ANZ Journal of Surgery最新文献

{"title":"The cyst of the canal of nuck: a great mimicker of groin hernia in female.","authors":"Imen Ben Ismail, Marwen Sghaier, Saber Rebii, Hakim Zeznaidi, Ayoub Zoghlami","doi":"10.1111/ans.19259","DOIUrl":"https://doi.org/10.1111/ans.19259","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379913","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":"Early detection of colonic anastomotic leak.","authors":"Claudia Paterson, Andrew G Hill","doi":"10.1111/ans.19243","DOIUrl":"https://doi.org/10.1111/ans.19243","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339948","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":"Where the rubber meets the road: pearls and pitfalls of implementing competency-based assessment","authors":"Julia Adriana Kasmirski MD, Christopher Wu MD, Brenessa Lindeman MD, MEHP","doi":"10.1111/ans.19246","DOIUrl":"10.1111/ans.19246","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 11","pages":"1906-1909"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339964","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":"Standard v mini percutaneous nephrolithotomy in the supine modified lithotomy position: a randomized pilot study on 10-25 mm stones.","authors":"Philip McCahy, Anthony Dat, Daniel Gilbourd, Eldho Paul, Shekib Shahbaz","doi":"10.1111/ans.19227","DOIUrl":"https://doi.org/10.1111/ans.19227","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous nephrolithotomy (PCNL) is the recommended treatment for stones >2 cm in size. The majority of PCNL are still conducted with larger telescopes using tracts up to 30F in size. We have conducted a randomized pilot study comparing mini PCNL with our standard 22F PCNL for renal stones between 10 and 25 mm in diameter.</p><p><strong>Methods: </strong>Patients were randomized to either PCNL (24F Amplatz sheath/22F nephrosocope) or mini PCNL (18F Amplatz sheath/11F nephroscope). All operations were performed in the modified supine position. Patients were reviewed with imaging to assess stone clearance and complications.</p><p><strong>Results: </strong>Eighteen well matched patients were randomized. All procedures were completed as planned and all were tubeless with no complications. There were no differences in operative time, analgesia requirements or length of stay. Seven of nine (77.75%) standard PCNL were completely stone free at CT review with a 2 mm and a 5 mm fragments in the other patients. Four (44.4%) of the mini PCNL group were stone free, with stone fragments 4-10 mm remaining in the others. 40 patients/arm would be required for an adequately powered study.</p><p><strong>Conclusion: </strong>There was no advantage in using mini PCNL compared to our standard 24F PCNL in this pilot study. There may be benefits in using mini PCNL compared to the more widely used 30F PCNL and it may be a more cost-effective alternative to laser pyeloscopic stone procedures.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339963","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":"Cystic pancreatic neuroendocrine tumour (cPNET): a diagnostic conundrum","authors":"Vibhu Jain MBBS, MS,&nbsp;Debajyoti Chatterjee MBBS, MD,&nbsp;Harish Bhujade MBBS, MD,&nbsp;Kailash Chand Kurdia MS, MCh","doi":"10.1111/ans.19251","DOIUrl":"10.1111/ans.19251","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 11","pages":"2084-2086"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339947","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":"Pointing to success: a discussion of the role of professional achievements in the selection of specialist surgical trainees","authors":"Daniel Jesudason,&nbsp;Thomas Muecke,&nbsp;Hugo Walker,&nbsp;Stephen Bacchi MBBS, PhD,&nbsp;Robert Casson MBBS, PhD, FRANZCO,&nbsp;Weng Onn Chan MBBS, FRANZCO","doi":"10.1111/ans.19247","DOIUrl":"10.1111/ans.19247","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In Australia and New Zealand, competitive selection processes for surgical specialty training programs often use a standardized curriculum vitae (CV) to assess criteria such as professional achievements. This review aims to assess the predictive validity, standardization, and implicit biases of these selection methods, as well as their implications for trainees and the diversity of surgical cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 2023 CV scoring criteria were collected for all available specialty surgical programs in Australia and New Zealand. In 2023, each of the 11 surgical craft programs published publicly available standardized CV scoring criteria. In this study, scored items that constitute ‘professional achievements’ were recorded and tabulated. Observational analysis of the collected data was then conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2023, each of the 11 specialty surgical craft programs published publicly available structured CVs, of which 10/11 allocated points for professional achievements. Designated points for professional achievements were classified as awards, scholarships, committee positions, and prior training courses: 4/11 programs offered points for scholarships/grants, 6/11 programs offered points for academic and/or non-academic prizes, and 8/11 programs offered points for professional development courses. Observational analysis of these findings suggests that professional achievements are desired in training program applicants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Variability in medical school opportunities and inherent heterogeneity reduce the CV's efficacy, unfairly disadvantaging some applicants. Observational analysis of hence highlights the need for future research to assess potential updates in CV parameters to enhance predictive validity, reduce bias, and promote diversity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 11","pages":"2000-2006"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.19247","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339961","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":"Provision and outcomes of publicly funded bariatric surgery in a metropolitan versus a provincial population of New Zealand","authors":"Henry Witcomb Cahill MbChB, MHSc,&nbsp;Matthew McGuinness MBChB, MHSc,&nbsp;Jamie Struthers MBChB,&nbsp;Ian Bissett MBChB, MD, BSC, FRACS,&nbsp;Christopher Harmston MBChB, FRACS (GS)","doi":"10.1111/ans.19206","DOIUrl":"10.1111/ans.19206","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Obesity is an important health problem worldwide. The prevalence of obesity in Aotearoa New Zealand (AoNZ) is the third highest amongst OECD countries. Previous studies have demonstrated inequity in the provision of bariatric and metabolic surgery (BMS) across AoNZ, but detailed data regarding patients and surgical outcomes is lacking. The aim of this study is to examine the rates and outcomes of BMS between patients domiciled in a metropolitan versus provincial area in AoNZ.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 5-year retrospective observational cohort study of all patients who received BMS domiciled in a metropolitan or a provincial area in the Northern region of AoNZ was performed. Interrogation of patient electronic medical records and clinical notes was performed to collect the required baseline characteristics, secondary outcome measure data and confirm domicile.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The rate of BMS was 6.1 times higher in the population with class III obesity domiciled in the metropolitan versus the provincial population. Patients in the metropolitan area were less obese, had lower rates of diabetes and had a wider range of procedures performed. Māori were underrepresented in both cohorts. There was a higher resolution of diabetes in the provincial patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study has highlighted significant differences in the rate, type and outcomes of BMS between a metropolitan and provincial area in the Northern region of AoNZ. This represents a significant health inequity. Changes in national and regional policies are needed to ensure equitable care for patients with obesity in AoNZ.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 10","pages":"1747-1751"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339962","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":"Effectiveness of combined botulinum toxin and fissurectomy on chronic anal fissures - a systematic review.","authors":"Rakesh Quinn, Giuleta Jamsari, Gary Kk Low, Sinan Albayati","doi":"10.1111/ans.19248","DOIUrl":"https://doi.org/10.1111/ans.19248","url":null,"abstract":"<p><strong>Background: </strong>Anal fissures are a debilitating benign condition, thought to be due to the hypertonicity of the internal anal sphincter resulting in localized ischaemia inhibiting healing. There are several surgical and non-surgical treatment options for chronic anal fissures. Clinical practice surveys report a trend toward sphincter-sparing options, reserving the more successful treatment of lateral sphincterotomy, with an incontinence rate up to 10%, for refractory fissures.</p><p><strong>Methods: </strong>A search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE for studies assessing sphincter-sparing treatment with botulinum toxin and fissurectomy was performed following PRISMA guidelines. Outcomes assessed included healing rate, persistence, recurrence, re-intervention and incontinence rates.</p><p><strong>Results: </strong>Fifteen non-randomized studies assessed 978 patients managed with botulinum toxin and fissurectomy. The mean age was 40.8 years with a female predominance of 58.9%. Healing rate was reported on 14 of the 15 studies, with a healing rate of 81% (95% CI:0.67, 0.90). Persistence rate was reported as 15% (95% CI:0.07, 0.28) and a recurrence rate of 6% (95% CI: 0.01, 0.19). Re-intervention was required in 8% of patients with 55.1% requiring a repeat dose of botulinum toxin with or without fissurectomy. Incontinence appears to be transient with studies reporting a rate of 1% with median long-term follow up 23 months (range: 5-60 months).</p><p><strong>Conclusion: </strong>Combination fissurectomy and botulinum toxin is a safe and viable sphincter sparing treatment option, with moderate success rate and negligible complications. Randomized controlled trials are required to further strengthen the evidence for its use in chronic anal fissures.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339949","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":"Patience is key for the surgeon in the management of a large haemorrhagic phaeochromocytoma with cardiomyopathy","authors":"James A. Pasch MBBS, MSc,&nbsp;Hazel Serrao-Brown MD, ChD, MS, MPH, FRACS,&nbsp;Daniel Nguyen MBBS, MS, FRACS,&nbsp;Jaswinder S. Samra MBChB, DPhil (Oxon), FRCS (Eng&Ed), FRACS,&nbsp;Roderick Clifton-Bligh BSc (Med), MBBS (Hons), FRACP, PhD, FFSc (RCPA),&nbsp;Mark S. Sywak MBBS, MMed Sci (Clin Epi), FRACS","doi":"10.1111/ans.19245","DOIUrl":"10.1111/ans.19245","url":null,"abstract":"&lt;p&gt;A 26-year-old female presented with abdominal pain, hypertension and acute catecholamine cardiomyopathy secondary to a large phaeochromocytoma of the left adrenal gland. The patient had undiagnosed multiple endocrine neoplasia (MEN) 2A syndrome.&lt;/p&gt;&lt;p&gt;Following presentation, the patient was intubated due to reduced consciousness associated with labile blood pressure (60–200 mmHg systolic) and investigated with computed tomography (CT), which demonstrated a 125 mm solid/cystic left adrenal lesion with extracapsular haemorrhage (Fig. 1a). This was managed with angioembolisation of superior, middle and inferior arterial supply with coils and gelfoam slurry (Fig. 1b). CT also identified tumour thrombus extending into the left adrenal and renal veins. Following restoration of intravascular volume, alpha- and beta-blockade was commenced with phenoxybenzamine then metoprolol. The patient was extubated after 1 week with complete resolution of cardiac dysfunction after 3 weeks (initial LVEF &lt;30%). Plasma metanephrine levels were elevated at 70 360 pmol/L (normal range: &lt;660 pmol/L). Serum parathyroid hormone was also elevated at 16.9 pmol/L (1.6–6.9 pmol/L) and calcitonin 498 ng/L (&lt;5 ng/L). A DOTATATE PET demonstrated peripheral rim avidity of the adrenal lesion with no uptake in the contralateral gland. A PET avid right thyroid nodule was confirmed as medullary thyroid carcinoma (MTC) on biopsy.&lt;/p&gt;&lt;p&gt;Following the resolution of cardiomyopathy, the tumour was excised by an open anterior approach. A midline laparotomy was performed with a Cattell-Braasch medial visceral rotation to access the aorta, inferior vena cava and proximal left renal vein. The lesser sac was entered, and the pancreas mobilized inferiorly to commence capsular dissection of the superomedial aspect of the tumour (Fig. 2a). The left renal vein was controlled, and tumour thrombus removed en bloc with the primary lesion via a longitudinal venotomy and primary repair with 6–0 prolene (Fig. 2b). The adrenal vein was ligated, and the tumour mobilized from the superior pole of kidney. The patient's recovery was complicated by a low-volume chyle leak managed successfully with drainage and low-fat diet. She is currently awaiting surgery for her MTC and primary hyperparathyroidism. Histopathology demonstrated a phaeochromocytoma without capsular invasion, Ki67 1%, mitotic count less than 1 per 2 mm&lt;sup&gt;2&lt;/sup&gt; and retained staining for SDH-A and B mutations (Fig. 3b). Genetic testing confirmed a germline pathogenic variant in &lt;i&gt;RET&lt;/i&gt; (634 codon) consistent with MEN2A.&lt;/p&gt;&lt;p&gt;Phaeochromocytoma crisis is a state of catecholamine excess, haemodynamic instability and end-organ dysfunction.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Even in such presentations, delay in surgery to allow optimisation of adrenergic blockade should be strongly pursued to avoid unacceptably high rates of mortality and morbidity.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Severe cardiogenic shock due to catecholamine cardiomyopathy is genera","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 11","pages":"2081-2083"},"PeriodicalIF":1.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.19245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339951","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":"25, 50 and 75 years ago","authors":"Julian A. Smith MBMS, MSurgEd, FRACS","doi":"10.1111/ans.19244","DOIUrl":"10.1111/ans.19244","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Norris B, Solomon MJ, Eyers AA, West RH, Glenn DC, Morgan BP. Abdominal surgery in the older Crohn's population. &lt;i&gt;ANZ. J. Surg&lt;/i&gt;. 1999;69:199–204.&lt;/b&gt;&lt;/p&gt;&lt;p&gt;The surgical literature perceives that the elderly cohort of Crohn's patients may have increased risk with surgery. A retrospective review and prospective database analysis of all patients with histologically proven Crohn's disease who had a laparotomy at a single Sydney teaching hospital were performed. The last laparotomy of each patient was included in the analysis for morbidity and mortality to assess whether an older cohort was at an increased risk. A total of 156 patients had 298 laparotomies for histopathologically proven Crohn's disease. The frequency distribution of age at last laparotomy was bimodal, and the statistically determined cut-off age between younger and older cohorts was 55 years. Thirty-three patients were older than 55 years. There was no difference in duration of symptoms before first diagnosis (older, 17 months vs. younger, 25 months), previous number of Crohn's operations (42.4% vs. 39.8%), or duration of known Crohn's disease. Isolated large bowel disease was more common in the elderly cohort (42.4% vs. 18.7%, χ&lt;sup&gt;2&lt;/sup&gt; = 8.09, &lt;i&gt;P&lt;/i&gt; &lt; 0.01). Small bowel and ileocaecal resections were more common in the younger cohort (72.4% vs. 51.6%, χ&lt;sup&gt;2&lt;/sup&gt; = 5.19, &lt;i&gt;P&lt;/i&gt; &lt; 0.025). There was one death in each cohort (overall mortality 1.3%) and anastomotic leak rates (defined as the number of leaks per number of patients with anastomoses), were 4.3% (older) vs. 5.3% (younger) despite frank sepsis present in 21.2% of all subjects at the time of surgery. The older group had more cardiac (18.2% vs. 0.8%, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and respiratory complications (18.2% vs. 2.4%, &lt;i&gt;P&lt;/i&gt; = 0.0003) and a longer mean but not median postoperative hospital admission. In conclusion, clinical features and presentation are similar in the older and younger Crohn's patients having a laparotomy. However, in the older patient there is a greater likelihood of large bowel disease, ileocaecal resection is done less commonly, there is a higher risk of minor cardiopulmonary postoperative complications, but with similar mortality and anastomotic leak rates to the younger patient.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Rieger N, Collopy B, Fink R, Mackay J, Woods R, Keck J. Total colectomy for Crohn's disease. &lt;i&gt;ANZ. J. Surg&lt;/i&gt;. 1999;69:28–30.&lt;/b&gt;&lt;/p&gt;&lt;p&gt;Total colectomy for Crohn's disease of the colon may be restorative with ileorectal anastomosis or with an ileostomy and rectal stump. The present paper retrospectively audits the results of total colectomy and in particular assesses the number of patients who had a permanent ileostomy and whether this was related to disease in the rectum at the time of the original operation. A retrospective case note review was undertaken of patients operated upon between 1968 and 1994. Thirty-eight patients were identified (mean age 35 years; range 17–65 years). One pat","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 10","pages":"1683-1684"},"PeriodicalIF":1.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.19244","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339946","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}