Carolynne J Vaizey’s research while affiliated with Imperial College London and other places

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Publications (253)


A UK wide survey of general surgeons' experience of the primary repair of obstetric anal sphincter injuries
  • Article

November 2024

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4 Reads

Colorectal Disease

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Gregory P. Thomas

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Emma V. Carrington

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[...]

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Carolynne J. Vaizey

Aim Obstetric anal sphincter injuries (OASIs) are associated with devastating consequences, mainly faecal incontinence. A timely and correct repair is necessary to reduce the risk of maternal morbidity. The aim was to explore the experience and practice of on‐call general surgeons in the acute repair of OASIs. Method A cross‐sectional, observational questionnaire study was performed. Registrars and consultants participating in an emergency general surgical rota in the UK were included. A 33‐item questionnaire was disseminated over a 9‐month period from April 2023. A descriptive, thematic analysis of the data was undertaken. Results In all, 310 responses were analysed. 42.3% of colorectal respondents (of which 29% were pelvic floor specialists), 24.3% of general surgeons, 16.7% of hepato‐biliary surgeons and 13.7% of upper gastrointestinal surgeons were contacted to assist with an acute repair. Of those contacted, 52.3% typically assisted with a 3C or 4 tear, 54.2% received no training and 95.5% performed less than three acute repairs in the previous year. 57.6% of all respondents were not confident at all in the repair of these injuries, 55% highlighted a lack of experience and 36% mentioned a curricular gap. Conclusion Surgeons may be called to assist with an acute OASI repair, particularly in cases of severe anatomical disruption. This occurs infrequently. There is a lack of consensus as to who is responsible for these injuries. Obstetricians have structured training in both the recognition and repair of these injuries. This paper serves to highlight the lack of training for surgeons who report doing this surgery despite lacking the required competences.


Interventions to reduce surgical site infection following elective colorectal surgery: protocol for a systematic review with narrative synthesis and GRADE recommendations

September 2024

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3 Reads

Journal of Surgical Protocols and Research Methodologies

Surgical site infection (SSI) is frequently associated with adverse patient outcomes. SSI is often perceived as a preventable complication following elective surgery, and a wide array of strategies have been reported to reduce its occurrence. Despite this, colorectal surgery continues to have among the highest incidences of SSI, and there is considerable variation in the use of evidence-based practices in its prevention. There are currently no systematic reviews describing the full range of interventions to reduce SSI across the perioperative period of elective colorectal surgery. To determine which perioperative interventions are effective in reducing SSI following elective colorectal surgery. A systematic search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science databases as well as grey literature sources will be performed. Data extraction, risk of bias assessments and narrative synthesis will be performed by a team of trained, independent reviewers. Certainty of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations framework. This review will form the most comprehensive assessment to date of measures to reduce SSI following elective colorectal surgery. This will promote the adoption of evidence-based practice and the identification of future research needs.


WP7.5 - Primary Repair of Obstetric Anal Sphincter Injuries (OASIS): a Survey of Surgeons’ Experience

September 2024

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2 Reads

BJS (British Journal of Surgery)

Purpose OASIS is associated with devastating consequences; namely incontinence. Timely, satisfactory repair of OASIS is necessary to mitigate the risk of maternal morbidity. Primary repair is typically undertaken by an obstetrician. In cases of profound anatomical disruption, the on-call surgeon may be called. The aim was to explore the experience and current practice of surgeons in the acute repair of OASIS. Methods A cross-sectional, observational study was performed. Registrars and consultants who participate in an on-call rota in the UK were included. The survey was disseminated to members of ASGBI and ACPGBI. It was also advertised via social media platforms, including Twitter and LinkedIn. A chain-sampling method was advocated. A descriptive analysis of the data was undertaken. Results 318 responses have been recorded so far. 32% of surgeons had been contacted to assist in an acute repair, of which 23% had a specialist interest in pelvic floor surgery. Of those who were contacted, 53% would typically be called for a 3c or 4 tear. Of these, 73% had not performed any primary repairs over the preceding year. 77% of all respondents had not received any training. Of those awarded the FRCS, 36% were not confident at all in performing an acute repair. Conclusion There remains a lack of consensus on who is responsible for the repair of these injuries. Surgeon involvement should only occur if adequate exposure and training is assured. Involvement may be reserved for cases where secondary repair is considered, when specialist pelvic floor opinion should be sought.


Surgical Management of Anal Incontinence

March 2024

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4 Reads

In most cases, conservative therapy should be the first line treatment for those with anal incontinence. In very selected patients, such as women in the post-partum period who have suffered an obstetric anal sphincter injury (OASI) and have a wound infection or breakdown, anal sphincter repair may be offered. There is evidence that the effectiveness of this operation will wane over time. Artifical anal sphincter devices are no longer routinely offered. Sacral neuromodulation is the most effective treatment available for those who do not improve with conservative measures and remains effective in the long term. However, its exact mechanism of action remains elusive. New anal injectable devices and regenerative medicine therapies may offer some promise. For those who fail all other therapies, a stoma may be the last resort of use.


EAGLE study.pdf
  • Data
  • File available

December 2023

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836 Reads

EAGLE is an international study bringing together surgeons, anaesthetists and theatre teams around the world to share best practice. The common goal is to reduce the global anastomotic leak rate after right colectomy and ileocaecal resection. Feel free to join ESCP Safe-anastomosis programme.

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A systematic review and a meta‐analysis on the incidence of obstetric anal sphincter injuries during vaginal delivery

December 2023

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34 Reads

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3 Citations

Colorectal Disease

Aim The incidence of obstetric anal sphincter injuries (OASIS) has increased in the past two decades despite improved awareness of the risk factors. This study aimed to define the incidence of OASIS in women with different features (instrumental delivery or other variables). Methods A systematic review was conducted on articles reporting the incidence of OASIS. This review aims to examine the association of instrumentation and OASIS by performing a formal systematic review of the published literature. Databases used for the research were MEDLINE, Embase, CINAHL and ‘Maternity and infant care’ databases. Results Two independent reviewers screened the selected articles. 2326 duplicates were removed from the total of 4907 articles. The remaining 2581 articles were screened for title and abstract. 1913 articles were excluded due to irrelevance. The remaining 300 were screened as full text. Primiparity associated with the use of forceps were the features associated with the highest incidence of OASIS in the selected articles (19.4%). OASIS in all women had an overall incidence of 3.8%. The incidence of OASIS in all women by geographical region was the highest (6.5%) in North America. Conclusions There are various factors that impact on the incidence of OASIS and the combination of some of these, such as the use of forceps in primiparas, resulted in the highest incidence of OASIS. The lack of international consensus is limiting the improvements that can be done to reduce OASIS rates and improve best clinical practice.


Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

November 2023

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1,573 Reads

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5 Citations

BJS (British Journal of Surgery)

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 percent of surgeons, high engagement; less than 50 percent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 percent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 percent respectively (adjusted OR 0.87, 95 percent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 percent (61 of 500) before intervention to 5.1 percent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 percent (59 of 714) and 13.8 percent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).


Laparoscopic modified mesh rectopexy: medium-term results of a novel approach for external rectal prolapse

October 2023

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14 Reads

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3 Citations

Colorectal Disease

Aim: Rectal prolapse is a common and significantly debilitating condition. Surgical correction is usually required. The two most common abdominal approaches are ventral mesh rectopexy and posterior suture rectopexy. Both may be complicated, respectively, by either mesh-related complications or significant postoperative constipation. We report the outcome of a novel rectopexy operation which combines aspects of both the aforementioned approaches, for the treatment of external rectal prolapse (ERP). Method: The technique involves laparoscopic partial posterior-lateral rectal mobilization of the rectum with posterior suture fixation to the sacral promontory and placement of an absorbable mesh in the rectovaginal space. Data were collected on postoperative complications, prolapse recurrence, mesh-related complications and the assessment of quality of life. Results: Eighty patients underwent a modified mesh rectopexy for ERP. Seventy-seven were women. The median age was 67.5 years. Almost a third had undergone a previous rectal prolapse repair. Recurrences were seen in 11 (13.8%). No mesh-related complications were seen. Eleven patients reported postoperative constipation. Conclusion: The laparoscopic modified mesh rectopexy may be a safe and effective operation for the treatment of ERP.


Acute Surgical Intestinal Failure. Sepsis and Enterocutaneous Fistula(s)

October 2023

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23 Reads

Acute surgical intestinal failure is commonly associated with abdominal sepsis, enterocutaneous fistula(s) and small bowel obstruction. It is a temporary (often months) but potentially reversible situation. The immediate management consists of resuscitation/fluid balance, detection and treatment of sepsis (the main cause of mortality), analgesia and wound management. Nutritional support should be given taking account of refeeding risks. Oral/enteral nutrition may be given if chyme is not draining into a cavity and if there is sufficient bowel for absorption. If the bowel proximal to a fistula is short (less than 100 cm), there is an abscess associated with a fistula or intestinal obstruction, then parenteral support is required. Once the output from a stoma or fistula has been reduced and wound care provided, psychosocial issues should be addressed and the patient’s mobility improved. When the patient’s condition has been stabilized, their intestinal and abdominal wall anatomy can be determined with a view to planning elective reconstructive surgery. This should only be undertaken when the patient’s condition has been fully optimized and, in particular, their sepsis extirpated and their nutritional status restored. The underlying condition which gave rise to acute intestinal failure may require specific medical treatment (e.g. immunosuppressive therapy for Crohn’s disease) and this may need to be co-ordinated with reconstructive surgery.



Citations (59)


... Manual perineal protection, which is known to reduce the risk of OASI [41] and is almost systematically performed in France [42], may partly explain the low prevalence of OASI. A review of the literature has shown conflicting conclusions [43]. Some studies reported a stable prevalence of OASI over time, while others observed moderate to substantial increases concurrent to decreasing episiotomy rates [17,18,[44][45][46]. ...

Reference:

Episiotomies and obstetric anal sphincter injuries following a restrictive episiotomy policy in France: An analysis of the 2010, 2016, and 2021 National Perinatal Surveys
A systematic review and a meta‐analysis on the incidence of obstetric anal sphincter injuries during vaginal delivery
  • Citing Article
  • December 2023

Colorectal Disease

... Resection with negative macroscopic and microscopic margins and adequate lymphadenectomy is the mandatory goal of surgery for localized CRC, according to the worldwide guidelines [3][4][5]. However, both colon and rectal resections are invasive procedures with non-negligible postoperative morbidity and mortality rates [6][7][8][9][10]. ...

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

BJS (British Journal of Surgery)

... Nevertheless, some recent questions about ventral rectopexy for RP are still debated, such as the interest in a robotic approach [5][6][7][8][9], using a biological mesh [10], the using glue [11] or staplers [12] for mesh fixation, the advantage of an associated sigmoid resection [13,14], the alternative of suture rectopexy [15][16][17], or perineal stapled prolapse resection [18]. ...

Laparoscopic modified mesh rectopexy: medium-term results of a novel approach for external rectal prolapse
  • Citing Article
  • October 2023

Colorectal Disease

... Malone antegrade continence enema was first introduced in 1990 for children with anorectal malformations aiming to produce a continent catheterisable stoma [1]. Many patients undergoing surgery for chronic constipation are < 50 years old with a consequent prolonged exposure to chronic diversion colitis and an unpredictable estimated lifetime risk of cancer diagnosis [2]. Therefore, a strict screening programme should be established for those patients. ...

Is there an increased risk of missing a colon cancer after a permanent ileostomy for constipation?
  • Citing Article
  • August 2023

Colorectal Disease

... Treatment options for urinary incontinence encompass a variety of approaches, including scheduled urination, pelvic floor muscle training, acupuncture, and pharmacological therapy. Post-stroke urinary incontinence and associated symptoms can be mitigated through structured nursing assessments, professional management, and specialized incontinence care [11].Upon diagnosing fecal incontinence, treatment strategies may involve lifestyle modifications, dietary advice, basic behavioral guidance (like toilet/bowel training), the use of stool dilators and/or anti-diarrheal medications, pelvic floor muscle exercises, absorbent products for containment, and skincare products to address anal skin irritation [12]. ...

Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

... The type of incontinence and its frequency are used to assess the level of severity (Rockwood et al., 1999). The prevalence of FI in patients with IBD ranges from 12.7% to 76% (Gu et al., 2018;Kurt et al., 2022;Proudfoot et al., 2018). FI can affect patients with IBD not only during flare-ups but also in the remission state (Matsuoka et al., 2018). ...

Faecal incontinence in inflammatory bowel disease: The Nancy experience
  • Citing Article
  • February 2022

Digestive and Liver Disease

... We also validated these models in an external validation cohort. This study was conducted in accordance with the TRIPOD guidelines (Supplementary Table 1) (Collins et al. 2015). ...

SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

Anaesthesia

... 15 Other studies, including the one published by the COVIDSurg collaboration, have suggested that preoperative COVID-19 is associated with an increased risk of postoperative pulmonary or cardiovascular complications and mortality. [22][23][24][25] Interestingly, a more recent study has not observed the same association. 26 While the primary focus of these studies was not specifically on this aspect, it appears that the presence of symptoms at the time of surgery may account for the observed effect of preoperative COVID-19 on postoperative outcomes. ...

Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.

Anaesthesia

... Serious complications were rare, with Grossi's systematic review suggesting a trend to a higher rate of surgical complications with resection rectopexy, although another systematic review by Emile et al. did not find difference [23]. Concerns regarding the use of mesh for functional GI disorders were addressed by the European Society of Coloproctology (ESCP) who published a guidance paper following rigorous literature review [94]. Mesh-related complications are serious but uncommon, reported in 1.1% of ventral mesh rectopexies for internal rectal prolapse [23]. ...

ESCP Guidance on use of mesh in pelvis in colorectal surgery
  • Citing Article
  • June 2021

Colorectal Disease

... Each patient's past surgical and medical history is documented with a focused history on previous surgery and previous ventral hernia repairs (mode of surgery, mesh location, current abdominal wall infection/fistula, stoma presence, previous mesh explantation, component separation, etc). 15,16,3,11,14,[26][27][28] Each patient's operative risk is assessed using the CeDAR 29 and P-POSSUM 30 scores, 15,16,[31][32][33][34] and fed back to the patient to illustrate the importance of reducing risk factors. Patient frailty 15 and cognitive function 15,16 are also assessed to assess fitness for surgery. ...

Evaluation of the Ventral Hernia Working Group classification for long-term outcome using English Hospital Episode Statistics: a population study

Hernia