ANZ Journal of Surgery最新文献

{"title":"Robotic Transabdominal Preperitoneal Inguinal Hernia Repair Is Feasible and Efficient: A Prospective Cohort Study of a Day-Only Protocol From a High-Volume Robotic Surgery Centre Evaluating Short-Term Outcomes.","authors":"Joseph Do Woong Choi, Lauren Bradford, Kim Tang, Mark Bukofzer, Paul Dunkin, Hannah Wong, Ammar Ali-Beck, Andrew Spillane, Jennifer Van Der Heever, Catherine Murphy, Julian Kueh, Rennie Woodman, Aime Needs, Kar Yin Fok, Michelle Chen, Assad Zahid, Jaswinder Samra, Andrew Craig Lynch, Christos Apostolou, Walid Barto, Stephen Pillinger","doi":"10.1111/ans.70263","DOIUrl":"https://doi.org/10.1111/ans.70263","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia repair (IHR) is one of the most frequently performed procedures in general surgery. There is clinical equipoise regarding the increasing global adoption of robotic IHR as a safe minimally invasive option. We present the short-term outcomes of robotic transabdominal (R-TAPP) preperitoneal IHR as a protocol-driven day-only procedure within a high-volume centre.</p><p><strong>Methods: </strong>Single institution prospective cohort study of 200 consecutive patients using the da Vinci Xi system from July 2023 to April 2025. Elective adult patients with index or recurrent unilateral or bilateral inguinal hernias were eligible. Postoperative day (POD) 1.7 and 28 pain scores and analgesia use were recorded. Thirty-day operative complications were tabulated.</p><p><strong>Results: </strong>Eighty-nine percent were male and 66% underwent unilateral R-TAPP IHR. Six percent had redo surgery for recurrent inguinal hernia. For unilateral IHR, the median console time was 29 min (IQR: 21-39.5), knife to skin and skin closure time was 49 min (IQR: 37-59.5) and total time into and out (wheels in to wheels out) of theatre was 77 min (IQR: 66.5-88.5). The median length of stay was 0 days (range: 0-2). Median POD 1.7 and 28 pain scores were 4, 2, and 0 (out of 10). Clavien-Dindo 1-2 complications occurred in 4%. There were no hernia recurrences.</p><p><strong>Conclusions: </strong>R-TAPP IHR is feasible and safe, with comparatively lower operative time than the reported literature. Most patients were discharged as a day-only procedure, with minimal postoperative pain. Future studies will investigate the cost and longer-term outcomes.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Gum Chewing in the Postoperative-Period: A Systematic Review and Meta-Analysis.","authors":"Calandra Li, Akhil Nair, Xi Ming Zhu, Mikaela Leung, Gabrielle Leung, Joseph Catapano, Mark McRae","doi":"10.1111/ans.70238","DOIUrl":"https://doi.org/10.1111/ans.70238","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative ileus (POI) is a transient impairment of gastrointestinal motility occurring after surgery. Patients with POI can suffer from complications such as increased risk of nosocomial infections, overall mortality risk, and higher overall healthcare costs. This study aims to (a) evaluate the effectiveness of gum chewing on relieving POI symptoms (b) conduct meta-analysis on POI outcome variables to estimate overall effect size.</p><p><strong>Methods: </strong>We searched MEDLINE (Ovid), EMBASE, CINAHL, Web of Science, and Scopus for English language randomized controlled trials (RCTs), evaluating the postoperative effects of gum chewing in adult surgical patients. Two reviewers independently screened titles, abstracts, and full texts, resolving conflicts by discussion. Study quality was assessed using the GRADE system. Meta-analysis was conducted within two surgical specialty subgroups separately.</p><p><strong>Results: </strong>From 1925 citations, 714 duplicates were removed. After title/abstract screening, 128 proceeded to full text review, out of which 43 studies met the inclusion criteria. Among RCTs, 69.8% noted statistically significant improvement in at least one of the POI outcomes in the intervention cohort. Meta-analysis showed significant reductions in time to first flatus (-7.4 h; p = 0.0003) and defecation (-18.64 h; p < 0.0001) in general and colorectal surgery. Similar reductions were also observed in the OBGYN and gynecology cohort: flatus (-6.52 h; p < 0.0001) and defecation (-9.71 h; p = 0.003).</p><p><strong>Conclusion: </strong>Chewing gum is a safe low-cost intervention that has the potential to significantly reduce POI symptoms and hospitalization times. Meta-analysis validated the clinical relevance of the intervention. Standardized protocols are still required to delineate true effect sizes and reduce heterogeneity.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Complex Ventral Hernia and Stoma on Body Image and Interpersonal Relationships.","authors":"Bing Wang, Sameer Mohammad Khan, Femi E Ayeni, Anita Jacombs","doi":"10.1111/ans.70264","DOIUrl":"https://doi.org/10.1111/ans.70264","url":null,"abstract":"<p><strong>Background: </strong>Complex ventral hernias (CVH) are an increasingly prevalent condition. Historically, surgeons have focused on surgical complications and recurrence in assessing the success of hernia repair surgery. In recent years, an increasing focus has been placed on quality-of-life outcomes in patients, with newer questionnaires being developed to assess these outcomes. Despite this, there is limited data available on the effects on body image and interpersonal relationships. Stomas are a similar condition which involves a defect in the abdominal wall, for which body image and relationship impacts have been studied more extensively. The aim of this project was to conduct a narrative review of the literature to determine how body image and interpersonal relationships are affected in complex ventral hernia patients, drawing from the data on stoma patients.</p><p><strong>Methods: </strong>This study was a narrative review, with searches conducted to examine the literature on complex ventral hernia and stoma patients' experiences with body image and interpersonal relationship changes.</p><p><strong>Results: </strong>We found patients with CVH notice significant impairments to their body image and quality of relationships, with the experience of negative changes to body image, sexual relationships, and social relationships.</p><p><strong>Conclusion: </strong>The impairments in body image and interpersonal relationships suggest a need to assess these outcomes when considering overall wellbeing in patients with complex ventral hernias. Further research and validation will provide insight into management and outcomes of such patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review on the Data Utility, Clinical Impact, and Cost of Multidisciplinary Team Meetings for Pancreatic Cancer.","authors":"Que Wuttivat Sabmeethavorn, Amy Sylivris, Rachael Mackie, Geertje Noë, Julie Chu, Belinda Lee, Benjamin Paul Timothy Loveday","doi":"10.1111/ans.70262","DOIUrl":"https://doi.org/10.1111/ans.70262","url":null,"abstract":"<p><strong>Background: </strong>Multidisciplinary Team Meetings (MDMs) are the accepted model for constructing treatment plans for pancreatic cancer (PC). With increasing PC diagnoses and budget constraints, MDMs must undertake cost-effective workflows. We aimed to summarize available evidence on the utility of information collected, their impact on care decisions, and cost burden.</p><p><strong>Methods: </strong>A systematic scoping review was conducted, searching MEDLINE, EMBASE, and CINAHL databases until December 2023. Included studies related to adult PCMDMs, their impact on diagnosis, treatment plans, and costs. Data were deductively and inductively analyzed based on study aims.</p><p><strong>Results: </strong>Exactly 36 studies were included from 3728 identified studies. Information influencing MDM decisions were patient age, alcohol use, comorbidities, CEA/CA19-9, and CT imaging, with structured referral forms reported to improve data collection. PCMDMs changed initial diagnosis in 3.4%-21.7%, resectability assessment in 18.7%-29.7%, and treatment plan in 18.2%-72.2% of patients. PCMDMs increased participation in clinical trials/cancer registries. PCMDMs accrued substantial time (16.5 h weekly preparation per MDM) and financial cost ($240 USD/case).</p><p><strong>Conclusion: </strong>PCMDM best practice should include standardization of collected data, identifying patients for clinical trials/registries, and knowledge of emerging technologies. Further research on PCMDM cost-burden is required to improve its cost-effectiveness.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General Surgical Management of Lower Gastrointestinal Bleeding in a Rural Setting-A Case for Establishing a Local Management Guideline.","authors":"Prahalath Sundaram, Alexandra Zalums, Nestor Sabat, Rakin Rahman, Mahanama Dissanayake, Theophilus I Emeto","doi":"10.1111/ans.70260","DOIUrl":"https://doi.org/10.1111/ans.70260","url":null,"abstract":"<p><strong>Background: </strong>Acute lower gastrointestinal bleeding (LGIB) presents a management challenge in regional and rural hospitals due to limited resources and potential delays in accessing specialist care. This study aimed to assess the performance of general surgeons in a rural general hospital in managing patients with acute LGIB using a quality indicator framework.</p><p><strong>Methods: </strong>A single-center retrospective study reviewed the records of adult patients presenting to the emergency department with acute LGIB between January 2017 and June 2022. Data on demographics, clinical and laboratory findings, initial management strategies, and patient outcomes were extracted from electronic medical records (EMR).</p><p><strong>Results: </strong>A total of 145 patients were included. Key findings revealed underutilization of the Oakland score system, inconsistencies in blood product transfusion practices, and inappropriate management of antiplatelet medications. Notably, there was an observed overuse of computed tomography angiography (CTA) despite limited access to interventional radiology services. Endoscopic interventions, however, demonstrated effectiveness in managing acute LGIB at the hospital.</p><p><strong>Conclusion: </strong>This study highlights the need for a locally developed clinical guideline tailored to the specific resource constraints of the hospital. The findings further emphasize the importance of proficiency in endoscopic techniques for rural general surgeons managing patients with acute LGIB. This study can serve as a foundation for the development of a local guideline to optimize the management of acute LGIB in this setting.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Impact of Mental Disorders on Outcomes Following Esophagectomy for Cancer: A Systematic Review and Meta-Analysis.","authors":"Dimitrios Papaconstantinou, Theano Perri, Nikolaos Christodoulou, Orestis Lyros, Dimosthenis Chrysikos, Efstathia Liatsou, Georgios D Lianos, Michail Mitsis, Vasileios Tatsis, Ioannis Karavokyros, Dimitrios Schizas","doi":"10.1111/ans.70255","DOIUrl":"https://doi.org/10.1111/ans.70255","url":null,"abstract":"<p><strong>Background: </strong>Esophageal cancer, the sixth leading cause of cancer-related deaths globally, imposes significant physical and psychological burdens on patients. Psychiatric comorbidities, such as anxiety and depression, are prevalent among esophagectomy patients and may adversely affect postoperative outcomes, quality of life, and survival. However, their clinical impact remains understudied and heterogeneous in existing literature.</p><p><strong>Objectives: </strong>This systematic review and meta-analysis evaluates the prevalence and clinical significance of perioperative mental disorders in esophageal cancer surgery, assessing their association with postoperative outcomes.</p><p><strong>Data sources: </strong>A comprehensive search of Medline, Embase, CINAHL, CENTRAL, and Web of Science was conducted from inception to March 2025. (Keywords included \"esophageal cancer,\" \"esophagectomy,\" \"anxiety,\" \"depression\").</p><p><strong>Review methods: </strong>PRISMA-guided analysis included 11 studies (n = 24 411 patients). Studies reporting preoperative psychiatric comorbidities or postoperative mental disorders (PMD) were eligible. Risk of bias was assessed using ROBINS-I. Random-effects meta-analyses pooled mortality risk, PMD incidence, and associated risk factors.</p><p><strong>Results: </strong>Preoperative psychiatric comorbidities (11.8%-28.8%) increased mortality risk by 33% (RR 1.33, 95% CI 1.15-1.55, p < 0.001). PMD incidence was 29.8% (95% CI 21.2%-38.4%), with anxiety being the most common (29.5%). Key risk factors included stage III disease (OR 3.2, 95% CI 1.66-6.2), postoperative complications (OR 2.32, 95% CI 1.55-3.49), female gender (OR 1.35, 95% CI 1.07-1.69), and higher Charlson Comorbidity Index (OR 1.04, 95% CI 1.01-1.06).</p><p><strong>Conclusions: </strong>Mental disorders significantly impact esophagectomy outcomes, elevating mortality, and complicating recovery. Proactive screening and multidisciplinary mental health support are warranted, particularly for high-risk patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cybersecurity Should be a Routine Component of Healthcare Provider Education.","authors":"Benjamin Piotrowski, Ishith Seth, Joshua Kovoor, Mathew Jacob, Toby Gilbert","doi":"10.1111/ans.70258","DOIUrl":"https://doi.org/10.1111/ans.70258","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Factors Associated With a Poor Outcome Following External Ventricular Drain Insertion for Spontaneous Intraparenchymal Haemorrhage.","authors":"Michael Brooks, Rebecca Nguyen, Alice Su, Ronald Murambi, Mark Sheridan, Ganeshwaran Shivapathasundram","doi":"10.1111/ans.70256","DOIUrl":"https://doi.org/10.1111/ans.70256","url":null,"abstract":"<p><strong>Introduction: </strong>External ventricular drains (EVDs) are used in the management of spontaneous intraparenchymal haemorrhage (ICH) to divert cerebrospinal fluid and reduce intracranial pressure. Despite being a recognised treatment, there remains a lack of data on outcomes after surgery.</p><p><strong>Methods: </strong>Data was collected for all EVDs inserted from 2010 to 2022 at a tertiary neurosurgery centre in Sydney. Baseline demographic, clinical and radiological parameters were identified. Multivariate logistical regression analyses were conducted to determine factors significantly associated with higher mortality.</p><p><strong>Results: </strong>Out of 116 identified patients, 60 (51.7% of the cohort) died during the index admission. Increasing age and pre-operative Glasgow Coma Score (GCS) were independent predictors of mortality and higher modified Rankin Score on discharge, while haematoma volume and presence of Swirl sign were associated with higher modified Rankin Score on discharge.</p><p><strong>Discussion: </strong>EVD insertion has long been performed in the setting of spontaneous ICH, particularly in the presence of intraventricular haemorrhage (IVH) and hydrocephalus. However, we have demonstrated a number of factors which have a high associated mortality risk even with surgical intervention. In particular, older patients with a lower GCS pre-operatively had a high rate of mortality.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paraganglioma: An Important Differential for Retroperitoneal Masses.","authors":"Timothy Kenyon-Smith, Kelly Ruecker, Gregory Turner, Catherine Mitchell, Alexander Heriot","doi":"10.1111/ans.70254","DOIUrl":"https://doi.org/10.1111/ans.70254","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Recovery After Surgery Programs Safely Accelerate Recovery in Emergency Abdominal Surgery: A Randomized Controlled Trial With Multivariable Risk Profiling.","authors":"Jianing Lu, Yan Zhuang, Zhenglu Wang, Hong Zheng, Xi Ma, Dejun Kong, Jinliang Duan, Shaofeng Chen, Tao Chen","doi":"10.1111/ans.70251","DOIUrl":"https://doi.org/10.1111/ans.70251","url":null,"abstract":"<p><strong>Background: </strong>Emergency abdominal surgery involves complex, diverse conditions with high patient variability, posing recovery challenges. While Enhanced Recovery After Surgery (ERAS) programs benefit elective surgery and show promise in emergencies, current research is disease-specific, limiting broad assessment. This study evaluates ERAS safety/effectiveness across multiple emergency abdominal conditions and identifies recovery risk factors.</p><p><strong>Methods: </strong>This single-blind trial randomized 305 emergency abdominal surgery patients to ERAS (n = 151) or conventional care (n = 154). ERAS patients underwent perioperative enhanced recovery programs, while controls received conventional management. The primary outcome was time to postoperative recovery criteria. Secondary outcomes included first postoperative flatus/semi-liquid diet tolerance time, complication rates, maximum pain scores (days 1-5), 30-day readmissions, and satisfaction. Data were analyzed via t-tests, Mann-Whitney U, Fisher's exact tests, and multivariate regression (p < 0.05 significance).</p><p><strong>Results: </strong>ERAS reduced median recovery time (141 h [IQR: 114-179] vs. 163 h [IQR: 131-204], p < 0.001), accelerated gastrointestinal recovery (first flatus: 1.10 vs. 1.30 days; semi-liquid tolerance: 3.60 vs. 4.10 days, both p < 0.05), and improved satisfaction (95 vs. 91, p < 0.001). No differences in complications (11.9% vs. 15.6%, p = 0.353) or 30-day readmissions (2.0% vs. 2.6%, p > 0.999). Shock index and APACHE II were common risk factors; ERAS-specific risks included SOFA (OR = 1.31, 1.03-1.71, p = 0.034), preoperative hemoglobin (OR = 0.95, 0.89-1.00, p = 0.046), preparation time (OR = 0.33, 0.14-0.68, p = 0.005), and blood transfusion (OR = 0.01, 0.00-0.23, p = 0.003).</p><p><strong>Conclusion: </strong>ERAS enhances postoperative recovery and satisfaction in emergency abdominal surgery without increasing complications/readmissions. Identified risk factors support personalized protocols, advancing ERAS implementation.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}