• Disease
  • Restorative
  • Restorative Proctocolectomy
  • Ralph John Nicholls

    Prominent publications by Ralph John Nicholls

    KOL Index score: 14482

    OBJECTIVE: To describe national reoperation rates after elective and emergency colorectal resection and to assess the feasibility of using reoperation as a quality indicator derived from routinely collected data in England.

    DESIGN: Retrospective observational study of Hospital Episode Statistics (HES) data.

    SETTING: HES dataset, an administrative dataset covering the entire English National Health Service.

    PARTICIPANTS: All patients undergoing a primary colorectal resection in England ...

    Also Ranks for: Colorectal Surgery |  episode statistics |  health quality indicators |  outcome measures |  retrospective analysis
    KOL Index score: 14387

    BACKGROUND: Preliminary data suggest that short-term antibiotic therapy with a single drug is effective for the treatment of patients with pouchitis. However, some patients are resistant to treatment.

    AIM: To evaluate the therapeutic efficacy of a prolonged course of a combination of two antibiotics in patients with refractory or recurrent pouchitis, as well as its impact on their quality of life.

    METHODS: Patients with active refractory or recurrent pouchitis were recruited. This was ...

    Also Ranks for: Patients Pouchitis |  quality life |  metronidazole ciprofloxacin |  bowel disease |  activity score
    KOL Index score: 12206

    One hundred and four patients were treated by restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial polyposis. Three different designs of reservoir were used (triple loop 68, double loop 13, quadruple loop 23). There were no postoperative deaths but six (5.8 per cent) had the reservoir removed. Rates for pelvic sepsis were 25, 15 and 13 per cent, and for intestinal obstruction requiring laparotomy 14.7,0 and 8.6 per cent. Function was assessed in 88 ...

    Also Ranks for: Ileal Reservoir |  ulcerative colitis |  restorative proctocolectomy |  cent patients |  familial adenomatous polyposis
    KOL Index score: 12115

    Defects of the external anal sphincter have traditionally been diagnosed by palpation, anal manometry and electromyography (EMG), but anal endosonography enables clear imaging of both the internal and external sphincter muscles. A study was performed to validate the interpretation of ultrasonographic images of external sphincter defects using histology as a 'gold standard'. In addition the accuracy of clinical examination, manometry, EMG mapping and anal endosonography in the diagnosis ...

    Also Ranks for: Anal Endosonography |  external sphincter |  clinical examination |  incontinence female |  emg mapping
    KOL Index score: 12098

    OBJECTIVE: Using meta-analytical techniques, the study compared postoperative adverse events and functional outcomes of stapled versus hand-sewn ileal pouch-anal anastomosis (IPAA) following restorative proctocolectomy.

    BACKGROUND: The choice of mucosectomy and hand-sewn versus stapled pouch-anal anastomosis has been a subject of debate with no clear consensus as to which method provides better functional results and long-term outcomes.

    METHODS: Comparative studies published between 1988 ...

    Also Ranks for: Stapled Ipaa |  pouch anal |  sewn versus |  postoperative complications |  functional outcomes
    KOL Index score: 11707

    OBJECTIVE: Restorative proctocolectomy (RPC) with or without mucosectomy is the treatment of choice for most patients with ulcerative colitis (UC) requiring surgery. The ileal mucosa in the reservoir and the anorectal columnar epithelium below the ileo-anal anastomosis are at risk of neoplastic transformation.

    METHOD: The literature has been reviewed to identify patients developing this complication and an attempt has been made to develop a rational follow-up policy based on the data ...

    Also Ranks for: Restorative Proctocolectomy |  ulcerative colitis |  patients dysplasia |  ileal mucosa |  10 years
    KOL Index score: 11074

    BACKGROUND: Colonic motor function has not been studied in the ambulatory setting over a prolonged period in the unprepared state. Furthermore, the disturbance of this function in patients with faecal incontinence is unknown.

    AIM: To study colonic function over two to three days in the ambulatory, unprepared state in health and in patients with idiopathic faecal incontinence.

    METHODS: Six healthy women and six women with faecal incontinence and a structurally intact anal sphincter ...

    Also Ranks for: Faecal Incontinence |  gastrointestinal transit |  ambulatory colonic |  pressure waves |  patients urge
    KOL Index score: 11059

    BACKGROUND: Unilateral posterior tibial nerve stimulation has been shown to improve fecal incontinence in the short term. Posterior tibial nerve stimulation is believed to work by stimulation of the ascending afferent spinal pathways. Bilateral stimulation may activate more of these pathways. This may lead to an improved therapeutic effect.

    OBJECTIVE: The aim of this study was to assess the efficacy of bilateral transcutaneous posterior tibial nerve stimulation for fecal ...

    Also Ranks for: Fecal Incontinence |  tibial nerve |  bilateral transcutaneous |  6 weeks |  stimulation treatment
    KOL Index score: 11042

    OBJECTIVE: To compare cancer-specific results of local excision with major resection.

    BACKGROUND: Technological advances have enabled endoscopic and local excision techniques to be applied in the treatment of early colorectal cancer in preference to radical surgery.

    METHOD: Patients with stage 0 (carcinoma in situ) or stage I (T1/2N0M0) adenocarcinoma of the colon or rectum undergoing surgery between 1998 and 2009 were included from the SEER (Surveillance, Epidemiology, and End Results) ...

    Also Ranks for: Local Excision |  survival outcome |  radical resection |  rectal cancer |  neoadjuvant therapy
    KOL Index score: 10376

    BACKGROUND AND METHOD: This systematic review assesses the efficacy and safety of sacral nerve stimulation (SNS) for faecal incontinence and constipation. Electronic databases and selected websites were searched for studies evaluating SNS in the treatment of faecal incontinence or constipation. Primary outcome measures included episodes of faecal incontinence per week (faecal incontinence studies) and number of evacuations per week (constipation studies).

    RESULTS: From 106 potentially ...

    Also Ranks for: Faecal Incontinence |  sns constipation |  sacral nerve stimulation |  evacuations week |  primary outcome measures
    KOL Index score: 10272

    BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis is the procedure of choice for the majority of patients with ulcerative colitis who require surgery. Over 2500 patients in the UK have undergone restorative proctocolectomy. It is now increasingly being performed in district general hospitals as well as in specialist inflammatory bowel disease units. Gastroenterologists are increasingly involved in the management of patients following restorative ...

    Also Ranks for: Restorative Proctocolectomy |  management patients |  ulcerative colonic pouches |  pelvic sepsis |  ileal pouchanal anastomosis
    KOL Index score: 10235

    A prospective randomized trial was performed to compare complications and function after hand sewn ileoanal anastomosis with mucosectomy (group A) with stapled ileoanal anastomosis without mucosectomy (group B) during restorative proctocolectomy. Thirty-two age- and sex-matched consecutive patients under the care of one surgeon were randomized. The median duration of anal dilatation while making the anastomosis was 19 min (range 14-33 min) and 1 min (range 0-39 min) in groups A and B ...

    Also Ranks for: Ileoanal Anastomosis |  restorative proctocolectomy |  anal function |  prospective randomized trial |  hand sewn
    KOL Index score: 10182

    BACKGROUND: Percutaneous, transcutaneous and sham transcutaneous posterior tibial nerve stimulation was compared in a prospective blinded randomized placebo-controlled trial.

    METHODS: Patients who had failed conservative treatment for faecal incontinence were randomized to one of three groups: group 1, percutaneous; group 2, transcutaneous; group 3, sham transcutaneous. Patients in groups 1 and 2 received 30-min sessions of posterior tibial nerve stimulation twice weekly for 6 weeks. In ...

    Also Ranks for: Faecal Incontinence |  tibial nerve |  transcutaneous posterior |  controlled trial |  6 weeks
    KOL Index score: 10137

    BACKGROUND: Anterior structural damage to the anal sphincter occurs in up to a third of women at first vaginal delivery, and of these a third have new bowel symptoms. The standard treatment for such structural damage is anterior overlapping anal-sphincter repair. We aimed to assess the long-term results of this operation.

    METHODS: We assessed the long-term results in 55 consecutive patients who had had repair a minimum of 5 years (median 77 months [range 60-96]) previously. Questionnaire ...

    Also Ranks for: Sphincter Repair |  anterior anal |  patients surgery |  vaginal delivery |  obstetric trauma


    Ralph John Nicholls: Influence Statistics

    Sample of concepts for which Ralph John Nicholls is among the top experts in the world.
    Concept World rank
    anal endosonography defects #1
    stellenwert chirurgie #1
    20 80 cent #1
    surgical treatment adenomas #1
    contrast pouchography #1
    salvage abdominal surgery #1
    local excision morphology #1
    concurrent pouchitis #1
    inflamed uninflamed pouches #1
    14 patients operation #1
    circumstances urgent surgery #1
    marks hospital experience #1
    complications temporary ileostomy #1
    water pouchmetrography #1
    non‐disseminated cancer #1
    minor leakage patients #1
    patients intact reservoir #1
    narrow rectum #1
    pre‐pouch ileitis #1
    unremitting pouchitis #1
    nocturnal fecal incontinence #1
    low pouch capacitance #1
    designs reservoir #1
    rectum adenomatous #1
    inflammation reservoir #1
    babies renal stones #1
    anteroposterior rectopexy #1
    metronidazole median #1
    reservoir mucosa months #1
    ileal pouch approach #1
    extramural spread mri #1
    mucosectomy risk #1
    aged defecation #1
    ulcer syndrome #1
    stimulus maximum relaxation #1
    week median frequency #1
    risk death colectomy #1
    transanal prolapse #1
    radical restorative surgery #1
    pouchvaginal fistula difference #1
    anterior mucosal prolapse #1
    median ability #1
    sterile sonicates #1
    ileoanal pouch compliance #1
    implantable neurostimulators life #1
    extramural spread survival #1
    length prepouch ileitis #1
    pouchitis mononuclear cells #1
    resistant pouchitis #1
    nbt multivariate analysis #1

    Key People For Restorative Proctocolectomy

    Top KOLs in the world
    Victor Warren Fazio
    restorative proctocolectomy ulcerative colitis crohns disease
    John Hogeland Pemberton†
    ulcerative colitis ileal pouch anal anastomosis
    Ralph John Nicholls
    restorative proctocolectomy faecal incontinence ulcerative colitis
    Roger R Dozois
    ulcerative colitis anal anastomosis ileal pouch
    Ian C Lavery
    rectal cancer ulcerative colitis restorative proctocolectomy
    James Michael Church
    familial adenomatous polyposis colorectal cancer lynch syndrome

    Ralph John Nicholls:Expert Impact

    Concepts for whichRalph John Nichollshas direct influence:Restorative proctocolectomy,  Faecal incontinence,  Ulcerative colitis,  Sacral nerve stimulation,  Rectal cancer,  Fecal incontinence,  Internal anal sphincter,  Nerve stimulation.

    Ralph John Nicholls:KOL impact

    Concepts related to the work of other authors for whichfor which Ralph John Nicholls has influence:Ulcerative colitis,  Rectal cancer,  Fecal incontinence,  Restorative proctocolectomy,  Inflammatory bowel disease,  Sacral nerve stimulation,  Ileal pouch.



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    Colorectal Surgery, Imperial College, London, UK | Visiting Professor in Colorectal Surgery, Imperial College London, London, UK. | Emeritus Consultant Surgeon, St Mark’s Hospital, Harrow, UK | Department of Surgery and Cancer, Imperial College, Lond