D. Michalinos, A. Baili, E. Mpoura, M. and Charalabopoulos, A. Manatakis, D. K. Balalis, D. Bolger, J. and Baban, C. Mastrosimone, A. McAnena, O. Quinn, A. and Suilleabhain, C. B. O. Hennessy, M. M. Ivanovski, I. Khizer, H. Ravi, N. Donlon, N. Cervellera, M. Vaccari, S. and Bianchini, S. Sartarelli, L. Asti, E. Bernardi, D. and Merigliano, S. Provenzano, L. Scarpa, M. Saadeh, L. and Salmaso, B. De Manzoni, G. Giacopuzzi, S. La Mendola, R. and De Pasqual, C. A. Tsubosa, Y. Niihara, M. Irino, T. and Makuuchi, R. Ishii, K. Mwachiro, M. Fekadu, A. Odera, A. and Mwachiro, E. AlShehab, D. Ahmed, H. A. Shebani, A. O. and Elhadi, A. Elnagar, F. A. Elnagar, H. F. Makkai-Popa, S. T. Wong, L. F. Yunrong, T. Thanninalai, S. Aik, H. C. and Soon, P. W. Huei, T. J. Basave, H. N. L. and Cortes-Gonzalez, R. Lagarde, S. M. van Lanschot, J. J. B. and Cords, C. Jansen, W. A. Martijnse, I Matthijsen, R. and Bouwense, S. Klarenbeek, B. Verstegen, M. van Workum, F. and Ruurda, J. P. van der Veen, A. van den Berg, J. W. Evenett, N. Johnston, P. Patel, R. MacCormick, A. Young, M. and Smith, B. Ekwunife, C. Memon, A. H. Shaikh, K. Wajid, A. and Khalil, N. Haris, M. Mirza, Z. U. Qudus, S. B. A. and Sarwar, M. Z. Shehzadi, A. Raza, A. Jhanzaib, M. H. and Farmanali, J. Zakir, Z. Shakeel, O. Nasir, I Khattak, S. and Baig, M. Noor, M. A. Ahmed, H. H. Naeem, A. Pinho, A. C. da Silva, R. Bernardes, A. Campos, J. C. Matos, H. and Braga, T. Monteiro, C. Ramos, P. Cabral, F. Gomes, M. P. Martins, P. C. Correia, A. M. Videira, J. F. and Ciuce, C. Drasovean, R. Apostu, R. Paitici, S. Racu, A. E. Obleaga, V, C. Beuran, M. Stoica, B. Ciubotaru, C. and Negoita, V Cordos, I Birla, R. D. Predescu, D. and Hoara, P. A. Tomsa, R. Shneider, V Agasiev, M. Ganjara, I Gunjic, D. Veselinovic, M. Babic, T. Chin, T. S. and Shabbir, A. Kim, G. Crnjac, A. Samo, H. del Val, I. Diez and Leturio, S. Ramon, J. M. Dal Cero, M. Rifa, S. Rico, M. Pomar, A. Pagan Corcoles, J. A. Martinez Miravalles, J. L. Rodicio Pais, S. A. Turienzo, S. A. Alvarez, L. S. and Campos, V, P. Rendo, A. G. Garcia, S. S. Santos, E. P. G. and Martinez, E. T. Diaz, M. J. Fernandez Alvarez, C. Magadan and Martin, V. Concepcion Lopez, C. Diaz Rodrigo, A. Rosat and Sanchez, L. E. Perez Cuadrado, M. Bailon Carrasco, C. Tinoco and Bhojwani, E. Choolani Sanchez, D. P. Ahmed, M. E. Dzhendov, T. Lindberg, F. Rutegard, M. Sundbom, M. Mickael, C. and Colucci, N. Schnider, A. Er, S. Kurnaz, E. Turkyilmaz, S. Turkyilmaz, A. Yildirim, R. Baki, B. E. Akkapulu, N. and Karahan, O. Damburaci, N. Hardwick, R. Safranek, P. and Sujendran, V Bennett, J. Afzal, Z. Shrotri, M. Chan, B. and Exarchou, K. Gilbert, T. Amalesh, T. Mukherjee, D. and Mukherjee, S. Wiggins, T. H. Kennedy, R. McCain, S. and Harris, A. Dobson, G. Davies, N. Wilson, I Mayo, D. and Bennett, D. Young, R. Manby, P. Blencowe, N. Schiller, M. Byrne, B. Mitton, D. Wong, V Elshaer, A. Cowen, M. Menon, V Tan, L. C. McLaughlin, E. Koshy, R. and Sharp, C. Brewer, H. Das, N. Cox, M. Al Khyatt, W. and Worku, D. Iqbal, R. Walls, L. McGregor, R. Fullarton, G. and Macdonald, A. MacKay, C. Craig, C. Dwerryhouse, S. and Hornby, S. Jaunoo, S. Wadley, M. Baker, C. Saad, M. and Kelly, M. Davies, A. Di Maggio, F. Mistry, P. Singhal, R. Tucker, O. Kapoulas, S. Powell-Brett, S. Davis, P. and Bromley, G. Watson, L. Verma, R. Ward, J. Shetty, V and Ball, C. Pursnani, K. Sarela, A. Ling, H. Sue Mehta, S. Hayden, J. To, N. Palser, T. Hunter, D. and Supramaniam, K. Butt, Z. Ahmed, A. Kumar, S. Chaudry, A. and Moussa, O. Kordzadeh, A. Patil, P. Noaman, I Willem, J. Bouras, G. Evans, R. Singh, M. Warrilow, H. and Ahmad, A. Tewari, N. Yanni, F. Couch, J. Theophilidou, E. Reilly, J. J. van Boxel, G. Akbari, K. Zanotti, D. and Sgromo, B. Sanders, G. Wheatley, T. Ariyarathenam, A. and Reece-Smith, A. Humphreys, L. Choh, C. Carter, N. and Knight, B. Pucher, P. Athanasiou, A. Tan, B. and Abdulrahman, M. Vickers, J. Akhtar, K. Chaparala, R. and Brown, R. Alasmar, M. M. A. Ackroyd, R. Patel, K. and Tamhankar, A. Wyman, A. Walker, R. Grace, B. Abbassi, N. and Slim, N. Ioannidi, L. Blackshaw, G. Havard, T. and Escofet, X. Powell, A. Owera, A. Rashid, F. Jambulingam, P. Padickakudi, J. Ben-Younes, H. McCormack, K. Makey, I. A. Karush, M. K. Seder, C. W. Liptay, M. J. and Chmielewski, G. Rosato, E. L. Berger, A. C. Zheng, R. and Okolo, E. Singh, A. Scott, C. D. Weyant, M. J. Mitchell, J. D. West Midlands Res Collaborative

Abstract

Background The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. Methods Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. Results Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). Conclusion Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on perioperative outcomes in the international multicentre Oesophago-Gastric Anastomosis Audit (OGAA). Analysis of 2232 oesophagectomies has shown that trainee involvement did not negatively impact perioperative outcomes.

Published
2021

7. Feeding jejunostomy in upper gastrointestinal resections: a UK-wide survey

Author

P Ireland and S Jaunoo

Subjects
medicine.medical_specialty, medicine.medical_treatment, Jejunostomy, Upper GI Surgery, Upper gastrointestinal cancer, 03 medical and health sciences, 0302 clinical medicine, Enteral Nutrition, Gastrectomy, Surveys and Questionnaires, Upper gastrointestinal, Medicine, Humans, In patient, Practice Patterns, Physicians', Digestive System Surgical Procedures, business.industry, General surgery, General Medicine, United Kingdom, Esophagectomy, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Surgery, Parenteral Nutrition, Total, business, Feeding jejunostomy
Abstract

Introduction The usage of a feeding jejunostomy has been a well-established practice in maintaining nutrition in patients undergoing resections for upper gastrointestinal cancer. As surgical technique has evolved, together with the adoption of enhanced recovery after surgery pathways, the routine insertion of feeding jejunostomy tubes appears to be changing. Materials and methods A survey was constructed using Google Forms. The link was distributed to consultant upper gastrointestinal surgeons via the Association of Upper Gastrointestinal Surgeons’ membership database. Results were collated and analysed using Microsoft Excel. Results A total of 55 responses were received from 28 units across the UK; 27 respondents (49.1%) no longer routinely use feeding jejunostomy in upper gastrointestinal resections, oesophagectomy or gastrectomy. The most common primary feeding modality used by these respondents was oral diet 17 (65.4%), with total parenteral nutrition (19.2%) and nasojejunal (11.5%) routes also being used. Respondents who used feeding jejunostomies inserted them primarily for oesophagectomy (n = 27; 96.4%), with fewer surgeons using them in extended total gastrectomy (n = 12; 42.9%) and total gastrectomy (n = 11; 39.3%). Of the total, 20 surgeons (71.4%) would insert the jejunostomy using an open approach, with 19 (67.9%) employing a Witzel tunnel. Eleven respondents (39.3%) would continue feeding via the jejunostomy after discharge. Some 24 responders thought that feeding jejunostomies did not facilitate the enhanced recovery after surgery pathway (strongly and slightly disagree), whereas 17 considered that they did (strongly and slightly agree); 13 responders did not have strong views either way. Conclusions There is a split in current practice regarding the usage of feeding jejunostomies. There is also a division of opinion on the role of feeding jejunostomy in enhanced recovery after surgery.

Published
2020

8. O161 LASTING SYMPTOMS AFTER ESOPHAGEAL RESECTION (LASER) – EUROPEAN MULTI-CENTER CROSS-SECTIONAL STUDY

Author

John M. Findlay, Marco Scarpa, Edward Cheong, R Alferi, Carlo Castoro, Arun Ariyarathenam, O McCormack, S Castro, Nick Maynard, S S Gisbertz, Grant Sanders, R. van Hillegersberg, Eleonora Pinto, B. Sunde, M Nilsson, Miguel Pera, Jeremy R Huddy, N Ravi, R Matthijsen, George B. Hanna, Sheraz R. Markar, William H. Allum, J Reynolds, S Jaunoo, B. P. L. Wijnhoven, J Roigg, Fredrik Klevebro, J. J. B. van Lanschot, Viknesh Sounderajah, Guillaume Piessen, Christophe Mariette, Asif Johar, Jessie A Elliott, S Antonowicz, Sjoerd M. Lagarde, Conor F. Murphy, Henegouwen M van Berge, Jelle P. Ruurda, Christine Greene, Pernilla Lagergren, Giovanni Zaninotto, and Hylke J. F. Brenkman

Subjects
medicine.medical_specialty, business.industry, Cross-sectional study, law, Gastroenterology, medicine, Center (algebra and category theory), General Medicine, Radiology, business, Laser, Resection, law.invention
Abstract

Aim Long-term functional outcomes and the associations to health-related quality of life (HRQOL) after esophagectomy is largely unknown. LASER is a multi-center European study aimed to identify the most prevalent symptoms, and those with the greatest impact upon HRQOL among patients surviving more than one-year after esophagectomy for cancer, and to develop a clinically relevant symptom-based tool to measure HRQOL. Background & Methods Between 2010 and 2016, patients from 20 European Centers who underwent esophagectomy for esophageal cancer, and were disease-free at least one year postoperatively were invited to complete the LASER questionnaire, EORTC-QLQ30 and OG25. Specific symptom questionnaire items that were associated with a poor HRQOL as identified by EORTC-QLQC30 and OG25 were identified by multivariable linear and logistic regression analysis and combined to form a tool, which was tested using receiver operating characteristics curve analysis. Results A total of 876 of 1081 invited patients responded to the questionnaire, giving a response rate of 81%. Of these, 66.9% stated in the last 6 months they had had symptoms associated with their esophagectomy and 52.4% of patients had sought medical treatment for their symptoms. Ongoing weight loss was reported by 10.4% of patients while 32.4% were struggling to maintain their body weight, and 18.8% of patients required supplemental oral nutrition. Only 13.8% of patients had returned to work with the same activities as before. Three LASER symptoms in multivariate analysis were correlated with poor HRQOL; pain on scars on chest (Odds ratio (OR) 1.27; 95% CI 0.97-1.65), low mood (OR 1.42; 95% CI 1.15-1.77) and reduced energy or activity tolerance (OR 1.37; 95% CI 1.18-1.59). The areas under the curves for the development and validation datasets were 0.81±0.02 and 0.82±0.09 respectively. Conclusions Two-thirds of patients experience symptoms related to their esophagectomy more than one year after surgery. The three key symptoms associated with poor HRQOL identified in this study should be further validated, and could be used in clinical practice to identify patients who require increased long-term term support.

Published
2019
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9. Pelvic sepsis following laparoscopic appendicectomy versus open appendicectomy: a retrospective study of 648 cases

Author

Sheik S. Jaunoo and Hannah L. Adams

Subjects
medicine.medical_specialty, business.industry, Retrospective cohort study, medicine.disease, Tertiary care, Appendicitis, Surgery, Laparoscopic appendicectomy, Increased risk, Referral centre, Retrospective analysis, medicine, Pelvic sepsis, business
Abstract

Background: The purpose of this retrospective study was to evaluate the development of postoperative pelvic collections following Laparoscopic Appendicectomy (LA) and Open Appendicectomy (OA). Methods: A retrospective analysis of all patients undergoing emergency appendicectomy between February 2010 and January 2012 at a single UK tertiary care referral centre were considered for inclusion in this study. Data collection was undertaken and analysed using descriptive statistics. Results: Of the 648 appendicectomies (361 male, 287 female), 177 were performed laparoscopically. Histology confirmed appendicitis in 484 patients. There were 19 cases of pelvic sepsis (LA n=2, OA n=17), not statistically significant (p=0.1184). Conclusions: Laparoscopic appendicectomy is a safe operative procedure and is not associated with an increased risk of pelvic sepsis.

Published
2015
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10. Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology

Author

A J Sutton, R S Vohra, M Hollyman, P J Marriott, A Buja, D Alderson, S Pasquali, E A Griffiths, P Spreadborough, A Kirkham, S Fenwick, M Elmasry, Q M Nunes, D Kennedy, R B Khan, M A S Khan, C J Magee, S M Jones, D Mason, C P Parappally, P Mathur, M Saunders, S Jamel, S Ul Haque, S Zafar, M H Shiwani, N Samuel, F Dar, A Jackson, B Lovett, S Dindyal, H Winter, T Fletcher, S Rahman, K Wheatley, T Nieto, S Ayaani, H Youssef, R S Nijjar, H Watkin, D Naumann, S Emesih, P B Sarmah, K Lee, N Joji, J Heath, R L Teasdale, C Weerasinghe, P J Needham, H Welbourn, L Forster, D Finch, J M Blazeby, W Robb, A G K McNair, A Hrycaiczuk, A Charalabopoulos, S Kadirkamanathan, C-B Tang, N V G Jayanthi, N Noor, B Dobbins, A J Cockbain, A Nilsen-Nunn, J de Siqueira, M Pellen, J B Cowley, W-M Ho, V Miu, T J White, K A Hodgkins, A Kinghorn, M G Tutton, Y A Al-Abed, D Menzies, A Ahmad, J Reed, S Khan, D Monk, L J Vitone, G Murtaza, A Joel, S Brennan, D Shier, C Zhang, T Yoganathan, S J Robinson, I J D McCallum, M J Jones, M Elsayed, E Tuck, J Wayman, K Carney, S Aroori, K B Hosie, A Kimble, D M Bunting, A S Fawole, M Basheer, R V Dave, J Sarveswaran, E Jones, C Kendal, M P Tilston, M Gough, T Wallace, S Singh, J Downing, K A Mockford, E Issa, N Shah, N Chauhan, T R Wilson, A Forouzanfar, J R L Wild, E Nofal, C Bunnell, K Madbak, S T V Rao, L Devoto, N Siddiqi, Z Khawaja, J C Hewes, L Gould, A Chambers, D U Rodriguez, G Sen, S Robinson, F Bartlett, D M Rae, T E J Stevenson, K Sarvananthan, S J Dwerryhouse, S M Higgs, O J Old, T J Hardy, R Shah, S T Hornby, K Keogh, L Frank, M Al-Akash, E A Upchurch, R J Frame, M Hughes, C Jelley, S Weaver, S Roy, T O Sillo, G Galanopoulos, T Cuming, P Cunha, S Tayeh, S Kaptanis, M Heshaishi, A Eisawi, M Abayomi, W S Ngu, K Fleming, D S Bajwa, V Chitre, K Aryal, P Ferris, M Silva, S Lammy, S Mohamed, A Khawaja, A Hussain, M A Ghazanfar, M I Bellini, H Ebdewi, M Elshaer, G Gravante, B Drake, A Ogedegbe, D Mukherjee, C Arhi, L G N Iqbal, N F Watson, S K Aggarwal, P Orchard, E Villatoro, P D Willson, J Mok, T Woodman, J Deguara, G Garcea, B I Babu, A R Dennison, D Malde, D Lloyd, S Satheesan, O Al-Taan, A Boddy, J P Slavin, R P Jones, L Ballance, S Gerakopoulos, P Jambulingam, S Mansour, N Sakai, V Acharya, M M Sadat, L Karim, D Larkin, K Amin, A Khan, J Law, S Jamdar, S R Smith, K Sampat, K M O'shea, M Manu, F M Asprou, N S Malik, J Chang, M Johnstone, M Lewis, G P Roberts, B Karavadra, E Photi, J Hewes, D Rodriguez, D A O'Reilly, A J Rate, H Sekhar, L T Henderson, B Z Starmer, P O Coe, S Tolofari, J Barrie, G Bashir, J Sloane, S Madanipour, C Halkias, A E J Trevatt, D W Borowski, J Hornsby, M J Courtney, S Virupaksha, K Seymour, H Hawkins, S Bawa, P V Gallagher, A Reid, P Wood, J G Finch, J Parmar, E Stirland, J Gardner-Thorpe, A Al-Muhktar, M Peterson, A Majeed, F M Bajwa, J Martin, A Choy, A Tsang, N Pore, D R Andrew, W Al-Khyatt, C Taylor, S Bhandari, D Subramanium, S K C Toh, N C Carter, S Tate, B Pearce, D Wainwright, S J Mercer, B Knight, V Vijay, S Alagaratnam, S Sinha, S S El-Hasani, A A Hussain, V Bhattacharya, N Kansal, T Fasih, C Jackson, M N Siddiqui, I A Chishti, I J Fordham, Z Siddiqui, H Bausbacher, I Geogloma, K Gurung, G Tsavellas, P Basynat, A K Shrestha, S Basu, A C Mohan, M Harilingam, M Rabie, M Akhtar, P Kumar, S F Jafferbhoy, N Hussain, S Raza, M Haque, I Alam, R Aseem, S Patel, M Asad, M I Booth, W R Ball, C P J Wood, A C Pinho-Gomes, A Kausar, M R Obeidallah, J Varghase, J Lodhia, D Bradley, C Rengifo, D Lindsay, S Gopalswamy, I Finlay, S Wardle, N Bullen, S Y Iftikhar, A Awan, J Ahmed, P Leeder, G Fusai, G Bond-Smith, A Psica, Y Puri, D Hou, F Noble, K Szentpali, J Broadhurst, R Date, M R Hossack, Y L Goh, P Turner, V Shetty, M Riera, C A W Macano, A Sukha, S R Preston, J R Hoban, D J Puntis, S V Williams, R Krysztopik, J Kynaston, J Batt, M Doe, A Goscimski, G H Jones, C Hall, N Carty, S Panteleimonitis, R T Gunasekera, A R G Sheel, H Lennon, C Hindley, M Reddy, R Kenny, N Elkheir, E R McGlone, R Rajaganeshan, K Hancorn, A Hargreaves, R Prasad, D A Longbotham, D Vijayanand, I Wijetunga, P Ziprin, C R Nicolay, G Yeldham, E Read, J A Gossage, R C Rolph, H Ebied, M Phull, M A Khan, M Popplewell, D Kyriakidis, N Henley, J R Packer, L Derbyshire, J Porter, S Appleton, M Farouk, M Basra, N A Jennings, S Ali, V Kanakala, H Ali, R Lane, R Dickson-Lowe, P Zarsadias, D Mirza, S Puig, K Al Amari, D Vijayan, R Sutcliffe, R Marudanayagam, Z Hamady, A R Prasad, A Patel, D Durkin, P Kaur, L Bowen, J P Byrne, K L Pearson, T G Delisle, J Davies, M A Tomlinson, M A Johnpulle, C Slawinski, A Macdonald, J Nicholson, K Newton, J Mbuvi, A Farooq, B S Mothe, Z Zafrani, D Brett, J Francombe, J Barnes, M Cheung, A Z Al-Bahrani, G Preziosi, T Urbonas, J Alberts, M Mallik, K Patel, A Segaran, T Doulias, P A Sufi, C Yao, S Pollock, A Manzelli, S Wajed, M Kourkulos, R Pezzuto, M Wadley, E Hamilton, S Jaunoo, R Padwick, M Sayegh, R C Newton, M Hebbar, S F Farag, J Spearman, M F Hamdan, C D'Costa, C Blane, M Giles, M B Peter, N A Hirst, T Hossain, A Pannu, Y El-Dhuwaib, T E M Morrison, G W Taylor, R L E Thompson, K McCune, P Loughlin, R Lawther, C K Byrnes, D J Simpson, A Mawhinney, C Warren, D McKay, C McIlmunn, S Martin, M MacArtney, T Diamond, P Davey, C Jones, J M Clements, R Digney, W M Chan, S McCain, S Gull, A Janeczko, E Dorrian, A Harris, S Dawson, D Johnston, B McAree, E Ghareeb, G Thomas, M Connelly, S McKenzie, K Cieplucha, G Spence, W Campbell, G Hooks, N Bradley, A D K Hill, J T Cassidy, M Boland, P Burke, D M Nally, E Khogali, W Shabo, E Iskandar, G P McEntee, M A O'Neill, C Peirce, E M Lyons, A W O'Sullivan, R Thakkar, P Carroll, I Ivanovski, P Balfe, M Lee, D C Winter, M E Kelly, E Hoti, D Maguire, P Karunakaran, J G Geoghegan, F McDermott, S T Martin, K S Cross, F Cooke, S Zeeshan, J O Murphy, K Mealy, H M Mohan, Y Nedujchelyn, M F Ullah, I Ahmed, F Giovinazzo, J Milburn, S Prince, E Brooke, J Buchan, A M Khalil, E M Vaughan, M I Ramage, R C Aldridge, S Gibson, G A Nicholson, D G Vass, A J Grant, D J Holroyd, M A Jones, C M L R Sutton, P O'Dwyer, F Nilsson, B Weber, T K Williamson, K Lalla, A Bryant, C R Carter, C R Forrest, D I Hunter, A H Nassar, M N Orizu, K Knight, H Qandeel, S Suttie, R Belding, A McClarey, A T Boyd, G J K Guthrie, P J Lim, A Luhmann, A J M Watson, C H Richards, L Nicol, M Madurska, E Harrison, K M Boyce, A Roebuck, G Ferguson, P Pati, M S J Wilson, F Dalgaty, L Fothergill, P J Driscoll, K L Mozolowski, V Banwell, S P Bennett, P N Rogers, B L Skelly, C L Rutherford, A K Mirza, T Lazim, H C C Lim, D Duke, T Ahmed, W D Beasley, M D Wilkinson, G Maharaj, C Malcolm, T H Brown, G M Shingler, N Mowbray, R Radwan, P Morcous, S Wood, A Kadhim, D J Stewart, A L Baker, N Tanner, H Shenoy, S Hafiz, J A De Marchi, D Singh-Ranger, E Hisham, P Ainley, S O'Neill, J Terrace, S Napetti, B Hopwood, T Rhys, S Kanavati, M Coats, D Aleksandrov, C Kallaway, S Yahya, A Templeton, M Trotter, C Lo, A Dhillon, N Heywood, Y Aawsaj, A Hamdan, O Reece-Bolton, A McGuigan, Y Shahin, A Ali, A Luther, J A Nicholson, I Rajendran, M Boal, and J Ritchie

Subjects
Pathology, medicine.medical_specialty, Cost effectiveness, medicine.medical_treatment, Cost-Benefit Analysis, Gallbladder disease, Population, Cholecystitis, Acute, 030230 surgery, State Medicine, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, education, education.field_of_study, Laparoscopyc cholecystectomy, business.industry, emergency, Cost-effectiveness analysis, Gallbladder, General surgery, medicine.disease, United Kingdom, Quality-adjusted life year, delayed surgery, medicine.anatomical_structure, Models, Economic, Cholecystectomy, Laparoscopic, Centre for Surgical Research, Cholecystitis, 030211 gastroenterology & hepatology, Surgery, Cholecystectomy, Quality-Adjusted Life Years, Emergencies, business, Cohort study
Abstract

Background The optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a ‘delayed’ operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease. Methods Using data from a prospective population-based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost–utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impact of parameter uncertainty on the results obtained from the model. Results Emergency cholecystectomy was found to be less costly (£4570 versus £4720; €5484 versus €5664) and more effective (0·8868 versus 0·8662 QALYs) than delayed cholecystectomy. Probabilistic sensitivity analysis showed that the emergency strategy is more than 60 per cent likely to be cost-effective across willingness-to-pay values for the QALY from £0 to £100 000 (€0–120 000). Conclusion Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.

Published
2017
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12. An international survey of opinion regarding investigation of possible appendicitis and laparoscopic management of a macroscopically normal appendix

Author

S S Jaunoo, S R Jaunoo, J P M Masters, and A L Hale

Subjects
Laparoscopic surgery, Male, Abdominal pain, medicine.medical_specialty, medicine.medical_treatment, Appendix, Gastrointestinal Surgery, Diagnosis, medicine, Appendectomy, Humans, In patient, Laparoscopy, Survey, medicine.diagnostic_test, business.industry, International survey, General Medicine, medicine.disease, Appendicitis, United States, Surgery, Abdominal Pain, medicine.anatomical_structure, England, Health Care Surveys, Female, Right iliac fossa pain, France, medicine.symptom, business
Abstract

INTRODUCTION The use of imaging and laparoscopy in patients with right iliac fossa pain as tools to make or exclude a diagnosis of appendicitis is at the discretion of the clinician. We sought to establish a consensus of opinion on this matter by surveying professional bodies for laparoscopic surgery in France, Italy and the US. METHODS A survey was sent to members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), as well as the French Society for Endoscopic Surgery (SFCE) and the Italian Society for Endoscopic Surgery (SICE). The survey asked about management of both male and female patients presenting with right iliac fossa pain and what operative strategy the respondents would pursue should they find a macroscopically normal appendix at laparoscopy. RESULTS A total of 364 responses were returned from the three groups. The responses from SAGES showed computed tomography to be the preferred modality for investigating patients with right iliac fossa pain, irrespective of sex. Both SFCE and SICE preferred the use of diagnostic laparoscopy, especially in the female patient group. The majority of all respondents stated that they would remove a macroscopically normal appendix at laparoscopy. CONCLUSIONS Laparoscopy remains a potent tool in the management of appendicitis. However, the dilemma of when to remove a macroscopically normal appendix remains. Our study shows that removal of the appendix in this instance would be supported by an international consensus.

Published
2012

13. Picture quiz When vomiting relieves severe abdominal pain

Author

B V Praveen, Tjun Y. Tang, S S Jaunoo, and A Brown

Subjects
medicine.medical_specialty, Abdominal pain, medicine.drug_class, business.industry, Proton-pump inhibitor, General Medicine, medicine.disease, Surgery, stomatognathic diseases, medicine, Vomiting, Left upper quadrant pain, Medical history, Hernia, medicine.symptom, business, Sudden onset
Abstract

A 72 year old woman presented with sudden onset of severe epigastric and left upper quadrant pain. The pain was sharp and constant, relieved only by vomiting. The vomitus was projectile and streaked with blood. Medical history included a hiatus hernia, for which the patient was taking a proton pump inhibitor.

Published
2007
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14. The management of chyle leak post-oesophagectomy for oesophageal carcinoma: a systematic review.

Author

Robinson AV, Kennedy L, Roper T, Khan M, and Jaunoo S

Subjects
Esophagectomy adverse effects, Humans, Prospective Studies, Chyle, Chylothorax etiology, Chylothorax surgery, Esophageal Neoplasms complications, Esophageal Neoplasms surgery
Abstract

Introduction: Chyle leak is an uncommon yet potentially fatal complication of oesophagectomy for oesophageal cancer. The management of chyle leak is a debated, controversial topic and to date there is no standardised approach or validated algorithm for its management. This review aims to summarise current treatment algorithms for chyle leak post-oesophagectomy and their outcomes., Methods: A systematic search of Embase, MEDLINE, UpToDate and Cochrane was conducted to identify studies reporting on the management of chyle leak following oesophagectomy for oesophageal cancer. Data on interventional success rate and mortality are reported., Findings: Twenty-one studies met the inclusion criteria including over 23,254 oesophagectomies and identifying 838 chyle leaks (incidence <3.6%). The majority of cases were initially managed conservatively (95.3%), with a failure rate of 50.4%. Immediate surgical or radiological management resolved chylothorax in the majority of cases (97.3%), however the numbers were small. Death occurred in 54 cases (6.6%), all of whom underwent conservative management initially., Conclusions: Owing to the heterogeneity of treatment algorithms, timings and indications for interventions, the optimal strategy for managing chyle leak remains unclear. This review has identified an unmet need for prospective multicentre studies assessing the efficacy of predefined algorithms.

Published
2022
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15. Feeding jejunostomy in upper gastrointestinal resections: a UK-wide survey.

Author

Ireland P and Jaunoo S

Subjects
Digestive System Surgical Procedures statistics & numerical data, Enteral Nutrition methods, Esophagectomy methods, Esophagectomy statistics & numerical data, Gastrectomy methods, Gastrectomy statistics & numerical data, Humans, Jejunostomy methods, Parenteral Nutrition, Total statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data, Surveys and Questionnaires, United Kingdom, Digestive System Surgical Procedures methods, Enteral Nutrition statistics & numerical data, Jejunostomy statistics & numerical data
Abstract

Introduction: The usage of a feeding jejunostomy has been a well-established practice in maintaining nutrition in patients undergoing resections for upper gastrointestinal cancer. As surgical technique has evolved, together with the adoption of enhanced recovery after surgery pathways, the routine insertion of feeding jejunostomy tubes appears to be changing., Materials and Methods: A survey was constructed using Google Forms. The link was distributed to consultant upper gastrointestinal surgeons via the Association of Upper Gastrointestinal Surgeons' membership database. Results were collated and analysed using Microsoft Excel., Results: A total of 55 responses were received from 28 units across the UK; 27 respondents (49.1%) no longer routinely use feeding jejunostomy in upper gastrointestinal resections, oesophagectomy or gastrectomy. The most common primary feeding modality used by these respondents was oral diet 17 (65.4%), with total parenteral nutrition (19.2%) and nasojejunal (11.5%) routes also being used. Respondents who used feeding jejunostomies inserted them primarily for oesophagectomy ( n = 27; 96.4%), with fewer surgeons using them in extended total gastrectomy ( n = 12; 42.9%) and total gastrectomy ( n = 11; 39.3%). Of the total, 20 surgeons (71.4%) would insert the jejunostomy using an open approach, with 19 (67.9%) employing a Witzel tunnel. Eleven respondents (39.3%) would continue feeding via the jejunostomy after discharge. Some 24 responders thought that feeding jejunostomies did not facilitate the enhanced recovery after surgery pathway (strongly and slightly disagree), whereas 17 considered that they did (strongly and slightly agree); 13 responders did not have strong views either way., Conclusions: There is a split in current practice regarding the usage of feeding jejunostomies. There is also a division of opinion on the role of feeding jejunostomy in enhanced recovery after surgery.

Published
2020
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16. Distal phalanx: an unusual site for a gastric adenocarcinoma metastasis.

Author

Harris H, Khan M, and Jaunoo S

Subjects
Aged, Female, Humans, Immunohistochemistry, Neoplasm Metastasis pathology, Neoplasm Staging, Osteomyelitis diagnosis, Radiotherapy methods, Adenocarcinoma pathology, Adenocarcinoma therapy, Bone Neoplasms diagnosis, Bone Neoplasms pathology, Bone Neoplasms secondary, Bone Neoplasms therapy, Drainage methods, Finger Phalanges diagnostic imaging, Finger Phalanges pathology, Finger Phalanges surgery, Palliative Care methods, Stomach Neoplasms pathology, Stomach Neoplasms therapy
Abstract

Gastric adenocarcinoma typically metastasises to the liver, peritoneum and lung. Bone metastasises are less frequent and particularly uncommon in the distal extremities. This is an unusual case of metastatic disease in the distal phalanx mimicking the presentation of osteomyelitis. This case highlights the need to remain vigilant in patients with known cancer and to always be mindful of metastatic disease, even if the presentation is atypical., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2020
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17. A delayed presentation of Boerhaave's syndrome with mediastinitis managed using the over-the-scope clip.

Author

Ramhamadany E, Mohamed S, Jaunoo S, Baker T, Mannath J, Harding J, and Menon V

Abstract

Boerhaave syndrome is a spontaneous perforation of the oesophagus secondary to forceful emesis. Surgery has been advocated in delayed presentations of Boerhaave's syndrome with mediastinitis. The over-the-scope clip (OTSC) by OVESCO(®) (Tubingen, Germany) has been used in the endoscopic management of gastrointestinal bleeds, fistulae and anastamotic leaks. We describe the successful endoscopic use of the OTSC in a delayed presentation of Boerhaave syndrome with mediastinitis. A 69-year-old gentleman underwent a computerised tomography scan, which demonstrated a lower oesophageal perforation and mediastinitis 7 days after admission, having presented with forceful emesis and chest discomfort. During endoscopy the defect was visualized and successfully closed using the OTSC. This resulted in a favourable outcome and is a technique not previously described in the literature to manage this condition., (Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2013.)

Published
2013
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18. Persistent air-leak after transhiatal oesophagectomy: A case report.

Author

Khan MA, Jaunoo S, Prasad A, and Tan LC

Abstract

Introduction: Transhiatal oesophagectomy is a widely accepted technique for resection of tumours of the lower oesophagus. We present a life-threatening complication associated with the placement of a corrugated neck drain during this procedure., Presentation of Case: Our patient underwent a transhiatal oesophagectomy for a lower oesophageal tumour. He developed persistent bilateral pneumothoraces despite chest drain insertions. Following removal of the corrugated neck drain, both lungs were successfully re-inflated., Discussion: To the authors' knowledge, this serious complication has been described only once before in the medical literature; other surgeons should be made aware of this problem., Conclusion: Alternative drainage systems should be considered to help prevent this injury. Exercise caution if positioning corrugated drains in the neck., (Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Published
2013
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19. Endovascular aneurysm repair (EVAR).

Author

Jaunoo S

Subjects
Blood Vessel Prosthesis, Decision Making, Humans, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation adverse effects
Abstract

Endovascular repair of an abdominal aortic aneurysm (AAA) is an evolving technology which continues to be practiced in more and more centres worldwide in an effort to avoid major abdominal surgery and its associated morbidity and mortality. As with conventional open surgery, the objective of endovascular management is to provide a durable repair maintaining antegrade flow in the graft whilst simultaneously excluding flow in the aneurysm. Endovascular treatment offers a less invasive alternative to standard surgical repair with the potential of reduced hospitalisation, morbidity and mortality.

Published
2008
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