ANZ Journal of Surgery最新文献

{"title":"Management of Complex Silastic Ring Erosion Following Roux-en-Y Gastric Bypass.","authors":"Preekesh Suresh Patel, Michael Booth","doi":"10.1111/ans.70212","DOIUrl":"https://doi.org/10.1111/ans.70212","url":null,"abstract":"","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":"144473857","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":"Efficacy of 'Triple Therapy' in Eradicating Ulcer Related Helicobacter pylori Infection at a Tertiary Hospital in Fiji-A Pilot Study.","authors":"Victa Vinay Kumar, Claudia Paterson, Andrew Hill, Vikash Sharma","doi":"10.1111/ans.70231","DOIUrl":"https://doi.org/10.1111/ans.70231","url":null,"abstract":"<p><strong>Background: </strong>Fiji currently uses a seven-day Clarithromycin based triple therapy regimen for Heliobacter pylori (H. pylori) eradication, and the local eradication rate is unknown. H. pylori testing is performed using a rapid urease test (RUT) during gastroscopy in Fiji.</p><p><strong>Methods: </strong>A year-long prospective observational study was undertaken at the Colonial War Memorial Hospital in Fiji. Eligible participants included patients who had peptic ulcer disease (PUD) on gastroscopy and a positive RUT. Consenting participants were prescribed Clarithromycin based triple therapy for 7 days, and underwent a second gastroscopy with RUT after 6 to 8 weeks. Participants who tested positive on a repeat RUT received Clarithromycin based triple therapy for 14 days, and underwent a third gastroscopy and RUT. Participants who remained positive for H. pylori were prescribed quadruple therapy for 14 days.</p><p><strong>Results: </strong>Forty-nine patients were enrolled in the study. Thirty-six (73.5%) had a negative RUT after a seven-day Clarithromycin-based regimen. Eleven of the 13 participants who remained positive eradicated H. pylori after being given another course of the same regimen for 14 days, resulting in a final eradication rate of 95.9%. The remaining two participants received quadruple therapy for 14 days.</p><p><strong>Conclusion: </strong>This study demonstrates an eradication rate of 73.5% using a seven-day Clarithromycin-based regimen in Fiji among H. pylori positive patients with PUD on gastroscopy. This was significantly improved using a 14-day regimen. H. pylori has reduced susceptibility to the current seven-day Clarithromycin based regimen. Future local guidelines should extend to 14 days to achieve a greater eradication rate.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473854","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":"An Evaluation of Four Predictive Scores for New Onset Atrial Fibrillation After Cardiac Surgery in a Tertiary Cardiac Centre.","authors":"Shantel Chang, Madeleen van der Merwe, Ammar Zaka, Aashray Gupta, Cheng He, Andrie Stroebel","doi":"10.1111/ans.70229","DOIUrl":"https://doi.org/10.1111/ans.70229","url":null,"abstract":"<p><strong>Background: </strong>Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, leading to increased mortality, morbidity, and length of stay. Various predictive indices have been validated to identify patients at risk of developing POAF. This study aimed to compare the discriminative ability of four bedside indices that predict POAF in cardiac surgical patients.</p><p><strong>Method: </strong>A total of 2465 consecutive patients who underwent cardiac surgery at an Australian tertiary hospital between 29 December 2015, and 31 December 2022, were retrospectively analysed. Exclusion criteria included pre-existing atrial fibrillation and transcatheter interventions. The area under the receiver-operating characteristic curve (AUC-ROC) analysis and Hosmer-Lemeshow calibration were performed to compare discriminative abilities. A logistic regression model was constructed to evaluate independent risk factors for developing POAF.</p><p><strong>Results: </strong>Older patients (aged > 69) were more likely to develop POAF compared to younger age groups (p < 0.001). The Atrial Fibrillation Risk Index, CHA₂DS₂-VASC, HATCH and POAF scores had weak discrimination and demonstrated poor predictive ability in this cohort (AUC-ROC 0.49, 0.49, 0.50, 0.52, respectively).</p><p><strong>Conclusion: </strong>Although previously validated in various cohorts, the four bedside predictive indices demonstrated poor discriminative ability and limited generalizability to our tertiary-hospital cohort.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473853","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":"Establishing the Frequency of the HLA Class II Pseudotumour 'at Risk' Genotype: A Pilot Epidemiologic Analysis.","authors":"Andrew P Kurmis, Kimberley F Kurmis","doi":"10.1111/ans.70232","DOIUrl":"https://doi.org/10.1111/ans.70232","url":null,"abstract":"<p><strong>Purpose: </strong>Immune-mediated adverse local tissue reactions (ALTRs) to implanted metallic devices are an increasingly recognised orthopaedic concern. Recent research has identified a critical HLA genotype associated with increased risk of ALTR development around in situ arthroplasty implants. Carriage imparts a > 700% increased relative-risk of high-grade peri-prosthetic lesion development, associated with pain and joint dysfunction and likely contributing to an increased burden of complex revision surgery. Despite being first reported in 2017, the 'at risk' genotype has only subsequently been described in selected metal-on-metal and revision arthroplasty cohorts and no population-level prevalence data has been reported. This novel epidemiologic pilot investigation aimed to explore allele-variant carriage frequencies of the previously-described 'at risk' HLA genotype in an undifferentiated orthopaedic population to inform larger screening investigations.</p><p><strong>Methods: </strong>One hundred consecutive patients were prospectively recruited. Targeted HLA class II genotyping was performed using a medium-resolution Luminex-based approach, and secondary screening was performed to identify the presence of four specific alleles previously-associated with immune-mediated reactions to implanted metal devices.</p><p><strong>Results: </strong>Our findings, in a non-differentiated orthopaedic cohort, suggest a carrier rate of the previously-defined 'at risk' allele of 38%, with 29% of those sampled carrying the defined 'at risk' genotype.</p><p><strong>Conclusion: </strong>Our results show a higher-than-anticipated incidence of the 'at risk' gene and genotype. As genotype-associated ALTRs may contribute to patient dissatisfaction following primary joint replacements, the impact of this result may be greater than had previously been considered. While acknowledging the preliminary nature of these data, they may guide future screening applications of the genotyping analysis and will provide a foundation contribution-to-knowledge for future endeavours in diverse populations.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473855","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":"To Stent or Not to Stent: Is It a Question? Routine Trans-Cystic Stenting Does Not Reduce Biliary Anastomotic Strictures Post-Liver Transplantation.","authors":"Marcos Vinicius Perini, Eunice Lee, Michael Fink, Graham Starkey, Osamu Yoshino, Bartholomew McKay, Ruelan Furtado, Enes Makalic, Robert Jones","doi":"10.1111/ans.70224","DOIUrl":"https://doi.org/10.1111/ans.70224","url":null,"abstract":"<p><strong>Background: </strong>We aim to compare the incidence and risk factors for biliary anastomotic stricture (BAS) in patients undergoing orthotopic liver transplant (OLT) with and without transcystic externalised trans-anastomotic biliary stenting.</p><p><strong>Methods: </strong>A retrospective analysis was performed of a prospective database focused on 836 cadaveric OLT. Primary outcome measures were the incidence of BAS and risk factors related to its development.</p><p><strong>Results: </strong>Duct-to-duct anastomosis was the most commonly performed biliary reconstruction (90.5%). Transcystic externalised trans-anastomotic biliary stenting was performed in 420 patients (62.0%), being mostly used in patients having a duct-to-duct anastomosis (63.6%). BAS was seen in 222 (32.8%) patients, with a median time to diagnosis of 145.5 days (IQR 50.3-370.5). BAS was higher in patients with a duct-to-duct reconstruction when compared to those having a bilio-enteric reconstruction (34.3% vs. 18.7%, p = 0.02). The prevalence of BAS was not significantly different between patients who were stented and those who were not (34.5% vs. 30.0% respectively, p = 0.25). Multivariable analysis showed that older donor age, transplants performed earlier in the study period, higher MELD score, and type of biliary reconstruction (duct-to-duct) were independently associated with a higher risk of BAS.</p><p><strong>Conclusion: </strong>Transcystic externalised biliary anastomotic stenting is not associated with a reduced biliary stricture incidence in OLT.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473858","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":"Long-Term Survival Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Pseudomyxoma Peritonei: A 22-Year Single Institution Experience.","authors":"Harleen Kaur, Margarita-Chrissi Litinas, Christoper Lauder, Nigel Da Silva, Emma L Bradshaw, Timothy Price, Markus Trochsler, Josephine Wright, Susan Lesley Woods, Peter Hewett","doi":"10.1111/ans.70214","DOIUrl":"10.1111/ans.70214","url":null,"abstract":"<p><strong>Background: </strong>Pseudomyxoma peritonei (PMP) is a rare condition, often associated with a poor prognosis if left untreated. Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), have emerged as the preferred treatment for this condition. The aim of this study was to report 22-year single centre outcomes for PMP following CRS and HIPEC.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively maintained database (CALHN reference number: Q20160412) from 2002-2024 was conducted on all patients that underwent CRS and HIPEC for PMP at The Queen Elizabeth Hospital, Adelaide, South Australia (TQEH).</p><p><strong>Results: </strong>One hundred and twenty one CRS procedures were performed on 108 patients. Complete cytoreduction (CC0-1) was achieved in 85.9% cases. The overall median 3, 5 and 10-year survival rate for patients with PMP managed at TQEH was 70%, 55% and 23%, respectively. Among those who underwent HIPEC alongside CRS, the median survival was 92 months, with a 5-year survival rate of 62%. Median RFS was 109 months, with 61% 5-year RFS and 54% 10-year RFS. The 5-year survival rates for low-grade PMP and high-grade PMP without signet cells was 64.0% and 30.0%, respectively.</p><p><strong>Conclusion: </strong>CRS and HIPEC is a safe and effective treatment for patients with PMP, demonstrating a 62% survival at 5 years. High-grade PMP histology and CEA ≥ 5 were independent predictors of worse OS. Our results demonstrate that comparable survival rates and recurrence free intervals to those reported by high-volume centres can be achieved, reinforcing the potential for successful outcomes in lower-volume settings while maintaining treatment quality and patient safety.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332376","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":"Mesenchymal Stem Cell Therapy for Perianal Crohn's Disease: Surgical Appraisal of Evidence and Translational Potential.","authors":"Rathin Gosavi, Charlotte Keung, Gregory Moore, T C Nguyen, William Teoh, Raymond Yap, Paul McMurrick, Vignesh Narasimhan","doi":"10.1111/ans.70225","DOIUrl":"https://doi.org/10.1111/ans.70225","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324296","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":"Autosomal Dominant Polycystic Kidney Disease Patients Requiring Nephrectomy: Characteristics and Surgical Considerations.","authors":"Joel Ern Zher Chan, Kate S Olakkengil, Shantanu Bhattacharjya, Santosh Antony Olakkengil","doi":"10.1111/ans.70192","DOIUrl":"https://doi.org/10.1111/ans.70192","url":null,"abstract":"<p><strong>Background: </strong>Nephrectomies are major surgeries often required in ADPKD for symptom control, removal of septic/malignant foci, and to create space for renal transplantation. Whether ADPKD patients should proceed with nephrectomy/ies should be guided by patient characteristics, technical considerations and anticipated risks and benefits.</p><p><strong>Methods: </strong>A retrospective review of prospectively collected data for all patients who underwent nephrectomy/ies between 1 January 1995 and 31 December 2021, comparing ADPKD patients to patients with alternative primary nephrological conditions. Patient characteristics, technical aspects, and outcomes informing the risks and benefits of nephrectomies were examined. Statistical analyses included descriptive statistics, χ²/Fisher's exact test and independent samples Mann-Whitney U test, as appropriate.</p><p><strong>Results: </strong>At the time of first nephrectomy, ADPKD patients were older and more likely to have end-stage renal failure, hypertension, gastro-oesophageal reflux disease, and hernia compared to non-ADPKD patients. They were more likely to require bilateral nephrectomies, open nephrectomies, and, where transplanted, receive donation after circulatory death. They were at higher risk of post-operative hypotension, anaemia, and more likely to require blood transfusions. Otherwise, nephrectomies achieved their indications in our ADPKD cohort with no apparent increase in adverse events. Renal cell carcinoma appears to be of higher incidence in our cohort, with a high proportion of multifocality and bilaterality, advanced staging at diagnosis and incidental diagnoses on histopathology.</p><p><strong>Conclusion: </strong>Overall, in our ADPKD patients who received nephrectomy/ies, the procedure appeared to be safe and effective, with benefits outweighing risks. RCC exclusion is a prudent consideration especially for ADPKD patients on dialysis awaiting transplantation.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324295","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":"Understanding Unwarranted Variation in Care for Victorian Oesophagogastric Cancer Patients Using Linked Data: A Comparative Analysis Between 2012-2016 and 2017-2021.","authors":"Frances Graham, Wanyu Chu, Helena Rodi, Paul Cashin, David S Liu, Norah Finn, Tommy Hon Ting Wong, Linda Nolte","doi":"10.1111/ans.70196","DOIUrl":"https://doi.org/10.1111/ans.70196","url":null,"abstract":"<p><strong>Background: </strong>The Victorian Integrated Cancer Services convened the second Oesophagogastric (OG) Cancer Optimal Care Summit to determine unwarranted variation in care between 2017 and 2021 and compare trends with the first summit (reporting 2012-2016). Statewide administrative datasets were assessed retrospectively at the population level in alignment with the optimal care pathway steps for OG.</p><p><strong>Methods: </strong>Victorians with a primary diagnosis of OG cancer were identified via the Victorian Cancer Registry dataset and linked to various administrative datasets to identify unwarranted variations.</p><p><strong>Results: </strong>Of the 9868 Victorians diagnosed with OG cancer between 2012 and 2021, 39.4% were metastatic at diagnosis. Improved outcomes between time periods included reduced mortality for OG cancer and post-surgical mortality 1 year post gastrectomy. Patient multidisciplinary meeting presentation increased from 74% to 86%. Unwarranted variations included time from diagnosis to any treatment within 6 weeks for non-metastatic gastric cancer (64%, 2012-2016 and 60%, 2017-2021) and for oesophageal cancer patients (58%, 2012-2016 and 60%, 2017-2021). One regional Integrated Cancer Service (ICS) demonstrated statistically lower survival compared to the statewide average for gastric cancer in 2017-2021. There was greater variation in survival for gastric cancer for 2017-2021 compared to 2012-2016. Rates of dietitian and/or physiotherapist involvement within 3 months of diagnosis for OG cancer surgical and/or chemotherapy patients were low across all ICS and both time periods.</p><p><strong>Conclusions: </strong>The Victorian cancer system demonstrates improved survival outcomes for OG cancer patients between the two time periods. Time between diagnosis and treatment, lower survival rates in some ICS, and access to supportive care (e.g., dietetics and physiotherapy) remain areas of deficiency.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324298","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":"Reimagining the Future.","authors":"Jenny May","doi":"10.1111/ans.70219","DOIUrl":"https://doi.org/10.1111/ans.70219","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324297","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}