ANZ Journal of Surgery最新文献

{"title":"External Validation of MRI-Based Prostate Cancer Risk Calculators in an Australian Cohort.","authors":"Nicole Williams, Sebastiaan Remmers, Alex Jay, Kerry Santoro, Michael O'Callaghan","doi":"10.1111/ans.70211","DOIUrl":"https://doi.org/10.1111/ans.70211","url":null,"abstract":"<p><strong>Objective: </strong>To validate magnetic resonance imaging (MRI)-based prostate cancer risk calculators in an Australian population.</p><p><strong>Methods: </strong>Data was retrospectively collected from patients biopsied at SALHN from May 2018 to March 2023. Men with MRI-suspicious lesions underwent biopsy. Performance of nine risk calculators was evaluated by discrimination, decision curve analysis (DCA), calibration, and recalibration. Subgroup analysis of biopsy-naïve patients was conducted.</p><p><strong>Results: </strong>Fifty-two percent had clinically significant cancer (International Society of Urological Pathology [ISUP] Grade Group ≥ 2). Median age of 67 years (IQR 62-67), PSA 7.3 ng/mL (IQR 5.3-11) and prostate volume 45 mL (IQR 32 mL-67 mL) were observed. Abnormal DRE was recorded in 47%, and in 65% a Prostate Imaging-Reporting and Data System (PIRADS) score of > 4 was observed. The RPCRC and Mehralivand risk calculators demonstrated the best performance, with the Radtke risk calculator demonstrating adequate performance in the biopsy naïve subgroup analysis. DCA demonstrated a net benefit of up to 12% of biopsies at a 15% risk threshold prior to recalibration. With recalibration, a net benefit of up to 6% at a 15% risk threshold was demonstrated. Analyses demonstrated a net benefit of up to 12.5% both pre and post recalibration in biopsy naïve patients. Discriminative ability was at least > 0.79, with most demonstrating discriminative ability > 0.82.</p><p><strong>Conclusion: </strong>Use of prostate biopsy decision-making tools provides avenues for individualized health care based on patient-specific risk factors. This study has successfully completed external validation of nine risk calculators, with one demonstrating adequate discriminatory capacity in all patients and three in biopsy-naïve patients. Systemic use may have a 12% net clinical benefit amongst biopsy-naïve patients, thereby reducing healthcare system burden.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504748","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 Modified Step-Up Approach to Elective Laparoscopic Cholecystectomy Safely Reduces Cost and Carbon Impacts.","authors":"Sanjna Gangakhedkar, Stanley Chen, Tommy Thio Sulputra, Mahdid Azam, Zachary Jelbart, Oliver McCahill","doi":"10.1111/ans.70223","DOIUrl":"https://doi.org/10.1111/ans.70223","url":null,"abstract":"<p><strong>Background: </strong>Contemporary surgery expends often excessive quantities of consumables, resulting in high cost and carbon footprint. This study examined the cost and carbon impacts of elective laparoscopic cholecystectomy (ELC), a common procedure involving near-universal disposable equipment, and whether a modification of approach to minimising these consumables can safely reduce these impacts, alongside rationalised antibiotic and venous thromboembolism (VTE) prophylaxis according to validated risk scoring instead of routine use.</p><p><strong>Methods: </strong>The modified step-up approach to ELC involved rationalised antibiotic and VTE prophylaxis, a minimal operative set-up, and opening of further equipment only as required. Consecutive patients undergoing ELC by this approach by a single surgeon across four metropolitan hospitals, both public and private, were prospectively audited over 12 months, and compared with a retrospective audit of a matched cohort treated by the same surgeon using a custom laparoscopic kit in a previous 12-month period. Primary outcomes were operating time, cost, weight, and carbon footprint of consumables from the custom laparoscopic kit. Secondary outcomes included post-operative complications and length of stay.</p><p><strong>Results: </strong>Compared with the previous standard approach, the modified step-up approach significantly reduced weight of surgical consumables by 51.9%, carbon footprint by 50.6%, and cost by 43.1%, without increasing operating time, complications or length of stay.</p><p><strong>Conclusion: </strong>This modified step-up approach to ELC demonstrates how rethinking common surgical practice can reduce consumable waste, carbon footprint, and costs, without compromising patient safety and outcomes or increasing operating time.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504747","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 Augmentation Pouch: Adding an S Pouch to a Straight Ileal-Anal Anastomosis.","authors":"James Church, David Liska","doi":"10.1111/ans.70178","DOIUrl":"https://doi.org/10.1111/ans.70178","url":null,"abstract":"<p><strong>Background: </strong>Straight ileo-anal anastomosis in patients undergoing proctocolectomy for ulcerative colitis or familial adenomatous polyposis is associated with diarrhea, incontinence, and anal excoriation. Techniques to improve function include takedown of the ileo-anal anastomosis with construction of a pouch and redo ileal pouch-anal anastomosis, or multiple ileal myotomies. Here is a technique for augmenting the ileum without taking down the ileo-anal anastomosis.</p><p><strong>Impact of innovation: </strong>Improves function in patients with straight ileo-anal anastomosis.</p><p><strong>Materials and methods: </strong>The apex of redundancy in the loop of distal ileum is pulled down toward the pelvis alongside the ileum going down to the anastomosis, and an S pouch is created. The apex of the loop is placed as close to the existing ileo-anal anastomosis as possible. A diverting ileostomy is constructed.</p><p><strong>Preliminary results: </strong>Four male patients with familial polyposis underwent this procedure. All recovered without complication, retained their S pouch, and noted improved function. One patient seen after formation and immediate excision of a J pouch underwent straight ileo-anal anastomosis with immediate construction of an augmentation S. There were no complications. Function is acceptable.</p><p><strong>Conclusions and future directions: </strong>Augmenting the terminal ileum above a straight ileo-anal anastomosis without disturbing the anastomosis is possible and may allow the patients to avoid a permanent ileostomy.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504751","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":"RETRACTION: Enteral Nutrition Versus Parenteral Nutrition in the Management of Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy: A Prospective Observational Study.","authors":"","doi":"10.1111/ans.70228","DOIUrl":"https://doi.org/10.1111/ans.70228","url":null,"abstract":"<p><strong>Retraction: </strong>R. Kodali, K. Parasar, U. Anand, S. Anwar, B. Saha, B. N. Singh, K. Kant and V. Karthikeyan, \"Enteral Nutrition Versus Parenteral Nutrition in the Management of Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy: A Prospective Observational Study,\" ANZ Journal of Surgery (Early View): https://doi.org/10.1111/ans.70096. The above article, published online on 19 March 2025 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors; the journal Editor-in-Chief, Julian A. Smith; the Royal Australasian College of Surgeons; and John Wiley & Sons Australia, Ltd. The retraction has been agreed upon following an investigation into several concerns raised by a third party. The investigation revealed extensive inconsistencies and discrepancies in the data reported in Tables 1, 2, 3 and 4, and throughout the text. The authors admitted that they made several errors in the published article, but they believe these errors do not alter the conclusions. Due to the extent and nature of the errors and inconsistencies, the editors consider the results and conclusions reported in this article unreliable.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504749","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":"Safety and Effect of Flow Diverters in the Management of Large and Giant Unruptured Intracranial Aneurysms.","authors":"Li Li, Qiao-Wei Wu, Bu-Lang Gao, Qiu-Ji Shao, Tian-Xiao Li, Hang Li, Liang-Fu Zhu","doi":"10.1111/ans.70221","DOIUrl":"https://doi.org/10.1111/ans.70221","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the safety and effect of flow diverters in the management of large and giant unruptured intracranial aneurysms and risk factors for complete aneurysm occlusion at a long-term follow-up.</p><p><strong>Materials and methods: </strong>Patients with large and giant unruptured intracranial aneurysms treated with flow diverters (Pipeline and Tubridge embolization devices) were retrospectively enrolled. The clinical data, peri-procedural complications, occlusion status of aneurysms, and factors affecting aneurysm occlusion were analyzed. Subanalyses between large and giant aneurysms or between saccular and fusiform aneurysms were also performed.</p><p><strong>Results: </strong>Ninety-two patients with 95 intracranial aneurysms were enrolled. Most aneurysms involved the internal carotid artery (77.9%). The size of the aneurysm was 10-25 mm in 81 (85.3%) and > 25 mm in 14 (14.7%). The procedure was successful in all patients (100%). At discharge, the mRS was 0 in 72 (78.3%) patients, 1 in 15 (16.3%), 2 in three (3.3%), 3 in one (1.1%), and 6 in one (1.1%). Four patients (4.3%) who had undergone PED (Pipeline embolization device) implantation experienced post-procedural complications. Follow-up was performed in 77 (83.7%) patients 6-65 (median 39) months after embolization, and 55 (71.4%) patients with 56 aneurysms experienced imaging follow-up. At the last angiographic follow-up 6-62 months (median 37) after the procedure, four (7.1% or 4/56) patients had instent stenosis, and total aneurysm occlusion with OKM (O'Kelly-Marotta) grade D was in 45 aneurysms (80.4%). Flow diverter combined with coiling is a single independent factor affecting complete aneurysm occlusion (OR = 8.98, 95% CI 1.87-43.22, p = 0.006). In subanalysis, the treatment modality was significantly (p = 0.04) different in the large versus giant aneurysms, with diversion plus coiling being performed in all 14 giant aneurysms but only in 43 (53.1%) large ones. Follow-up angiographic occlusion of aneurysms was significantly (p = 0.04) better in giant aneurysms than in large ones.</p><p><strong>Conclusion: </strong>The Pipeline and Tubridge flow diverting devices seem safe and effective in the treatment of large and giant unruptured intracranial aneurysms, and flow diverter combined with coiling is an independent risk factor for complete aneurysm occlusion at the long-term follow-up even though serious peri-procedural complications remain to be solved.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504750","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":"For CPR or Not-For-CPR? Demographic Factors Predict Resuscitation Order Documentation and CPR Status in General Surgery Patients.","authors":"Joshua G Kovoor, Stephen Bacchi, Daksh Tyagi, Aashray K Gupta, Brandon Stretton, Nidhi Aujayeb, Amy Lu, Kayla Nathin, Thomas J Hugh, Gregory Crawford, Guy J Maddern","doi":"10.1111/ans.70233","DOIUrl":"https://doi.org/10.1111/ans.70233","url":null,"abstract":"<p><strong>Background: </strong>To improve healthcare equity, this study aimed to determine which demographic factors are associated with resuscitation order documentation and not-for-cardiopulmonary resuscitation (CPR) status in general surgery patients.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted including patients admitted under general surgical services of two hospitals in South Australia over 2 years. Logistic regression evaluated associations between demographic factors, and resuscitation order documentation and not-for-CPR status.</p><p><strong>Results: </strong>12 846 patients were included, with 1853 (14.4%) having documented resuscitation orders. Of those with resuscitation orders, 964 (52.0%) were for CPR in cardiac arrest. Increased age (OR 1.05, 95% CI 1.04-1.05, p < 0.001), increased Charlson comorbidity index (OR 1.15, 95% CI 1.13-1.17, p < 0.001) and lower socioeconomic status (OR 0.997, 95% CI 0.995-0.999, p = 0.008) were associated with a greater likelihood of having a resuscitation order documented. Female sex (OR 0.76, 95% CI 0.60-0.95, p = 0.016), increased age (OR 0.92, 95% CI 0.91-0.93, p < 0.001), and Charlson comorbidity index (OR 0.89, 95% CI 0.86-0.92, p < 0.001) were significantly associated with being not-for-CPR. Having a resuscitation order documented (OR 18.0, 95% CI 10.9-29.7, p < 0.001) and being not-for-CPR (OR 20.7, 95% CI 10.0-42.8, p < 0.001) were significantly associated with increased in-hospital mortality. Having a specified religion was associated with an OR of 1.29 for being for CPR (95% CI 1.02-1.62, p = 0.032).</p><p><strong>Conclusion: </strong>This study demonstrated that multiple demographic factors predict resuscitation order documentation and content in general surgery patients, including which patients are not-for-CPR. These findings may improve equity in care for general surgery patients in clinical deterioration and end-of-life situations.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144493808","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":"Proceed With Caution When Operating on Female Patients With Gastro-Oesophageal Reflux!","authors":"Sarah K Thompson, Jennifer C Myers","doi":"10.1111/ans.70236","DOIUrl":"https://doi.org/10.1111/ans.70236","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482964","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":"Success of a Transdisciplinary Peri-Operative Pathway for Patients Undergoing Emergency Laparotomy During the COVID-19 Pandemic: A CUSUM Analysis.","authors":"Kai Siang Chan, Woan Wui Lim, Jingwen Lee, Yu Jing Ong, Marc Weijie Ong, Sivaraj Gunasekaran, Jerry Tiong Thye Goo","doi":"10.1111/ans.70234","DOIUrl":"https://doi.org/10.1111/ans.70234","url":null,"abstract":"<p><strong>Background: </strong>Emergency laparotomy (EL) is associated with high post-operative morbidity. This study aims to evaluate the sustainability of our peri-operative pathway for EL (Emergency Laparotomy Pathway (ELAP)) during the COVID-19 pandemic.</p><p><strong>Methods: </strong>This is a single-center retrospective study on patients who underwent EL following ELAP implementation from Jan 2019-Dec 2022. Exclusion criteria were EL for trauma or vascular surgery. The cohort was divided based on the COVID-19 pandemic (COVID was defined from 7 Feb 2020-25 Apr 2022). Cumulative sum (CUSUM) analysis was used to assess the chronologic performance of ELAP. Our primary outcomes were efficiency outcomes (time to surgery, presence of senior surgeon/anaesthetist in theatre and post-operative geriatric review). Our secondary outcomes were post-operative complications, major morbidity, and 30-day mortality.</p><p><strong>Results: </strong>There were 564 patients (30.5% pre-COVID, 52.1% COVID, 17.4% post-COVID). The median age was 66.0 years, and 57.6% had ASA score ≥ 3. The commonest indication for EL was intestinal obstruction (56.9%). Overall major morbidity was 14.0%, and 30-day mortality was 2.8%. CUSUM analysis showed two phases-exploration phase (Case 1-158) and proficiency phase (Case 159-564); an inflection point was noted following the exploration phase, which showed a more sustained performance in achieving post-operative geriatric review and absence of post-operative complications or major morbidity. There was no observed relationship between COVID-19 and the performance of ELAP in both efficiency and clinical outcomes.</p><p><strong>Conclusion: </strong>The good performance of ELAP was sustained at 4 years following its initial implementation despite the COVID-19 pandemic, which resulted in major disruptions to healthcare delivery.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482965","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":"Academic Institutions Must Play a Greater Role in Combating the Predatory Publishing and Conference Industry.","authors":"Henry H Woo, Marnique Basto","doi":"10.1111/ans.70237","DOIUrl":"https://doi.org/10.1111/ans.70237","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482963","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":"Exercise Induced Omental Infarction, an Unusual Cause of Right Iliac Fossa Pain.","authors":"E Kelsey, A Kuzminov, S Clifforth","doi":"10.1111/ans.70235","DOIUrl":"https://doi.org/10.1111/ans.70235","url":null,"abstract":"<p><p>Exercise induced omental infarction clinically masquerading as acute appendicits, a reminder to include omental infarction in a list of differentials for right iliac fossa pain.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473856","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}