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: 1 hour 23 min ago

Drain‐site metastasis from papillary thyroid carcinoma

May 11, 2019 - 23:41
ANZ Journal of Surgery, EarlyView.

How to do it: a modified transabdominal wall approach for direct external iliac artery access during endovascular thoracic aneurysm repair

May 8, 2019 - 22:05

We describe the combined application of a transabdominal wall sheath tunnel, ‘pre‐close’ purse‐string sutures and manual external support of the iliac artery to facilitate introduction of an 18F sheath for endovascular exclusion of a 6‐cm thoracic aortic aneurysm.


Actinomycetoma of the hand: a case report

May 8, 2019 - 22:05
ANZ Journal of Surgery, EarlyView.

Comparing the sterility and visibility of surgical marking pens available in Australia

May 8, 2019 - 22:03

This is an unblinded, prospective cohort study assessing the sterility and visibility of surgical marking pens. Photographs of the pen marks were taken before and after wash with surgical prep solutions to analyse ink visibility during surgery. The pen tips were swabbed for culture.


Background

Surgical site marking is an important safety procedure prior to surgery. Visibility of pen marks is affected by surgical wash which increases the risk of wrong‐site surgery. Additionally, multiple patient contact with a single pen is a potential source of bacterial transmission. In this study we compare pens commonly used for surgical marking in Australia.

Methods

We conducted an unblinded, prospective cohort study comparing 12 marking pens. Six volunteers' thighs were marked with each pen. Standardized photographs were taken before and after wash with four prep solutions. Ink visibility was analysed using grayscale images, comparing the pen mark tone before and after wash. The pen tips were swabbed for culture.

Results

Red tinted 2% chlorhexidine gluconate (w/v) with 70% isopropyl alcohol (v/v) was shown to reduce pen mark visibility significantly more than the other solutions used. The Pentel N50 permanent marker and Aspen WriteSite Plus were least affected by wash. No pen tip cultured any bacteria.

Conclusions

When marking the correct site for surgery, we recommend the use of either the Pentel N50 permanent marker or Aspen Writesite Plus pen. A 2‐min interval between patient contact limits bacterial transmission.

Primary aortoenteric fistula: a case of delayed diagnosis

May 8, 2019 - 22:03
ANZ Journal of Surgery, EarlyView.

Blue rubber bleb nevus syndrome: a rare cause of abdominal pain

May 8, 2019 - 22:02
ANZ Journal of Surgery, EarlyView.

Solitary precaval right renal artery

May 8, 2019 - 22:02
ANZ Journal of Surgery, EarlyView.

Acute necrotizing cholecystitis as a rare cause of mechanical small bowel obstruction

May 8, 2019 - 22:01
ANZ Journal of Surgery, EarlyView.

Parasitic leiomyoma in the anterior abdominal wall

May 8, 2019 - 22:01
ANZ Journal of Surgery, EarlyView.

Airbag related penetrating brain injury

May 8, 2019 - 22:01
ANZ Journal of Surgery, EarlyView.

De Garengeot hernia: revisited

May 8, 2019 - 22:01
ANZ Journal of Surgery, EarlyView.

Outcomes of hip and knee replacement surgery in private and public hospitals in Australia

May 8, 2019 - 22:00

This study determined the contributing factors of hospital sector (private versus public) variation in revision rates after elective total hip replacement for hip fracture, and elective total knee replacement. Considerable variation was seen in the revision rate after total hip replacement and total knee replacement between hospital sectors in Australia. The variation was largely due to differences in prosthesis selection.


Background

This study determined the contributing factors of hospital sector (private versus public) variation in revision rates after elective total hip replacement (THR) for hip fracture, and elective total knee replacement (TKR).

Methods

Using data from a large national arthroplasty registry, funnel plots for hospitals were generated, displaying the proportion of revised primary procedures. The proportion of outliers for each distribution was defined as the proportion outside the upper 99.7% confidence limit. Survival analyses determined differences between hospital sector revision rates separately for implants with the lowest revision rate, and for all other implants. Multivariate Cox regression determined the role of hospital sector in revision, adjusting for possible confounders.

Results

For THR performed for osteoarthritis, 17.4% of private and 4.4% of public hospitals were outliers. For TKR performed for osteoarthritis, 19.6% of private and 10.0% of public hospitals were outliers. For THR for fractured neck of femur, 8.1% of private and 0.0% of public hospitals were outliers. Adjusted and unadjusted Kaplan–Meier analyses showed higher THR revision rates in private hospitals for osteoarthritis and fractured neck of femur, but no difference when restricted to the 10 prostheses with the lowest revision rate. The Kaplan–Meier analysis of TKR showed higher revision rates for private hospitals, with the association reversing when restricted to prostheses with the lowest revision rate.

Conclusions

Considerable variation was seen in the revision rate after THR and TKR between hospital sectors in Australia. The variation was largely due to differences in prosthesis selection.

Clear cell sugar tumour: a rare tumour of the lung

May 8, 2019 - 22:00
ANZ Journal of Surgery, EarlyView.

Primary duct closure combined with transcystic drainage versus T‐tube drainage after laparoscopic choledochotomy

May 8, 2019 - 22:00

Primary duct closure combined with transcystic drainage after laparoscopic choledochotomy is a simplified technique for external drainage of the biliary tract. The technique facilitates post‐operative channel decompression, examination and treatment. We can effectively prevent post‐operative complications, especially biliary leakage by this means. Furthermore, it provides a convenient means to treat remnant stones of the bile duct. Finally, compared with minimally invasive drainage using T‐tubes, cystic duct biliary drainage significantly shortens the time for patients to recover and resume normal activities.


Background

We compared the post‐operative course and final outcome of primary duct closure combined with transcystic drainage with those of T‐tube drainage.

Methods

We retrospectively analysed 112 consecutive patients treated with laparoscopic choledochotomy for common bile duct stones between February 2014 and December 2017. Primary closure with transcystic drainage was performed in 59 patients (group A), and laparoscopic choledochotomy with T‐tube drainage was performed in 53 (group B). The primary endpoints were morbidity, the bile drainage quantity, operative time, post‐operative stay, time until return to work and post‐operative complications.

Results

The operation was successfully completed in all patients. The return to work period in group A was significantly shorter than that in group B (7.25 ± 1.27 versus 46.47 ± 3.86 days, P < 0.05). The average daily drainage was not significantly different between the two groups (P > 0.05). There was no significant difference in the operation time (133.75 ± 14.51 versus 132.21 ± 12.71 min) and duration of hospital stay (5.15 ± 1.23 versus 5.94 ± 0.95 days) between the two groups (P > 0.05). Bile leakage was seen in one T‐tube removal patient. No complications were reported in group A. The patients were followed for 2 to 29 months (average: 10). Normal liver function and no stricture of the bile duct were detected with ultrasonography.

Conclusion

Primary closure of choledochotomy and subsequent transcystic drainage is a simple and less invasive procedure than T‐tube placement.

Low recurrence of lung adenoid cystic carcinoma with radiotherapy and resection

May 8, 2019 - 21:59

Adenoid cystic carcinoma is a rare cause of thoracic malignancy, and the prognosis may depend on extent of surgical resection and adjuvant radiotherapy. Complete resection has low rates of local recurrence but is complicated by the involvement of central airways. Adjuvant radiotherapy is frequently recommended, but unproven. Our case series consolidates evidence that early radical resection and radiotherapy is associated with a low risk of local recurrence in patients with thoracic adenoid cystic carcinoma.


Background

Adenoid cystic carcinoma is a rare cause of thoracic malignancy, and the prognosis may depend on the extent of surgical resection and adjuvant radiotherapy. Complete resection has low rates of local recurrence but is complicated by the involvement of central airways. Adjuvant radiotherapy is frequently recommended but unproven.

Methods

We describe the technicalities of radical resection and adjuvant radiotherapy using the primary endpoint of local recurrence and secondary endpoints of locoregional (mediastinal) recurrence and distant metastasis. Resections were classed as microscopically and macroscopically clear (R0) or only macroscopically clear (R1).

Results

Twelve patients (eight males) diagnosed between 1999 and 2016, with an average age of 44 ± 12 years, were included. Six of these were operable (operative group), and six had non‐resectable lesions (radiotherapy group). In the operative group, three had tracheal disease and three had bronchial disease. Tracheal lesions underwent excision with tracheal anastomosis (all R1 resections). Main bronchial lesions underwent complete excision via pneumonectomy (two R0 and one R1 resections). All these patients received 50–60 Gray of adjuvant radiotherapy. At an average follow‐up of 6.1 ± 4.3 years, no patient had local recurrence, two had locoregional recurrence and four had distant metastasis. The radiotherapy group received 60–70 Gray as definitive therapy, and at an average follow‐up of 5.4 ± 4.2 years, three had locoregional recurrence and four had distant metastasis.

Conclusion

Our case series consolidates evidence that early radical resection and radiotherapy is associated with a low risk of local recurrence in patients with thoracic adenoid cystic carcinoma.

Rapid Rhino versus brain: a case report in traumatic epistaxis

May 8, 2019 - 21:59
ANZ Journal of Surgery, EarlyView.

Cervical re‐explorations and proxy survival following parathyroidectomy for primary hyperparathyroidism using Australian administrative data

May 8, 2019 - 21:59

A perspective of surgical outcomes including cervical re‐exploration rates and survival following 2165 parathyroidectomies performed for primary hyperparathyroidism, assessed using Australian administrative data for the period 1993–2015.


Background

Administrative data may have utility in the impartial assessment of surgical outcomes and rare events. We have used a publicly available sample of the Australian pharmaceutical and health service provision (medical benefits scheme) databases to assess outcomes following parathyroidectomy for primary hyperparathyroidism (PHP).

Methods

A cohort study using linked pharmaceutical and medical benefits schemes data was performed covering the period 1993–2014. Procedure codes identified participants undergoing parathyroidectomy for PHP and subsequent cervical re‐exploration surgery (CRX), and the last service date used as a proxy for survival. Time to CRX and survival were modelled using Kaplan–Meier analysis. Demographic data and the era of parathyroid surgery were managed as covariates for Cox regression survival analyses.

Results

A total of 2165 persons undergoing parathyroidectomy for PHP were identified. Median follow‐up was 5.3 years (range 0.2–22). The annual number of parathyroidectomies for PHP increased gradually; 72 individuals underwent CRX (3.3%). The median time to CRX was 152 days (confidence interval 0–396) in 2000–2004 reducing to 47 days (confidence interval 15–78) for the period 2010–2014 (log‐rank P = 0.027). The proportion of persons requiring CRX reduced over time from 6.1% in 1997 to 2.1% in 2012 (r 2 = 0.5817, P = 0.023). Overall median survival (24.6 years) was poorer when compared with age matched controls (log‐rank P = 0.025) but was not associated with CRX or gender.

Conclusion

Administrative data can be used for the assessment of surgical outcomes and may be useful for comparisons of surgical performance, and the appraisal of infrequent events. CRX rates following parathyroidectomy for PHP are improving in Australia.