Cosimo Alex Leo

London North West University Healthcare NHS Trust · General Surgery

Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, an...

Aim Single-staged abdominal wall reconstruction (AWR) with simultaneous enterocutaneous fistula (ECF) repair is safe. This study aims to evaluate short-term outcomes from AWR with ECF repair and compare short-term outcomes between two commonly used acellular dermal matrices (ADM) as well as suture repair alone, with focus on ECF recurrence. Method...

Background: Robotic-assisted surgery (RAS) offers improved visualisation and dexterity compared to laparoscopy. As a result, RAS is considered an attractive option for performing rectopexy, particularly in the confines of the lower pelvis. The aim of this study was to explore the benefits of RAS in rectopexy by analysing the views of a group of su...

Introduction An Amyand Hernia (AH) is the presence of an Appendix within an Inguinal Hernia. We present here our clinical management of acute appendicitis in an AH and subsequent literature review. A 73 year old male patient presented with a two day history of right sided irreducible inguinoscrotal hernia with tender swelling on standing and walkin...

Introduction An Amyand Hernia (AH) is the presence of an Appendix within an Inguinal Hernia. We present here our clinical management of acute appendicitis in an AH and subsequent literature review. A 73-year-old male patient presented with a two-day history of right sided irreducible inguinoscrotal hernia with tender swelling on standing and walkin...

Purpose: To define the change in Emergency Surgical Unit (ESU) workload during the COVID-19 pandemic. Methods: Patient data for a three-week period was prospectively collected for ESU patients during lockdown period and compared to the ESU workload for the same time period prior to lockdown. Results: Surgical emergencies admissions reduced by...

Background Endoscopic pilonidal sinus treatment (EPSiT) is a novel minimally invasive option for the treatment of pilonidal sinus disease (PSD). To optimise the postoperative wound management after EPSiT, an ultraportable negative pressure wound therapy (NPWT) device was used. The aim of this study was to assess the clinical outcomes of negative pr...

Background: Anal inserts and percutaneous tibial nerve stimulation may be offered to those with fecal incontinence who have failed other conservative treatments. Objective: We aimed to compare anal inserts and percutaneous tibial nerve stimulation. Design: This was an investigator blinded randomized pilot study. Settings: The study was condu...

Aim: Sacral Nerve Stimulation (SNS) is a minimally invasive treatment for faecal incontinence (FI). We report our experience of patients who have undergone SNS for FI with a minimum of five years follow-up. This is a single centre prospective observational study with the aim to assess the long-term function of SNS. Method: All patients implanted...

Background In March, 2020, the World Health Organization declared COVID-19 a pandemic. The absence of previous knowledge of COVID-19 has made decision-making difficult for all in health care, including surgical departments. We reviewed the management recommendations for surgical activity and changes to surgical practice, identifying concordances an...

Aim The SphinKeeper™ artificial bowel sphincter implant is relatively new surgical technique for the treatment of refractory faecal incontinence. This study presents the first experience in two UK tertiary centres. Method This is a retrospective audit of prospectively collected clinical data in relation to technique, safety, feasibility and short‐...

Background Short-term outcomes for patients undergoing contaminated complex abdominal wall reconstruction (CCAWR), including risk stratification, have not been studied in sufficiently high numbers. This study aims to develop and validate risk-stratification models for Clavien–Dindo (CD) grade ≥ 3 complications in patients undergoing CCAWR.MethodsA...

PurposeComplex abdominal wall repair (CAWR) in a contaminated operative field is a challenge. Available literature regarding long-term outcomes of CAWR comprises studies that often have small numbers and heterogeneous patient populations. This study aims to assess long-term outcomes of modified-ventral hernia working group (VHWG) grade 3 repairs. B...

Aim: Anorectal physiology tests provide a functional assessment of the anal canal. The aim of this study was to compare the results generated by the standard high-resolution water perfused manometry (WPM) with the newer THD® Anopress manometry system. Method: This was a prospective observational study. Conventional manometry was carried out usin...

Preliminary results of Sphinkeeper treatment for Faecal Incontinence

Aim To assess anatomy and variations of sacral nerve roots in patients with faecal incontinence (FI) reconstructed using the diffusion tensor imaging (DTI) technique. Methods Magnetic resonance imaging data of 5 patients with FI was collected with a 1.5 Tesla scanner including a spin-echo DTI sequence with 8 to 14 non-weighted images and 160 to 280...

Background: THD® Anopress has been promoted as a new portable anal manometer providing measurements of whole anal canal pressures. This study aims to report the anorectal function of patients suffering from Faecal Incontinence (FI) using this new device and the associated patient comfort. Methods: We reviewed data from patients suffering from FI wh...

Introduction: Restorative proctocolectomy has gained acceptance in the surgical management of medically refractive ulcerative colitis and cancer prevention in familial adenomatous polyposis. Incontinence following restorative proctocolectomy occurs in up to 25% of patients overnight. The Renew® insert is an inert single use device which acts as an...

Purpose: This study aims to compare the outcomes of posterior component separation and transversus abdominis release (PCSTAR) with the open anterior component separation (OACS) technique. OACS, first described by Ramirez et al. (Plast Reconstr Surg 86(3):519-526, 1990), has become an established technique for local myofascial advancement in abdomi...

Introduction Restorative proctocolectomy (RPC) has gained acceptance in the surgical management of medically refractive ulcerative colitis and cancer prevention in familial adenomatous polyposis (FAP).Incontinence following RPC has not been widely researched. In one study at 10 year follow-up, continence to stool and flatus was present in 79.3% of...

Background/aims: The Anopress device is a new portable manometry system. The aim of this study is to formulate normative data using this new device by recording the anorectal function of asymptomatic subjects. Patient comfort was also assessed. Methods: Anorectal function was assessed in asymptomatic volunteers using the Anopress. All volunteers...

Introduction Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally.

[This corrects the article DOI: 10.18632/oncotarget.24257.].

Background: The Internet has become an important platform for information communication. This study aim to investigate the utility of social media and search engines to disseminate faecal incontinence information. Methods: We looked into Social media platforms and search engines. There was not a direct patient recruitment and any available infor...

We evaluated the benefit of tailoring treatments for a colorectal adenocarcinoma cancer cohort according to tumor molecular profiles, by analyzing data collected on patient responses to treatments that were guided by a tumor profiling technology from Caris Life Sciences. DNA sequencing and immunohistochemistry were the main tests that predictions w...

Hemorrhoids are a common condition affecting the anorectum. The clinician must accurately diagnose the condition and exclude more sinister causes responsible for the same symptoms. A focused history and thorough examination help in establishing a differential diagnosis. The treatment modality is guided by the degree of the hemorrhoids. Conservative...

Background: THD Anopress® has been promoted as a new portable anal manometer providing measurements of whole anal canal pressures. This study aims to report the anorectal function of patients suffering from Faecal Incontinence (FI) using this new device and the associated patient comfort.Methods: We reviewed data from patients suffering from FI who...

Introduction Trans anal minimal invasive surgery (TAMIS) is a novel technique gaining popularity in colorectal surgery due to its precision in pelvic dissection and easy accessibility to the distal rectum. Its use in colorectal cancer surgery is well documented although inflammatory bowel disease (IBD) poses a unique set of disease-specific and pro...

Aim: To demonstrate the results of a 5 year screening program for SCC in HIV patients. Method: We identified retrospectively 204 HIV patients who underwent a screening program for SCC from October 2010 to January 2015. All patients were screened by DARE, anal Pap Test including HPV test and cytology, and High Resolution Video-Proctoscopy (HR-VPS) w...

Report long-term effectiveness of Sacral Nerve Stimulator (SNS) in a cohort of patients with faecal incontinence (FI) with a minimum of 5 years’ follow-up

Aim: To investigate the current practice of continence advisors in the United Kingdom. Method: Continence advisors were contacted by email or letter to participate in a survey. The survey contained 27 questions which addressed the practice of each continence advisor, their knowledge of continence management and the adequacy of their training. R...

Objectives. The best treatment of early stage anal squamous cell carcinoma (SCC) is under debated. Wide local excision (WLE) may be considered adequate for stage 1 anal margin cancer. This study demonstrates our experience in treatment of patients with SCC over 5 years. Patients and methods. We conducted a retrospective study of patients who had un...

Objectives: The best treatment of early stage anal squamous cell carcinoma (SCC) is under debated. Wide local excision (WLE) may be considered adequate for stage 1 anal margin cancer. This study demonstrates our experience in treatment of patients with SCC over 5 years. Patients and methods: We conducted a retrospective study of patients who had...

Aim: Potential screening modalities for early diagnosis of squamous cell anal cancer (SCC) in HIV patients include digital anorectal examination (DARE), anal Papanicolaou testing (Pap test), human papilloma virus (HPV) co-testing, and high-resolution anoscopy. The aim of this study was to demonstrate the results of a five-year screening program fo...

This are the preliminary results of our study where we show the first normative values for the newer portable manometric device Anopress.

A meta-analysis comparing posterior component separation (transversus abdominus release) with anterior component separation in the repair of midline ventral/incisional hernias

Introduction Trans anal minimal invasive surgery is a novel technique gaining popularity in pelvic surgery due to its precision in pelvic dissection and easy accessibility to the distal rectum. Use of Transanal surgery for mesorectal excision in colorectal cancer surgery is well documented (Velthuis et al. 2013) although inflammatory bowel disease...

Purpose: Single port laparoscopic surgery (SPLS) is a technique which is increasing in popularity. The benefit of SPLS in complex Crohn's disease (CD), which includes a significant cohort of young patients sometimes needing multiple operations, has not been comprehensively assessed. This study analyses our early experience with this technique. Me...

Treatments for anal intraepithelial neoplasia (AIN) include non-operative options and more invasive treatments, such as wide local excision.1 Unfortunately, recurrence rates remain high regardless of treatment and therefore surveillance is paramount.2 We performed a study of patients who underwent treatment of condyloma and AIN using imiquimod 5% c...

Purpose: To evaluate long-term functional outcomes of Internal Delorme's Procedure (IDP) in patients refractory to conservative treatment for Obstructed Defecation Syndrome (ODS), and to compare those who received postoperative rehabilitation with those who did not. Materials and methods: All patients with ODS refractory to nonoperative therapy...

Background: Anastomosis technique following right sided colonic resection is widely variable and may affect patient outcomes. This study aimed to assess the association between leak and anastomosis technique (stapled versus handsewn) METHODS: This was a prospective, multicentre, international audit including patients undergoing elective or emergen...

Introduction: Minimal evidence exists to guide the surgeon on the risk of complications when performing abdominal wall reconstruction (AWR) in the presence of active infection, contamination or enterocutaneous fistula. This study aims to establish the outcomes of contaminated complex AWR. Methods: Analysis was conducted according to PRISMA guide...

Aim The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn). Method This was a prospective, multicentre, international audit including patients undergoing elective or emergency rig...

Background and aims: Restorative proctocolectomy in elderly inflammatory bowel disease [ IBD] patients is controversial and limited data are available on the outcomes of surgery. The aim of this study was to evaluate the safety, efficacy, and long-term results of ileal-pouch-anal anastomosis in elderly patients, in a multicentre survey from Europe...

The aim of the study was to assess if objective evaluation and specialized supportive care improves QOL after pouch surgery. This poster has been presented at the ESCP 2016 and the abstract published in the Colorectal Disease Journal, 2016, Issue 18 S

This is a result on an online UK survey. The abstract has been published in the Colorectal Disease Journal, September 2016, Issue 18, Supplement, Abstract from the ESCP 2016

Describes the use of SILS in acute UC patients for subtotal colectomy

Single Incision Laparoscopic Surgery (SILS) as surgical option in Crohn’s disease: our experience

Case series of acute severe UC patients undergoing subtotal colectomy with SILS

At St Mark’s we have developed a new laparoscpic mesh rectopexy tailored towards patients with external rectal prolapse with concurrent rectocele, enterocele and/or intussusception. Here We describe 1-year outcomes of our modified laparoscopic ventral rectopexy technique.

BACKGROUND: Obturator hernia is a rare condition associated with a high morbidity and mortality. It is an uncommon cause of bowel obstruction most commonly described in elderly females with comorbidity. Surgical intervention is often delayed as a result of subtle presenting signs. Coexisting ipsilateral femoral hernia is an even rarer condition re...

Social media has become an important platform for information communication. We investigated its use for exchanging information relating to faecal incontinence.

We aim to establish the outcomes of complex AWR for VHWG grade 3 and 4 defects.

Social media has become an important platform for information communication. We investigated its use for exchanging information relating to faecal incontinence.

Aim: Laparoscopic surgery is well established for colon cancer with defined benefits. In performing restorative proctocolectomy (RPC) with ileoanal anastomosis it is more controversial. Technical aspects include difficult dissection of the distal rectum and a potentially increased risk of anastomotic leakage through multiple firings of the stapler...

Unlabelled: Gallbladder perforation with hemorrhage may be the source of massive hemoperitoneum under rare and extreme circumstances. In cirrhotic patients the bleeding may be associated with the tearing of gallbladder varices and represents a fatal complication, as reported in all the cases available in literature. The incidence of gallbladder va...

Sorafenib has improved the median overall survival of unresectable or otherwise untreatable hepatocellular carcinoma (HCC) of ∼3 months, compared to supportive cares. Complete response, although rare, has been reported. The authors reported herein a case of complete biochemical and radiological remission of advanced unresectable HCC with lymph node...

Aim. Idiopatic thrombocytopenic purpura (ITP) is the most common indication for splenectomy. The failure rate of surgery is about 8% and the failure rate after splenectomy is approximately 28% for all patients. When the presence of an accessory spleen is diagnosed, splenectomy is recommended. Laparoscopic approach is considered the first choice. Pa...

Introduction: Lynch syndrome is an autosomal dominant disorder and is responsible of 3-5% of all colorectal cancers. These cancers show characteristic features of mismatch repair deficiency, allowing them to be differentiated from sporadic cancers. The Bethesad guidelines were introduced to identify tumours more likely to have arisen as a result of...

Introduction: There has been increased use of single-incision laparoscopic surgery (SILS) for colorectal surgery. Since 2013 we have been adopting this technique for IBD surgery in our centre. The benefits include less incisions and the possibility to switch between open and laparoscopic surgery without loss of advantage. The combination of SILS wi...

Aim SILS is an acceptable form of laparoscopic surgery. Complex Crohn's disease patients may require more than one operation and this technique has the perceived benefit of switching between laparoscopic and ‘open’ surgery without loss of advantage. This study assesses the feasibility and safety of SILS in complex Crohn's disease. Method Data we...

Aim Single incision laparoscopic surgery (SILS) combined with transanal minimally invasive surgery (TAMIS) has the ability to provide a pure minimally invasive approach in patients who need an ileoanal pouch (IPAA). We present our initial experience and surgical technique of this procedure. Method Since May 2013, 10 patients have undergone SILS...

Introduction: Single-incision laparoscopic surgery (SILS) for colorectal surgery has been growing since the first SILS colectomy in 2008.It has many benefits including lesser incisions and in patients who require more than one operation this technique has the perceived benefit of switching between laparoscopic and ‘open’ surgery without loss of adv...

Macrocystic serous cystadenomas (MaSCA) are rare benign tumor of the pancreas which represent an atypical macroscopic morphologic variant of serous cystadenomas (SCA). They are characterized by a limited number of cysts with a diameter of >2 cm and share imaging features overlapping those of mucinous cystic neoplasm (MCN) and branch-duct intraducta...