ANZ Journal of Surgery最新文献

{"title":"Back to the Roots-Reconstructing Full Thickness Oral Cavity Defects in Women With the Versatile Bi-Folded PMMC Flap.","authors":"Pranav Mohan Singhal, Pinakin Patel, Kamal Kishor Lakhera, Suresh Singh, Agil Babu","doi":"10.1111/ans.70723","DOIUrl":"https://doi.org/10.1111/ans.70723","url":null,"abstract":"<p><strong>Background: </strong>Full thickness defects of the oral cavity present a challenge to the surgeon for reconstruction. The advent of microsurgical vascular anastomosis has led to acceptance of free flaps as reconstructive procedures of choice for such patients. But financial constraints and resource limited settings can force us to fall back on the ever-reliable Pectoralis major myo-cutaneous (PMMC) flap. The present study aspires to analyze the complications and functional outcomes of reconstruction with bi-folded PMMC flaps in female patients.</p><p><strong>Materials and methods: </strong>Retrospective analysis of the data of 60 female patients who were reconstructed with bi-folded PMMC flaps over a period of 2 years between July 2020 and June 2022 was done. Data was analyzed in terms of patient factors, flap-related complications, and functional outcomes.</p><p><strong>Results: </strong>The overall complication rate including major/minor complications was 46.6% with flap detachment at 23.3% being the commonest complication observed. A total of 16.6% patients developed an Oro-cutaneous fistula and surgical site infection was seen in 11.66%. A total of 5% patients suffered a complete flap failure, whereas 11.66% suffered a partial flap failure. A total of 11.66% patients suffered from oral commissural incontinence and needed a redo commissuroplasty. Overall 33.33% patients were subjected to a second surgical intervention. Only 3.33% patients suffered from total inability to swallow liquids or solids. Only 6.66% patients had a completely unintelligible speech post operatively.</p><p><strong>Conclusion: </strong>The PMMC flap is a robust, dependable, and economical option for reconstruction of oral cavity defects with acceptable functional outcomes in settings where the microvascular surgical facilities are unavailable or are unaffordable.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832868","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":"Hartmann's Reversal and Abdominal Wall Reconstruction: Too Risky to Combine?","authors":"María A Casas, Agustín C Valinoti, Francisco Schlottmann, María M Ledesma, Maximiliano E Bun, Emmanuel E Sadava, Nicolás A Rotholtz","doi":"10.1111/ans.70710","DOIUrl":"https://doi.org/10.1111/ans.70710","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing Hartmann's reversal (HR) frequently present with an incisional hernia. It is not clear whether HR and incisional hernia repair (IHR) should be performed simultaneously, given the high risk of complications. The aim of this study was to evaluate the outcomes of concomitant HR and IHR.</p><p><strong>Methods: </strong>Patients who underwent HR between 2012 and 2024 were revised. The sample was divided into two groups: patients who underwent HR alone (HR) and those with concomitant HR and IHR (CP). The primary outcomes were 30-day overall morbidity, major morbidity (Clavien-Dindo III/IV complications), and anastomotic leak rates. Secondary outcomes were surgical site infections (SSI), surgical site occurrences (SSO), length of stay (LOS), reoperation rates, mortality, and hernia recurrence.</p><p><strong>Results: </strong>A total of 52 patients were analyzed: 35 (67%) HR and 17 (33%) CP. Demographic variables were similar between groups. Operative time (HP: 196 vs. CP: 286 min, p = 0.001) was longer in the CP group. Most HR were laparoscopically performed (HR: 33 (94.2%) vs. CP: 2 (11.7%), p < 0.001). 30-day overall morbidity (HR: 15 (42.8%) vs. CP: 12 (70.5%), p = 0.06), major morbidity (HR: 2 (5.7%) vs. CP: 4 (23.5%), p = 0.06), and anastomotic leak (HR: 1 (2.8%) vs. CP: 0 (0%), p = 0.48) rates were similar between groups. No significant differences were observed regarding SSI (HR: 9 (25.7%) vs. CP: 3 (17.6%), p = 0.72) or reoperation rates (HR: 1 (2.8%) vs. CP: 0 (0%), p = 0.48). LOS was similar between groups (HR: 5 (2-16) days vs. CP: 6 (3-13) days, p = 0.2). No recurrences were observed in the CP group after a mean follow-up of 49 (12-132) months. One patient died in the HR group (HR: 1 (2.8%) vs. CP: 0 (0%), p = 0.48).</p><p><strong>Conclusion: </strong>Simultaneous HR and IHR might be feasible in very selected patients treated by experienced colorectal and abdominal wall surgeons. The small, heterogeneous, and imbalanced patient cohorts of our study, however, warrant further research to support the safety of the combined approach.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809935","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":"Evaluation of ChatGPT's and Gemini's Ability to Find Studies About Neurosurgical Training and Trainees' Anatomy Understanding.","authors":"Dimitrios Chytas, Marios Salmas, Angelo V Vasiliadis, Alexandros Samolis, George Triantafyllou, Maria Piagkou","doi":"10.1111/ans.70715","DOIUrl":"https://doi.org/10.1111/ans.70715","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of research about artificial intelligence's potential to explore neurosurgical literature. We aimed to investigate ChatGPT's and Gemini's ability to identify and outline studies about neurosurgical training and trainees' anatomy understanding.</p><p><strong>Methods: </strong>We asked ChatGPT 4.0 Turbo and Gemini 2.5 flash (in July 2025), and ChatGPT 5.3 and Gemini 3 flash (in March 2026) to list and summarize five papers: (1) about the use of virtual reality in neurosurgical training, (2) about the role of virtual reality in neurosurgery trainees' anatomy understanding, (3) that compared virtual reality with other neurosurgical training methods. We evaluated how many studies were successfully identified and accurately outlined.</p><p><strong>Results: </strong>For ChatGPT 4.0 Turbo, the successful identification and summarization percentages were 100%/60%, 40%/40%, and 60%/40% respectively. For ChatGPT 5.3, the respective percentages were 100%/0%, 20%/0%, and 40%/0%. For Gemini 2.5 flash, they were 80%/60%, 40%/20%, and 0%/0%. For Gemini 3 flash, they were 60%/0%, 20%/0%, and 0%/0%. There was a tendency towards reporting outcomes in favor of virtual reality. Gemini 2.5 flash and 3 flash hallucinated 5/15 and 6/15 papers respectively. Gemini 2.5 flash misattributed first authorship in 8/15 papers.</p><p><strong>Conclusions: </strong>Apart from the excellent ChatGPT's ability to simply detect studies about the use of virtual reality in neurosurgical training, ChatGPT and Gemini did not provide reliable responses. Gemini performed worse and frequently hallucinated, while both platforms exhibited bias in favor of virtual reality. Newer versions performed generally worse than older ones. Ongoing development may improve these platforms' role in neurosurgical research.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809932","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":"Re: Methods and Timing of the Assessment of Post-Operative Pain in Minimally Invasive Hernia Surgery: A Scoping Review Comparing Robotic With Laparoscopic Repair.","authors":"Abdul Raheem Malik, Khadija Malik","doi":"10.1111/ans.70720","DOIUrl":"https://doi.org/10.1111/ans.70720","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809928","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":"Evaluation of the Role of VAC in the Treatment of Fournier's Gangrene.","authors":"Süleyman Öner, Utku Bekyürek, Betül Altıntaş Öner, İyimser Üre, Aydın Yenilmez","doi":"10.1111/ans.70712","DOIUrl":"https://doi.org/10.1111/ans.70712","url":null,"abstract":"<p><strong>Objective: </strong>Standard treatment for Fournier's gangrene (FG) includes hemodynamic stabilization, aggressive surgical debridement, and broad-spectrum antibiotics. However, prolonged hospitalizations and multiple debridements increase costs and reduce productivity. This study compares vacuum-assisted closure (VAC) therapy with open wound dressing (OWD) in post-debridement management of FG.</p><p><strong>Materials and methods: </strong>Data of 60 patients diagnosed with FG and treated in our clinic were retrospectively analyzed. Data collected included demographic characteristics, comorbid systemic diseases, presence of sepsis at initial presentation, the origin of the gangrene (urogenital or perianal), FGSI, the need for additional surgical interventions during debridement (such as orchiectomy, penectomy, or colostomy), the type of wound dressing used (open wound dressing [OWD] or vacuum-assisted closure [VAC]), the number of debridement sessions, length of hospital stay, the requirement for grafting during wound closure, and mortality outcomes. These variables were analyzed based on hospital records.</p><p><strong>Results: </strong>VAC therapy was applied to 30 patients (50%). The mean age of patients in the VAC group was 63.1 ± 11.7 years, compared to 65.2 ± 12.1 years in the OWD group. The VAC group had a significantly shorter average hospital stay (15.17 ± 9.19 days) than the OWD group (22.8 ± 14.76 days) (p = 0.019). Additionally, the mean number of debridement sessions was significantly lower in the VAC group (3.27 ± 2.15) compared to the OWD group (4.87 ± 3.17) (p = 0.026).</p><p><strong>Conclusion: </strong>VAC therapy is an effective method for FG management, reducing debridement sessions and hospital stay compared to OWD.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760618","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":"Timeliness of Care and Treatment Patterns for Pancreatic Cancer in Victoria, Australia: Comparison With Optimal Care Pathways Targets.","authors":"Sam Banks, Belinda Lee, Nadia Ayres, Silja Schrader, Benjamin Thomson, Benjamin P T Loveday, Michael Michael, Frances Barnett, Sue-Anne McLachlan, Brett Knowles, Mehrdad Nikfarjam, Jon Emery, Peter Gibbs","doi":"10.1111/ans.70705","DOIUrl":"https://doi.org/10.1111/ans.70705","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal care pathways (OCP) were developed in Australia as a framework to define quality and timeliness targets. The 2022 National Pancreatic Cancer Roadmap highlighted a paucity of population-level data on pancreatic cancer management in Australia, such that compliance with OCP targets is uncertain. This study used real-world data to compare pancreatic cancer care in Victoria, Australia, against OCP targets.</p><p><strong>Methods: </strong>Data collected on pancreatic cancer patients between January 2016 and July 2025 were extracted from the PURPLE registry for five Victorian tertiary hospitals. Care processes and timeliness outcomes were compared with OCP benchmarks.</p><p><strong>Results: </strong>1878 patients were identified, with a median age of 70 years. At diagnosis, 41% had metastatic disease and 69% were ECOG performance status 0-1. Median interval from diagnosis to surgery was 20 days (OCP benchmark ≤ 28 days) with 60% of patients operated on within the timeframe, and to adjuvant therapy 55 days with 88% of patients receiving chemotherapy within the OCP benchmark of ≤ 84 days. However, just 33% received neoadjuvant chemotherapy, and 38% received palliative chemotherapy within the 28-day timeframe for commencing systemic treatment. Palliative care referral occurred in 65% of patients with advanced disease and 61% were discussed at a multidisciplinary meeting. Marked inter-site variation was evident across metrics.</p><p><strong>Conclusion: </strong>In Victoria, Australia, pancreatic cancer care variably met OCP targets. Real-world registry data can identify domains of care where performance is strong and highlight opportunities for process improvement and resource optimisation. Where OCP targets are rarely achieved, these findings support review of their real-world feasibility.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760233","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":"Re: How I Do It-Video-Assisted Thoracoscopic (VATS) Ligation of the Thoracic Duct Using Indocyanine Green (ICG) Fluorescence for Chyle Leak.","authors":"Eylem Yentürk","doi":"10.1111/ans.70713","DOIUrl":"https://doi.org/10.1111/ans.70713","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760572","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 American College of Surgeons Minimum Hospital Standardization Programme and the Foundation of the College of Surgeons of Australasia.","authors":"R James Aitken","doi":"10.1111/ans.70661","DOIUrl":"https://doi.org/10.1111/ans.70661","url":null,"abstract":"<p><p>The American College of Surgeons' Minimum Hospital Standardization (MHS) Programme was central to its foundation and subsequent growth over the next 40 years. Its significance was second only to the election of its Fellows. The development of the MHS exactly overlapped the years preceding the foundation of the College of Australasian Surgeons in 1927 and its reputation was well known to Australasian surgeons and governments-yet it was never developed in Australasia. The current interest in Australian Clinical Quality Registries and the upcoming College's Centenary is an opportunity to reappraise a missed opportunity.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760148","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":"Introducing a Dedicated Plastic Surgery Burns Dressings Clinic in Rural Australia: Challenges and Solutions.","authors":"Jack Gerrard, Robert Toma","doi":"10.1111/ans.70709","DOIUrl":"https://doi.org/10.1111/ans.70709","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760614","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":"Practice Patterns and Outcomes of Preoperative Mechanical Bowel Preparation and Oral Antibiotics for Restorative Elective Colorectal Surgery: Nationwide Analysis of the ACS-NSQIP Australian Data.","authors":"Joseph Do Woong Choi, Nguyen Huynh, Kalai Kuppusamy, David Clark, Richard Bryant, Aleksandra Edmundson, Rebecca Radford, Andrew Gilmore, Yasser Farooque, Elaine Zhang, Nimmi Kumar, Matthew Morgan, Neil Merrett, Mingjuan Zeng, Bruce Hodge, Andrew Sutherland, Jimmy Chin Li Lee, Andrea Giles, Diana Tam, Emma Plecas, Boris Strekozov, Chantel Gablonski, Shella de Robles, Jennifer Hearn, Gregory Nolan, Michelle Cooper, Rebecca Boyle, Kelvin Kwok, Ian Incoll, Caitlin Queripel, Amy Cao, Nimalan Pathma-Nathan, Toufic El-Khoury, Arthur J Richardson, Kerry Hitos, James Wei Tatt Toh","doi":"10.1111/ans.70670","DOIUrl":"https://doi.org/10.1111/ans.70670","url":null,"abstract":"<p><strong>Background: </strong>There is increasing evidence that the addition of preoperative antibiotics (OAB) reduces infectious complications after colorectal surgery. To understand practice patterns in Australia, Australian hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) collecting targeted colectomy and proctectomy data were collated.</p><p><strong>Methods: </strong>Adult patients who had elective restorative colectomy or proctectomy between January 2015 and November 2023.</p><p><strong>Results: </strong>Eight hundred thirty-nine patients were included. Mechanical bowel preparation (MBP) alone was the most common strategy for segmental colectomy (42.46%) and proctectomy (75%). The rate of MBP and oral antibiotics (OAB) remained low (11.7% to 25.3% between 2019 and 2023). This was associated with a decline in superficial SSI (11.7% to 4%) over this time. When the cohort was divided into three groups: MBP+/OAB+ (n = 143), MBP+/OAB- (n = 458) and MBP-/OAB- (n = 238), there were no statistical differences in infectious complications between the groups. However, the MBP+/OAB+ group had the lowest superficial surgical site infection (SSI) rate in the laparoscopic (5.3%) and open surgery (9.2%) subgroups. This was associated with a significant reduction in the odds ratio (OR) 0.52 (95% CI 0.27-1.01) of developing any SSI and a reduced length of stay in the open subgroup.</p><p><strong>Conclusions: </strong>Despite recommendations by several international guidelines, level 1 evidence from meta-analyses and network meta-analyses as well as a Cochrane review that MBP and OAB reduce infectious complications, there remains a low uptake of MBP and OAB in major colorectal surgery at major NSQIP hospitals in Australia, with even lower uptake in smaller non-NSQIP hospitals.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760630","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}