Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
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To analyse surgical outcomes of fulminate and medically resistant ulcerative colitis (UC) carried out laparoscopically. ⋯ Laparoscopic subtotal and restorative proctocolectomies in fulminate and medically resistant UC are feasible, safe and largely predictable operations that allow for early hospital discharge. Laparoscopic colectomy facilitates subsequent proctectomy and pouch construction.
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The role of neoadjuvant radiotherapy in the management of rectal cancers has not reached a consensus in colorectal surgical practice. In the light of the preliminary results of the CRO7 trial, we undertook a national questionnaire survey to assess the current pattern of practice in the UK. The aim of this study was to assess the correlation between CRO7 trial results and current practice amongst consultant members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI). ⋯ Despite the evidence of the CRO7 trial supporting the use of NASCRT for operable rectal cancer, approximately two-third of consultant surgeons in the UK have yet to implement this treatment regime routinely. A change in practice in 39% of surgeons following the early dissemination of trial results indicate that colorectal surgeons practice is guided by scientific evidence. Because the mature trial data have yet to be published, a further survey of practice is warranted after that publication to determine the ultimate impact of this trial. This survey measures the baseline practice to compare changes over the next 2 years.
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One of the 2-week wait (2WW) criteria for suspected lower gastrointestinal cancer states that patients should be referred who have iron deficiency anaemia (IDA) without obvious cause [Haemoglobin (Hb) <11 g/dl men, <10 g/dl postmenopausal women]. ⋯ Although iron deficiency is a good marker for gastrointestinal cancer, it is evident that 2WW referral guidelines are not being followed. 89.2% of referrals are inappropriate according to guidelines. This not only has considerable workload and financial implications but could be potentially detrimental to patient health.
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Comparative Study
Is a morphologically intact anal sphincter necessary for success with sacral nerve modulation in patients with faecal incontinence?
Sacral nerve modulation (SNM) for the treatment of faecal incontinence was originally performed in patients with an intact anal sphincter or after repair of a sphincter defect. There is evidence that SNM can be performed in patients with faecal incontinence and an anal sphincter defect. ⋯ A morphologically intact anal sphincter is not a prerequisite for success in the treatment of faecal incontinence with SNM. An anal sphincter defect of <33% of the circumference can be effectively treated primarily with SNM without repair.
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Comment Letter Comparative Study
Inflated 'non-leak' mortality compared to 1995 Wessex CRC Audit.