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Aim: People living with ulcerative colitis (UC) have two broad treatment avenues, namely medical or surgical therapy. The choice between these can depend on patient preference as well as the receipt of relevant information. The aim of this study was to define the informational needs of patients with UC. Method: A postal survey was designed to capture respondent demographics, treatment experienced within the previous 12 months and informational preferences by rating a long list of items. It was delivered through two hospitals that provide tertiary inflammatory bowel disease services. Descriptive analyses were performed to describe demographics and experiences. Principal component analysis was carried out using a varimax rotation to investigate informational needs. Results: A total of 101 responses were returned (20.1% response rate). The median age of respondents was 45 years and the median time since diagnosis was 10 years. Control preferences skewed towards shared (42.6%) or patient‐led but clinician‐informed (35.6%). Decision regret was low for the population (median 12.5/100, range 0–100). Key informational needs related to medical therapy were benefits and risks of long‐term therapy, burden of hospital attendance, reproductive health, need for steroid treatment and impact on personal life. For surgery, these were stoma information, effect on daily life, effect on sexual and reproductive health, risks and benefits and disruption of life due to surgery. Conclusion: This study has identified key areas for discussion when counselling patients about treatment decisions around medical therapy and surgery for UC. [ABSTRACT FROM AUTHOR]

Aim: Approximately 20%–30% of patients with ulcerative colitis (UC) will undergo surgery during their disease course, the vast majority being elective due to chronic refractory disease. The risks of elective surgery are reported variably. The aim of this systematic review and meta‐analysis is to summarize the outcomes after elective surgery for UC. Methods: A systematic review was conducted that analysed studies reporting outcomes for elective surgery in the modern era (>2002). It was prospectively registered on the PROSPERO database (ref: CRD42018115513). Searches were performed of Embase and MEDLINE on 15 January 2019. Outcomes were split by operation performed. Primary outcome was quality of life; secondary outcomes were early, late and functional outcomes after surgery. Outcomes reported in five or more studies underwent a meta‐analysis of incidence using random effects. Heterogeneity is reported with I2, and publication bias was assessed using Doi plots and the Luis Furuya‐Kanamori index. Results: A total of 34 studies were included (11 774 patients). Quality of life was reported in 12 studies, with variable and contrasting results. Thirteen outcomes (eight early surgical complications, five functional outcomes) were included in the formal meta‐analysis, all of which were outcomes for ileal pouch–anal anastomosis (IPAA). A further 71 outcomes were reported (50 IPAA, 21 end ileostomy). Only 14 of 84 outcomes received formal definitions, with high inter‐study variation of definitions. Conclusion: Outcomes after elective surgery for UC are variably defined. This systematic review and meta‐analysis highlights the range of reported incidences and provides practical information that facilitates shared decision making in clinical practice. [ABSTRACT FROM AUTHOR]

Aim: One in three patients with Crohn's disease will develop a perianal fistula, but only a few achieve long‐term healing. Treatment is both medical and surgical. Since there is no 'best' surgical procedure, patient preference is important in selecting the appropriate treatment for this condition. The aim of this study was to investigate the informational and decisional preferences of patients when surgical treatment is being considered. Method: Patients who had undergone surgery for Crohn's anal fistula underwent face‐to‐face semi‐structured interviews. These explored the experience of treatments for fistula, of receiving information and of participation in decision‐making. Transcripts were analysed by two investigators through inductive thematic analysis. Saturation was assessed for at 12 interviews and then after each subsequent interview. Results: Seventeen patients completed interviews, and saturation was achieved. Five themes were identified, of which two (desired information and decision‐making) were relevant to this study. Other themes included experience of Crohn's disease, experience of receiving information and procedure‐specific comments. Participants wanted to have information on any risks, high‐level outcomes (e.g. success), impact on day‐to‐day life and aftercare. Participants felt they did not always receive the information they needed to select the best treatment option. Participants felt uninvolved in treatment decisions and would have liked to trade off operations to reach their treatment goal. Conclusion: Information provided to patients about surgical treatment of Crohn's perianal fistula does not meet their needs. Clinicians should address aftercare, impact on quality of life and the risks and benefits of the any proposed procedure. [ABSTRACT FROM AUTHOR]

Abstract: Aim: YouTube™ is an open‐access, nonpeer‐reviewed video‐hosting site and is used as a source of publicly available healthcare information. This study aimed to assess the thematic content of the most viewed videos relating to surgery and Crohn's disease and to explore the viewer interactions with these videos. Method: A search of YouTube™ was carried out using one search string. The 50 most viewed videos were identified and categorized by source and content themes and assessed for viewer interactions. Video comments were used to describe the usefulness of the video content to viewers. Results: The majority of videos were uploaded by patients (n = 21).The remainder were uploaded by individual healthcare professionals (n = 9), hospital/speciality associations (n = 18) and industry (n = 2). The median number of likes for patient videos was significantly higher than for hospital/speciality association videos (P < 0.001). Patient videos received more comments praising the video content (n = 27) and more comments asking for further information (n = 14). The median number of likes for ‘experience of surgery’ (P < 0.001) and ‘experience of disease’ (P = 0.0015) themed videos were significantly higher than for ‘disease management’ themed videos. Conclusion: Crohn's disease patients use YouTube™ as a surgical information source. The content of patient‐sourced videos focused on surgical and disease experience, suggesting that these themes are important to patients. Current patient developed videos provide limited information, as reflected by viewers requesting further information. Storytelling patient‐centred videos combined with clinical evidence may be a good model for future videos. [ABSTRACT FROM AUTHOR]

Aim Many women undergoing sacral neuromodulation for faecal incontinence have coexisting pelvic floor dysfunction. We used a global pelvic-floor assessment questionnaire to evaluate the effect of sacral neuromodulation on non-bowel related symptomatology. Method The electronic Personnel Assessment Questionnaire - Pelvic Floor (e PAQ-PF) is a validated Web-based electronic pelvic floor questionnaire. Women with faecal incontinence underwent assessment using the e PAQ. Pre- and poststimulator data were analysed over a 4.5-year period. Results Forty-three women (mean age 56.5 years; median follow up 6.8 months) were included. All (100%) had urinary symptoms, 81.4% had vaginal symptoms and 85.7% described some sexual dysfunction. There was a significant improvement in faecal incontinence and in bowel-related quality of life ( P < 0.005) as well as in irritable bowel syndrome ( IBS)-related symptoms ( P < 0.01) and in bowel-related sexual heath ( P < 0.01). Symptoms of vaginal prolapse significantly improved ( P = 0.05). There was also improvement in symptoms of overactive bladder ( P = 0.005) and in urinary-related quality of life ( P < 0.05). A global health improvement was reported in 58.1%, mainly in bowel evacuation ( P < 0.01) and in vaginal pain and sensation ( P < 0.05). In sexually active female patients, significant improvements in vaginal and bowel-related sexual health were seen ( P < 0.005). Improvement in general sex life following stimulation was reported in 53.3%. Conclusion A Web-based electronic pelvic-floor assessment questionnaire has demonstrated global improvement in pelvic floor function in bowel, urinary, vaginal and sexual dimensions in women following sacral neuromodulation for faecal incontinence. [ABSTRACT FROM AUTHOR]

Aim The use of laparoscopy, with or without appendicectomy, is becoming more common in the management of acute right iliac fossa (RIF) pain, but little is known of the 'unintended' consequences of this change. This study aimed to evaluate the impact of increased use of laparoscopy on the number and type of patients treated surgically and on the rate of negative appendicectomy. Method A prospective audit was carried out of admissions to a teaching hospital over two, 3-month periods during 2007 and 2008. The management, investigations and outcome of patients presenting with RIF pain were studied. Results Admissions were stable over the two time-periods. There was a significant increase in the number of laparoscopic operations performed, from 22.5% (14/62) in 2007 to 85.7% (72/84) in 2008 ( P < 0.0001), and the percentage of patients undergoing surgery rose from 55.4% ( n = 62) in 2007 to 71.2% ( n = 84) in 2008 ( P < 0.01). In 2008, female patients were more likely to have surgery, an increase from 37.1% to 66.2% ( P < 0.001), and were more likely to have a laparoscopic procedure, an increase from 50% to 98% ( P < 0.0001). The rate of histologically confirmed appendicitis did not increase significantly (50/122 vs 57/118; P = 0.25), but the number of patients with a normal appendix either left in situ because it was macroscopically normal or found to be histologically normal following excision, increased significantly, from 9.01% in 2007 to 21.2% in 2008 ( P < 0.01). The diagnostic value of pelvic ultrasound decreased from 75.6% of examinations in 2007 to 54.5% in 2008 ( P = 0.039). Conclusion An increase in laparoscopic procedures has resulted in more operations in women, an associated higher negative appendicectomy rate and decreased usefulness of pelvic ultrasound. Increased use of laparoscopy needs to be balanced against the diagnostic benefits of 'negative' laparoscopy. [ABSTRACT FROM AUTHOR]