ANZ Journal of Surgery最新文献

{"title":"Vertical Rectus Abdominis Myocutaneous Flap Reduces Pelvic Exenteration Morbidity: A Retrospective Single-Centre Cohort Study.","authors":"Bernard Hanekom, Ranesh Palan, Aaron Rusnak, Ranjit Kunchur, Rhys Filgate","doi":"10.1111/ans.70967","DOIUrl":"https://doi.org/10.1111/ans.70967","url":null,"abstract":"<p><strong>Background: </strong>Pelvic exenteration (PE) has emerged as a viable resection strategy for locally advanced and recurrent pelvic cancers; however, it carries the burden of significant morbidity. The vertical rectus abdominis myocutaneous (VRAM) flap is a reconstructive method designed to minimise postoperative wound complications, and this study highlights its potential for minimising morbidity following PE.</p><p><strong>Method: </strong>We present results from a retrospective cohort study of patients undergoing PE at the sole tertiary referral service in Western Australia from 2017 to 2025. Patients were identified from the departmental database and data extracted from electronic records. Data was collected including demographics, operative outcomes, postoperative complications and survival. We analysed complications in those undergoing VRAM flap vs. primary closure and discuss our results.</p><p><strong>Results: </strong>Forty-five patients underwent PE of which 35 patients had colorectal adenocarcinoma, 20 patients received VRAM flaps and 25 underwent primary closure, 11 of whom received mesh reconstruction. Postoperative complications were less frequent in the VRAM group compared with primary closure and we identified 24 patients who developed postoperative pelvic collections (RR = 0.75), 15 who developed deep pelvic infections (RR = 0.31) and 13 who developed superficial perineal wound infections (RR = 0.78). Twenty-three patients experienced major (Clavien-Dindo ≥ 3) postoperative morbidity, 90-day overall survival was 97.8%, and 1-year overall survival was 89.9%.</p><p><strong>Conclusion: </strong>VRAM flaps were associated with a reduced incidence of postoperative collections, deep infections and wound infections. Our results are consistent with existing literature and support VRAM flaps as a safe reconstruction technique to minimise postoperative morbidity following PE.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103362","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":"Intermediate Term Asymmetric Wear of Vitamin E-Infused Polyethylene Following Total Hip Arthroplasty With Resultant Liner Dissociation and Metallosis.","authors":"Tim Cheok, Rachit Srivastava, Marjoree Sehu, Iulian Nusem","doi":"10.1111/ans.70997","DOIUrl":"https://doi.org/10.1111/ans.70997","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103224","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":"Comment on How to Do an Arthrogram Following Open Arthrotomy of the Paediatric Elbow-Indications and Technique.","authors":"Amaim Chaudhary","doi":"10.1111/ans.70993","DOIUrl":"https://doi.org/10.1111/ans.70993","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103275","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 Strangulating Violin String: Closed-Loop Small Bowel Obstruction Through Fitz-Hugh-Curtis Adhesions.","authors":"Vi-Seth Bak, Christopher Darlington, Emma Robertson, Claire Honeyman, Juyong Cheong","doi":"10.1111/ans.70990","DOIUrl":"https://doi.org/10.1111/ans.70990","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103270","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 Benson Relaxation and Progressive Muscle Relaxation Techniques on Pain and Sleep Quality in Patients Undergoing Lobectomy.","authors":"Cemile Aydın, Çağla Toprak","doi":"10.1111/ans.70979","DOIUrl":"https://doi.org/10.1111/ans.70979","url":null,"abstract":"<p><strong>Background/objective: </strong>Pain is one of the most common complications in patients undergoing lobectomy and can negatively affect sleep quality. This study aims to compare the effects of Benson relaxation technique and progressive muscle relaxation exercises on pain and sleep quality in patients who have undergone lobectomy.</p><p><strong>Methods: </strong>This study was conducted as a three-arm, randomized controlled trial involving 180 patients who underwent lobectomy at a hospital in Turkey's Marmara region. The patients were randomly assigned to three groups (60 patients in each group): the Benson relaxation group, the progressive relaxation group, and the control group. Patients in the Benson relaxation and progressive relaxation groups were instructed to perform the exercises twice: once on the first day after surgery and once on the second day after surgery. The control group did not perform any exercises. Pain intensity and sleep quality were assessed at baseline (on the first day after surgery, before the exercise) and re-assessed on the second and third days after surgery.</p><p><strong>Results: </strong>Significant differences were observed between the groups in pain scores on postoperative Days 1, 2, and 3 (p < 0.05). Patients in both exercise groups had lower pain scores on postoperative Day 3 compared to the control group; the lowest pain level was observed in the progressive muscle relaxation group. In terms of sleep quality, significant differences were found between the groups on Days 1 and 3 postsurgery (p < 0.05). Sleep quality was higher in the Benson and progressive relaxation groups than in the control group. The highest sleep quality scores were found in the progressive muscle relaxation group.</p><p><strong>Conclusions: </strong>This study has shown that both the Benson relaxation technique and the progressive muscle relaxation technique may be effective in reducing pain and improving sleep quality in patients who have undergone a lobectomy. However, it has been demonstrated that the progressive muscle relaxation technique is more effective.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103255","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":"Drain Fluid Lipase as a Biomarker for Anastomotic Leak After Colorectal Resection and an Extra-Peritoneal Anastomosis With Omission of a Diverting Ileostomy.","authors":"Muhammad Imran Aumeerally, Imogen Clark, David Alan Clark","doi":"10.1111/ans.70975","DOIUrl":"https://doi.org/10.1111/ans.70975","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leak (AL) is the anathema of colorectal surgery. Early diagnosis is important to enable early intervention. Temporary diverting ileostomy (TDI) does not prevent AL and presents inherent complications. Numerous drain fluid biomarkers have been studied in colorectal surgery and extravasated intraluminal substances such as lipase have shown promise. The aim of this study was to assess drain fluid lipase (DFL) as a biomarker of AL after rectal resection with low colorectal anastomosis and no TDI.</p><p><strong>Methods: </strong>This prospective observational cohort study collected samples of DFL in consecutive patients undergoing rectal resection with low colorectal anastomosis and without TDI. Data were collected and analysed relating to patient demographics, operation, indication, and daily DFL measurements from pelvic drains.</p><p><strong>Results: </strong>Between August 2018 and March 2021, there were 62 patients recruited who met eligibility criteria. Overall, the anastomotic leak rate was 9.7% (6/62). These six patients were assigned to the AL group. The DFL on postoperative day 3 was found to be higher in the AL group compared to the NAL group (p = 0.034). A DFL cutoff threshold of less than 64 U/L was found to have a negative predictive value of 97.6% and a negative likelihood ratio of 0.32 in excluding AL.</p><p><strong>Conclusion: </strong>This is the first study to assess the utility of DFL as a biomarker for AL following colorectal anastomosis without TDI. The measurement of DFL has value as a strong negative predictor of AL and moderate impact on post-test probability. The results are comparable to the use of systemic biomarkers.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103265","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":"Still in Place: Clinical Uncertainty in Intercostal Catheter Removal After Trauma.","authors":"Madeleine C Y Tse, Biswadev Mitra, David J Read, Ee-Jun Ban, Guy Sheahan, Mark C Fitzgerald","doi":"10.1111/ans.70994","DOIUrl":"https://doi.org/10.1111/ans.70994","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103230","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":"Using Motion-Tracking to Objectively Assess Skill in Surgery.","authors":"Tanay Bapna, Samuel J A Robinson, John Valles, Damir Ljuhar, Taiqing Zhang, Paul McIntosh, Maurizio Pacilli, Ramesh M Nataraja","doi":"10.1111/ans.70988","DOIUrl":"https://doi.org/10.1111/ans.70988","url":null,"abstract":"<p><strong>Background: </strong>Surgical assessment often relies on subjective expert observation, which may introduce bias. We aimed to objectively differentiate skill levels in a complex simulated operative procedure using hand-tracking metrics through a wearable mixed reality headset.</p><p><strong>Methods: </strong>A validated paediatric open inguinal herniotomy simulator was used to simulate a surgical task composed of multiple sequential operative steps. Novices (medical students) and experts (paediatric surgeons) were recruited. After completing a pre-task questionnaire, participants performed the task while wearing the mixed reality headset (Microsoft HoloLens 2). A post-task questionnaire was completed. Metrics collected included total path length, average path length, average movement velocity and total time. Data are reported as mean (± SD) and analysis included descriptive statistics, frequency counts and comparative testing using t-tests. A p-value of < 0.05 was considered significant.</p><p><strong>Results: </strong>A total of 33 participants were recruited (9 experts, 24 novices). The expert group had a shorter mean total path length: 287.0 ± 60.0 cm versus 450.1 ± 55.7 cm (p < 0.0001). They also had a shorter mean path length; 71.8 ± 15.1 cm versus 112.5 ± 13.9 cm (p < 0.0001). The expert mean velocity of movement was 0.17 ± 0.07 cm/s versus 0.14 ± 0.02 cm/s in novices (p = 0.13). Experts took less time to complete the task: 458.1 ± 65.8 s versus 836.0 ± 70.0 s (p < 0.0001).</p><p><strong>Conclusions: </strong>This study objectively demonstrated that experts had a more efficient economy of movement and that hand-tracking metrics can differentiate between novice and expert performance during a simulated complex surgical task.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103237","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 Novel Variant of Common Hepatic Artery Absence.","authors":"George Triantafyllou, Daniel Gondorf, Nikolaos-Achilleas Arkoudis, Georgios Velonakis, Maria Piagkou","doi":"10.1111/ans.70996","DOIUrl":"https://doi.org/10.1111/ans.70996","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079551","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":"Combatting Postcode Lottery: A Qualitative Exploration of Staff Perspectives on Rural Surgical Outreach Clinics in Hawke's Bay, Aotearoa New Zealand.","authors":"Sarah Cowan, Korban Hill, Jamie-Lee Rahiri","doi":"10.1111/ans.70991","DOIUrl":"https://doi.org/10.1111/ans.70991","url":null,"abstract":"<p><strong>Background: </strong>Rural communities in Aotearoa New Zealand experience inequitable access to surgical care. Rural surgical outreach clinics aim to reduce geographic and financial barriers by delivering specialist care closer to patients. Healthcare professionals' perspectives on the functioning, value and sustainability of these services remain underexplored.</p><p><strong>Methods: </strong>A qualitative descriptive study was conducted using semi-structured interviews with nine staff members (consultant surgeons, nurses, junior doctors and administrative staff) purposively sampled from general surgical outreach clinics in Waipukurau and Wairoa, Hawke's Bay, Aotearoa New Zealand. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.</p><p><strong>Results: </strong>Five interconnected themes were identified: (1) bringing care to the people-outreach as equity in action; (2) reducing the hidden costs of care; (3) relationships, cultural safety and trust; (4) staff as agents of change and rural outreach champions; and (5) the fragility and sustainability of outreach services. Participants perceived outreach clinics as improving access to specialist care, reducing the practical and financial burden of travel for patients, strengthening relationships with rural and Māori patients and enhancing team cohesion and professional fulfilment. However, outreach services were seen as vulnerable to resource constraints, centralised booking processes, reliance on committed individuals and policy pressures favouring centralisation.</p><p><strong>Conclusion: </strong>Rural surgical outreach clinics form part of a rural and regional model of healthcare that mitigates barriers for patients and the wider health system. Sustaining and scaling these services will require deliberate institutional support and appropriate resourcing.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079708","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}