ANZ Journal of Surgery

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Table of Contents for ANZ Journal of Surgery. List of articles from both the latest and EarlyView issues.
Updated: 10 hours 3 min ago

Giant double‐barrel recto‐uterine prolapse

May 14, 2019 - 03:34
ANZ Journal of Surgery, EarlyView.

Analysis of portal vein thrombosis after liver transplantation

May 13, 2019 - 22:01
Background

Portal vein thrombosis (PVT) is one of the most deadly complications after orthotopic liver transplantation (OLT). This study aimed to identify risk factors and summarize the experience of PVT management after OLT.

Methods

The clinical data of 407 adult patients received OLT from July 2011 to December 2015 was retrospectively investigated.

Results

The incidence rate of PVT was 2.9% (12/407). Pre‐transplant PVT (P = 0.001), post‐operative transfusion of erythrocyte (P = 0.006) and platelet (P = 0.036) were significantly associated with PVT in the univariate analysis and the appearance of pre‐transplant PVT (P = 0.002, odds ratio 6.05) was the independent risk factor according to binary logistic regression. Among patients with PVT, three cases (3/12) received balloon dilation through selective catheterization of portal vein, five (5/12) received balloon‐expandable stent placement, three (3/12) received thrombectomy and surgical revascularization and one (1/12) received retransplantation. Six patients (6/12) died from various complications and the remaining six were followed up with normal liver function and patent portal vein.

Conclusions

The risk factors were pre‐transplant PVT and post‐operative transfusion of erythrocyte and platelet. To recipients with high risk, early diagnosis and prompt management of PVT are essential to improve prognosis.

Acute variceal haemorrhage in the context of posterior flail chest

May 13, 2019 - 22:01
ANZ Journal of Surgery, EarlyView.

Intraoperative detection of aberrant biliary anatomy via intraoperative cholangiography during laparoscopic cholecystectomy

May 13, 2019 - 21:59

Intraoperative cholangiography (IOC) is widely used as an adjunct to laparoscopic cholecystectomy, but there is still no worldwide consensus on the value of its routine use. The purpose of this study was to assess the adequacy of and the reporting of 300 IOCs during laparoscopic cholecystectomy. Aberrant right sectoral ducts were identified in 15.2% of the complete IOCs, and 2.6% demonstrated left sectoral or confluence anomalies. Only 20.4% of these were reported intraoperatively. Surgeons generally demonstrate biliary anatomy well on IOC, but reporting of sectoral duct variation can be improved.


Background

Laparoscopic cholecystectomy (LC) is the standard of treatment for symptomatic cholelithiasis. Although intraoperative cholangiography (IOC) is widely used as an adjunct to LC, there is still no worldwide consensus on the value of its routine use. Anatomical studies have shown that variations of the biliary tree are present in approximately 35% of patients with variations in right hepatic second‐order ducts being especially common (15–20%). Approximately, 70–80% of all iatrogenic bile duct injuries are a consequence of misidentification of biliary anatomy. The purpose of this study was to assess the adequacy of and the reporting of IOCs during LC.

Methods

IOCs obtained from 300 consecutive LCs between July 2014 and July 2016 were analysed retrospectively by two surgical trainees and confirmed by a radiologist. Biliary tree anatomy was classified from IOC films as described by Couinaud (1957) and correlated with documented findings. The accuracy of intraoperative reporting was assessed. Biliary anatomy was correlated to clinical outcome.

Results

A total of 95% of IOCs adequately demonstrated biliary anatomy. Aberrant right sectoral ducts were identified in 15.2% of the complete IOCs, and 2.6% demonstrated left sectoral or confluence anomalies. Only 20.4% of these were reported intraoperatively. Bile leaks occurred in two patients who had IOCs (0.73%) and two who did not (7.4%).

Conclusion

Surgeons generally demonstrate biliary anatomy well on IOC but reporting of sectoral duct variation can be improved. Further research is needed to determine whether anatomical variation is related to ductal injury.

Health economic implications of postoperative complications following liver resection surgery: a systematic review

May 13, 2019 - 21:59

Limited data exists concerning the health economics of liver resection, with even less information on the costs emerging from complications. To address the need for evidence of the economic burden of complications following liver resection, we performed a systematic review aiming to compile worldwide evidence regarding the cost of liver resection into a clear and concise format.


Background

Limited data exists concerning the health economics of liver resection, with even less information on the costs emerging from complications, despite this remaining an important target from a health economic perspective. Our objective was to describe the financial burden of complications following liver resection.

Methods

We conducted a systematic search and included studies reporting resource use of in‐hospital complications during the index liver resection admission. All indications for liver resection were considered. All techniques were considered. Data was collected using a data extraction table and a narrative synthesis was performed.

Results

We identified 12 eligible articles. There was considerable heterogeneity in study designs, patient populations and outcome definitions. We found weak evidence of increased costs associated with major liver resection compared to minor resections. We found robust evidence supporting the increasing economic burden arising from complications after liver resection. Acceptable evidence for increased cost due to the presence and grade of complication was found. Strong evidence concerning the association of length of stay with costs was demonstrated.

Conclusions

The presence and grade of complications increase hospital cost across diverse settings. The costing methodology should be transparent and complication grading systems should be consistent in future studies.

It is not appendicitis? An uncommon case of appendiceal tumour

May 13, 2019 - 21:58
ANZ Journal of Surgery, EarlyView.

Distal locked or unlocked nailing for stable intertrochanteric fractures? A meta‐analysis

May 13, 2019 - 21:58

Distal locking screw was not worthy of being recommended as routine choice for stable intertrochanteric fractures because of little advantage when compared with distal unlocked nails.


Background

To date, there are just several studies comparing distal locked nails with distal unlocked nails in treating intertrochanteric fractures. We report the first meta‐analysis about this issue.

Methods

Systematic search was conducted for studies in PubMed, Embase and Cochrane Library. Meta‐analyses were performed regarding intra operative outcomes, complications and functional outcomes.

Results

Pooled results showed insignificant difference between distal locking group and distal unlocking group in hip pain (relative risk (RR) 1.14, 95% confidence interval (CI) 0.59–2.19), distal tip fracture (RR 1.08, 95% CI 0.37–3.11), lag screw cut‐out (RR 1.60, 95% CI 0.54–4.78), delayed or nonunion (RR 1.32, 95% CI 0.25–7.06), deep vein thrombosis (RR 1.06, 95% CI 0.23–4.84), wound infection (RR 0.58, 95% CI 0.28–1.22), Harris hip score (standard mean deviation (SMD) 0.03, 95% CI −0.15 to 0.21) and walking ability. However, significant difference was detected in operation time (SMD 0.77, 95% CI 0.36–1.17), fluoroscopy exposure time (SMD 1.02, 95% CI 0.52–1.52), blood loss (SMD 0.80, 95% CI 0.62–0.99) and total incision length (SMD 1.16, 95% CI 0.86–1.47). Result of trial sequential analysis indicated conclusive evidence.

Conclusion

Current evidence indicates that the distal locked intramedullary nails should not be recommended as routine choice for stable intertrochanteric fractures.

Unusual cause of small intestinal obstruction

May 13, 2019 - 21:56
ANZ Journal of Surgery, EarlyView.

Colorectal cancer in young patients: a retrospective cohort study in a single institution

May 13, 2019 - 21:56

Young onset colorectal cancer is on the rise, with a disproportionate increase in incidence among young people. This retrospective cohort study of young patients undergoing colonoscopy shows an incidence rate greater than the age‐standardized incidence rate of colorectal cancer in Australia. Patients found to have malignancy were symptomatic and thus investigation should be offered early to young patients presenting with any warning symptoms. Flexible sigmoidoscopy may be an appropriate alternative to awaiting colonoscopy and lead to earlier diagnosis.


Background

Young onset colorectal cancer is on the rise, with a disproportionate increase in incidence among young people, both in Australia and internationally. Current national guidelines for bowel cancer screening in average risk individuals include only patients greater than 50 years of age. It is well recognized that colorectal cancer is a highly treatable malignancy when detected at an early stage, and timely diagnosis yields a greater than 90% chance of cure and survival. The aims of this study were to define the clinical presentations leading to colonoscopy in young patients and assess the incidence of malignancy in this group.

Methods

This is a retrospective cohort study including all patients ≤35 years of age without any baseline indication for early bowel cancer surveillance that underwent colonoscopy at Caboolture Hospital from January 2017 to April 2018.

Results

A total of 224 patients underwent colonoscopy in the study period. A total of 210 (93.8%) had symptoms including rectal bleeding (51.7%), altered bowel habit (25.9%), abdominal pain (10.3%) and symptomatic anaemia (6.7%) prior to colonoscopy. Two cases of invasive adenocarcinoma were identified (0.89%, P < 0.01), both of which were symptomatic and were defined as stage IIIB disease on histopathology.

Conclusion

In a theoretically low‐risk population, the incidence of malignancy was nearly 1%. More advanced disease at diagnosis may be due to a delay in investigating these patients due to an overall low suspicion of cancer in young individuals. As such, investigation should be offered early to young patients presenting with any warning symptoms.

Case study of the lumbar hernia: the rare diagnosis often missed

May 13, 2019 - 21:54
ANZ Journal of Surgery, EarlyView.

Do we need to scan the whole neuraxis for coexistent abnormalities in children with surgically treated occult spinal dysraphism?

May 13, 2019 - 21:53

Cranial pathologies rarely coexisted with spina bifida occulta, while spinal abnormalities frequently accompany to this malformation. Therefore, we strongly suggest the radiological screening of whole spinal axis in occult spinal dysraphism, yet the necessity of cranial imaging was suspicious according to our results.


Background

Spina bifida occulta (SBO) is generally known as a benign isolated entity; however, there are ambiguous approaches for neuroaxial screening in cases of symptomatic SBO among institutions. This study aims to demonstrate the infrequency of cranial anomalies associated with symptomatic SBO and inquire the necessity of cranial radiological surveillance in those patients.

Methods

Between 2012 and 2016 pediatric patients who were surgically treated in our clinic due to symptomatic SBO were retrospectively evaluated. All radiological findings in craniospinal evaluation were documented.

Results

There were 76 patients with mean age of 5.3 years (range 2 months to 17 years), and female predominance (53 female and 23 male patients). Of those, 64 patients had whole neuroaxis investigation including cranial imaging. Among 64 patients with cranial screening, only two patients had occipital encephalocele and posterior fossa arachnoid cyst. There was neither hydrocephalus nor Chiari malformation in our case series.

Conclusions

We detected high number of additional spinal abnormalities accompanying to symptomatic SBOs, whereas cranial findings rarely coexisted with them. Therefore, we strongly suggest the radiological screening of whole spinal axis in occult spinal dysraphism with significant spinal findings. On the other hand, cranial imaging as a part of neuraxis screening in cases of symptomatic SBOs is not required in all cases; however, it can be done in selected patients where clinically indicated.

Herniated gastric varix presenting as an epigastric hernia: a rare case report

May 13, 2019 - 21:52
ANZ Journal of Surgery, EarlyView.

Unusual presentation of rectal prolapse

May 12, 2019 - 22:56
ANZ Journal of Surgery, EarlyView.

Rare case of a dopamine‐secreting para‐aortic paraganglioma

May 12, 2019 - 22:55
ANZ Journal of Surgery, EarlyView.

Giant pneumosalpinx secondary to colonic diverticular disease

May 12, 2019 - 22:54
ANZ Journal of Surgery, EarlyView.

Synthetic double barrelled graft: a novel approach to manage inferior vena cava injury

May 12, 2019 - 22:53
ANZ Journal of Surgery, EarlyView.

Mucinous adenocarcinoma of the rectum with uninjured mucosa

May 12, 2019 - 22:53
ANZ Journal of Surgery, EarlyView.

Management of unilateral opacity on chest X‐ray in the setting of trauma

May 12, 2019 - 22:53
ANZ Journal of Surgery, EarlyView.