ANZ Journal of Surgery

  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
  • warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Australia/Melbourne' for 'AEDT/11.0/DST' instead in /home/lambertn/public_html/content/modules/aggregator/aggregator.pages.inc on line 259.
Syndicate content
Wiley Online Library : ANZ Journal of Surgery
Updated: 14 hours 25 min ago

Cost-effective imaging for resectability of liver lesions in colorectal cancer: an economic decision model

October 6, 2017 - 09:40
Background

This study aimed to determine the cost-effectiveness of contrast-enhanced magnetic resonance imaging (CE-MRI) compared with multiphase CE computed tomography (CE-CT) scan to characterize suspected liver lesions in patients with known colorectal carcinoma.

Methods

A decision analytic model linking diagnostic accuracy to health outcomes in patients with colorectal carcinoma was constructed. The model assumed that CE-MRI has superior sensitivity and equivalent specificity to CE-CT, and patients with a colorectal liver metastasis could be eligible for curative surgery or chemotherapy and palliation. Delayed diagnosis or misdiagnosis was associated with worse health outcomes (disutility). Cost-effectiveness was calculated as the incremental cost relative to the incremental benefit, the benefit was estimated using quality-adjusted life years. Sensitivity analyses were conducted to test the robustness of the results.

Results

The clinical evidence supports increased sensitivity of CE-MRI compared with CE-CT (0.943 versus 0.768). CE-MRI was more effective and more costly than CE-CT. The incremental cost-effectiveness ratio was estimated to be $40 548 per quality-adjusted life year gained. The model is most sensitive to the cost of MRI, cost of palliative treatment and the disutility associated with delayed palliative care. The results were also sensitive to the assumptions made about the clinical algorithm.

Conclusion

The results provide evidence of the potential cost-effectiveness associated with CE-MRI for the diagnosis of liver metastases in patients with identified colorectal carcinoma. CE-MRI can be recommended as cost-effective provided it replaces CE-CT and that improved diagnostic accuracy results in earlier, curative, disease management.

Comparing pathological complete response rate using oral capecitabine versus infusional 5-fluorouracil with preoperative radiotherapy in rectal cancer treatment

October 6, 2017 - 09:40
Background

Infusional 5-fluorouracil (5-FU) has been the standard radiation sensitizer in patients undergoing preoperative long-course chemoradiotherapy (CRT) for locally advanced rectal cancer in Australia. Capecitabine (Xeloda) is an oral 5-FU prodrug of comparable pharmacodynamic activity, currently preferred in place of 5-FU infusion, its established counterpart in neoadjuvant CRT for rectal cancer. The few studies quantifying pathological complete response (pCR) of Xeloda versus 5-FU have produced inconsistent results. We reviewed our own data to determine if the rates of pCR of oral capecitabine were non-inferior to intravenous 5-FU in patients undergoing neoadjuvant CRT for rectal cancer.

Methods

A retrospective study was performed from a prospectively kept database. Four hundred and fifty-two patients received preoperative CRT from January 2006 to January 2016. Pelvic radiotherapy was delivered concurrently with capecitabine (n = 42) or infusional 5-FU (n = 341). The remaining received different chemotherapy regimens. Surgery was performed 6–12 weeks of CRT completion. Pathological responses were assessed using Dworak regression grading score (0–4). Clinical outcomes were evaluated in terms of local control and recurrence-free survival.

Results

The proportion of patients who had a tumour regression score of 4 (pCR) after CRT was 4/42 (9.5%) in the capecitabine group and 71/341 (20%) in the infusional 5-FU group (P = 0.082). pCR was an independent predictor for survival in this group of patients (hazard ratio: 0.002, P = 0.0001, 95% confidence interval: 0.0001–0.027).

Conclusion

The use of capecitabine as neoadjuvant chemotherapy in patients with rectal cancer was associated with a reduced rate of pCR. However this difference did not achieve statistical significance.

Pancreatoduodenectomy in a public versus private teaching hospital is comparable with some minor variations

October 6, 2017 - 09:40
Background

The impact of the public and private hospital systems on major abdominal operations that are demanding on clinical resources, such as pancreatic surgery, has not been explored in an Australian setting. This study examines the perioperative outcome of patients undergoing pancreatoduodenectomy (PD) at a major public and private hospital.

Methods

Patients undergoing PD between January 2004 and October 2015 were classified based on their health insurance status and location of where the surgery was performed. Clinical variables relating to perioperative outcome were retrieved and compared using univariate and multivariate analyses.

Results

Four hundred and twenty patients underwent PD of whom 232 patients (55%) were operated on in the private hospital. Overall, there was no difference in morbidity and mortality in the public versus the private hospital. However, there were variations in public versus private hospital, this included longer duration of surgery (443 min versus 372 min; P < 0.001), increased estimated blood loss (683 mL versus 506 mL; P < 0.001) and more patients requiring perioperative blood transfusion (25% versus 13%; P = 0.001). Of the 10 complications compared, post-operative bleeding was higher in the private hospital (11% versus 5%; P = 0.051) and intra-abdominal collections were more common in the public hospital (11% versus 5%; P = 0.028). Independent predictive factors for major complications were American Society of Anesthesiologists score (odds ratio (OR) = 1.91; P = 0.050), patients requiring additional visceral resection (OR = 3.36; P = 0.014) and post-operative transfusion (OR = 3.37; P < 0.001). The hospital type (public/private) was not associated with perioperative outcome.

Conclusion

Comparable perioperative outcomes were observed between patients undergoing PD in a high-volume specialized unit in both the public and private hospital systems.

25, 50 & 75 years ago

October 4, 2017 - 10:40

Hirschsprung disease

October 4, 2017 - 10:40

Medicine in small doses

October 4, 2017 - 10:40

Issue information - TOC

October 4, 2017 - 10:40

Perianal cauliflower

October 4, 2017 - 10:40

Urgent closed reduction of the dislocated cervical spine in New Zealand

September 28, 2017 - 17:30
Background

Emergent decompression, either by closed reduction or surgical decompression, of the acutely compressed cervical spinal cord is recognized as important in minimizing the neurological outcomes of these injuries. The aim of this study is to optimize New Zealand's capability to perform closed reductions.

Methods

Regional hospitals throughout New Zealand were surveyed on their capability to reduce acute cervical spine dislocations using traction. A systematic literature review was performed to investigate aspects of patient selection, reduction technique and the outcomes achieved with closed reduction of such injuries. This information was combined with our local experience to develop an evidence-based guideline.

Results

Most (12/14) of the regional centres throughout New Zealand have recent experience, remain willing and have the resources necessary to reduce appropriate cervical spine injuries using traction. Fourteen published studies from nine countries detail a 75% success rate from 363 cases of attempted closed reduction, with the greatest neurological recovery noted in patients with shorter time period from injury to reduction. One patient suffered neurological worsening. The published protocols were compared and coupled with our local practice to create an online, step-by-step, evidence-based reference to help clinicians in regional hospitals perform a safe and successful closed reduction.

Conclusion

To optimize the capability of inexperienced personnel to perform closed reductions in a safe and timely manner, we have developed an online, step-by-step, evidence-based reference (www.closedreduction.co.nz). This forms part of New Zealand's strategy to achieve urgent cord decompression for appropriate cervical spinal cord injuries.

Immediate autologous breast reconstruction after neoadjuvant chemoradiotherapy for breast cancer: initial results of the first 29 patients

September 25, 2017 - 12:16
Background

Breast reconstruction after mastectomy in the treatment of locally advanced breast cancer is often done in stages and before radiotherapy. We have previously published an algorithm for immediate free autologous reconstruction after neoadjuvant chemotherapy and preoperative radiotherapy. This protocol was designed to provide a shorter and simpler reconstructive path whilst improving cosmesis and maintaining oncological efficiency.

Methods

A total of 29 patients were included and underwent surgery for 30 cancers by the first author between 2010 and September 2015. Data were prospectively entered into a database and analysed for tumour size, chemotherapeutic response, lymph node involvement, surgical complications and tumour recurrence.

Results

The mean age was 55 ± 7 years. Eighty percent of patients had either a partial or complete chemotherapeutic response defined as >25% decrease in tumour size. Twenty-eight patients had free abdominal tissue transfer. One patient was excluded due to advanced disease. There were no take-backs due to microsurgical issues. One patient was reoperated on for a haematoma. Four patients had recurrent cancer during follow-up, three of whom are deceased.

Conclusion

Many, but not all, breast reconstructive surgeons consider autologous reconstruction as the ‘gold’ standard in the presence of radiotherapy. Rearranging the order of radiotherapy and surgery means operating in a recently irradiated field. We believe the surgical challenges are outweighed by a shorter and simpler reconstructive journey that additionally results in a better cosmesis. It is possible to perform immediate free autologous reconstruction after neoadjuvant chemotherapy and preoperative radiotherapy with excellent results and at least equivalent oncological efficacy.

Arthroscopic, open and mini-open approach for rotator cuff repair: no difference in pain or function at 24 months

September 22, 2017 - 09:00
Background

The New Zealand Rotator Cuff Registry was established in 2009 to collect prospective functional, pain and outcome data on patients undergoing rotator cuff repair (RCR).

Methods

Information collected included an operation day technical questionnaire completed by the surgeon and Flex Shoulder Function (SF) functional and pain scores preoperatively, immediately post-operatively and at 6, 12 and 24 months. A multivariate analysis was performed analysing the three surgical approaches to determine if there was a difference in pain or functional outcome scores.

Results

A total of 2418 RCRs were included in this paper. There were 418 (17.3%) arthroscopic, 956 (39.5%) mini-open and 1044 (43.2%) open procedures. Twenty-four-month follow-up data were obtained for pain and Flex SF in 71% of patients. At 24 months, there was no difference in the average Flex SF score for the arthroscopic, mini-open and open groups. There was no difference in improvement in Flex SF score at 24 months. At 24 months, there was no difference in mean pain scores. There was no difference in improvement in pain score from preoperation to 24 months. Most patients returned to work within 3 months of surgery, with no difference between the three surgical approaches.

Conclusion

RCR has good to excellent outcomes in terms of improvement in pain and function at 2-year follow-up. We found no difference in pain or functional outcome at 24 months between arthroscopic, open and mini-open approaches for RCR.

Benchmarking against the National Emergency Laparotomy Audit recommendations

September 20, 2017 - 10:06
Background

The Royal College of Anaesthetists published the National Emergency Laparotomy Audit (NELA) to describe and compare inpatient care and outcomes of major emergency abdominal surgery in England and Wales in 2015 and 2016. The purpose of this article is to compare emergency abdominal surgical care and mortality in a regional hospital (Logan Hospital, Queensland, Australia) with NELA results.

Methods

Data were extracted from two databases. All deaths from May 2010 to April 2015 were reviewed and patients who had an emergency abdominal operation within 30 days of death were identified. The health records of all patients who underwent abdominal surgery were extracted and those who had an emergency laparotomy were identified for analysis.

Results

Three hundred and fifty patients underwent emergency laparotomy and were included in the analysis. The total 30-day mortality during this 5-year period was 9.7%. Factors affecting mortality included age, Portsmouth-Physiological and Operative Severity Score (P-POSSUM) and admission source. Timing of antibiotic administration, use of perioperative medical service and frequency of intensive care admission were the same in patients who died and survived.

Conclusion

Mortality in patients following emergency laparotomy at Logan Hospital compares favourably with 11.1% reported by NELA. This may be partly attributable to case mix distribution as for each P-POSSUM risk Logan Hospital mortality was at the upper end of that reported by NELA. Further Australia data are required. Improved compliance with NELA recommendations may improve outcomes.

Functional outcome of low rectal resection evaluated by anorectal manometry

September 19, 2017 - 09:50
Background

Low anterior resection syndrome (LARS) covers disordered bowel function after rectal resection, leading to deterioration in patients’ quality of life. The aim of this study was to evaluate anorectal function after laparoscopic low anterior resection (LAR) by means of standardized instruments.

Methods

This was a prospective clinical cohort study conducted in a single institution to assess functional outcome of patients 1 year after laparoscopic LAR by means of LARS score and high-resolution anorectal manometry.

Results

In total, 65 patients were enrolled in the study. Mean tumour height was 9.4 ± 1.8 cm; total mesorectal excision during laparoscopic LAR with low end-to-end colorectal anastomosis was performed in all patients. One year after the surgery, minor LARS was detected in 33.9% of patients, major LARS in 36.9% of patients. Anorectal manometry revealed decreased resting pressure and normal squeeze pressure of the anal sphincters in the majority of our patients. Rectal compliance and rectal volume tolerability (first sensation, urge to defaecate and discomfort volume) were significantly reduced. The statistical testing of the correlation between LARS and manometry parameters showed that with increasing seriousness of LARS, values of some parameters (resting pressure, first sensation, urge to defaecate, discomfort volume and rectal compliance) were reduced.

Conclusion

This study indicates that the majority of patients after laparoscopic LAR experience symptoms of minor or major LARS. These patients have decreased resting anal sphincter pressures, decreased rectal volume tolerability and decreased rectal compliance.