Royal Berkshire Hospital in Reading has a large catchment area of 600,000 and a very busy colorectal unit with five consultants and is able to offer robotic surgery fellowships and 2-3 laparoscopic colorectal resections/week which is an excellent way of preparing to be a consultant surgeon.
Contact Dominic Coull to let him know when you would be looking to start and to arrange a visit to look round the unit.
BDRF is once again offering £5,000 to newly qualified consultant surgeons wishing to set up collaborative research projects.
DAMASCUS is an audit of the acute management of patients presenting acutely with diverticular abscesses. The study team are seeking to determine the international differences in the variation in index management and are also hoping to investigate whether these variations are associated with short term clinical outcomes at 30 days or with readmission or re-intervention rates over the subsequent 6 months.
We are looking for a team of 2 trainee collaborators and 1 consultant as a principal investigator per site. If you would like to be involved please see further study information and complete and return an expression of interest form.
Paper of the Month for May is a a single centre retrospective study looking at the use of cystogram following segmental bowel resection in patients with enterovesical fistula
Selective use of cystogram following segmental bowel resection in patients with enterovesical fistula.
de Groof et al. Colorectal disease 2019 [epub ahead of print] https://onlinelibrary.wiley.com/doi/abs/10.1111/codi.14652
Enterovesical fistula is not infrequently seen, and typically occurs with complicated diverticular disease, or sometimes Crohn’s disease. Management is typically resection of bowel, bladder closure and urinary drainage for 10-14 days, often followed by a check cystogram. This practice seems to be one which has been handed down between surgeons, rather than truly evidence driven.
Design: This is a single centre retrospective study undertaken in a single Dutch teaching hospital over a 21 year period.
Primary endpoints: The primary endpoint is bladder leakage, assessed clinically or with check cystogram.
Secondary endpoints: Recurrence of fistula, surgical complications, and death were reported as secondary outcomes.
Results: The study identified 46 patients in this study period. All underwent double layered closure of the bladder +/- omental flap. A check cystogram was performed for 26 patients at a median of 10 days post op (14 of these were performed before day 10). Bladder drainage was continued for a median of 11 days post surgery. Just 3 patients had a leak detected on cystogram, which was typically performed before day 10. One patient had a persistent leak on a second cystogram but had their catheter removed anyway with no reported sequelae. There was one recurrent fistula, which was ultimately found to be related to a bladder cancer.
Caution should be applied to interpretation of this study; it is small and retrospective. Nevertheless, it suggests that in this setting, check cystogram may not be required unless the patient shows signs of leakage before day 10 post op. Even where a leak is discovered, it is possible this may not mandate continued urinary drainage. I suspect clinicians would not be keen to move away from the safe conservative approach to bladder drainage, it might suggest a cystogram is not mandatory in all cases. A larger study is required to identify those at highest risk of ongoing leakage in order to limit additional radiation to this group.
In 2018 Ethicon broadcasted a number of Colorectal Webexs. Please see below for the links:
Technical tips for modern laparoscopic colorectal surgery
Innovations in Perioperative Management
Thank you so much to all collaborators to the CLOSE-IT study!
Congratulations to the newly appointed Dukes’ club/ ACPGBI regional representatives:
The last 6 months of Dukes’ club newsletters are now available on the website
The University of East Anglia are offering an online Masters in Coloproctology course through the University of East Anglia for UK trainees. The feedback has been positive with two of the SpRs commenting that it helped them with both the exit exam and EBSQ exam – one of the students got the highest mark in their sitting of the EBSQ.
The course is completely online and starts in January. There are 4 clinical modules – Colorectal emergencies / Neoplasia / Inflammatory bowel disease / Proctology & Functional bowel disease – plus modules in research and management. Each module last 16 weeks. Single modules can be completed for CME/CPD purposes, 3 modules for a Postgraduate Certificate, 6 modules for a Postgraduate Diploma or 6 modules + dissertation for the full MS Coloproctology.
For more information: https://www.uea.ac.uk/medicine/education/specialist-courses/coloproctology
This fantastic course will provide hands-on practice on Thiel cadavers for senior trainees, fellows and consultants with a interest in pelvic floor dysfunction. Although this course is already heavily subsided, there is in addition, one free place available for a member of the Dukes’ club and the Pelvic Floor Society. The deadline for applying for this is the end of August and the winner will be selected based on CV and personal statement. Please contact The Pelvic Floor Society via twitter DM for further details.
