ANZ Journal of Surgery最新文献

{"title":"Portal annular pancreas: a rare surgical challenge.","authors":"Ferhat Arabaci, Mehrdad Nikfarjam","doi":"10.1111/ans.70098","DOIUrl":"https://doi.org/10.1111/ans.70098","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690861","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":"Fistulotomy versus fistulectomy for simple fistula-in-ano: a systematic review and meta-analysis of randomized controlled trials.","authors":"Rakesh Quinn, Alexandra Peacock, Rebecca J Lendzion","doi":"10.1111/ans.70095","DOIUrl":"https://doi.org/10.1111/ans.70095","url":null,"abstract":"<p><strong>Background: </strong>Perianal fistulas are a common anorectal pathology. The sphincter-cutting techniques of fistulectomy and fistulotomy are associated with high cure rates for low or simple fistula-in-ano, with negligible risk of incontinence. However, the superiority of either technique has not previously been conclusively demonstrated. The aim of this systematic review is to compare the outcomes of the two surgical techniques for the management of simple fistula-in-ano.</p><p><strong>Methods: </strong>A search of MEDLINE, EMBASE and Cochrane Databases for randomized controlled trials (RCT) comparing fistulotomy to fistulectomy for simple fistula-in-ano was conducted. The primary outcome was healing time; secondary outcomes included operative time, length of hospital stay, post-operative pain score, post-operative complications and fistula recurrence.</p><p><strong>Results: </strong>Thirteen RCTs meet inclusion criteria, comprising a total of 685 fistulectomy and 688 fistulotomy patients. There was no significant difference between the techniques for healing time (P = 0.15), operative time (P = 0.13), length of stay (P = 0.05), wound infection (P = 0.97), flatus or faecal incontinence (P = 0.35 and P = 0.70, respectively) or recurrence (P = 0.19). Post-operative pain at 24 h, assessed using a visual analogue scale, was significantly lower in the fistulectomy group (MD-0.49, 95% CI: -0.90, -0.08; P = 0.02), and we found significantly fewer post-operative bleeding complications in the fistulotomy group (OR: 3.81, 95% CI: 1.23, 11.80; P = 0.02).</p><p><strong>Conclusion: </strong>This systematic review did not find conclusive evidence of the superiority of either fistulectomy or fistulotomy in terms of healing time. The two statistically significant findings were lower post-operative pain scores with fistulectomy and reduced post-operative bleeding with fistulotomy.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690779","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":"Telehealth for vascular outpatients may help combat rising healthcare pressures with high levels of patient satisfaction.","authors":"Philip Allan, Finn Roberts-Craig, Richard Evans, Anantha Narayanan","doi":"10.1111/ans.70049","DOIUrl":"https://doi.org/10.1111/ans.70049","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662344","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":"Enteral nutrition versus parenteral nutrition in the management of postoperative pancreatic fistula following pancreaticoduodenectomy: a prospective observational study.","authors":"Rohith Kodali, Kunal Parasar, Utpal Anand, Saad Anwar, Bijit Saha, Basant Narayan Singh, Kislay Kant, Venkatesh Karthikeyan","doi":"10.1111/ans.70096","DOIUrl":"https://doi.org/10.1111/ans.70096","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pancreatic fistula (POPF) presents a significant challenge to oral intake after pancreaticoduodenectomy (PD). Strategies such as enteral feeding via nasojejunal tube, feeding jejunostomy (FJ), and total parenteral nutrition (TPN) are commonly used to optimize postoperative nutrition. However, the routine use of FJ in PD remains controversial. This study assesses the effectiveness of enteral feeding versus TPN in the management of POPF.</p><p><strong>Methods: </strong>A prospective observational study was conducted on 100 patients undergoing classical PD at a tertiary care centre in eastern India between July 2019 and July 2024. Patients were randomly allocated to FJ and non-FJ groups in a 1:1 ratio. The primary endpoints were procedure-related complications (POPF, delayed gastric emptying (DGE), post-pancreatectomy haemorrhage, bile leak, Clavien-Dindo grade ≥ 3), hospital stay, additional costs and 30-day mortality in patients with clinically relevant POPF.</p><p><strong>Results: </strong>Of the 100 patients, 50 underwent routine FJ placement, and 50 did not. Most POPF cases were Grade B (34% versus 24%). Subgroup analysis of patients with clinically relevant POPF revealed that FJ placement significantly reduced fistula duration (3.8 versus 5.2 weeks, P < 0.001), intra-abdominal drain duration (26.4 versus 34.9 days, P < 0.001), hospital stay (7.9 versus 9.9 days, P < 0.001) and cost expenses (1301 ± 524 versus 1982 ± 441, P < 0.001). There were no differences in complication rates, reoperations, readmissions or 30-day mortality. FJ placement was not associated with adverse events.</p><p><strong>Conclusion: </strong>Routine FJ is a safe and cost-effective strategy for PD patients requiring prolonged nutritional support.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656053","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":"Impact of Magseed® localization on re-excision rates of non-palpable breast cancers in an Australian regional hospital","authors":"Madison Bowles MBBS,&nbsp;Su Su Naing MBBS,&nbsp;Guat Shi Ng MBChB, MSc,&nbsp;Emilia Dauway MD, FRACS","doi":"10.1111/ans.70009","DOIUrl":"10.1111/ans.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Impalpable breast cancers have traditionally been localized under hook-wire guidance. Magseed® is an innovative method of breast cancer localization that consists of a tiny paramagnetic seed designed to enable more precise tumour localization and greater scheduling flexibility by decoupling the timing of radiological insertion and surgery. The primary outcome of this study was to evaluate whether the implementation of the Magseed® localization technique in our healthcare facility led to a reduction in re-excision rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single institution retrospective evaluation was carried out for 96 women who underwent Magseed® localization (MSL) between 01 August 2020 and 30 April 2022. To allow direct comparison to the hospitals wire-guided localization (WGL) re-excision rates, data was collected from the Queensland Cancer Registry for patients who underwent WGL excision at our hospital between 01 January 2015 and 30 June 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 105 Magseeds® were inserted in 96 patients with 95% placed within 1 mm of the target lesion. All Magseeds® markers were successfully retrieved. Re-excision rates were 14% and of the re-excisions only 24% (<i>n</i> = 3) had residual tumour in the re-excision specimen. In the preceding 5 years when hook-wires were used as the localization technique, the re-excision rate was 38%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Magseed® technology is a safe and effective pre-operative localization method that has the potential to reduce re-excision rates for non-palpable breast lesions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 3","pages":"512-516"},"PeriodicalIF":1.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646821","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":"Professional indemnity insurance rates for metabolic bariatric surgeons in Australia: survey results.","authors":"Jacob Chisholm, Lilian Kow, Adam Skidmore, Nicholas Williams","doi":"10.1111/ans.70087","DOIUrl":"https://doi.org/10.1111/ans.70087","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623318","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":"30 years of history, evolution, and surgical outcomes of pancreas transplants in a single Australian national pancreatic transplant unit","authors":"David S. C. Soon MBBS (Hons), MSc, FRACS,&nbsp;Dennison Cheung MD, BPharm (Hons),&nbsp;David Scott MD, MS, FRACS,&nbsp;Erwin Yii MD, MS,&nbsp;Alan Saunder MBBS, FRACS,&nbsp;Roger Bell MBBS, FRACS,&nbsp;Stephen Thwaites MBBS, FRACS,&nbsp;William Mulley MBBS, PhD, FRACP,&nbsp;John Kanellis MBBS, PhD, FRACP,&nbsp;Ming Kon Yii MBBS, MPH, FRACS","doi":"10.1111/ans.70059","DOIUrl":"10.1111/ans.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The first pancreas transplant in Australia was performed at Prince Henry's Hospital in 1984 (which subsequently relocated to Monash Medical Centre in 1992) in the setting of a successful pancreas transplant reported from the University of Minnesota in 1966.¹ This study is aimed at reviewing the evolution of surgical technique in pancreas transplants and the surgical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All pancreas transplants were reviewed from 1992 to 2022. The evolution of surgical technique for pancreas transplants were collected. Outcomes include graft associated complications such as graft thrombosis rate, pancreas graft survival rate, and length of stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-four pancreas transplants were done from 1992 to 2001, following that from 2002 to 2022 that number increased to 236 transplants. Venous drainage went from systemic to portal and subsequently reverted to systemic with modification, directly into the inferior vena cava (IVC). The rate of Early pancreatic allograft thrombosis (EPAT) in the institution was (3/18, 17% Common iliac vein (CIV), 3/19, 16% External iliac vein (EIV) and 1/7, 14% Superior Mesenteric Vein (SMV) from 1992 to 2001 and subsequently reduced to 7/119, 5.9% (IVC.) 5/19, 23.3% (CIV), 6/23, 26.1% (EIV), and 10/75, 13.3% (SMV) after modification. The average length of stay of patients in the first cohort was 18.1 days and the subsequent group was 15.5 days. Finally, pancreatic graft survival rates were 77.3% 1-year graft survival and 54.6% 5-year graft survival from 1992 to 2001 and 93.5% 1-year graft survival and 80.6% 5-year graft survival from 2002 to 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pancreas transplants are complex and technically demanding procedures that should be performed within a specialized unit.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 4","pages":"795-800"},"PeriodicalIF":1.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623315","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":"25, 50 and 75 years ago","authors":"Julian A. Smith MBMS, MSurgEd, FRACS","doi":"10.1111/ans.70094","DOIUrl":"10.1111/ans.70094","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 4","pages":"635-636"},"PeriodicalIF":1.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633227","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":"Safety and efficacy of a surgical ambulatory care pathway for superficial abscesses.","authors":"Thomas Coates, Raelene Y M Tan, Yat Cheung Chung, Andrew Gray, Suellyn Centauri, Sarah Martin","doi":"10.1111/ans.70050","DOIUrl":"https://doi.org/10.1111/ans.70050","url":null,"abstract":"<p><strong>Background: </strong>Superficial abscess of the skin is a common emergency presentation often requiring surgical management. Ambulatory Care Pathways (ACPs) are a method that can reduce the burden of this disease on hospital bed pressure by treating patients with superficial abscesses as day cases. We conducted a prospective cohort study to assess the safety and effectiveness of an ACP for patients meeting strict criteria with a superficial abscess.</p><p><strong>Methods: </strong>Data on a new ACP for the management of superficial abscesses was collected for 12 months from June 20th, 2021 and compared to a retrospective control cohort of patients managed on an inpatient care pathway. Primary outcomes were length of inpatient stay and cost of admission, secondary outcomes were delays to theatre, complications, hospital or theatre readmission within 30 days.</p><p><strong>Results: </strong>In total, 151 patient presentations were assessed, 79 in the ACP and 72 in the retrospective cohort. The mean age in our retrospective cohort was 36.3 ± 14.2 years, which was similar to our ACP cohort at 33.2 ± 12.5 (P = 0.16). Both cohorts had similar patient demographics. Inpatient bed days were significantly shorter for ACP patients with a median of 0.30 (IQR 0.20-0.95) days, compared to 1.53 (IQR 1.06-1.70) days for the retrospective cohort (P < 0.001). Both corhorts had similar postoperative complication rates (P > 0.4).</p><p><strong>Conclusion: </strong>Managing selected patients who present out of hours with a superficial abscess using an ambulatory care pathway reduced cumulative inpatient length of stay and resulted in no increase in patient morbidity.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603677","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":"Systemic lupus erythematosus and the risk of thyroid surgery: lessons from tracheal injury.","authors":"Jiahua Chen, Mi Zhang","doi":"10.1111/ans.70051","DOIUrl":"https://doi.org/10.1111/ans.70051","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603681","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}