ANZ Journal of Surgery最新文献

{"title":"Correction of Secondary Chest Wall Deformity After Bentall and Sternal Turnover Procedures: Modified Wang and Wenlin Procedures.","authors":"Shaoyi Zheng, Wenlin Wang, Weiguang Long, Yang Liu, Bin Cai, Juan Luo","doi":"10.1111/ans.70210","DOIUrl":"https://doi.org/10.1111/ans.70210","url":null,"abstract":"<p><p>Secondary chest wall deformities are usually more complex and difficult to correct than primary deformities, especially the secondary chest wall deformity after cardiovascular surgery. This occurs because the severe adhesions in the mediastinum, the risk of bleeding, and the complexity of the deformity increase the difficulty of correcting the deformity. However, by combining the modified Wang procedure and Wenlin procedure, we can overcome these shortcomings.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224106","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":"Pre-Operative Radiological Diagnosis of Appendiceal Neuroendocrine Neoplasms: Implications for Conservative Management of Acute Appendicitis.","authors":"Orit Twito, Shai Ken Dror, Maya Paran, Feda Fanadka, Rachel Chava Rosenblum, Adi Rov, Haim Paran","doi":"10.1111/ans.70174","DOIUrl":"https://doi.org/10.1111/ans.70174","url":null,"abstract":"<p><strong>Background: </strong>Non-surgical treatment of appendicitis carries the risk of missed tumors, such as appendiceal neuroendocrine neoplasms (ANEN), the most common appendiceal tumor. The aim of this study is to identify radiological features of ANEN that will distinguish them from simple acute appendicitis.</p><p><strong>Methods: </strong>Data were extracted from a database of 8327 appendectomies conducted during 2005-2018. Pre-operative computerized tomography (CT) or ultrasound (US) scans of patients with ANEN and a random sample of patients with simple appendicitis were compared. Patients with other appendiceal tumors were excluded. All images were reviewed by a blinded, experienced radiologist.</p><p><strong>Results: </strong>Thirty-five ANEN (20 CT, 15 US) were compared to 50 cases with simple appendicitis (30 CT, 20 US). Age was similar between study groups (33.8 ± 19.2 vs. 35.2 ± 17.9, respectively, p = 0.378); female gender was more prevalent in the ANEN group (65.7% vs. 38.3%, p = 0.017). ANEN size per pathology report was 17.0 ± 13.4 mm, and mesoappendix invasion was evident in 37.1%. Appendiceal diameter, regional lymph node number, and size were similar. Evidence of solid tissue in the appendiceal lumen per CT was more prevalent in the ANEN group compared to controls (7/20 [35%] vs. 2/30 [6.7%], p = 0.0008).</p><p><strong>Conclusions: </strong>Although the majority of ANEN cannot be identified in pre-appendectomy imaging, 35% of cases demonstrate the presence of solid tissue in the appendiceal lumen. This finding may distinguish these patients from those with simple appendicitis and should lead to early surgical intervention, or close and more cautious surveillance if a conservative approach is chosen.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214749","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":"Subperiosteal Implants for Auricular Reconstruction in the Setting of Significant Temporal Bone Defects.","authors":"Yu Jin Jeong, Masako Dunn, Sophie Fleming, Richard Thomas, Dale Howes, Jonathan Clark, Tsu-Hui Low","doi":"10.1111/ans.70201","DOIUrl":"https://doi.org/10.1111/ans.70201","url":null,"abstract":"<p><strong>Background: </strong>While several techniques have been established in the field of auricular reconstruction, these methods are often inadequate in restoring aesthetic function for cases involving significant defects of the temporal bone, particularly after a lateral temporal bone resection for malignancy. This case series describes a novel approach of auricular reconstruction using subperiosteal implants (IPS Implants Craniofacial Epithesis, KLS Martin Group, Tuttlingen, Germany) at an Australian tertiary cancer referral centre.</p><p><strong>Methodology: </strong>The virtual surgical planning (VSP) process and operative technique for subperiosteal implant-retained auricular prosthetic reconstruction in conjunction with a free flap at our institution is described. A retrospective series of cases performed from November 2023 to July 2024 is presented.</p><p><strong>Results: </strong>Three patients underwent auricular reconstruction with subperiosteal implants. Indications for reconstruction included basal cell carcinoma of the auricle (n = 1) and squamous cell carcinoma involving the ear canals (n = 2). Each patient received one subperiosteal implant (n = 3 retention posts per implant framework). Reconstruction was undertaken with an anterolateral thigh free flap (n = 2) or a radial forearm free flap with adipofascial extension (n = 1). No surgical complications or implant losses were observed in our cohort. Two patients underwent successful loading of an auricular prosthesis 4 and 7 months postoperatively, and retained a functional prosthesis on follow-up. One patient unfortunately died of distant disease at 9 months before prosthesis could be fabricated.</p><p><strong>Conclusion: </strong>Our series supports the feasibility of a subperiosteal implant-retained prosthetic auricular reconstruction after a temporal bone resection in the setting of malignancy. It provides opportunity for a reliable and robust aesthetic rehabilitation after oncological resection. Long-term data is required to establish the reliability and long-term quality-of-life outcomes associated with this novel application of this technique.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214750","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 Outcomes of Repair of Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries.","authors":"Samuel J Macalister, Igor E Konstantinov, Tyson A Fricke, Robert G Weintraub, Christian P Brizard, Edward Buratto","doi":"10.1111/ans.70193","DOIUrl":"https://doi.org/10.1111/ans.70193","url":null,"abstract":"<p><strong>Background: </strong>While complete repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCAs) is achieved with low surgical mortality, this condition poses ongoing mid- and late-term mortality. The long-term data for repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries at a single institution are presented in this paper.</p><p><strong>Methods: </strong>We reviewed the outcomes for 100 patients with PA/VSD/MAPCAs who had surgery between January 1987 and July 2018. Two patients were excluded who had palliative surgery not intended to reach a complete repair.</p><p><strong>Results: </strong>Of the 98 patients who were suitable candidates for complete repair, 13% (13/98) had primary complete repair and 64% (63/98) had staged complete repair. Estimated survival at 1, 5, 10, and 20 years of age was 93%, 87%, 81%, and 76%, respectively. The median age of those patients alive at follow-up was 15 (interquartile range 9-21) years. Freedom from reintervention after staged complete repair was 58% at 5 years after complete repair. Ligating or embolizing MAPCAs was associated with a decreased hazard of death in the staged complete repair group (hazard ratio 0.6, p-value 0.04).</p><p><strong>Conclusions: </strong>A strategy of staged complete repair can be used to achieve complete repair and stable long-term survival for patients with PA/VSD/MAPCAs.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198101","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":"Mortality and Major Amputation in Patients With Diabetes-Related Foot Ulcers and Chronic Renal Disease.","authors":"M Beaumont, K Hobson, H Rax, A Sutton, A Hill, D Lindström, A Dean","doi":"10.1111/ans.70194","DOIUrl":"https://doi.org/10.1111/ans.70194","url":null,"abstract":"<p><strong>Background: </strong>This study examines mortality and major limb amputation (MLA) in patients with diabetes-related foot ulcers (DRFU) and renal impairment.</p><p><strong>Methods: </strong>All patients admitted for management of a DRFU between October 2016 and September 2021 at a tertiary hospital in Aotearoa New Zealand (AoNZ) were included and followed until September 2024. Patients were grouped according to renal function: intact renal function; renal impairment with baseline creatinine greater than 150 μmol/L; and requirement for dialysis. Rate of mortality and rate of major limb amputation (MLA) were calculated at 1, 3, 5, and 7 years. Kaplan-Meier probability estimates were utilised to compare the survival and amputation-free survival of the dialysis cohort to the non-dialysis cohort. R Version 4.4.1 and Python were used for statistical analyses.</p><p><strong>Results: </strong>Seven hundred seventy-two patients were admitted for management of a DRFU, of whom 431 (59%) had intact renal function, 160 (27%) had impaired renal function, and 136 (18.7%) required dialysis. The median follow-up was 19.3 months. Patients in the dialysis cohort were younger, median age 64 years, compared to 70 years in the non-dialysis cohort. Mortality rates were significantly higher in the dialysis cohort at 1 (33.8% vs. 17.6%), 3 (58.8% vs. 37.9%), 5 (69.9% vs. 50.5%) and 7 years (87.6% vs. 64.4%) (p < 0.001) with median survival time of 27.1 months compared to 47.7 months (p < 0.001). The MLA rate was significantly higher in the dialysis cohort at each time point: 1 year (31.6% vs. 3.2%), 3 years (36% vs. 7.5%), 5 years (40.5% vs. 12.4%), and 7 years (42.6% vs. 19.6%) (p < 0.001). There was no difference in outcomes between those with renal impairment and intact renal function cohorts, and no difference by ethnicity.</p><p><strong>Conclusion: </strong>AoNZ patients with a DRFU and ESRD on dialysis have significantly higher mortality and major amputation rates, even within the first year of a new admission with a DFRU. Limited life expectancy should be considered when planning interventions for these patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191366","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":"Benign Symptomatic Thyroid Nodules-A Place for a Randomised Trial of Sham Procedure Versus Radiofrequency Ablation?","authors":"Adam Morton","doi":"10.1111/ans.70206","DOIUrl":"https://doi.org/10.1111/ans.70206","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186350","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":"The Impact of Obesity on Intraoperative Complications in Rectal Cancer.","authors":"Simon Xu, Rathin Gosavi, Yigeng Li, James Lim, T C Nguyen, William Teoh, Geraldine Ooi, Vignesh Narasimhan","doi":"10.1111/ans.70190","DOIUrl":"https://doi.org/10.1111/ans.70190","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a growing global health concern and poses significant challenges in rectal cancer surgery. Excess visceral fat can obscure surgical landmarks, complicate dissection, and increase the risk of intraoperative adverse events (iAEs). Despite these recognized difficulties, there is limited objective data quantifying the impact of obesity on intraoperative complications. This study utilizes the CLASSIntra classification system to assess the incidence and severity of iAEs in patients with obesity (BMI ≥ 30 kg/m²) undergoing rectal cancer resection.</p><p><strong>Methods: </strong>This retrospective cohort study reviewed patients undergoing rectal cancer resection between January 2014 and December 2023. Patients were stratified into groups by BMI (obese (BMI≥ 30 kg/m²) versus non-obese (BMI < 30 kg/m²)). The primary outcome was the incidence and severity of iAEs, graded using the CLASSIntra system. Secondary outcomes included conversion to open surgery, postoperative complications, ICU admissions, and overall length of stay.</p><p><strong>Results: </strong>There were 350 patients included (112 obese, 238 non-obese). There were significantly more iAEs in the obese group (40% vs. 26%, p = 0.010). Obesity was an independent predictor of intraoperative complications (OR 1.92, p = 0.010). Conversion to open surgery (27% vs. 40%, OR 2.30, p = 0.0100) and ICU readmission (50% vs. 31%, OR 2.35, p = 0.003) were significantly more common in patients with obesity. There were no significant differences in postoperative complication rates and hospital length of stay between groups.</p><p><strong>Conclusion: </strong>Obesity leads to a higher risk of intraoperative complications in rectal cancer surgery, increased conversion rates, and greater ICU resource utilisation. These findings highlight the technical challenges of rectal surgery in obese patients and emphasize the need for tailored preoperative planning, prehabilitation, and intraoperative strategies. Despite these intraoperative difficulties, structured postoperative care appears to mitigate differences in postoperative outcomes. Further research should explore preoperative interventions, such as weight optimization programs, to improve surgical outcomes in this high-risk population.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186355","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":"The Impact of Metachronous Colorectal Neoplasia Requiring Surgery After Cessation of Colonoscopic Surveillance at Age 75.","authors":"Ammar Manasawala, John Woodfield, Kari Clifford, Mark Thompson Fawcett","doi":"10.1111/ans.70199","DOIUrl":"https://doi.org/10.1111/ans.70199","url":null,"abstract":"<p><strong>Background: </strong>To assess the clinical and financial impact of metachronous colorectal neoplasia (MCRN) requiring surgery after cessation of colonoscopic surveillance at age 75.</p><p><strong>Methods: </strong>The Otago Clinical Audit database was interrogated to identify all colorectal neoplasia (CRN) resections between January 2020 and November 2022 and additional patients undergoing surgery for MCRN aged ≥ 75 (MCRN ≥ 75) between 2010 and 2020. The morbidity, hospital stay, and costs of surgery for MCRN ≥ 75 cases were compared to first colorectal neoplasia (FCRN) cases ≥ 75 and to all other colorectal resections, with and without propensity matching.</p><p><strong>Results: </strong>MCRN was identified in 3.1% of patients < 75 and 13.1% of patients ≥ 75. Identifying a further 41 patients with surgery for MCRN ≥ 75 after 2010 resulted in 55 patients with MCRN aged ≥ 75, 93 with FCRN aged ≥ 75, and 130 with CRN aged < 75. The median(IQR) age for MCRN ≥ 75 was 81 (78-86). Surgery for MCRN ≥ 75 compared to FCRN ≥ 75 resulted in complication rates of 70.9% and 50.5% (p = 0.024), hospital stay nine versus seven days (p = 0.012), readmissions 20% versus 6.5% (p = 0.026) and cost of NZD 31 021 versus 24 157 (p = 0.028). When compared to all other resections, and adjusting for different approaches to rectal cancer in elderly patients, these differences all increased. The estimated annual hospital cost for MCRN ≥ 75 surgery was NZD 317 777.</p><p><strong>Conclusion: </strong>MCRN accounted for 13.1% of operations in patients aged ≥ 75. This resulted in more morbidity and cost than surgery for FCRN ≥ 75. Stopping surveillance of those with previous surgery for CRN at 75 years of age results in significant institutional cost and patient morbidity.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186354","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":"Acute Type-A Aortic Dissection in Hunter New England-A 10-Year Regional Australian Experience.","authors":"Ayesh Rathnayake, Apoorva Saboo, Olivia Chang, Takuya Narita, Rosauro Mejia","doi":"10.1111/ans.70181","DOIUrl":"https://doi.org/10.1111/ans.70181","url":null,"abstract":"<p><strong>Background: </strong>Acute aortic dissection (AD) is a surgical emergency with significant mortality without prompt diagnosis and operative intervention. The management is time critical, and regional Australia represents an area of interest owing to its large distances and often paucity of resources. No previous studies examining Type-A AD in regional Australia have been done. The aim of this study is to describe acute Type-A AD within a regional population of Australia. The primary outcomes were incidence and mortality. The secondary outcomes were assessment of risk factors, challenges in diagnosis, and associated complications.</p><p><strong>Methods: </strong>A retrospective analysis was undertaken in the Hunter New England (HNE) health district of New South Wales (NSW) from 2010 to 2020. A total of 122 patients with an ICD-10 diagnosis of Type-A AD were included in the study. The data was analysed using the statistical package for the social sciences (SPSS). Odds ratio and 95% confidence interval (CI) were reported, and statistical significance was assumed at p < 0.05.</p><p><strong>Results: </strong>The incidence of Type-A AD in the HNE was 1.27 per 100 000 and overall mortality was 14.5%. Five percent of patients identified as Aboriginal and Torres Strait Islander. Combined risk factors of smoking and hypertension, postoperative CVA, and misdiagnosis demonstrated higher mortality which was statistically significant (p < 0.05).</p><p><strong>Conclusion: </strong>This study is the first study to illustrate Type-A AD in regional Australia. The findings reported here present a solid foundation for future studies to better understand the challenges faced in the diagnosis and management of AD.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186349","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":"The Growing Role of Artificial Intelligence in Surgical Education: ChatGPT Undertakes the Australian Generic Surgical Sciences Examination.","authors":"Allen Ao Guo, Ashan Canagasingham, Krishan Rasiah, Venu Chalasani, Julie Mundy, Amanda Chung","doi":"10.1111/ans.70186","DOIUrl":"https://doi.org/10.1111/ans.70186","url":null,"abstract":"<p><strong>Background: </strong>Large language models have undergone vast development in recent years. The advent of large language models such as ChatGPT may play an important role in enhancing future medical education.</p><p><strong>Methods: </strong>To evaluate the accuracy and performance of ChatGPT in the Generic Surgical Sciences Examination, we constructed a sample examination used to assess ChatGPT. Questions were sourced from a past questions bank and formatted to mirror the structure and layout of the examination. The performance of ChatGPT was assessed based on a predefined answer key recorded earlier.</p><p><strong>Results: </strong>ChatGPT scored a total of 468 marks out of a maximum total of 644 marks, scoring a final percentage of 72.7% across all sections tested. ChatGPT performed best in the physiology section, scoring 77.9%, followed by pathology, scoring 75.0%, and scored lowest in the anatomy section with 66.3%. When scoring was analyzed by question type, it was identified that ChatGPT performed best in the type \"A\" questions (multiple choice), scoring a total of 75%, which was followed closely by its performance in type \"X\" questions (true or false), where ChatGPT scored 73.2%. However, ChatGPT only scored 43.8% when answering type \"B\" questions (establishing a relationship between two statements).</p><p><strong>Conclusion: </strong>Our results demonstrate that ChatGPT completed the Generic Surgical Sciences Examination with accuracy exceeding the required threshold for a pass in this examination. However, the large language model struggled with certain question types and sections. Overall, further research regarding the utility of ChatGPT in surgical education is required, and caution should be exercised with its use, as it remains in its infancy stages.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186353","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}