ANZ Journal of Surgery最新文献

{"title":"Outcomes of laparoscopic and open inguinal hernia repair in overweight and obese patients.","authors":"Rosa Miranda Thais, Michael Talbot","doi":"10.1111/ans.70055","DOIUrl":"https://doi.org/10.1111/ans.70055","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia repair in patients with high body mass index (BMI) ≥25 kg/m² is associated with higher technical difficulties and longer perioperative time. Few studies, however, have compared the outcomes of laparoscopic versus open inguinal hernia repair in patients with high BMI in the Australian population.</p><p><strong>Methods: </strong>In this retrospective observational study, we analyzed the data from 315 adult patients with a healthy BMI of 18.5-24.9, overweight BMI of 25-29.9, and obese BMI of 30-≥40 and analyzed the operative time and recovery time considering the type of surgery, patient comorbidities, BMI category, and operator expertise.</p><p><strong>Results: </strong>There is a significant positive relationship between the BMI of the patient and the type of surgery performed (laparoscopic/open) as well as the BMI and recovery time p < 0.001.</p><p><strong>Conclusion: </strong>Post-operative recovery time was measurably longer in patients with BMI > 25, with an average of 28 extra minutes compared to patients with a normal BMI. Open inguinal hernia repair was mainly offered to morbidly obese patients (obesity class 3) and elderly patients, and laparoscopic surgery was offered to younger patients with lower BMI.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555695","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":"Diagnostic value of the derived neutrophil-to-lymphocyte ratio for acute appendicitis.","authors":"Julio César Moreno-Alfonso, Ada Molina Caballero, Alberto Pérez Martínez, María Concepción Yárnoz Irazábal","doi":"10.1111/ans.70006","DOIUrl":"https://doi.org/10.1111/ans.70006","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of appendicitis in children can present several challenges, leading to an increased risk of complications. Herein, we aimed to evaluate the diagnostic value of the derived neutrophil-to-lymphocyte ratio (dNLR) as a novel adjunctive diagnostic tool for appendicitis.</p><p><strong>Methods: </strong>Diagnostic study of patients with appendicitis and non-surgical abdominal pain (AP) admitted to our hospital between 2020 and 2022. White blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), and dNLR were compared between the two groups of patients.</p><p><strong>Results: </strong>Overall, 202 patients were enrolled: 101 with appendicitis (69% male, age 9.9 years) and 101 with AP (56% male, age 9.4 years). WBC, NLR, and dNLR were higher in patients in the appendicitis group than in those in the AP group (16.47 versus 11.18 × 10³ cells/mm³; 9.5 versus 3.3; and 5.2 versus 2.3; P ≤ 0.0001, respectively). The sensitivity, specificity, positive predictive value, area under ROC curve, and cutoff point of dNLR for the diagnosis of appendicitis were 71%, 74%, 73%, 0.811, and 3.78, respectively. The positive likelihood ratios for WBC, NLR, and dNLR were 1.95, 2.05 and 2.77.</p><p><strong>Conclusion: </strong>dNLR is a novel and noninvasive biomarker with high accuracy for diagnosing appendicitis. Its inclusion as an additional diagnostic tool in clinical practice may aid in determining the need for further studies in cases with ambiguous presentations and a dNLR value ≥3.78.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565865","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":"Experiences of anorectal surgery among gay and bisexual men: a mixed methods study.","authors":"Matthew Joseph Marino, Oliver Malcolm Gregory, Julio Joseph Quealy, Megan Clare Kelly, Anthony K J Smith, Richard Clive Turner","doi":"10.1111/ans.70037","DOIUrl":"https://doi.org/10.1111/ans.70037","url":null,"abstract":"<p><strong>Background: </strong>The experiences of gay, bisexual, and other men who have sex with men (GBMSM) receiving anorectal surgery are not well understood, including their interaction with surgeons and the impact of surgery on receptive anal intercourse. This pilot exploratory study aimed to understand the experiences of GBMSM who recently received anorectal surgery.</p><p><strong>Methods: </strong>This mixed methods study utilized surveys and semi-structured interviews with gay and bisexual men who received operative treatment by a general or colorectal surgeon for a benign anorectal condition within Australia. Descriptive and qualitative thematic analysis was employed to assess the impact of anorectal surgery and the experience of the surgical encounter.</p><p><strong>Results: </strong>Participants reported impaired sexual function and reduced overall well-being after anorectal surgery. They expected surgeons to inquire about their sexual practices and provide additional support and post-operative education, which most often did not occur. Participants perceived their surgeon to lack understanding regarding their sexual orientation and well-being.</p><p><strong>Conclusions: </strong>Anorectal surgery has a significant impact on the sexual and overall well-being of GBMSM. Surgeons should inquire about sexual practices and offer adequate counselling about sexual practices accordingly. Surgeons may require education and training to help improve outcomes for GBMSM patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540027","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":"Comparative analysis of suture choice in open bilateral carpal tunnel surgery: a randomized controlled trial.","authors":"Jessica Leary, Chris Frampton, Andrew Muller, Timothy Lynskey","doi":"10.1111/ans.70030","DOIUrl":"https://doi.org/10.1111/ans.70030","url":null,"abstract":"<p><strong>Objective: </strong>This randomized controlled trial (RCT) compared outcomes of absorbable and non-absorbable sutures for skin closure in open carpal tunnel decompression.</p><p><strong>Methods: </strong>Patients diagnosed with bilateral carpal tunnel syndrome proceeding to staged open carpal decompression were invited to participate in the trial. Patients elected left or right hand for the first operation and were randomized to receive Prolene (non-absorbable) or Vicryl Rapide (absorbable) first, and the alternative suture to the contralateral side. Recorded pre-operative data included the Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. At 2 weeks post-operatively the BCTQ, a Visual Analogue Score (VAS) for pain and Asepsis Wound Score were recorded. At 6 weeks, the BCTQ and VAS were repeated and a Patient and Observer Scar Assessment Scale (POSAS) was performed. Patients were asked preference for left or right suture. Statistical analysis using a linear mixed model assessed improvements in the BCTQ, as well as wound scores between sutures. The individual scales were compared using non-parametric Wilcoxon signed rank test. Specific patient factors including age, comorbidities, and previous steroid injections were evaluated for their impact on outcome.</p><p><strong>Results: </strong>There was no significant difference between the two suture types in any of the overall recorded assessments, complications or patient preferences. BCTQ scores improved significantly post-operatively, P = 0.001. Previous steroid injection, diabetes and age over 65 did not affect outcomes.</p><p><strong>Conclusions: </strong>Patients can be advised there is no difference in the outcome following open carpal tunnel decompression from using either absorbable or no-absorbable suture material for skin closure.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540016","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":"Transposition flap and skin graft techniques for optimizing anastomosis coverage.","authors":"Yooseok Ha, Ji Ah Park, Youn Hwan Kim","doi":"10.1111/ans.70035","DOIUrl":"https://doi.org/10.1111/ans.70035","url":null,"abstract":"<p><strong>Background: </strong>This study explores a novel technique combining transposition flaps with Split-Thickness Skin Grafts (STSG) to enhance anastomosis site coverage in free tissue transfer surgeries, particularly in lower limb reconstructions using Thoracodorsal Artery Perforator (TDAP) free flap procedures. This method aims to alleviate tension at the anastomosis sites, a common issue affecting reconstructive surgery success.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 20 patients who underwent TDAP free flap procedures. These cases were chosen due to the anticipated tension at anastomosis sites, necessitating the use of transposition flaps and STSG. Surgical procedures were meticulously documented, and postoperative outcomes were monitored, focusing on complications and overall surgical success.</p><p><strong>Results: </strong>The study found no instances of complete flap failure, indicating the potential efficacy of the combined approach. Minor complications included two cases of partial tip necrosis in the transposition flaps and two cases of partial graft loss in the STSGs. These issues were resolved through secondary intention healing, demonstrating the technique's ability to manage minor postoperative challenges and maintain flap viability.</p><p><strong>Conclusion: </strong>Integrating transposition flaps with STSG significantly improves tension management at anastomosis sites in TDAP free flap procedures. This technique not only reduces immediate postoperative complications but also supports the long-term success of reconstructive surgeries. The findings advocate for further research to confirm the efficacy of this approach in microsurgical applications, aiming to enhance patient outcomes and advance reconstructive microsurgery.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539987","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":"Surgical Research Society of Australasia - Abstracts in order 2023.","authors":"","doi":"10.1111/ans.19425","DOIUrl":"https://doi.org/10.1111/ans.19425","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539985","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 20-year case-series of distal intestinal obstruction syndrome at a state-wide cystic fibrosis service.","authors":"Chen Lew, Chelsea Lin, Matthew Lukies, Peter Wark, Sarah Birks, Maria K Vanguardia, Satish Warrier","doi":"10.1111/ans.70005","DOIUrl":"https://doi.org/10.1111/ans.70005","url":null,"abstract":"<p><strong>Background: </strong>Distal intestinal obstruction syndrome (DIOS) presents significant management challenges for people with cystic fibrosis (pwC). We evaluated the treatment outcomes and identified risk factors associated with the need for surgical intervention in patients admitted with DIOS.</p><p><strong>Method: </strong>We conducted a retrospective case series of 96 encounters of DIOS over a 20-year period, observing outcomes between cases of medical management versus those requiring for operative intervention. To our knowledge, this is the largest Australian study to review intervention in DIOS.</p><p><strong>Results: </strong>Among the patients studied, 94.8% were successfully treated non-surgically. Using computed tomography (CT) confirmation of DIOS as the gold standard, only 9.1% of abdominal x-rays were accurate in finding DIOS. Gastrografin was used in half of cases and was associated with a shorter recovery time. One in 16 patients required operative management, with two cases experiencing surgery following prolonged medical treatment. A history of previous laparotomy increased the odds of requiring surgical intervention by 16 times (95% CI: 1.2-209.9, P = 0.035), while a history of meconium ileus increased the odds by 15.6 times (95% CI: 1.2-204.8, P = 0.036). All patients who underwent surgery also had pancreatic insufficiency.</p><p><strong>Conclusion: </strong>Medical management was successful in the majority of DIOS presentations. Our study emphasizes a low threshold for abdominal CT scans to identify complete DIOS in high-risk patients, particularly those with a history of laparotomy or meconium ileus, who may require surgical intervention. Furthermore, we advocate for the adjunctive use of Gastrografin alongside medical management. Future research should refine protocols for these high-risk groups to improve outcomes and reduce morbidity.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540014","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":"How to do a transperineal rectovesical fistula repair with dartos flap interposition.","authors":"Dhanushke T Fernando, David Sofield","doi":"10.1111/ans.70012","DOIUrl":"https://doi.org/10.1111/ans.70012","url":null,"abstract":"<p><p>Rectovesical fistula (RVF) is defined as an extra-anatomic communication between the rectum and bladder. A multitude of approaches and techniques have been described; however, there is a lack of consensus regarding which of these procedures is the optimal cost-effective, appropriate treatment to perform. We describe the repair of a persistent RVF via a transperineal approach, utilizing the dartos fascia flap, a technique with minimal description in the literature.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540030","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":"Adrenalectomy in regional Australia: a balance of benefits and potential harms","authors":"Christine J. O'Neill MBBS(Hons), MS, FRACS","doi":"10.1111/ans.19364","DOIUrl":"https://doi.org/10.1111/ans.19364","url":null,"abstract":"&lt;p&gt;Internationally, centralization of surgical care in higher volume centres for complex and oncological surgery has led to improved clinical outcomes.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; The challenges of the vast geography and comparative low density of the Australian population require this model of care to be tested in an Australian context. Approximately 29% of the Australian population lives in regional Australia and is comparatively under-resourced by surgical care.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; Patients in regional areas deserve high quality care in their local vicinity. It is imperative to ensure surgeons servicing these areas develop and maintain an adequate skill mix, and as such can enjoy a viable and rewarding career path in their local community.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Whilst increased surgical volume may improve clinical outcomes, this can be offset by distress cause by travel and psychosocial and financial harm associated with care distant to home. With this in mind, patients in regional areas may preference procedures undertaken closer to home and their support networks, even if informed of associated higher morbidity and mortality.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this edition, Tree &lt;i&gt;et al&lt;/i&gt;. have published their case series of 31 adrenalectomy cases performed by two surgeons in Lismore NSW, over a 16-year period.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; The majority were laparoscopic (90%), 52% were admitted to ICU/HDU post-operatively and the mean length of stay was 3.1 days. Similarly, in 2023, Cui &lt;i&gt;et al&lt;/i&gt;. published a single surgeon series from Dubbo NSW, of 13 cases of adrenalectomy over 9 years.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; In both series, the hospital volume was &lt;2 cases per year and there were no mortalities. The authors are to be congratulated on documenting their case series and challenging the paradigm of centralisation.&lt;/p&gt;&lt;p&gt;Adrenalectomy is an infrequent procedure within scope of practice both general surgeons (endocrine, upper GI and HPB subspecialities) as well as urologists. International data suggest that surgeon thresholds of ≥6–12 adrenal resections annually are associated with improved clinical outcomes.&lt;span&gt;&lt;sup&gt;8-10&lt;/sup&gt;&lt;/span&gt; Higher annual volumes again (&gt;12 adrenal resections annually) may be associated with improved outcomes (completeness of resection, decrease in complications, more comprehensive pre-operative work-up) in open adrenal surgery and adrenocortical cancer care.&lt;span&gt;&lt;sup&gt;11-13&lt;/sup&gt;&lt;/span&gt; International guidelines also stress the importance of thorough pre-operative work-up and the multidisciplinary team in the care of patients undergoing adrenal surgery.&lt;span&gt;&lt;sup&gt;10, 14&lt;/sup&gt;&lt;/span&gt; Yet, surgical volume remains a crude marker of either the skill of the surgeon themselves or of their team.&lt;/p&gt;&lt;p&gt;For surgeons wishing to undertake adrenalectomy, or any other uncommon procedure, it is unlikely that a fellowship (FRACS) of any surgical speciality will provide adequate skills and experience. Thus, both","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 1-2","pages":"6-7"},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.19364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bio-absorbable mesh and early positron emission tomography avidity: implications in oncological surveillance.","authors":"Ernest Cheng, Mina Sarofim, Amit Sarkar, Assad Zahid, Andrew Gilmore","doi":"10.1111/ans.70043","DOIUrl":"https://doi.org/10.1111/ans.70043","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522531","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}