Colorectal Surgery Unit

Haifa, Israel

Colorectal Surgery Unit

Haifa, Israel
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Lui D.H.,Royal Infirmary | McDonald J.J.,Ninewells Hospital | de Beaux A.,Royal Infirmary | Tulloh B.,Royal Infirmary | Brady R.R.W.,Colorectal Surgery Unit
Hernia | Year: 2017

Purpose: Healthcare professional engagement is increasing. This study aims to identify levels of adoption and engagement of several social media platforms by a large international cohort of hernia surgery specialists. Methods: Hernia specialists attending the 38th International Congress of the European Hernia Society were identified. A manual search was then performed on Twitter, ResearchGate, and LinkedIn to identify those who had named accounts. Where accounts were identified, data on markers of utilisation were assessed. Results: 759 surgeons (88.5% male) from 57 countries were identified. 334 surgeons (44%) engaged with a social media platform. 39 (5.1%) had Twitter accounts, 189 (24.9%) had ResearchGate accounts and 265 (34.9%) had LinkedIn accounts. 137 surgeons (18.1%) had accounts on 2 or more social media platforms. There was no gender association with social media account ownership (p > 0.05). Engagement in one social media platform was associated with increased engagement and utilisation on other platforms; LinkedIn users were more likely to have Twitter accounts (p < 0.001) and ResearchGate profiles (p < 0.001). Surgeons on all three SM platforms were more likely to have high markers of engagement across all SM platforms (multiple outcomes, p < 0.05). Geographical variation was noted with UK and South American Surgeons being more likely to be present on Twitter than their counterparts (p = 0.031). Conclusions: The level of engagement with social media amongst Hernia surgeons is similar to other surgical specialities. Geographical variation in SM engagement is seen. Engagement with one SM platform is associated with presence on multiple platforms. © 2017 Springer-Verlag France


PubMed | Rambam Health Care Campus, Colorectal Surgery Unit and Hasharon Medical Center
Type: | Journal: International journal of surgery (London, England) | Year: 2016

Diverticular hemorrhage may be massive or recurrent, requiring surgical management. The aim of our study is to define risk factors that predict rebleeding or need for urgent operation in patients with diverticular hemorrhage.Retrospective study was conducted on patients who were admitted for diverticular hemorrhage. Data pertaining to patient and bleeding characteristics, method of diagnosis, blood transfusion and type of operation were collected. Multivariate analysis model compared patients who experienced single bleeding episode with those with recurrent episodes, and patients who underwent surgery with those who did not.One hundred and four patients met the inclusion criteria. Thirty four patients experienced more than one bleeding episode. Ten patients needed surgery for recurrent bleeding. Five patients presented with hemodynamic instability, none of them required surgical treatment. Neither patients comorbidity nor anticoagulant and antiaggregant treatments were associated with increased risk for recurrent hemorrhage. Diabetes mellitus was correlated with decreased risk for recurrent hemorrhage, OR=0.21, (CI 95% (0.06-0.73)); p=0.014. Independent risk factor for massive recurrent diverticular hemorrhage requiring surgery was right sided diverticulosis, OR=4.6(CI 95% (2.1-19)); p=0.006.Right colon diverticulosis rather than patient characteristics and medical treatment should prompt for aggressive management with lower threshold for surgical intervention.


Diaz-Jimenez D.,University of Chile | Nunez L.E.,University of Chile | Beltran C.J.,University of Chile | Candia E.,University of Chile | And 5 more authors.
World Journal of Gastroenterology | Year: 2011

AIM: To correlate circulating soluble ST2 (sST2) levels with the severity of ulcerative colitis (UC) and serum levels of pro-inflammatory cytokines, and to demonstrate the predictive power of sST2 levels for differentiation between active and inactive UC. METHODS: We recruited 153 patients: 82 with UC, 26 with Crohn's disease (CD) and 43 disease controls [non-inflammatory bowel disease (IBD)]. Subjects were excluded if they had diagnosis of asthma, autoimmune diseases or hypertension. The serum levels of sST2 and pro-inflammatory cytokines [pg/mL; median (25th-75th)] as well as clinical features, endoscopic and histological features, were subjected to analyses. The sST2 performance for discrimination between active and inactive UC, non-IBD and healthy controls (HC) was determined with regard to sensitivity and specificity, and Spearman's rank correlation coefficient (r). To validate the method, the area under the curve (AUC) of receiver-operator characteristic (ROC) was determined (AUC, 95% CI) and the total ST2 content of the colonic mucosa in UC patients was correlated with circulating levels of sST2. RESULTS: The serum sST2 value was significantly higher in patients with active [235.80 (90.65-367.90) pg/mL] rather than inactive UC [33.19 (20.04-65.32) pg/mL], based on clinical, endoscopic and histopathological characteristics, as well as compared with non-IBD and HC (P < 0.001). The median level of sST2 in CD patients was 54.17 (35.02-122.0) pg/mL, significantly higher than that of the HC group only (P < 0.01). The cutoff was set at 74.87 pg/mL to compare active with inactive UC in a multicenter cohort of patients. Values of sensitivity, specificity, and ability to correctly classify UC, according to activity, were 83.33%, 83.33% and 83.33%, respectively. The AUC of the ROC curve to assess the ability of this molecule to discriminate between active vs inactive UC was 0.92 (0.86-0.97, P < 0.0001). The serum levels of sST2 in patients with UC significantly correlated with endoscopic and histo-pathological scores (r = 0.76 and r = 0.67, P < 0.0001, respectively), and with the pro-inflammatory cytokine, tumor necrosis factor-α (r = 0.69 and r = 0.61, respectively, P < 0.0001). Interestingly, we found a direct correlation between total intestinal ST2 content and serum levels of sST2, adjusted to endoscopic activity score in patients with mild (r = 0.44, P = 0.004), moderate (r = 0.59, P = 0.002) and severe disease (r = 0.82, P = 0.002). Only patients with inactive UC showed no significant correlation (r = 0.45, P = 0.267). CONCLUSION: sST2 levels correlated with disease severity and inflammatory cytokines, are able to differentiate active from inactive UC and might have a role as a biomarker. © 2011 Baishideng. All rights reserved.


De la Fuente M.,University of Chile | Franchi L.,University of Michigan | Araya D.,University of Chile | Diaz-Jimenez D.,University of Chile | And 9 more authors.
International Journal of Medical Microbiology | Year: 2014

Crohn's disease (CD) is a multifactorial pathology associated with the presence of adherent-invasive Escherichia coli (AIEC) and NLRP3 polymorphic variants. The presence of intracellular E. coli in other intestinal pathologies (OIP) and the role of NLRP3-inflammasome in the immune response activated by these bacteria have not been investigated. In this study, we sought to characterize intracellular strains isolated from patients with CD, ulcerative colitis (UC) and OIP, and analyze NLRP3-inflammasome role in the immune response and bactericidal activity induced in macrophages exposed to invasive bacteria. For this, intracellular E. coli isolation from ileal biopsies, using gentamicin-protection assay, revealed a prevalence and CFU/biopsy of E. coli higher in biopsies from CD, UC and OIP patients than in controls. To characterize bacterial isolates, pulsed-field gel electrophoresis (PFGE) patterns, virulence genes, serogroup and phylogenetic group were analyzed. We found out that bacteria isolated from a given patient were closely related and shared virulence factors; however, strains from different patients were genetically heterogeneous. AIEC characteristics in isolated strains, such as invasive and replicative properties, were assessed in epithelial cells and macrophages, respectively. Some strains from CD and UC demonstrated AIEC properties, but not strains from OIP. Furthermore, the role of NLRP3 in pro-inflammatory cytokines production and bacterial elimination was determined in macrophages. E. coli strains induced IL-1β through NLRP3-dependent mechanism; however, their elimination by macrophages was independent of NLRP3. Invasiveness of intracellular E. coli strains into the intestinal mucosa and IL-1β production may contribute to CD and UC pathogenesis. © 2014 Elsevier GmbH.


Beltran C.J.,University of Chile | Nunez L.E.,University of Chile | Diaz-Jimenez D.,University of Chile | Farfan N.,University of Chile | And 7 more authors.
Inflammatory Bowel Diseases | Year: 2010

Background: ST2 has been proposed to be a regulator of inflammation and Th1/Th2 balance. ST2L is the IL-33 membrane receptor and belongs to the IL-1R family. The soluble variant, ST2s, is identical to the extracellular region of ST2L and competes for IL-33 binding, inhibiting receptor signaling. Although ST2s has been associated with inflammatory processes in patients with sepsis, trauma, asthma, and autoimmunity, until now there are no reported studies showing the role of ST2/IL-33 in inflammatory bowel disease (IBD). Methods: Expression of ST2 and IL-33 was determined in serum and colonic biopsies from IBD patients. ST2 transcript and protein was determined by reverse-transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA)/immunoblot, respectively, and IL-33 protein by ELISA. Intestinal mucosa localization of ST2 and IL-33 was conducted by immunofluorescence. Results: ST2s transcript in the colonic mucosa was mainly expressed in UC patients rather than Crohn's disease or control; however, ST2L mRNA remained constant in all samples. Total ST2 protein was significantly higher in mucosa samples from patients with active UC, with a predominant induction of ST2s that strongly correlates with serum ST2 levels. Mucosa IL-33 levels were higher in UC patients and serum levels were barely detected in all patient groups. ST2 and IL-33 are both abundantly expressed in the cytoplasm of epithelial cells of control subjects; however, in ulcerative colitis patients ST2 decreases and IL-33 showed cytoplasm-nuclear redistribution. Conclusions: The novel association between the ST2/IL-33 system and IBD seems to identify that variations in this axis might regulate the inflammatory process in these diseases. Copyright © 2009 Crohn's & Colitis Foundation of America, Inc.


PubMed | Hasharon Hospital and Colorectal Surgery Unit
Type: | Journal: International journal of surgery (London, England) | Year: 2016

Local excision is the treatment of choice for large benign rectal lesions. Transanal endoscopic microsurgery is recommended. The excision of large lesions >4cm has been previously described. We report our series of lesions >5cm that have been excised via the transanal endoscopic microsurgery.Patients who underwent transanal endoscopic microsurgery for rectal tumors, between the years 2002-2012, were identified. Patients with tumors greater than 5cm consisted the study group. Tumor diameter was determined based on fresh specimen measurements. Data pertaining to patients and tumor characteristics, operative and histopathology findings, postoperative outcomes were collected. Local recurrence and effects on anal sphincter function were assessed.Twenty five patients (14 female) with mean age of 70.310.1 years, met the inclusion criteria. The mean tumor size was 5.70.9cm. The median distance from anal verge was 8cm (range 1-17). Preoperative biopsy of the rectal tumor revealed adenoma with/without dysplasia in 24 patients. Postoperative findings were adenoma with/without dysplasia in 20 patients, T1 rectal cancer in 4 patients and tail gut cyst in one patient. Free margins were documented in 17 patients, in 7 it was involved and in one patient it could not be determined. In 2 cases the procedure was discontinued. Except for nonspecific transient fever no postoperative complications were reported. After a median follow up of 24.2 months, the 3-year LR rate was 10.9%.TEM is feasible for the treatment of large benign rectal tumors. It may be an alternative method for proctectomy in selected patients with large rectal lesions.


PubMed | Inflammatory Bowel Disease Program, Coordinator Nurse of the Inflammatory Bowel Disease Program, Academic Research Unit and Colorectal Surgery Unit
Type: | Journal: Journal of clinical nursing | Year: 2016

To assess disease-related knowledge among patients with IBD and to identify the factors that are possibly associated with the knowledge level.Disease-related knowledge can positively influence the acceptance of the disease, increase treatment compliance and improve the quality of life in patients with IBD.An observational, cross-sectional study was conducted and prospectively included patients from the IBD program between October 2014 and July 2015.A Spanish-translated version of the 24-item Crohns and Colitis Knowledge score was used to assess disease-related knowledge. Patients also completed a demographic and clinical questionnaire.A total of 203 patients were included, 62% were female, and 66% were diagnosed with ulcerative colitis; the median age was 34 years (range 18-79), and the median disease duration was 4 years. The median disease-related knowledge score was 9 (range 1-20). Only 29% of the patients answered more than 50% of the questions correctly. Lower disease-related knowledge was observed in questions related to pregnancy/fertility and surgery/complications. Patients older than 50 years, with ulcerative colitis, with disease durations less than 5 years, and patients without histories of surgery exhibited lower disease-related knowledge. There was no association between the knowledge scores and the educational levels.The patients who attended our IBD program exhibited poor disease-related knowledge that was similar to the knowledge levels that have been observed in developed countries. It is necessary to assess patient knowledge to develop educational strategies and evaluate the influences of these strategies on patient compliance and quality of life. This article is protected by copyright. All rights reserved.


Khoury W.,Colorectal Surgery Unit | Gilshtein H.,Colorectal Surgery Unit | Nordkin D.,Colorectal Surgery Unit | Kluger Y.,Colorectal Surgery Unit | Duek S.-D.,Colorectal Surgery Unit
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2013

Background: The benefits of transanal endoscopic microsurgery (TEM) for the excision of benign and low-grade malignant lesions in the low and middle rectum are well recognized. This study examined the feasibility and safety of a repeated TEM procedure. Patients and Methods: Patients who underwent a repeat TEM for excision of rectal lesions, either for involved resection margins or for local recurrence, between the years 2000 and 2010, were identified. Rectal lesion characteristics were retrieved. Mean operative times, length of hospital stay, and intra- and postoperative complications were compared between primary and repeated procedures. The postoperative histopathology reports were reviewed, and the adequacy of resection was determined. All patients completed a questionnaire based on the Wexner score for anal sphincter function evaluation. Results: Fourteen patients (3 female, 11 male) underwent a repeat TEM operation during the study period. All procedures were completed endoscopically. Indications for repeated TEM were involved margins in 12 patients and recurrence of benign tumor in 2. Mean operative time, mean length of hospital stay, and rate of postoperative complications were similar for primary and repeated TEM procedures (62.5±17 versus 55±23 minutes, P=.181; 1.7±1.3 versus 1.7±1.12 days, P=.99; and 35.7% versus 21.4%, P=.66, respectively). The Wexner score was comparable at baseline and after the first and the second TEM procedures (1.5±2.3, 1.5±2.3, and 3.3±3.1, respectively; P=.188). No cases of fecal incontinence following a repeat TEM were documented. Conclusions: Repeated TEM is feasible and safe and may be appropriate for selected patients. © Copyright 2013, Mary Ann Liebert, Inc. 2013.


Alcantara M.,Colorectal Surgery Unit | Serra-Aracil X.,Colorectal Surgery Unit | Falco J.,Radiodiagnosis Service UDIAT | Mora L.,Colorectal Surgery Unit | And 2 more authors.
World Journal of Surgery | Year: 2011

Background: The main aim of this study was to compare short-term results and long-term outcomes of patients who underwent intraoperative colonic lavage (IOCL) with primary anastomosis with those who had stent placement prior to scheduled surgery for obstructive left-sided colonic cancer (OLCC). Methods: We conducted a prospective, controlled, randomized study of patients diagnosed with OLCC. Patients were divided into two groups: stent and deferred surgery (group 1) and emergency IOCL (group 2). Demographic variables, risk prediction models, postoperative morbidity and mortality, staging, complications due to stent placement, surgical time, clinical follow-up, health costs, and follow-up of survival were recorded. Results: Twenty-eight patients (15 group 1 and 13 group 1) were enrolled. The study was suspended upon detecting excess morbidity in group 2. The two groups were homogeneous in clinical and demographic terms. Overall morbidity in group 1 was 2/15 (13.3%) compared with 7/13 (53.8%) in group 2 (p = 0.042). None of the 15 patients in group 1 presented anastomotic dehiscence compared with 4/13 (30.7%) in group 2 (p = 0.035). Surgical site infection was detected in 2 (13.3%) patients in group 1 and in 6 (46.1%) in group 2 (p = 0.096). Postoperative stay was 8 days (IQR 3, group 1) and 10 days (IQR 10, group 2) (p = 0.05). The mean follow-up period was 37.6 months (SD = 16.08) with no differences in survival between the groups. Conclusion: In our setting, the use of a stent and scheduled surgery is safer than IOCL and is associated with lower morbidity, shorter hospital stay, and equally good long-term survival. © 2011 Société Internationale de Chirurgie.


Gilshtein H.,Colorectal Surgery Unit | Duek S.-D.,Colorectal Surgery Unit | Khoury W.,Colorectal Surgery Unit
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2016

Transanal endoscopic microsurgery is part of the colorectal surgeons' armamentarium for over 2 decades. Since its first implementation for the resection of benign and T1 malignant lesions in the rectum several new indications were developed and it carries additional promise for further extension in upcoming years. Herein we review the technique, its current indications, novel implications, and future perspectives. © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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