ANZ Journal of Surgery最新文献

{"title":"Transposition flap and skin graft techniques for optimizing anastomosis coverage","authors":"Yooseok Ha MD, PhD,&nbsp;Ji Ah Park,&nbsp;Youn Hwan Kim MD, PhD","doi":"10.1111/ans.70035","DOIUrl":"10.1111/ans.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study explores a novel technique combining transposition flaps with Split-Thickness Skin Grafts (STSG) to enhance anastomosis site coverage in free tissue transfer surgeries, particularly in lower limb reconstructions using Thoracodorsal Artery Perforator (TDAP) free flap procedures. This method aims to alleviate tension at the anastomosis sites, a common issue affecting reconstructive surgery success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 20 patients who underwent TDAP free flap procedures. These cases were chosen due to the anticipated tension at anastomosis sites, necessitating the use of transposition flaps and STSG. Surgical procedures were meticulously documented, and postoperative outcomes were monitored, focusing on complications and overall surgical success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study found no instances of complete flap failure, indicating the potential efficacy of the combined approach. Minor complications included two cases of partial tip necrosis in the transposition flaps and two cases of partial graft loss in the STSGs. These issues were resolved through secondary intention healing, demonstrating the technique's ability to manage minor postoperative challenges and maintain flap viability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Integrating transposition flaps with STSG significantly improves tension management at anastomosis sites in TDAP free flap procedures. This technique not only reduces immediate postoperative complications but also supports the long-term success of reconstructive surgeries. The findings advocate for further research to confirm the efficacy of this approach in microsurgical applications, aiming to enhance patient outcomes and advance reconstructive microsurgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 3","pages":"533-538"},"PeriodicalIF":1.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539987","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":"Surgical Research Society of Australasia – Abstracts in order 2023","authors":"","doi":"10.1111/ans.19425","DOIUrl":"10.1111/ans.19425","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 3","pages":"597-607"},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 20-year case-series of distal intestinal obstruction syndrome at a state-wide cystic fibrosis service.","authors":"Chen Lew, Chelsea Lin, Matthew Lukies, Peter Wark, Sarah Birks, Maria K Vanguardia, Satish Warrier","doi":"10.1111/ans.70005","DOIUrl":"https://doi.org/10.1111/ans.70005","url":null,"abstract":"<p><strong>Background: </strong>Distal intestinal obstruction syndrome (DIOS) presents significant management challenges for people with cystic fibrosis (pwC). We evaluated the treatment outcomes and identified risk factors associated with the need for surgical intervention in patients admitted with DIOS.</p><p><strong>Method: </strong>We conducted a retrospective case series of 96 encounters of DIOS over a 20-year period, observing outcomes between cases of medical management versus those requiring for operative intervention. To our knowledge, this is the largest Australian study to review intervention in DIOS.</p><p><strong>Results: </strong>Among the patients studied, 94.8% were successfully treated non-surgically. Using computed tomography (CT) confirmation of DIOS as the gold standard, only 9.1% of abdominal x-rays were accurate in finding DIOS. Gastrografin was used in half of cases and was associated with a shorter recovery time. One in 16 patients required operative management, with two cases experiencing surgery following prolonged medical treatment. A history of previous laparotomy increased the odds of requiring surgical intervention by 16 times (95% CI: 1.2-209.9, P = 0.035), while a history of meconium ileus increased the odds by 15.6 times (95% CI: 1.2-204.8, P = 0.036). All patients who underwent surgery also had pancreatic insufficiency.</p><p><strong>Conclusion: </strong>Medical management was successful in the majority of DIOS presentations. Our study emphasizes a low threshold for abdominal CT scans to identify complete DIOS in high-risk patients, particularly those with a history of laparotomy or meconium ileus, who may require surgical intervention. Furthermore, we advocate for the adjunctive use of Gastrografin alongside medical management. Future research should refine protocols for these high-risk groups to improve outcomes and reduce morbidity.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540014","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 transperineal rectovesical fistula repair with dartos flap interposition","authors":"Dhanushke T. Fernando MD, MSc, BSc,&nbsp;David Sofield FRACS (UROL), FRCSE, MBBS","doi":"10.1111/ans.70012","DOIUrl":"10.1111/ans.70012","url":null,"abstract":"<p>Rectovesical fistula (RVF) is defined as an extra-anatomic communication between the rectum and bladder. A multitude of approaches and techniques have been described; however, there is a lack of consensus regarding which of these procedures is the optimal cost-effective, appropriate treatment to perform. We describe the repair of a persistent RVF via a transperineal approach, utilizing the dartos fascia flap, a technique with minimal description in the literature.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 4","pages":"817-820"},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540030","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":"Adrenalectomy in regional Australia: a balance of benefits and potential harms","authors":"Christine J. O'Neill MBBS(Hons), MS, FRACS","doi":"10.1111/ans.19364","DOIUrl":"https://doi.org/10.1111/ans.19364","url":null,"abstract":"&lt;p&gt;Internationally, centralization of surgical care in higher volume centres for complex and oncological surgery has led to improved clinical outcomes.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; The challenges of the vast geography and comparative low density of the Australian population require this model of care to be tested in an Australian context. Approximately 29% of the Australian population lives in regional Australia and is comparatively under-resourced by surgical care.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; Patients in regional areas deserve high quality care in their local vicinity. It is imperative to ensure surgeons servicing these areas develop and maintain an adequate skill mix, and as such can enjoy a viable and rewarding career path in their local community.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Whilst increased surgical volume may improve clinical outcomes, this can be offset by distress cause by travel and psychosocial and financial harm associated with care distant to home. With this in mind, patients in regional areas may preference procedures undertaken closer to home and their support networks, even if informed of associated higher morbidity and mortality.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this edition, Tree &lt;i&gt;et al&lt;/i&gt;. have published their case series of 31 adrenalectomy cases performed by two surgeons in Lismore NSW, over a 16-year period.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; The majority were laparoscopic (90%), 52% were admitted to ICU/HDU post-operatively and the mean length of stay was 3.1 days. Similarly, in 2023, Cui &lt;i&gt;et al&lt;/i&gt;. published a single surgeon series from Dubbo NSW, of 13 cases of adrenalectomy over 9 years.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; In both series, the hospital volume was &lt;2 cases per year and there were no mortalities. The authors are to be congratulated on documenting their case series and challenging the paradigm of centralisation.&lt;/p&gt;&lt;p&gt;Adrenalectomy is an infrequent procedure within scope of practice both general surgeons (endocrine, upper GI and HPB subspecialities) as well as urologists. International data suggest that surgeon thresholds of ≥6–12 adrenal resections annually are associated with improved clinical outcomes.&lt;span&gt;&lt;sup&gt;8-10&lt;/sup&gt;&lt;/span&gt; Higher annual volumes again (&gt;12 adrenal resections annually) may be associated with improved outcomes (completeness of resection, decrease in complications, more comprehensive pre-operative work-up) in open adrenal surgery and adrenocortical cancer care.&lt;span&gt;&lt;sup&gt;11-13&lt;/sup&gt;&lt;/span&gt; International guidelines also stress the importance of thorough pre-operative work-up and the multidisciplinary team in the care of patients undergoing adrenal surgery.&lt;span&gt;&lt;sup&gt;10, 14&lt;/sup&gt;&lt;/span&gt; Yet, surgical volume remains a crude marker of either the skill of the surgeon themselves or of their team.&lt;/p&gt;&lt;p&gt;For surgeons wishing to undertake adrenalectomy, or any other uncommon procedure, it is unlikely that a fellowship (FRACS) of any surgical speciality will provide adequate skills and experience. Thus, both","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 1-2","pages":"6-7"},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.19364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530279","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":"Bio-absorbable mesh and early positron emission tomography avidity: implications in oncological surveillance.","authors":"Ernest Cheng, Mina Sarofim, Amit Sarkar, Assad Zahid, Andrew Gilmore","doi":"10.1111/ans.70043","DOIUrl":"https://doi.org/10.1111/ans.70043","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522531","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":"Perivascular epithelioid cell tumour (PEComa) of the ligamentum teres hepatis, a rare and mobile tumour presentation","authors":"Jacques-Emmanuel Saadoun MD,&nbsp;Eddy Traversari MD,&nbsp;Hélène Meillat,&nbsp;Jérôme Guiramand MD","doi":"10.1111/ans.19418","DOIUrl":"10.1111/ans.19418","url":null,"abstract":"&lt;p&gt;A 25-year-old man with no medical history consulted his general practitioner following self-palpation of a mobile abdominal mass. Clinical examination demonstrated the highly mobile nature of the mass, as can be seen in the video. He did not present any digestive symptoms. Computed tomography showed a large 11 cm heterogeneous mass, partially calcified and necrotic, located in the left flank. On computed tomography (CT) scan, the mass appeared to originate either from the mesentery or a small bowel loop. Significant contrast enhancement was observed, including during the portal phase, with a necrotic core. Work-up was completed by MRI, which showed a mass with necrotic core that had moved to the right flank. MRI suggested a mesenteric origin for the mass. Pre-contrast, the mass borders had an isointense T1 signal, which showed variable enhancement of the tumour post-contrast. The mass's center exhibited mixed composition, including a 3 cm region of avascular necrosis. This heterogeneity suggested a desmoid tumour in the peritoneal cavity. An ultrasound-guided biopsy was performed, and histological analysis supported the diagnosis of a PEComa (perivascular epithelioid cell tumour). The patient did not have a history of tuberous sclerosis. Surgery was decided at a multidisciplinary team meeting. During the procedure, we found a mass developed from the round ligament of the liver with numerous varicose veins. A mini laparotomy centered around the umbilicus was performed, providing adequate access to the lesion. No distant lesions were identified. There were no adhesions with the mesentery or the small bowel. However, its close association with multiple varicose veins required careful ligation to control venous drainage and prevent bleeding. Finally, ligation of the round ligament allowed for complete release and successful resection of the tumour, ensuring no further interference with surrounding structures. No bowel resection was necessary. Post-operative course was uneventful, and patient was discharged on day 2. Histological analysis confirmed a PEComa measuring 10 cm in long axis. The immunohistochemical profile of the tumour cells was as follows: Smooth Muscle Actin (SMA)+, Desmin−, Caldesmon+, HMB45+, Melan-A+, P53 WT, RB preserved, TFE3+, CK AE1/AE3−, S100−, and SOX10−. The low proliferative index (Ki67 &lt; 10%) further supports the diagnosis. No adjuvant treatment was administered. Additionally, after 2 years of follow-up, no recurrence has been detected (Figs. 1-3).&lt;/p&gt;&lt;p&gt;The World Health Organization characterized PEComa as a tumour of mesenchymal origin that typically exhibits a close relationship with blood vessel walls and generally displays markers associated with melanocytes and smooth muscle cells.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Due to its extreme rarity, diagnosing PEComa is particularly challenging, with a significant potential for confusion with other soft tissue lesions. The preoperative differential diagnosis encompasses terato","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 4","pages":"832-833"},"PeriodicalIF":1.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.19418","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522462","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":"Biomarkers to predict 30-day mortality in patients with Fournier's gangrene disease: a retrospective study","authors":"Akile Zengin MD,&nbsp;Gokberk Alagas MD,&nbsp;Yusuf Murat Bag MD,&nbsp;Ahmet Murat Sendil MD,&nbsp;Ahmet Umit Cebeci MD,&nbsp;Elif Gundogdu MD,&nbsp;Yavuz Selim Angin MD,&nbsp;Mehmet Kılıc MD,&nbsp;Murat Ulas MD","doi":"10.1111/ans.70025","DOIUrl":"10.1111/ans.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Fournier gangrene disease (FGD) is a condition that requires emergent surgery due to its high risk of mortality. The use of biomarkers to predict outcomes after surgery for patients with FGD may be critical, as they assist in tailoring treatment approaches to individual needs. Our aim in our study is to investigate the presence of simple and easily accessible biochemical markers that can be used to predict early mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The medical records of 100 patients diagnosed with FGD at our hospital between January 2015 and December 2023 were retrospectively reviewed. Clinical and laboratory variables were assessed, and predictive factors for mortality were analyzed using multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Demographics and perioperative clinical data of the whole study group, and subgroups according to the mortality status are evaluated. CRP was found to be independent predictor for 30-day mortality in FGD. In ROC curve analysis provided a cutoff value of 121.3 mg/L for CRP which was significantly associated with 30-day mortality for FGD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Preoperative CRP ≥ 121.3 mg/L value could be predict 30-day mortality in patients diagnosed with FGD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 3","pages":"433-439"},"PeriodicalIF":1.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522458","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":"Evaluation of the treatment effectiveness of oral and intralesional steroids in idiopathic granulomatous mastitis using superb microvascular imaging.","authors":"Oğuz Karakayalı, Yasemin Kayadibi, Berrin Papila, Seda Aladag Kurt, Gökçen Yıldız Civan, Mehmet Velidedeoglu, Mehmet Halit Yılmaz","doi":"10.1111/ans.70044","DOIUrl":"https://doi.org/10.1111/ans.70044","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to compare the efficacy of oral and intralesional steroid injection in the treatment of idiopathic granulomatous mastitis (IGM) cases with clinical, ultrasonography (US) and Superb microvascular imaging (SMI) findings.</p><p><strong>Methods: </strong>A total of 53 patients with newly diagnosed IGM who applied to our outpatient clinic between September 2021 and December 2022 were included. Oral steroid therapy was administered to 26 patients, while intralesional steroid therapy was administered to 27 patients. Pretreatment and postreatment difference of the affected area was compared clinically (Unresponsive to treatment: stable or progression; Partial response: <50% reduction; Near complete response: >50% reduction; Complete response: 100% reduction) and radiologically. Grey scale US (size, skin thickness) and SMI vascular index (SMIvi) for vascularization of the pathological area were noted. Recurrence and side-effect rates at the 6 months were compared.</p><p><strong>Results: </strong>No statistically significant difference was found in the efficacy of oral steroid and intralesional steroid treatment, both radiologically (P = 0.839) and clinically (P = 0.550). There was a considerable difference in size and SMIvi values before and after treatment (P < 0.001) in patients with an adequate response. There was no significant difference between the two treatment methods in terms of recurrence (P = 0.153) or side effects (P = 1).</p><p><strong>Conclusion: </strong>Intralesional steroid was as effective as oral steroid treatment in IGM patients, and SMI is a reliable sonographic method that can be used to evaluate clinical findings, treatment response, and patient follow-up.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498085","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":"Surgical Research Society of Australasia – Abstracts in order 2024","authors":"","doi":"10.1111/ans.19426","DOIUrl":"10.1111/ans.19426","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 3","pages":"608-616"},"PeriodicalIF":1.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498086","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}