T R C Porrett

Homerton University Hospital NHS Foundation Trust, Londinium, England, United Kingdom

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Publications (6)15.24 Total impact

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    ABSTRACT: Aim  Fibrin glue and porcine intestinal submucosa are used in novel sphincter-preserving techniques to heal anal fistulae. However, their success is highly variable and decreases with the length of follow up. The aim of this study was to assess the safety, feasibility and potential efficacy of another novel agent, cross-linked collagen, in two different physical formats, to heal anal fistulae.Method  Prospectively recruited patients underwent symptom, continence and anal physiology assessments and magnetic resonance imaging. Patients with secondary tracts or acute sepsis were excluded. At operation, participants were randomized to receiving a solid collagen implant or collagen fibres suspended in fibrin glue. Follow up included repeat symptom, continence and physiological assessments at 3 months, and regular clinical review thereafter.Results  Twenty-nine of 43 entrants were eligible for inclusion. Thirteen patients received the collagen implant, and 16 collagen–fibrin glue. Three months postoperation, no patient experienced acute sepsis or continence disturbance, and sphincter function and integrity were unchanged. At 29 months, 12 of 15 (one lost to follow up) patients treated with collagen–fibrin glue were healed, compared with seven of 13 who received the implant.Conclusion  In the short-to-medium term, both techniques are safe and equally effective. The results justify continued research into the use of biomaterials to heal anal fistulae.
    Colorectal Disease 12/2010; 13(1):94 - 104. · 2.08 Impact Factor
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    ABSTRACT: Stomal complications are prevalent and associated with considerable morbidity. This study examined the incidence and potential risk factors for their development. The time of onset and presence of ten specific complications were recorded for patients with an intestinal stoma over 10 years at two urban hospitals. A database was established with 20 explanatory variables (such as common medical co-morbidities) derived from the stomatherapy and medical records. Univariable and multivariable analyses were performed to identify potential risk factors for the development of complications. Some 1216 patients (mean age 64 years) with a minimum of 2 years' follow-up were included, of whom 544 (44·7 per cent) underwent surgery for malignancy and 647 (53·2 per cent) had a colostomy formed. There were 1219 complications in total; 807 major complications (excluding excoriation and slough) occurred in 564 patients (46·4 per cent), of which the commonest was parastomal hernia (171, 14·1 per cent). On multivariable analysis, musculoskeletal co-morbidity (odds ratio (OR) 1·79, 95 per cent confidence interval 1·05 to 3·07; P = 0·032), cancer (OR 1·48, 1·13 to 1·93; P = 0·004) and high American Association of Anesthesiologists score (OR = 3·80, 2·14 to 6·75; P < 0·001) were associated with an increased risk of complications. Preoperative siting was associated with a reduced risk (OR 0·59, 0·39 to 0·90; P = 0·014). Intestinal stomal complications are common, occurring in almost half of patients. There are certain irremediable risk factors, allowing appropriate preoperative counselling.
    British Journal of Surgery 12/2010; 97(12):1885-9. · 4.84 Impact Factor
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    ABSTRACT: Aim: This study aimed to determine whether a 'straight to test'(STT) strategy for 2-week wait (2 wk) referrals for suspected colorectal cancer (CRC) reduced the time to diagnosis and treatment for patients with CRC. Consecutive 2-week referrals for suspected CRC over a period of 2 years from February 2007 were analysed. The times to the first diagnostic test and treatment and the cancers identified were analysed for those going to STT or the outpatient clinic. Of 662 patients having a 2 wk referral, 519 (78.4%) were suitable for the hospital colorectal telephone triage service, 121 (18.3%) patients went to STT and 502 (75.8%) were seen in the clinic. Of these 401 (79.8%) underwent diagnostic tests and 25 (6.2%) had CRC and in 12 (2.9%) patients other cancers were detected. In the STT group, 7 (5.8%) patients were diagnosed with CRC. The median time to first diagnostic test was 12 days (IQR 9-13) in the STT pathway, compared with 23 days (17-31) in those seen in the clinic (P < 0.0001). The median time to first treatment was 40 (32-48) days for those via STT, compared to 46 (28-55) days for those seen in the clinic (P = 0.004). A total of 162 CRC were diagnosed during the study period of whom 34 (20.9%) were 2 wk referrals (5.1% of all suspected CRC 2 wk referrals), and 14 (2.1%) other cancers were detected via this pathway. STT speeds up the patient pathway by reducing the time to diagnosis and treatment for patients with CRC.
    Colorectal Disease 10/2010; 12(10 Online):e250-4. · 2.08 Impact Factor
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    ABSTRACT: The main aims of the study were to determine the frequency with which two-week wait (2ww) referrals for colorectal cancer (CRC) could proceed directly to straight to test (STT), and the potential improvement in time to diagnosis. A telephone interview was attempted in all 2ww referrals not requiring an advocate and under 80 years. Data were assessed according to a test protocol, and where indicated a potential slot for the appropriate investigation was recorded (virtual test). All patients proceeded to clinic, following which differences in time from GP referral to virtual compared with actual requested test, and any discrepancies between virtual and requested tests were analysed. Between 8th January and 16th February 2007, there were 42 2ww referrals. Twenty-one patients were contacted, of whom 14 were suitable for STT: 13 virtual colonoscopies and one CT scan were booked. Following out-patient consultation, eight colonoscopies; three flexible sigmoidoscopies, one barium enema, and two CT scans were actually booked. There was a difference of 15.5 days between the median times of the virtual and actual test. During this 6-week period a total of nine patients were diagnosed with CRC, of whom three were referred via the 2ww pathway, but none were suitable for STT. This 'straight to test' pilot study suggests a potential strategy for reducing the time to diagnosis and therefore first treatment of those identified with CRC, and offers a methodology for individual hospitals to assess their suitability to employ such a strategy.
    Colorectal Disease 08/2008; 10(6):569-76. · 2.08 Impact Factor
  • Colorectal Disease 04/2008; 10(3):303-4. · 2.08 Impact Factor
  • T R C Porrett, P J Lunniss
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    ABSTRACT: The overburdening of colorectal out-patient clinics necessarily leads to delays in time from referral to consultation and subsequent clinic attendance. This study aimed to ascertain the feasibility of 'paper clinic' follow-up rather than all patients receiving a routine follow-up appointment following investigation. A more efficient outpatient follow-up process should reduce unnecessary follow-up, thereby facilitating the speedy investigation and diagnosis of patients through changes in clinic profiles. From August 2001 all patients seen in the outpatient clinic of one (part time) Consultant colorectal surgeon, who required investigation, were prospectively recorded on a 'paper clinic' form. These patients were given the necessary test request forms but were not given a further outpatient appointment. The results of the investigations were reviewed, together with the patients' medical records at a formal fortnightly 'paper clinic' session carried out by the Consultant and Nurse Consultant, and a treatment plan derived. Patients then followed one of 5 follow-up pathways and were notified in writing with a copy to their GP. During a 24-month period a total of 897 patients were reviewed using the 'paper clinic' follow-up system. Of these, 285 (31.8%) patients were discharged without further follow-up. In a given 3-month period when the clinic was well established, 152 patients were reviewed, of whom 27% were discharged from follow-up, 17% received SOS appointments, 13% required further investigation (and consequently were returned to 'paper clinic' follow-up), and 7% received Nurse led follow-up. In this 3-month period 64% of patients reviewed by 'paper clinic' follow-up did not return to Surgical Outpatient's and 12% received a Surgical Outpatient appointment for review. 'Paper clinic' follow-up is an effective and feasible follow-up alternative, resulting in a major decrease in outpatient follow-up burden. This has allowed the redesign of the outpatient clinic profile allowing for an increase in new urgent slots, and more rapid clinic follow up review of those patients who need it. Re-design and rationalization of existing services can result in considerable service improvement. Expanding clinics should not be considered the only option when faced with capacity and demand issues.
    Colorectal Disease 08/2004; 6(4):268-74. · 2.08 Impact Factor