Remote Sensing and UAVs for the Geomorphological and Habitat Analysis in Ephemeral and Permanent Mediterranean Streams

Tesis por compendio[ES] Los ecosistemas riparios presentan una gran variabilidad, desde un punto de vista geomorfológico como hidrológico y ecológico, incluyendo las complejas interacciones que la morfología y la vegetación de ribera puede presentar. La vegetación se presenta como un factor físico muy influyente en los sistemas fluviales, con una relación directa en los procesos geomorfológicos que tienen lugar en los corredores fluviales. La detección, monitoreo y evaluación de los procesos que se desarrollan en el espacio ripario son clave a la hora de poder entender las funciones ecológicas y el desarrollo de dichos hábitats, y por tanto para tomar decisiones para su conservación y restauración. Según la distribución de especies y los rasgos de las plantas, las comunidades vegetales y su dinámica presentan distintas características en el ecosistema ripario, a las cuales los métodos de detección y monitoreo deben adaptarse. Los constantes cambios que sufren estos espacios a lo largo del tiempo se deben en gran parte a procesos físicos relacionados con las dinámicas de erosión y sedimentación, las variaciones de la trayectoria del cauce, variaciones en la distribución de especies y vegetación en el bosque de ribera, etc., pero también se deben al impacto antropogénico, que puede llegar a generar grandes desajustes en la dinámica ecológica de los ecosistemas en cuestión. Debido a las interacciones de diversos procesos y alteraciones antropogénicas, y las complejas dinámicas espacio-temporales, resulta necesario continuar desarrollando metodologías teóricas y prácticas para la monitorización y caracterización de estos ecosistemas. La teledetección, incluyendo el uso de drones, se presenta como una herramienta muy interesante y óptima para el mapeo y recogida de información en estos espacios naturales. Los beneficios que demuestran las aeronaves no tripuladas -UAV- incluyen las mejoras en la resolución espacial y temporal de los datos capturados, así como la cartografía de áreas extensas en poco tiempo, lo que los convierte en instrumentos clave en tareas de gestión y conservación de los espacios riparios. La necesidad de estudiar la dinámica geomorfológica que se produce en los cauces fluviales ha sido la principal motivación en los estudios que se presentan en esta tesis doctoral. Los capítulos 2 y 3 se basan en técnicas de captura de datos con láser escáner terrestre (TLS) y en el modelado de los datos obtenidos en vuelos fotogramétricos de UAV. Con ellos se han caracterizado los procesos que tienen lugar en una cierta área de estudio, un cauce efímero del sureste de la Península Ibérica, la Rambla de la Azohía (Murcia). Estos estudios también han permitido comparar el ajuste y precisión de los datos capturados a partir de dos técnicas distintas. Además, el interés en caracterizar los cauces fluviales con un flujo permanente ha motivado el estudio de la topografía sumergida en un tramo de río, segmentado por tipos de mesohábitat. Así pues, el capítulo 4 presenta un algoritmo y una herramienta de corrección para el efecto de la refracción en un tramo del rio Palancia (Castellón), para llevar a cabo la correcta representación de la morfología del lecho sumergido. A partir de la metodología planteada y el algoritmo desarrollado, es posible minimizar los efectos de distorsión debidos a la presencia del agua, para obtener la reconstrucción tridimensional del lecho a partir de imágenes tomadas con UAV. La construcción del modelo 3D se llevó a cabo mediante la técnica de Structure from Motion. Finalmente, y como elemento clave en la dinámica de los ecosistemas riparios, el capítulo 5 desarrolla una metodología para clasificar las fases de sucesión de la vegetación del bosque ripario. Dichas fases de sucesión se basan en la metodología del proyecto RIPFLOW, que también está implementada en el modelo dinámico CASiMiR-vegetation.[CA] Els ecosistemes riparis presenten una gran variabilitat, des d'un punt de vista geomorfològic com a hidrològic i ecològic, incloent les complexes interaccions que la morfologia i la vegetació de ribera pot presentar. La vegetació es presenta com un factor físic molt influent en els sistemes fluvials, amb una relació directa en els processos geomorfològics que tenen lloc en els corredors fluvials. La detecció, monitoratge i avaluació dels processos que es desenvolupen en l'espai ripari són clau a l'hora de poder entendre les funcions ecològiques i el desenvolupament d'aquests hàbitats, i per tant per a prendre decisions per a la seua conservació i restauració. Segons la distribució d'espècies i els trets de les plantes, les comunitats vegetals i la seua dinàmica presenten diferents característiques en l'ecosistema ripario, a les quals els mètodes de detecció i monitoratge han d'adaptar-se. Els constants canvis que pateixen aquests espais al llarg del temps es deuen en gran part a processos físics relacionats amb les dinàmiques d'erosió i sedimentació, les variacions de la trajectòria del llit, variacions en la distribució d'espècies i vegetació en el bosc de ribera, etc., però també es deuen a l'impacte antropogènic, que pot arribar a generar grans desajustaments en la dinàmica ecològica dels ecosistemes en qüestió. A causa de les interaccions de diversos processos i alteracions antropogèniques, i les complexes dinàmiques espaciotemporals, resulta necessari continuar desenvolupant metodologies teòriques i pràctiques per al monitoratge i caracterització d'aquests ecosistemes. La teledetecció, incloent l'ús de drons, es presenta com una eina molt interessant i òptima per al mapatge i recollida d'informació en aquests espais naturals. Els beneficis que demostren les aeronaus no tripulades -UAV- inclouen les millores en la resolució espacial i temporal de les dades capturades, així com la cartografia d'àrees extenses en poc temps, la qual cosa els converteix en instruments clau en tasques de gestió i conservació dels espais riparis. La necessitat d'estudiar la dinàmica geomorfològica que es produeix en els llits fluvials ha sigut la principal motivació en els estudis que es presenten en aquesta tesi doctoral. Els capítols 2 i 3 es basen en tècniques de captura de dades amb làser escàner terrestre (TLS) i en el modelatge de les dades obtingudes en vols fotogramètrics de UAV. Amb ells s'han caracteritzat els processos que tenen lloc en una certa àrea d'estudi, un llit efímer del sud-est de la Península Ibèrica, la Rambla de la Azohía (Múrcia). Aquests estudis també han permés comparar l'ajust i precisió de les dades capturades a partir de dues tècniques diferents. A més, l'interés a caracteritzar els llits fluvials amb un flux permanent ha motivat l'estudi de la topografia submergida en un tram de riu, segmentat per tipus de mesohábitat. Així doncs, el capítol 4 presenta un algorisme i una eina de correcció per a l'efecte de la refracció en un tram del va riure Palància (Castelló), per a dur a terme la correcta representació de la morfologia del llit submergit. A partir de la metodologia plantejada i l'algorisme desenvolupat, és possible minimitzar els efectes de distorsió deguts a la presència de l'aigua, per a obtindre la reconstrucció tridimensional del llit a partir d'imatges preses amb UAV. La construcció del model 3D es va dur a terme mitjançant la tècnica de Structure from Motion. Finalment, i com a element clau en la dinàmica dels ecosistemes riparis, el capítol 5 desenvolupa una metodologia per a classificar les fases de successió de la vegetació del bosc ripari. Aquestes fases de successió es basen en la metodologia del projecte RIPFLOW, que també està implementada en el model dinàmic CASiMiR-vegetation.[EN] Riparian ecosystems show great variability, from a geomorphological, hydrological and ecological point of view, including the complex interactions that riparian morphology and vegetation can present. Vegetation appears as a very influential physical factor in river systems, with a direct relationship in the geomorphological processes that take place in river corridors. The detection, monitoring and evaluation of the processes that take place in the riparian space are key when it comes to understanding the ecological functions and development of these habitats, and therefore for making decisions for their conservation and restoration. According to the distribution of species and plant traits, plant communities and their dynamics present different characteristics in the riparian ecosystem, to which detection and monitoring methods must be adapted. The constant changes that these spaces undergo over time are largely due to physical processes related to the dynamics of erosion and sedimentation, variations in the path of the channel, variations in the distribution of species and vegetation in the riparian forest, etc. These processes also are due to the anthropogenic impact, which can generate major imbalances in the ecological dynamics of the ecosystems in question. Due to the interactions of various anthropogenic processes and alterations, and the complex spatio-temporal dynamics, it is necessary to continue developing theoretical and practical methodologies for the monitoring and characterization of these ecosystems. Remote sensing, including the use of drones, is presented as a very interesting and optimal tool for mapping and collecting information in these natural spaces. The benefits demonstrated by unmanned aircraft -UAV- include improvements in the spatial and temporal resolution of the captured data, as well as the mapping of large areas in a short time, which makes them key instruments in the management and conservation tasks of riparian spaces. The need to study the geomorphological dynamics that occur in river channels has been the main motivation in the studies presented in this doctoral thesis. Chapters 2 and 3 are based on ground-based laser scanner (TLS) data capture techniques and modelling of UAV photogrammetric flight data. They have characterized the processes that take place in a certain study area, an ephemeral riverbed in the southeast of the Iberian Peninsula, the Rambla de la Azohía (Murcia). These studies have also made it possible to compare the fit and precision of the data captured from two different techniques. In addition, the interest in characterizing the fluvial channels with a permanent flow has motivated the study of the submerged topography in a stretch of river, segmented by types of mesohabitat. Thus, chapter 4 presents an algorithm and a correction tool for the effect of refraction in a stretch of the Palancia river (Castellón), to carry out the correct representation of the submerged bed morphology. From the proposed methodology and the developed algorithm, it is possible to minimize the distortion effects due to the presence of water, to obtain the three-dimensional reconstruction of the bed from images taken with UAVs. The construction of the 3D model was carried out using the Structure from Motion technique. Finally, and as a key element in the dynamics of riparian ecosystems, chapter 5 develops a methodology to classify the phases of succession of riparian forest vegetation. These succession phases are based on the RIPFLOW project methodology, which is also implemented in the dynamic CASiMiR-vegetation model.Agradezco a Francisca Segura y a Carles Sanchis por su ayuda y trabajo conjunto en el proyecto “Natural and anthropogenic changes in Mediterranean river drainage basins: historical impacts on rivers morphology, sedimentary flows and vegetation” financiado por el Ministerio de Economía y Competitividad (MINECO) (CGL2013-44917-R). Agradezco también a la Universidad de Murcia y la Universidad de Alicante así como al proyecto de investigación “Respuesta morfológica y sistémica al cambio climático en cauces efímeros mediterráneos: dinámica, resiliencia y propuestas de actuación” funded by ERDF/Spanish Ministry of Science, Innovation and Universities—State Research Agency/Project CGL2017-84625-C2-1-R (CCAMICEM); State Program for Research, Development and Innovation Focused on the Challenges of Society, del Ministerio de Economía y Competitividad (MINECO) y EU FEDER (Project TEC2017- 85244-C2-1-P) y de la Universidad de Alicante (vigrob-157 and GRE18-05).Puig Mengual, CA. (2021). Remote Sensing and UAVs for the Geomorphological and Habitat Analysis in Ephemeral and Permanent Mediterranean Streams [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/177643TESISCompendi

Simulation of retrospective morphological channel adjustments using high-resolution differential digital elevation models versus predicted sediment delivery and stream power variations

[EN] This work proposes a methodological approach applied to ephemeral gravel-bed streams to verify the change in the magnitude and frequency of hydrological events affecting the morphological dynamics and sediment budget in this type of channel. For the case study, the Azohia Rambla, located in southeastern Spain, was chosen, emphasizing the research on two reference riverbed sections (RCRs): an upper one, with a predominance of erosion, and a middle one, where processes of incision, transport, and deposition were involved. First, this approach focuses on relationships between peak discharges and sediment budgets during the period 2018-2022. For this purpose, water level measurements from pressure sensors, a One-Dimensional Hydrodynamic model, and findings from comparative analyses of high-resolution differential digital elevation models (HRDEM of Difference-HRDoD) based on SfM-MVS and LiDAR datasets were used. In a second phase, the GeoWEPP model was applied to the period 1996-2022 in order to simulate runoff and sediment yield at the event scale for the watersheds draining into both RCRs. During the calibration phase, a sensitivity analysis was carried out to detect the most influential parameters in the model and confirm its capacity to simulate peak flow and sediment delivery in the area described above. Values of NS (Nash-Sutcliffe efficiency) and PBIAS (percent bias) equal to 0.86 and 7.81%, respectively, were found in the calibration period, while these indices were 0.81 and -4.1% in the validation period. Finally, different event class patterns (ECPs) were established for the monitoring period (2018-2022), according to flow stage and morphological channel adjustments (overtopping, bankfull and sub-bankfull, and half-sub-bankfull), and then retrospectively extrapolated to stages of the prior simulated period (1996-2018) from their typical sequences (PECPs). The results revealed a significant increase in the number of events and PECPs leading to lower bed incision rates and higher vertical accretion, which denotes a progressive increase in bed armoring and bank erosion processes.This research was funded by ERDF/Spanish Ministry of Science, Innovation and Universities-State Research Agency (AEI)/Project CGL2017-84625-C2-1-R. State Program for Research, Develop-ment and Innovation focused on the Challenges of SocietyConesa-García, C.; Martínez-Salvador, A.; Puig-Mengual, C.; Martinez-Capel, F.; Pérez-Cutillas, P. (2023). Simulation of retrospective morphological channel adjustments using high-resolution differential digital elevation models versus predicted sediment delivery and stream power variations. Water. 15(15):1-35. https://doi.org/10.3390/w15152697135151

Combining SfM Photogrammetry and Terrestrial Laser Scanning to Assess Event-Scale Sediment Budgets along a Gravel-Bed Ephemeral Stream

[EN] Stream power represents the rate of energy expenditure along a stream reach and can be calculated using topographic data acquired via structure-from-motion (SfM) photogrammetry and terrestrial laser scanning (TLS). This study sought to quantitatively relate morphological adjustments in the Azohia Rambla, a gravel-bed ephemeral stream in southeastern Spain, to stream power (omega), critical power (omega(c)), and energy gradients ( partial differential omega/ partial differential s), along different reference channel reaches of 200 to 300 m in length. High-resolution digital terrain models (HRDTMs), combined with ortophotographs and point clouds from 2018, 2019, and 2020, and ground-based surveys, were used to estimate the spatial variability of morphological sediment budgets and to assess channel bed mobility during the study period at different spatial scales: reference channel reaches (RCRs), pilot bed survey areas (PBSAs), and representative geomorphic units (RGUs). The optimized complementary role of the SfM technique and terrestrial laser scanning allowed the generation of accurate and reliable HRDTMs, upon which a 1-D hydrodynamic model was calibrated and sediment budgets calculated. The resulting high-resolution maps allowed a spatially explicit analysis of stream power and transport efficiency in relation to volumes of erosion and deposition in the RCR and PBSA. In addition, net incision or downcutting and vertical sedimentary accretion were monitored for each flood event in relation to bedforms and hydraulic variables. Sediment sources and sinks and bed armoring processes showed different trends according to the critical energy and stream power gradient, which were verified from field observations. During flows exceeding bankfull discharges (between 18 and 24 m(3) s(-1) according to channel reach), significant variations in partial differential omega/ partial differential s values and omega/omega(c) ratios (e.g., -15 2 for a peak discharge of 31 m(3) s(-1)) were associated with a large amount of bedload mobilized upstream and vertical accretion along the middle reach (average rise height of 0.20 to 0.35 m for the same event). By contrast, more moderate peak flows (<= 10 m(3) s(-1)) only produced minor changes resulting in surface washing, selective transport, and local bed scouring.This research was funded by ERDF/Spanish Ministry of Science, Innovation and Universities-State Research Agency/Project CGL2017-84625-C2-1-R (CCAMICEM); State Program for Research, Development and Innovation Focused on the Challenges of Society, the Spanish Ministry of Economy and Competitiveness (MINECO) and EU FEDER under Project TEC2017-85244-C2-1-P and by the University of Alicante (vigrob-157 and GRE18-05).Conesa-García, C.; Puig-Mengual, C.; Riquelme, A.; Tomás, R.; Martinez-Capel, F.; García-Lorenzo, R.; Pastor, JL.... (2020). Combining SfM Photogrammetry and Terrestrial Laser Scanning to Assess Event-Scale Sediment Budgets along a Gravel-Bed Ephemeral Stream. Remote Sensing. 12(21):1-27. https://doi.org/10.3390/rs12213624S127122

Aplicación de datos LiDAR aéreo en la estimación de copas y de variables dendrométricas de árboles frutales

En este treball es va plantejar i desenrotllar una metodologia per a la delineació i extracció de forma individual de les diferents copes arbòries que es troben situades en l’àmbit de la zona d’estudi per mitjà de dades LIDAR del sistema aèri. Per a això, en primer lloc es va calcular i validar el model digital d’elevacions (MDT), el model de superfície (MDS) i el model de superfície normalitzat (MDSn) necessaris per a identificar la posició i geometria de les diferents copes de la zona treball. A partir d’esta informació es van calcular els diferents estadístics de la distribució de les dades LIDAR en cada copa amb vista a calcular diferents models predictius de les variables dendrométriques que els definixen: diàmetre de copa, altura de copa, altura total, volum total i volum de copa. Finalment es va estimar la bondat de l’ajust dels paràmetres obtinguts així com la normalitat dels residus per a donar per satisfactori l’estudi realitzat.En este trabajo se planteó y desarrolló una metodología para la delineación y extracción de forma individual de las diferentes copas arbóreas que se encuentran situadas en el ámbito de la zona de estudio mediante datos LIDAR del sistema aéreo. Para ello, en primer lugar se calculó y validó el modelo digital de elevaciones (MDT), el modelo de superficie (MDS) y el modelo de superficie normalizado (MDSn) necesarios para identificar la posición y geometría de las diferentes copas de la zona trabajo. A partir de esta información se calcularon diferentes estadísticos de la distribución de los datos LIDAR en cada copa con vistas a calcular diferentes modelos predictivos de las variables dendrométricas que los definen: diámetro de copa, altura de copa, altura total, volumen total y volumen de copa. Finalmente se estimó la bondad del ajuste de los parámetros obtenidos así como la normalidad de los residuos para dar por satisfactorio el estudio realizado.In this paper we proposed and developed a methodology for the delineation and extraction individually from different tree tops that are located in the area of the study using aerial LIDAR data system. To do this, first we calculated and validated the necessary digital elevation model (DTM), the surface model (MDS) and the normalized surfaces model (MDSn) to identify the position and geometry of the different cups of work area. Thanks this information, different statistical from the LIDAR data are calculated to each top in order to calculate the different predictive models that define dendrometric variables: Crown diameter, crown height, total height, total volume and top volume. Finally, was estimated the goodness of fit of the parameters obtained and the normality of the residuals to provide for satisfactory study.Puig Mengual, CA. (2014). Aplicación de datos LiDAR aéreo en la estimación de copas y de variables dendrométricas de árboles frutales. Universitat Politècnica de València. http://hdl.handle.net/10251/4515

Changes in stream power and morphological adjustments at the event-scale and high spatial resolution along an ephemeral gravel-bed channel

Sediment budgets and morphological channel adjustments are closely related to changes in stream power. In ephemeral channels, whose geomorphic response depends on the magnitude and frequency of hydrological events isolated in time, such relationships are often difficult to establish. This study sought to quantitatively relate morphological adjustments to stream power along different reference channel reaches for the period 2018–2020 in the Azohía Rambla, a Mediterranean gravel-bed ephemeral stream in southeastern Spain. Very high resolution digital terrain models (VHR DTM) (at 1 to 2.5 cm pixel size), combined with ortophotographs and 3D point clouds, generated via SfM photogrammetry and terrestrial laser scanning (TLS) for pre- and post-event stages, together with ground-based surveys were used to estimate the spatial variability of morphological sediment budgets and to assess channel bed mobility and changes in net sediment flux during the study period in two spatial scenarios: reference channel reaches (RCRs) and pilot bed survey areas (PBSAs). The hydraulic variables (flow velocity, Froude number, shear stress, mean stream power and energy gradient, among other) were estimated using a 1D hydrodynamic model calibrated with field information. The high resolution maps allowed a spatially-explicit analysis of stream power and transport efficiency in accordance with the areas of erosion and deposition in each RCR. The incision and bed armoring processes showed different trends according to the stream power (ω), cumulative excess energy (εc), and relative bed stability (RBS). The greatest morphological adjustments at the event scale coincided with ω values above 300 W m−2, εc higher than 3 MJ, and RBS below 0.5. The relationships between the mean stream power gradient at peak flood discharges and the changes in bed elevation verified the bed aggradation (an average surface raising of 0.17 to 0.22 m for δω/δs of −6.2 to −14.5 W m−2 m−1) during the major flood and bed scour (average surface lowering of 0.16 to 0.19 m for δω/δs of 5.8to 10.6 W m−2 m−1) in the moderated events at the bankfull and sub-bankfull stages. Furthermore, this study contributes new relevant data to the scarce existing literature on the relationships between stream power and morphosedimentary adjustments in a fluvial system highly sensitive and resilient to climate change, as is the case of ephemeral gravel-bed channels.This work has been financed by ERDF/Spanish Ministry of Science, Innovation and Universities - State Research Agency (AEI)/Project CGL2017-84625-C2-1-R (CCAMICEM); State Program for Research, Development and Innovation focused on the Challenges of Society, and by the University of Alicante (Project GRE18-15)

Changes in stream power and morphological adjustments at the event-scale and high spatial resolution along an ephemeral gravel-bed channel

[EN] Sediment budgets and morphological channel adjustments are closely related to changes in stream power. In ephemeral channels, whose geomorphic response depends on the magnitude and frequency of hydrological events isolated in time, such relationships are often difficult to establish. This study sought to quantitatively relate morphological adjustments to stream power along different reference channel reaches for the period 2018¿2020 in the Azohía Rambla, a Mediterranean gravel-bed ephemeral stream in southeastern Spain. Very high resolution digital terrain models (VHR DTM) (at 1 to 2.5 cm pixel size), combined with ortophotographs and 3D point clouds, generated via SfM photogrammetry and terrestrial laser scanning (TLS) for pre- and post-event stages, together with ground-based surveys were used to estimate the spatial variability of morphological sediment budgets and to assess channel bed mobility and changes in net sediment flux during the study period in two spatial scenarios: reference channel reaches (RCRs) and pilot bed survey areas (PBSAs). The hydraulic variables (flow velocity, Froude number, shear stress, mean stream power and energy gradient, among other) were estimated using a 1D hydrodynamic model calibrated with field information. The high resolution maps allowed a spatially-explicit analysis of stream power and transport efficiency in accordance with the areas of erosion and deposition in each RCR. The incision and bed armoring processes showed different trends according to the stream power (¿), cumulative excess energy (¿c), and relative bed stability (RBS). The greatest morphological adjustments at the event scale coincided with ¿ values above 300W m¿2, ¿c higher than 3 MJ, and RBS below 0.5. The relationships between the mean stream power gradient at peak flood discharges and the changes in bed elevation verified the bed aggradation (an average surface raising of 0.17 to 0.22 m for ¿¿/¿s of ¿6.2 to ¿14.5Wm¿2 m¿1) during the major flood and bed scour (average surface lowering of 0.16 to 0.19 m for ¿¿/¿s of 5.8 to 10.6 W m¿2 m¿1) in the moderated events at the bankfull and sub-bankfull stages. Furthermore, this study contributes new relevant data to the scarce existing literature on the relationships between stream power and morphosedimentary adjustments in a fluvial system highly sensitive and resilient to climate change, as is the case of ephemeral gravel-bed channels.This work has been financed by ERDF/Spanish Ministry of Science, Innovation and Universities-State Research Agency (AEI) /Project CGL2017-84625-C2-1-R (CCAMICEM) ; State Program for Research, Development and Innovation oriented to the Challenges of Society, and by the University of Alicante (Project GRE18-15) . We also would like to extend our thanks to AEMET and the Segura River Hydrographic Confederation Center (SHC) , Government of Spain, for their collaboration.Conesa-Garcia, C.; Puig-Mengual, C.; Riquelme, A.; Tomás, R.; Martinez-Capel, F.; Garcia-Lorenzo, R.; Pastor, JL.... (2022). Changes in stream power and morphological adjustments at the event-scale and high spatial resolution along an ephemeral gravel-bed channel. Geomorphology. 398:1-25. https://doi.org/10.1016/j.geomorph.2021.10805312539

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit.

This is the peer reviewed version of the following article: , (2018), Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi‐centre, prospective audit. Colorectal Dis, 20: 15-32. doi:10.1111/codi.14362, which has been published in final form at https://doi.org/10.1111/codi.14362. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsINTRODUCTION: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. RESULTS: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30-0.92, P = 0.02) but MBP was not (OR 0.92, 0.63-1.36, P = 0.69) compared to NBP. CONCLUSION: This non-randomised study adds 'real-world', contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice

Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit.

This is the peer reviewed version of the following article: group, T. E. S. o. C. c. (2018). "Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit." Colorectal Disease 20(S6): 47-57., which has been published in final form at https://doi.org/10.1111/codi.1437. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsINTRODUCTION: Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection. METHODS: A pre-planned analysis of the European Society of Coloproctology 2017 audit. Adult patients (> 16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic or rectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindo grade 3 to 5). RESULTS: From 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). In multivariable models, anastomosis was associated with a similar major complication rate to end stoma (adjusted odds ratio for end stoma 1.52, 95%CI 0.83-2.79, P = 0.173). Although a defunctioning stoma was not associated with reduced anastomotic leak (12% defunctioned [4/33] vs 13% not defunctioned [13/97], adjusted odds ratio 2.19, 95%CI 0.43-11.02, P = 0.343), it was associated with less severe complications (75% [3/4] with defunctioning stoma, 86.7% anastomosis only [13/15]), a lower mortality rate (0% [0/4] vs 20% [3/15]), and fewer reoperations (50% [2/4] vs 73% [11/15]) when a leak did occur. CONCLUSIONS: Primary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications

The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit.

This is the peer reviewed version of the following article: The and E. S. o. C. c. groups (2018). "The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit." Colorectal Disease 20(S6): 69-89., which has been published in final form at https://doi.org/10.1111/codi.14371. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.BACKGROUND: Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. METHODS: Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V. RESULTS: Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27-2.11, P < 0.001). CONCLUSIONS: Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection

An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)

IntroductionTransanal 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.MethodsA pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.ResultsOf 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02-2.48, P=0.04) and robotic TaTME (OR 3.05, 1.10-7.34, P=0.02) were associated with a higher risk of anastomotic leak than non-transanal laparoscopic TME. However this association was lost in the mixed-effects model controlling for patient and disease factors (OR 1.23, 0.77-1.97, P=0.39 and OR 2.11, 0.79-5.62, P=0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55-4.77, P<0.001) and male gender (OR 2.29, 1.52-3.44, P<0.001) remained strongly associated. The overall positive circumferential margin resection rate was 4.0%, which varied between operative approaches: laparoscopic 3.2%, transanal 3.8%, open 4.7%, robotic 1%.ConclusionThis contemporaneous international snapshot shows that uptake of the TaTME approach is widespread and is associated with surgically and pathologically acceptable results