ANZ Journal of Surgery最新文献

{"title":"Routine Preoperative Oesophagogastroduodenoscopy Before Roux-en-Y Gastric Bypass: A Retrospective Cohort Analysis From Queensland, Australia.","authors":"Rija Amer, Muhammad Shehryar","doi":"10.1111/ans.70995","DOIUrl":"https://doi.org/10.1111/ans.70995","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073247","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":"Cost-Utility Analysis of Wireless Versus Catheter-Based Oesophageal pH Monitoring in the Pre-Operative Assessment of Anti-Reflux Surgery: A Decision-Analytic Model.","authors":"Du H Phan, Naomi Moy, Iain G Thomson, Adam J Frankel","doi":"10.1111/ans.70983","DOIUrl":"https://doi.org/10.1111/ans.70983","url":null,"abstract":"<p><strong>Background: </strong>Distal oesophageal pH testing is an important component of the pre-operative workup for anti-reflux surgery, providing diagnostic confirmation and prognostic information. Catheter-based reflux testing is currently the standard modality in Australia. Although associated with improved patient tolerability, wireless testing remains limited by access and funding restrictions.</p><p><strong>Methods: </strong>A cost-utility analysis was conducted to compare the cost-effectiveness of wireless versus catheter-based reflux monitoring before anti-reflux surgery. Health service costs (administrative, labour, and equipment) and EuroQol 5-Dimension-derived utility weights were used to calculate incremental costs per quality-adjusted life-year (QALY) over a one-year time horizon.</p><p><strong>Results: </strong>Wireless pH monitoring was associated with marginally lower costs and higher QALYs compared with catheter-based monitoring (AUD $11001.51 vs. AUD $11210.47; 0.87 vs. 0.82 QALYs). The base-case incremental cost-effectiveness ratio was -AUD $5026.64 per QALY, indicating that wireless monitoring was the dominant strategy. At a willingness-to-pay threshold of AUD $50 000 per QALY, the incremental net monetary benefit was AUD $2287.47, indicating potential cost-effectiveness. One-way sensitivity analyses suggested that base-case findings were robust across key parameter variations.</p><p><strong>Conclusion: </strong>Within this model evaluating the pH testing component of the pre-operative work-up, wireless monitoring may represent a cost-effective alternative to catheter-based monitoring without substantially increasing healthcare costs.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073234","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 Laparoscopic Iliac Lymph Node Biopsy Under Indocyanine Green (ICG) Guidance.","authors":"Hong Xiang Lee, Julian Soares, Zi Qin Ng","doi":"10.1111/ans.70992","DOIUrl":"https://doi.org/10.1111/ans.70992","url":null,"abstract":"<p><p>Isolated abdominal lymphadenopathy can be difficult to diagnose when lesions are inaccessible to percutaneous biopsy. We describe a laparoscopic common iliac lymph node biopsy performed using indocyanine green (ICG) fluorescence guidance. A 67-year-old woman with bilateral lower limb oedema was found to have an FDG-avid right common iliac lymph node causing ureteric compression and deep venous thrombosis. Following ultrasound-guided inguinal node ICG injection, near-infrared fluorescence imaging enabled localisation of the target node. Intravenous ICG further delineated adjacent iliac vessels, facilitating safe dissection and biopsy. Histology demonstrated reactive follicular hyperplasia. ICG fluorescence imaging may improve the safety and accuracy of laparoscopic intra-abdominal lymph node biopsy.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069368","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":"Prostate Abscess Following the 2025 Far North Queensland Floods: Implications for Rural Surgical Practice During a Melioidosis Outbreak.","authors":"John Peacey, Clement Tan, Simon Pridgeon","doi":"10.1111/ans.70989","DOIUrl":"https://doi.org/10.1111/ans.70989","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Natural disasters increasingly challenge healthcare systems through both direct injury and secondary infectious disease outbreaks. Following severe flooding in Far North Queensland in early 2025, Australia experienced one of its largest documented outbreak of melioidosis. Prostate abscess is an uncommon but potentially life-threatening manifestation of disseminated melioidosis and presents unique diagnostic and management challenges, particularly in rural and remote communities. This study aimed to describe the presentation, management and outcomes of prostate abscesses occurring during the 2025 flood-associated melioidosis outbreak and to explore the implications for rural surgical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective observational cohort study was conducted of all patients undergoing drainage of a radiologically confirmed prostate abscess at Cairns Hospital, the tertiary referral centre for Far North Queensland and the Torres Strait, between 1 January and 1 August 2025. Demographic, clinical, microbiological, radiological and perioperative data were collected from electronic medical records.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nineteen prostate abscess drainage procedures were performed during the study period. Mean age was 66 years (range 40-88 years). Five patients (26%) identified as Aboriginal and/or Torres Strait Islander and six (32%) required transfer from rural or remote hospitals. All patients had at least one recognised risk factor for severe melioidosis, including diabetes mellitus, hazardous alcohol use, smoking, chronic kidney disease, chronic lung disease or malignancy. Burkholderia pseudomallei was isolated in 12 patients (63%) and represented the predominant causative organism. Lower urinary tract symptoms were present in all patients; however, clinical presentation was heterogeneous and frequently included non-urological symptoms. Digital rectal examination was non-tender in all cases and fluctuance was identified in only six patients (32%). Concurrent extra-prostatic infection occurred in 16 patients (84%), most commonly pulmonary involvement. Four patients required intensive care admission and two patients died from disseminated melioidosis despite surgical drainage and intensive medical management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The 2025 Far North Queensland floods were associated with a marked increase in melioidosis-related prostate abscesses, highlighting the downstream surgical consequences of climate-related natural disasters. Clinical presentation was variable and traditional examination findings lacked sensitivity. Rural clinicians practising in endemic regions should maintain a high index of suspicion, facilitate early cross-sectional imaging and expedite referral to specialist surgical services. The disproportionate burden observed among rural and First Nations patients highlights ongoing inequities in access to healthcare and vulnerability to tropical infectious","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149057327","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":"Left Behind After Impact: The Hidden Toll of Trauma Recovery in New Zealand","authors":"Sarah Logan,&nbsp;Duncan Finlayson,&nbsp;Nikita Quinn,&nbsp;Daniel Jemberie,&nbsp;Laura R. Joyce,&nbsp;Andrew McCombie,&nbsp;Christopher Wakeman","doi":"10.1111/ans.70722","DOIUrl":"10.1111/ans.70722","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Major trauma recovery extends beyond physical healing, with psychological outcomes and patient experiences influencing long-term well-being. This study explored trauma survivors' experiences of follow-up care and Accident Compensation Corporation (ACC) in New Zealand, and how these relate to psychological distress and social support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted at Christchurch Hospital using New Zealand Major Trauma Registry data (May 2016–March 2020, Injury Severity Score ≥ 12). In 2020, eligible patients were invited to complete a follow-up survey including DSM-5—aligned screeners for PTSD, anxiety, and depression, questions on follow-up care and ACC, and a validated social support scale. Associations were assessed with chi-square and Mann–Whitney <i>U</i> tests; free-text responses underwent thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 415 eligible patients, 134 (32.3%) responded. Issues accessing follow-up care were reported by 20 patients (14.9%), and ACC-related challenges by 33 (24.6%). Thematic analysis identified insufficient follow-up, lack of mental health support, communication gaps, and premature return-to-work expectations. Psychological morbidity was strongly associated with reported difficulties: patients screening positive for PTSD, anxiety, or depression were 3–5 times more likely to report problems with follow-up or ACC (all <i>p</i> &lt; 0.001). Lower perceived social support was also significantly associated with increased reported difficulties (<i>p</i> = 0.01–0.03). Injury severity and ICU admission were not associated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Mental health symptoms and poor social support were strongly linked to dissatisfaction with trauma follow-up and ACC processes. Routine psychological screening, improved communication, and coordinated support may enhance recovery outcomes in New Zealand's no-fault trauma system.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2353-2360"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70722","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832886","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":"The Influence of Gender on Publication Outcomes in Postgraduate Surgical Research: A 12-Year Cohort Study","authors":"Chan Ho Kim,&nbsp;Nazim Bhimani,&nbsp;Anthony R. Glover,&nbsp;May Thwin,&nbsp;Chaiwei Tong,&nbsp;Cindy Xu,&nbsp;USYDSurgEd Collaborative Group,&nbsp;Meet Patel","doi":"10.1111/ans.70837","DOIUrl":"10.1111/ans.70837","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Historically, systemic barriers have limited women's participation in surgical training and academia. Whilst the representation of women among surgical trainees has increased globally, continued examination of gender inequality within surgical academia is necessary to ensure holistic and sustainable diversity. This study explored the association between student and supervisor gender and research outcomes and assessed temporal trends in gender representation within a postgraduate surgery coursework degree.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted among students who completed the Master of Surgery dissertation subject at The University of Sydney between 2010 and 2021. Data included dissertation mark, publication rate, time to publication, citation count, journal impact factor and total publications within 2 years. Outcomes were compared by student and supervisor gender, and student–supervisor dyads, using Mann–Whitney <i>U</i>, chi-squared and Kruskal–Wallis tests. Temporal trends were analysed using regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 424 students were included (305 men, 119 women). Dissertation mark and short-term research outcomes did not differ by student gender with both having a median of one publication. Students supervised by men had higher dissertation publication rates (56% vs. 30%, <i>p</i> &lt; 0.001) and more publications within 2 years (median 1 vs. 0, <i>p</i> = 0.009) than those supervised by women. Woman–woman student–supervisor dyads were less likely to publish their dissertation (29%) than man–man (57%) and woman–man dyads (53%) (<i>p</i> = 0.006). While the number of women supervisors increased over time, the number of women students and the proportional representation of women students and supervisors remained unchanged.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Academic performance and short-term research outcomes were similar by student gender, suggesting that disparities in surgical training and academia are unlikely to be explained by differences in academic capability or early research productivity. Differences associated with supervisor gender and persistent under-representation highlight ongoing structural influences on academic productivity, and the need for sustained, system-level equity initiatives across the surgical training pipeline.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2284-2291"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70837","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418109","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":"Foundation of the International Collaborative of Surgical Education and Training (ICOSET)","authors":"John P. Collins,&nbsp;Adrian Anthony","doi":"10.1111/ans.70866","DOIUrl":"10.1111/ans.70866","url":null,"abstract":"&lt;p&gt;Born of necessity and developed by consensus, the concept of an International Collaboration of Surgical Educators and Trainers (ICOSET) was first agreed at an inaugural conference in Melbourne in 2008. ICOSET was founded to provide a forum where surgical educators from around the globe could come together to share the issues they faced, discuss possible solutions and learn about new innovations in medical education. Transforming this aspiration into a reality required a formal structure and business plan, and a host organisation willing to underwrite these conferences. The inherent difficulties in achieving these requirements resulted in an ad hoc arrangement of finding organisations and convenors willing to organise the subsequent conferences, until a not-for-profit organisation partnered with the International Society of Surgery (ISS) was established in 2025. This article provides a brief history of the foundation of ICOSET and the subsequent challenges experienced in transforming the original concept into a sustainable reality.&lt;/p&gt;&lt;p&gt;Informal discussions between those responsible for the education and training of surgeons in different countries demonstrated the remarkably similar challenges being encountered. After decades of stability, an increasing number of factors began to affect the traditional methods used for training surgeons. These condensed into three main factors: generational challenges, regulatory and accountability requirements and competency-based training. New directions of medical schools changed the demography of their student population and modified the content of the curriculum. The introduction of short-stay and ambulatory care, and of minimally invasive operations, changed the practice of surgery. Safe working hours, an increasing regulatory environment and advances in educational methods including surgical skills laboratories began to question whether the traditional apprenticeship model for training surgeons remained appropriate or in need of major reform. In addition, an increasingly litigious world demanded more transparent and defensible methods for the selection of surgical residents and their subsequent assessment. It had also become clear that greater recognition and support were required to sustain appropriately equipped surgical teachers. Furthermore, surgeons voiced concerns that the existing conferences they had attended on medical education failed to cater for their specific needs. These factors were compounded by the simultaneous increase in public demands for greater accountability regarding the adequacy of surgical services being provided to the community.&lt;/p&gt;&lt;p&gt;At the commencement of the 21st century, the Royal Australasian College of Surgeons (RACS), which is responsible for the selection, training, assessment and certification of surgeons in Australia and New Zealand, began to experience unprecedented criticisms and negative public press relating to its educational practices and processes including s","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2260-2263"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454444","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":"Establishing a Pre-Vocational Surgical Society: Early Experience, Outputs and Educational Value","authors":"Jack Gerrard,&nbsp;Teresa Liew,&nbsp;Alexandra Stathis","doi":"10.1111/ans.70846","DOIUrl":"10.1111/ans.70846","url":null,"abstract":"&lt;p&gt;Developing a skilled future surgical workforce requires engagement across the continuum of medical training. The prevocational period includes work after completion of basic medical qualifications before entry into a formal training pathway, such as the Royal Australasian College of Surgeons (RACS) Surgical Education and Training (SET) program. While medical student surgical societies may foster early interest in surgery, structured engagement after medical school until gaining entry into surgical training remains variable [&lt;span&gt;1&lt;/span&gt;]. In Australia and Aotearoa New Zealand, the transition from medical graduate to junior doctor represents a critical phase where clinicians consolidate clinical skills, refine career intentions and begin preparing for competitive specialty training [&lt;span&gt;2-4&lt;/span&gt;]. However, targeted surgical education, mentorship and professional development outside clinical rotations is often limited [&lt;span&gt;3-6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In response, the Pre-Vocational Australasian Surgical Society (PVASS) was established to support doctors interested in surgery across Australia and Aotearoa New Zealand. This article outlines the rationale for its inception, reviews early activities and considers its educational value within surgical training and governance frameworks.&lt;/p&gt;&lt;p&gt;Prevocational doctors encounter inconsistent surgical exposure, which is often service-oriented, with variable support and access to protected teaching time [&lt;span&gt;1, 5-8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Additionally, prevocational doctors in Australia and Aotearoa New Zealand are spending more years progressing through internship, residency and unaccredited registrar roles before commencing surgical training [&lt;span&gt;7-11&lt;/span&gt;]. Preparation for surgical training remains costly with estimates reporting successful candidates may spend over $50 000 AUD on examinations, courses and professional development [&lt;span&gt;12, 13&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;A prevocational society addresses the need for sustained mentorship, career guidance and equitable access to educational opportunities and professional development, through providing a collective voice for prevocational doctors navigating this prolonged, uncertain and increasingly complex transition into specialty training [&lt;span&gt;10, 14, 15&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;PVASS was founded in 2021 with early engagement from surgical trainees, consultants and RACS. The society's founding objectives were to: provide accessible surgical education to prevocational doctors; facilitate mentorship and networking; support early career development, including research and training preparation; and advocate for prevocational doctors within RACS frameworks and hospital networks.&lt;/p&gt;&lt;p&gt;Since its inception, PVASS has become a registered charity with the Australian Charities and Not-for-profits Commission. The organisation has benefited from the contributions of 44 volunteers, reflecting broad engagement and sustainability. Governance includes an executive committee that reports to a ","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2256-2259"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70846","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410159","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":"When Success Makes Experience Scarce: Trauma Laparotomy, System Maturity, and the New Readiness Challenge","authors":"Dieter G. Weber,&nbsp;Li Hsee","doi":"10.1111/ans.70758","DOIUrl":"10.1111/ans.70758","url":null,"abstract":"&lt;p&gt;The contemporary management of abdominal trauma is one of modern surgery's quiet successes. Advances in rapid computed tomography, haemostatic resuscitation, interventional radiology and protocolised selective non-operative management (SNOM) have transformed a procedure that was once routine into one performed sparingly and with precision. In this issue, Noonan and colleagues document exactly this evolution in a 23-year analysis from The Alfred Hospital, Melbourne [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Their trauma registry study of 25 497 major trauma patients (Injury Severity Score &gt; 12) between 2001 and 2024 shows emergency laparotomy rates falling from 10.7% to 2.7% of all major trauma admissions despite trauma volume more than doubling and abdominal injury burden rising. Solid organ embolisation increased significantly, while laparoscopy remained uncommon. The decline was most pronounced in blunt trauma, which comprised 93.8% of the cohort, and persisted in sensitivity analyses using abdominal injury burden as the denominator. Although causation cannot be assigned to individual process changes, the pattern is strongly consistent with the maturation of imaging enabled, selective and multidisciplinary trauma care.&lt;/p&gt;&lt;p&gt;The reduction in trauma laparotomies is not a reflection of diminished surgical relevance; it is the hallmark of an evolving and mature trauma system. Laparotomy was historically both diagnostic and therapeutic because exploration was the only reliable way to identify intra-abdominal injury. Modern imaging now provides immediate, high-resolution characterisation, enabling confident SNOM for most solid-organ injuries in stable patients without peritonitis [&lt;span&gt;2&lt;/span&gt;]. This approach is successful in the large majority of appropriately selected cases and endorsed by international guidelines [&lt;span&gt;3-5&lt;/span&gt;]. Interventional radiology has further expanded the non-operative options. Consequently, laparotomy is now reserved for the minority with physiological instability, uncontrolled haemorrhage, hollow-viscus injury, failed SNOM or complex multisystem trauma. The case mix has shrunk, but the stakes have risen.&lt;/p&gt;&lt;p&gt;This success creates a paradox: by avoiding unnecessary laparotomies, we have reduced routine operative exposure. Surgeons have become victims of our own progress. The very procedure that once built capability is now uncommon precisely because care has improved. Operative readiness is therefore no longer a byproduct of service volume; it is a deliberate systems obligation. In Australia and New Zealand, where trauma is distributed unevenly across large geographies and variable hospital settings, some centres will retain meaningful exposure while others will see these operations become almost vanishingly rare [&lt;span&gt;6&lt;/span&gt;]. Passive reassurance that ‘experience will somehow persist’ is insufficient.&lt;/p&gt;&lt;p&gt;Maintaining surgical leadership in this highly visible domain of acute care remains essential. Trauma surgery in Austra","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2248-2249"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70758","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986289","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":"Efficacy and Safety of Anal High-Grade Squamous Intraepithelial Lesion Treatment Modalities: A Systematic Review","authors":"Matthew Joseph Marino,&nbsp;Sophie Jones,&nbsp;Nicholas Reid Caldwell,&nbsp;Catherine Cartwright,&nbsp;Benedict Blacket,&nbsp;Richard Clive Turner","doi":"10.1111/ans.70738","DOIUrl":"10.1111/ans.70738","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is compelling evidence that treating high-grade squamous intraepithelial lesions (HSIL), the anal squamous cell cancer (ASCC) precursor, reduces the risk of developing ASCC. Using high-resolution anoscopy (HRA), surgical excision, ablative and topical therapies are widely used to treat HSIL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>With ASCC incidence increasing and new guidelines on screening high-risk patients, we sought to evaluate the efficacy and safety of HSIL treatment modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources</h3>\u0000 \u0000 <p>EMBASE, MEDLINE, and Cochrane databases were searched for English-language, original studies specifically on HSIL or anal intraepithelial neoplasia (AIN) treatment from inception until December 31, 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Review Methods</h3>\u0000 \u0000 <p>Two reviewers independently reviewed abstracts and full-text articles with a third reviewer for discrepancies. Studies were evaluated for efficacy, recurrence and safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-four original papers were evaluated, of which five were randomised controlled trials (two directly comparing different modalities). Numbers in each study and overall quality were low, and extensive heterogeneity existed in methodology. Side effects were common, but significant complications only occurred with surgical excision and photodynamic therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is insufficient evidence to clearly identify any gold standard HSIL treatment modality. Regardless of the modality, treatment overall is safe, but recurrence is high. Studies directly comparing modalities with standardisation of methodologies and outcome measures are required, especially in light of increasing incidence of ASCC and up-take of HRA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2339-2352"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70738","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925859","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}