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Publisher: John Wiley and Sons   (Total: 1592 journals)

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Showing 1 - 200 of 1592 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 13, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 66, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 47, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 54, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 171, SJR: 0.101, h-index: 9)
Acta Geologica Sinica (English Edition)     Hybrid Journal   (Followers: 3, SJR: 0.552, h-index: 41)
Acta Neurologica Scandinavica     Hybrid Journal   (Followers: 5, SJR: 1.203, h-index: 74)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 14, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 6, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 56, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 6, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 37, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 7, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 5)
Addiction     Hybrid Journal   (Followers: 36, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 15, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 26, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 26, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 51, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 14, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 279, SJR: 9.021, h-index: 345)
Advanced Materials Interfaces     Hybrid Journal   (Followers: 6, SJR: 1.177, h-index: 10)
Advanced Optical Materials     Hybrid Journal   (Followers: 7, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 18, SJR: 2.729, h-index: 121)
Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 21)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 13)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 11)
African Development Review     Hybrid Journal   (Followers: 33, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 16, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 16, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 11, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 3, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 16, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 45, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 32, SJR: 1.122, h-index: 120)
Alcoholism and Drug Abuse Weekly     Hybrid Journal   (Followers: 7)
Alcoholism Clinical and Experimental Research     Hybrid Journal   (Followers: 7, SJR: 1.416, h-index: 125)
Alimentary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 34, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 51, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 152, SJR: 0.951, h-index: 61)
American Business Law J.     Hybrid Journal   (Followers: 24, SJR: 0.205, h-index: 17)
American Ethnologist     Hybrid Journal   (Followers: 93, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 29, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 35, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 13, SJR: 1.018, h-index: 58)
American J. of Industrial Medicine     Hybrid Journal   (Followers: 16, SJR: 0.993, h-index: 85)
American J. of Medical Genetics Part A     Hybrid Journal   (Followers: 17, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 6, SJR: 2.315, h-index: 79)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 38, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 296, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 4, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 18, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 10, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 141, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 10, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 20)
Anatomia, Histologia, Embryologia: J. of Veterinary Medicine Series C     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 27)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1, SJR: 0.633, h-index: 24)
Andrologia     Hybrid Journal   (Followers: 2, SJR: 0.528, h-index: 45)
Andrology     Hybrid Journal   (Followers: 2, SJR: 0.979, h-index: 14)
Angewandte Chemie     Hybrid Journal   (Followers: 166)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 234, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 41, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 7, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 49, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 8, SJR: 0.336, h-index: 23)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5, SJR: 2.389, h-index: 189)
Annual Bulletin of Historical Literature     Hybrid Journal   (Followers: 12)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 26, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 18, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 15)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 93, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 52, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 8, SJR: 0.432, h-index: 59)
Anzeiger für Schädlingskunde     Hybrid Journal   (Followers: 1)
Apmis     Hybrid Journal   (Followers: 1, SJR: 0.855, h-index: 73)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 73, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 181, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 51, SJR: 0.868, h-index: 13)
Applied Stochastic Models in Business and Industry     Hybrid Journal   (Followers: 5, SJR: 0.613, h-index: 24)
Aquaculture Nutrition     Hybrid Journal   (Followers: 14, SJR: 1.025, h-index: 55)
Aquaculture Research     Hybrid Journal   (Followers: 32, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 36, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 30, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 15, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 27, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 3, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 5)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 13, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 267, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 55, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 27, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 15)
Asia & the Pacific Policy Studies     Open Access   (Followers: 16)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 326, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (Followers: 1, SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 8, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 4, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 4, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (Followers: 1, SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 6, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 12, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 3, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 15, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 9, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 8, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 6, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 14, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 3, SJR: 0.709, h-index: 14)
Australian and New Zealand J. of Family Therapy (ANZJFT)     Hybrid Journal   (Followers: 3, SJR: 0.382, h-index: 12)
Australian and New Zealand J. of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 47, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 13, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 6, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 6, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 31, SJR: 0.23, h-index: 9)
Australian Economic Review     Hybrid Journal   (Followers: 6, SJR: 0.357, h-index: 21)
Australian Endodontic J.     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 24)
Australian J. of Agricultural and Resource Economics     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 36)
Australian J. of Grape and Wine Research     Hybrid Journal   (Followers: 5, SJR: 0.879, h-index: 56)
Australian J. of Politics & History     Hybrid Journal   (Followers: 15, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 18, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 429, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 6, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 74, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 12, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 23, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 37, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 11, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 5, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 9, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 23, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 10, SJR: 0.11, h-index: 5)
Beton- und Stahlbetonbau     Hybrid Journal   (Followers: 2, SJR: 0.493, h-index: 14)
Biochemistry and Molecular Biology Education     Hybrid Journal   (Followers: 6, SJR: 0.311, h-index: 26)
Bioelectromagnetics     Hybrid Journal   (Followers: 1, SJR: 0.568, h-index: 64)
Bioengineering & Translational Medicine     Open Access  
BioEssays     Hybrid Journal   (Followers: 10, SJR: 3.104, h-index: 155)
Bioethics     Hybrid Journal   (Followers: 14, SJR: 0.686, h-index: 39)
Biofuels, Bioproducts and Biorefining     Hybrid Journal   (Followers: 1, SJR: 1.725, h-index: 56)
Biological J. of the Linnean Society     Hybrid Journal   (Followers: 18, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 5, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 41, SJR: 0.12, h-index: 1)
Biology of the Cell     Full-text available via subscription   (Followers: 9, SJR: 1.812, h-index: 69)
Biomedical Chromatography     Hybrid Journal   (Followers: 6, SJR: 0.572, h-index: 49)
Biometrical J.     Hybrid Journal   (Followers: 5, SJR: 0.784, h-index: 44)
Biometrics     Hybrid Journal   (Followers: 37, SJR: 1.906, h-index: 96)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 10, SJR: 0.715, h-index: 44)
Biopolymers     Hybrid Journal   (Followers: 18, SJR: 1.199, h-index: 104)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 44, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 157, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 14, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 20, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 9, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 38, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 7, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)
BJOG : An Intl. J. of Obstetrics and Gynaecology     Partially Free   (Followers: 248, SJR: 2.083, h-index: 125)

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Journal Cover Anz Journal of Surgery
  [SJR: 0.432]   [H-I: 59]   [8 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1445-1433 - ISSN (Online) 1445-2197
   Published by John Wiley and Sons Homepage  [1592 journals]
  • Body weight change is unpredictable after total thyroidectomy
    • Authors: Ron Glick; Paula Chang, Peter Michail, Jonathan W. Serpell, Simon Grodski, James C. Lee
      Abstract: BackgroundThere is a common perception that total thyroidectomy causes weight gain beyond expected age-related changes, even when thyroid replacement therapy induces a euthyroid state. The aim of this study was to determine whether patients who underwent total thyroidectomy for a wide spectrum of conditions experienced weight gain following surgery.MethodsWe retrospectively studied 107 consecutive total thyroidectomy patients treated between January 2013 and June 2014. Medical records were reviewed to determine underlying pathology, thyroid status, use of antithyroid drugs and preoperative weight. Follow-up data were obtained from 79 patients at least 10 months post-operatively to determine current weight, the type of clinician managing thyroid replacement therapy and patient satisfaction with post-thyroidectomy management.ResultsThe cohort was 73% female, with a mean age of 55.8 ± 15.7 years and a mean preoperative weight of 78.8 ± 17.5 kg. Commonest pathologies were multinodular goitre, Graves’ disease, thyroid cancer and Hashimoto’s thyroiditis. Preoperatively, 63.2% of patients were hyperthyroid. Mean weight change at follow-up was a non-significant increase of 0.06 ± 6.9 kg (P = 0.094). Weight change was not significant regardless of preoperative thyroid function status. This study did not demonstrate any significant differences in clinical characteristics (including post-operative thyroid-stimulating hormone) between the group with>2% weight gain and those who did not.ConclusionsThis study did not reveal significant weight gain following thyroidectomy for a wide spectrum of pathologies. Specifically, preoperative hyperthyroidism, female gender and use of antithyroid medications do not predict weight gain after thyroid surgery.
      PubDate: 2018-02-14T19:31:00.14528-05:0
      DOI: 10.1111/ans.14421
  • Morbidity and mortality meetings: gold, silver or bronze'
    • Authors: Thomas D. Vreugdenburg; Deanne Forel, Nicholas Marlow, Guy J. Maddern, John Quinn, Richard Lander, Stephen Tobin
      Abstract: BackgroundMorbidity and mortality (M&M) meetings contribute to surgical education and improvements in patient care through the review of surgical outcomes; however, they often lack defined structure, objectives and resource support. The aim of this study was to investigate the factors that impact the effective conduct of M&M meetings.MethodsWe conducted a rapid systematic literature review. Three biomedical databases (PubMed, the Cochrane Library and the University of York Centre for Reviews and Dissemination), clinical practice guideline clearinghouses and grey literature sources were searched from May 2009 to September 2016. Studies that evaluated the function of a hospital-based M&M process were included. Two independent reviewers conducted study selection and data extraction. Study details and key findings were reported narratively.ResultsNineteen studies identified enablers, and seven identified barriers, to the effective conduct of M&M meetings. Enabling factors for effective M&M meetings included a structured meeting format, a structured case identification and presentation, and a systems focus. Absence of key personnel from meetings, lack of education regarding the meeting process, poor perceptions of the process, logistical issues and heterogeneity in case evaluation were identified as barriers to effective M&M meetings.ConclusionTaking steps to standardize and incorporate the enabling factors into M&M meetings will ensure that the valuable time spent reviewing M&M is used effectively to improve patient care.
      PubDate: 2018-02-11T21:31:44.949962-05:
      DOI: 10.1111/ans.14380
  • Usefulness of Rapiplug in nipple reconstruction to improve nipple
    • Authors: Joon Seok Lee; Joon Hyun Kwon, Jeong Woo Lee, Kang Young Choi, Ho Yun Chung, Byung Chae Cho, Jung Dug Yang
      Abstract: BackgroundThe final stage of breast reconstruction after mastectomy for breast cancer is nipple reconstruction. However, a consistent and reliable method resulting in the most ideal aesthetic results has yet to be clarified. This study analysed the long-term outcomes of nipple reconstruction using Rapiplug.MethodsForty-one patients who underwent immediate breast reconstruction after mastectomy between January 2014 and February 2017 were enrolled. Nipple reconstruction was performed with C-V flap and Hammond flap, and hat-shaped Rapiplug was implanted at the flap core. Nipple projection and width were measured and nipple reduction rates were calculated immediately after and at 3, 6, and 12 months after surgery. Patient satisfaction was surveyed at the 12-month follow-up and compared with patient characteristics and other variables.ResultsForty-one nipple reconstructions were performed in 41 patients. Most post-operative adverse events were resolved with conservative management, and revision was performed in only one case. The mean nipple projections were 8.9 ± 1.8, 7 ± 1.8, 5.6 ± 1.6 and 4.9 ± 1.6 mm immediately, and 3, 6 and 12 months after surgery, respectively, and the mean reduction rate of nipple size with reference to the size immediately after surgery was 22.2%, 37.2% and 44.7% at 3, 6 and 12 months after surgery, respectively. Patient satisfaction was 82.9% in overall outcome, and 85.3% of projection was good or excellent.ConclusionRapiplug can improve the long-term preservation of nipple projection after nipple reconstruction and is considered to be consistent and reliable with good aesthetic outcomes and no severe complications.
      PubDate: 2018-02-08T23:57:03.721093-05:
      DOI: 10.1111/ans.14410
  • How to insert an internal seton for supralevator sepsis: an effective
           technique for complex fistulae
    • Authors: Amanda L. Nikolic; Corina Behrenbruch, Benjamin Flemming, Philip Smart, Rodney Woods
      PubDate: 2018-02-08T23:56:37.31502-05:0
      DOI: 10.1111/ans.14394
  • Sentinel lymph node mapping in liver resection for colorectal liver
    • Authors: Marcos V. Perini; James Tai, Vijayaragavan Muralidharan, Christopher Christophi
      PubDate: 2018-02-08T22:26:18.034966-05:
      DOI: 10.1111/ans.14405
  • Pulmonary actinomycosis masquerading as lung cancer: keep it in mind
    • Authors: Nikolaos A. Papakonstantinou; Garyfalia Vlachou, Christina Vourlakou, Charalambos Zisis
      PubDate: 2018-02-08T22:26:05.872728-05:
      DOI: 10.1111/ans.14397
  • Variability of perioperative mortality of hepatic resection in Australia
    • Authors: Claire L. Stevens; Wendy J. Babidge, Guy J. Maddern
      Abstract: BackgroundHepatic resection is a relatively young and complex specialized procedure. A strong relationship between volume and perioperative mortality has been reported internationally. However, there has been no multicentre study into hepatic resection in Australia. This retrospective, population-based cohort study was conducted to determine national, state and territory based volume and perioperative mortality rates (POMRs).MethodsAustralian Institute of Health and Welfare data was interrogated for the Australian Classification of Health Intervention codes for hepatic resection defined as extended hemi-hepatectomy (30421), hemi-hepatectomy (30418), segmental hepatic resection (30415) and sub-segmental hepatic resection (30414). Logistic regression analysis was performed using the de-identified data to investigate trends and differences between states/territories. Mortality rates were risk adjusted for age, gender and public or private admission. The data set included patients who underwent hepatic resection in the financial years 2005/2006 to 2012/2013.ResultsThe overall POMR for all types of hepatic resection was 1.6% (201/12 562). There was no significant change in POMR over time. However, there was significant variation between the states and territories with two states having significantly higher POMR for major hepatic resections (regional range: 1.3–3.8%). POMRs increased with age with the highest mortality seen in the 75–79 year age group. The POMR was lower in private than in public hospitals.ConclusionThe results of this study confirm that the overall Australian POMR for major hepatic resection is similar to results reported internationally. National and state/territory POMR has not varied significantly over time. The significant variation between states/territories warrants further investigation.
      PubDate: 2018-02-08T22:25:57.923716-05:
      DOI: 10.1111/ans.14408
  • Audit of 117 otoplasties for prominent ear by one surgeon using a
           cartilage-cutting procedure
    • Authors: Tess Brian; Paul T. Cheng, Stanley S. Loo
      Abstract: BackgroundThe plethora of surgical procedures for prominent ear correction reflects lack of satisfaction with outcomes achieved. This paper describes a cartilage-cutting otoplasty procedure and reports an audit of its outcomes.MethodsDischarge coding was used to retrospectively identify patients who had undergone the otoplasty of interest at Middlemore Hospital, Auckland, during the 5 years from March 2010 to the end of February 2015. Hospital records were accessed. Demographic, procedure and patient satisfaction data were recorded and analysed (PASW/SPSS Statistics 18.0). Chi-square test and t-test were used to assess associations, with significance accepted at two-sided P
      PubDate: 2018-02-07T19:31:22.015879-05:
      DOI: 10.1111/ans.14401
  • Uterine colorectal metastatic disease: a rare occurrence
    • Authors: Laura Reynolds; Sarah Kenny, Geoff Crozier-Shaw, Charles Connolly, William P. Joyce
      PubDate: 2018-02-07T19:30:56.800534-05:
      DOI: 10.1111/ans.14402
  • Clinical characteristics affecting length of stay in patients with
    • Authors: Megan Grinlinton; Stephen Sohn, Andrew Hill, Irene Zeng, Jenny Wagener
      Abstract: BackgroundThis study aimed to profile the clinical characteristics of patients presenting to Middlemore Hospital with cellulitis in order to identify factors that are associated with an increased length of stay (LOS).MethodsRetrospective clinical data were collected for all patients aged 18 and above who were admitted with cellulitis to Middlemore Hospital General Surgical Department between 1 January and 31 March 2014. Comorbidities, laboratory results and medical conditions were included in the investigation.ResultsThe study included 201 patients. Significant factors associated with increased LOS include type 2 diabetes mellitus (P
      PubDate: 2018-02-07T19:30:33.868677-05:
      DOI: 10.1111/ans.14413
  • Pulse oximetric assessment of anatomical vascular contribution to tissue
           perfusion in the gastric conduit
    • Authors: Tomoyuki Irino; Saga Persson, Lars Lundell, Magnus Nilsson, Jon A. Tsai, Ioannis Rouvelas
      Abstract: BackgroundTubularized stomach is a common substitute used after oesophageal resection. The risk for gastric conduit ischemia, as well as the mechanisms and dynamics for the occurrence of deficient tissue perfusion during the critical construction of a gastric tube, is poorly understood.MethodsTwenty-nine patients that underwent oesophagectomy were studied with transmural pulse oximetry of different parts of the stomach, and at predefined preparatory steps during the construction of the gastric conduit.ResultsAfter ligation of the left gastric artery (LGA), a reduction to 83.5% in tissue saturation was observed. Three patients (10.3%) had a sustained saturation despite ligation at this point. During final preparation of the gastric tube, and after stapling of the minor curvature, saturation fell to 76.5%. Saturation increased significantly to 80.0% 2 h after the stapling, just before construction of the anastomosis (P = 0.021). There was no association between the level of oxygen saturation and the risk of anastomotic dehiscence.ConclusionDuring gastric tube construction for oesophageal replacement, conduit perfusion, measured as oxygen saturation with pulse oximetry, decreases significantly. The main cause of this reduction seems to be ligation of the LGA and the final stapling of the gastric tube. Future studies are needed to establish the clinical implications of this finding.
      PubDate: 2018-02-07T04:30:45.325519-05:
      DOI: 10.1111/ans.14399
  • Leaving surgical training: some of the reasons are in surgery
    • Authors: Deanne Forel; Meegan Vandepeer, Joanna Duncan, David R. Tivey, Stephen A. Tobin
      Abstract: In 2014, the Royal Australasian College of Surgeons identified, through internal analysis, a considerable attrition rate within its Surgical Education and Training programme. Within the attrition cohort, choosing to leave accounted for the majority. Women were significantly over-represented. It was considered important to study these ‘leavers’ if possible. An external group with medical education expertise were engaged to do this, a report that is now published and titled ‘A study exploring the reasons for and experiences of leaving surgical training’. During this time, the Royal Australasian College of Surgeons came under serious external review, leading to the development of the Action Plan on Discrimination, Bullying and Sexual Harassment in the Practice of Surgery, known as the Building Respect, Improving Patient Safety (BRIPS) action plan. The ‘Leaving Training Report’, which involved nearly one-half of all voluntary ‘leavers’, identified three major themes that were pertinent to leaving surgical training. Of these, one was about surgery itself: the complexity, the technical, decision-making and lifestyle demands, the emotional aspects of dealing with seriously sick patients and the personal toll of all of this. This narrative literature review investigates these aspects of surgical education from the trainees’ perspective.
      PubDate: 2018-02-07T04:30:23.642502-05:
      DOI: 10.1111/ans.14393
  • Common bile duct obstruction secondary to gastroduodenal pseudoaneurysm
    • Authors: Felix M. Lee; Jeremy F. Khoo, Simon Edelstein, Daniel G. Croagh
      PubDate: 2018-02-05T19:00:38.4563-05:00
      DOI: 10.1111/ans.14404
  • First case of the migrating MiniMizer ring
    • Authors: Elizabeth W. Tan; Tara Luck, Andrew Huo, Yuan Cheng
      PubDate: 2018-02-05T00:50:34.753068-05:
      DOI: 10.1111/ans.14388
  • Neoadjuvant radiotherapy provided survival benefit compared to adjuvant
           radiotherapy for hepatocellular carcinoma
    • Authors: Huapeng Lin; Xiaocheng Li, Ye Liu, Yingchun Hu
      Abstract: BackgroundThis study compared the impact of neoadjuvant radiotherapy (RT) and adjuvant RT on survival for patients with hepatocellular carcinoma (HCC).MethodsPatients with HCC were identified from the Surveillance, Epidemiology and End Results (SEER) database. The Kaplan–Meier method and multivariate Cox regression analysis were used to compare the impact of neoadjuvant RT on survival with adjuvant RT. Subsequently, a propensity score-matched analysis was performed to confirm the result.ResultsA total of 244 patients with HCC identified from the SEER database (2004–2014) received preoperative or post-operative radiation. A total of 151 patients received post-operative RT and 93 patients received preoperative RT. Preoperative RT had a clear superiority in terms of unadjusted overall survival and cancer-specific survival (P 
      PubDate: 2018-02-05T00:50:26.497557-05:
      DOI: 10.1111/ans.14387
  • Effects of early antiplatelet therapy after splenectomy with
           gastro-oesophageal devascularization
    • Authors: Jin-Bao Zhou; Bao-Yang Luo, Chi-Wen Liu, Feng Zhu
      Abstract: BackgroundThis study aimed to explore the effects of early antiplatelet therapy (APT) for portal vein thrombosis (PVT) in patients with cirrhotic portal hypertension after splenectomy with gastro-oesophageal devascularization.MethodsWe retrospectively analysed 139 patients who underwent splenectomy with gastro-oesophageal devascularization for portal hypertension due to cirrhosis between April 2010 and December 2016. Based on the post-operative platelet values, we used two different APT regimens: APT was started when platelet counts were increased to 200 × 109/L or above (group A, n = 64) or 300 × 109/L or above (group B, n = 75). We took note of the patients’ clinical symptoms, operative factors and biochemical indicators.ResultsPlatelet count, mean platelet volume, D-dimer and pancreatic fistula were closely related to the development of PVT. Early APT was an independent protective factor for PVT. The incidence of post-operative PVT was 15.1% (21/139) overall, 4.7% (3/64) in group A and 24% (18/75) in group B; there was a significant difference between groups A and B (χ2 = 10.042, P = 0.002).ConclusionPlatelet count, mean platelet volume, D-dimer and pancreatic fistula were independent risk factors for the development of PVT after splenectomy with gastro-oesophageal devascularization. Selection of the appropriate timing for early APT according to the post-operative platelet count was feasible. Moreover, the use of aspirin combined with dipyridamole was safe and effective for early prevention of PVT.
      PubDate: 2018-02-03T02:16:07.946609-05:
      DOI: 10.1111/ans.14395
  • Arm morbidity of axillary dissection with sentinel node biopsy versus
           delayed axillary dissection
    • Authors: Helen Ballal; Catherine Hunt, Chrianna Bharat, Kevin Murray, Roshi Kamyab, Christobel Saunders
      Abstract: BackgroundStaging of axillary lymph nodes in breast cancer is important for prognostication and planning of adjuvant therapy. The traditional practice of proceeding to axillary lymph node dissection (ALND) if sentinel lymph node biopsy (SLNB) is positive is being challenged and clinical trials are underway. For many centres, this will mean a move away from intra-operative SLNB assessment and utilization of a second procedure to perform ALND. It is sometimes perceived that a delayed ALND results in increased tissue damage and thus increased morbidity. We compared morbidity in those undergoing SLNB only, or ALND as a one- or two-stage procedure.MethodsA retrospective review of a prospectively collected institutional database was used to review rates of lymphoedema and shoulder function in women undergoing breast cancer surgery between 2008 and 2012.ResultsThe overall lymphoedema rate in 745 patients was 8.2% at 12 months. There was no difference in lymphoedema rates between those undergoing immediate or delayed ALND (17.8 and 8.6%, respectively, P = 0.092). Post-operative shoulder elevation, odds ratio (OR) = 0.390, 95% confidence interval (CI) = (0.218, 0.698) and abduction, OR = 0.437 (95% CI = (0.271, 0.705)) were reduced if an ALND was performed although there was no difference between immediate or delayed.ConclusionALND remains a risk factor for post-operative morbidity. There is no increased risk of lymphoedema or shoulder function deficit with a positive SLNB and delayed ALND compared to immediate ALND.
      PubDate: 2018-02-02T04:25:22.238678-05:
      DOI: 10.1111/ans.14382
  • Hepatic angiomyolipoma detected using computed tomography
    • Authors: Yoshihiro Miyazaki; Takashi Kokudo, Amane Takahashi, Katsumi Amikura, Hirohiko Sakamoto
      PubDate: 2018-02-01T23:07:00.073354-05:
      DOI: 10.1111/ans.14156
  • Hepatic angiomyolipoma presenting as an arterially enhancing liver lesion
    • Authors: Chun Yuet Khoo; Wei Keat Wan, Brian K. P. Goh
      PubDate: 2018-02-01T23:06:22.660094-05:
      DOI: 10.1111/ans.14389
  • Large bowel obstruction due to adhesion bands following right nephrectomy
           and transplanted pelvic kidney
    • Authors: Stacey L. Chamberlain; Smita Deb, Tamara M. Vu, Zdenek Dubrava
      PubDate: 2018-02-01T00:36:49.601491-05:
      DOI: 10.1111/ans.14396
  • Clinical patterns and management of primary mucosal melanoma: a single
           centre experience
    • Authors: Yvonne Y. R. Ng; Grace H. C. Tan, Richard H. H. Quek, Mohamad B. H. R. Farid, Khee Chee Soo, Melissa C. C. Teo
      Abstract: BackgroundPrimary mucosal melanomas (MM) are rare neoplasms arising from melanocytes in mucosal membranes. Delayed diagnosis and aggressive disease biology contribute to a poorer prognosis. The clinical patterns of MMs treated in a large tertiary centre, and the differences between MMs in the head and neck versus other anatomical sites are described.MethodsA retrospective review of 43 patients diagnosed with MM in the head and neck, urogenital, esophageal and anorectal sites from 1993 to 2015 was conducted.ResultsDistribution of head and neck, urogenital and gastrointestinal MM were 42, 30 and 28% respectively. Disease extent was local in 44%, regional in 40% and distal in 12% at diagnosis. Head and neck MMs were more likely to be diagnosed at an earlier stage as compared to other sites (P = 0.04). Surgery was performed with curative intent in 72%, while 2% had palliative surgery for symptom control. Of the remaining patients who did not undergo surgery, four had palliative chemotherapy and/or radiotherapy. Median disease-free survival was 13 months (1–179 months). There was a significantly longer time to locoregional recurrence in head and neck MM (16 months) compared to other sites (11 months) (P = 0.03). The 2-year overall survival was also significantly higher in head and neck MM (P = 0.003).ConclusionMM of the head and neck is diagnosed at an earlier stage and associated with a longer time to locoregional recurrence. Surgical resection is the mainstay of treatment and may offer long-term survival benefit in selected patients.
      PubDate: 2018-02-01T00:36:18.01973-05:0
      DOI: 10.1111/ans.14373
  • Effect of sarcopenia on the outcomes after pancreaticoduodenectomy for
           distal cholangiocarcinoma
    • Authors: Satoko Umetsu; Taiichi Wakiya, Keinosuke Ishido, Daisuke Kudo, Norihisa Kimura, Takuya Miura, Yoshikazu Toyoki, Kenichi Hakamada
      Abstract: BackgroundThe relationship between sarcopenia and patient outcomes after pancreaticoduodenectomy (PD) for distal cholangiocarcinoma (DCC) remains unclear. We assessed the impact of sarcopenia on the outcomes after PD for DCC.MethodsWe retrospectively analysed 65 patients who underwent PD for DCC. The quality of skeletal muscle indicated by the psoas muscle mass index (PMI) were measured on pre-operative computed tomography images. The impact of pre-operative sarcopenia on short- and long-term outcomes was evaluated.ResultsRegarding short-term surgical outcomes, there were no marked differences between the high and low PMI groups. Regarding long-term oncological outcomes, the rates of recurrence (23.5% versus 58.3%, P = 0.011) was significantly lower in the high PMI group than in the low PMI group. Furthermore, the recurrence-free survival and disease-specific survival were longer in the high PMI group (P = 0.023 and P = 0.043, respectively). On multivariate analyses, low PMI was an independent predictor of recurrence (hazard ratio (HR) 11.06; P = 0.022) and disease-specific death (HR 11.88; P = 0.043).ConclusionsOur findings suggested an association between pre-operative sarcopenia and poor long-term oncological outcomes after PD for DCC.
      PubDate: 2018-02-01T00:36:16.178152-05:
      DOI: 10.1111/ans.14304
  • Incarcerated urachal remnant
    • Authors: Alexander L. Birrell; Asiri Arachchi, Wajiha Sufyan, Ruth Hardstaff
      PubDate: 2018-02-01T00:36:10.514889-05:
      DOI: 10.1111/ans.14338
  • Acute scrotum in the setting of acute necrotizing pancreatitis: a surprise
    • Authors: Uttam K. Mete; Ashish Khanna, Aditya P. Sharma
      PubDate: 2018-02-01T00:35:46.51125-05:0
      DOI: 10.1111/ans.14348
  • Content analysis of consumer information about knee arthroscopy in
    • Authors: Rachelle Buchbinder; Allison Bourne
      Abstract: BackgroundDespite the availability of consistent guidelines recommending against arthroscopic treatment for people with symptomatic knee osteoarthritis, Australian data indicate continued use of this treatment modality. A paucity of easy to understand and reliable consumer information about knee arthroscopy may be one explanatory factor. The aim of this study was to determine whether consumer information about knee arthroscopy available in Australia is adequate to inform evidence-based decision-making for people with symptomatic osteoarthritis.MethodsWe performed a content analysis of consumer information about knee arthroscopy for symptomatic osteoarthritis. Information sources were identified from the Australian Commission on Quality and Safety in Health Care and Internet searches conducted 20–28 May 2015. Search terms were ‘knee arthroscopy’, ‘knee pain’, ‘osteoarthritis knee’ and ‘meniscal tear’, and ‘orthopaedic surgeon’ linked to each Australian capital city. Two independent reviewers selected documents for inclusion and extracted data. Main outcomes were specific advice regarding use of arthroscopic treatment for people with knee osteoarthritis, mention of guidelines, and/or supporting evidence.ResultsNinety-three documents were analyzed (44 were a paragraph or less). Only eight made a clear recommendation against use of arthroscopy for all/most people with knee osteoarthritis. None included an explicit statement attributed to a guideline, while only six provided any research evidence to support their advice. Wikipedia provided the most valid information but it may be incomprehensible to the average reader.ConclusionCurrently available consumer information about knee arthroscopy in Australia may be inadequate to help people with symptomatic knee osteoarthritis make informed decisions about this treatment.
      PubDate: 2018-01-30T01:11:55.48675-05:0
      DOI: 10.1111/ans.14412
  • Neutrophil-to-lymphocyte ratio predicts anastomotic dehiscence
    • Authors: Patrick A. Walker; Bindu Kunjuraman, David C. C. Bartolo
      Abstract: BackgroundAnastomotic dehiscence (AD) is the most feared complication following colonic and rectal anastomosis. Multiple attempts have been made to correlate the levels of biomarkers to the risk of AD. This study attempts to compare C-reactive protein (CRP), procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) as predictors of AD.MethodThis case-controlled study collected data on patients undergoing colonic and rectal anastomosis over an 18-month period. Levels of CRP, PCT and NLR were recorded daily for the first 5 days post-operatively. These results were then compared between those who developed AD and those who did not.ResultsA total of 136 patients were included; 11 (8.1%) patients developed AD. CRP and NLR were useful predictors of AD with an area under the curve of 0.81 and 0.78 on post-operative day 4. PCT was not found to be raised significantly higher in patients who developed AD compared to those who did not.ConclusionCRP and NLR are useful predictors of AD. PCT is not a useful predictor of AD.
      PubDate: 2018-01-27T03:15:48.977867-05:
      DOI: 10.1111/ans.14369
  • Rare differential for large bowel obstruction
    • Authors: Rebecca Reardon; Terence C. Chua, Jane Cross, Austin Curtin
      PubDate: 2018-01-23T20:30:58.300732-05:
      DOI: 10.1111/ans.14385
  • Pressure dressings in mastoid and middle ear surgery: are they
           necessary' A retrospective review of patient outcomes
    • Authors: Justin Xavier O'Brien; Olivia Ruskin, Tim Price
      Abstract: BackgroundThe application of mastoid pressure dressings following mastoid and middle ear surgery is widely practised to reduce the risk of haematoma and seroma. There are a number of minor morbidities associated with use of the dressings, as well as a financial cost associated with an overnight stay in hospital or a return appointment for removal of the dressings. The benefit of having these dressings in situ overnight is questionable.MethodsA retrospective review of 133 patients who had their mastoid dressing removed 2 h after their procedure was undertaken at our Hospital. The patient records were scanned for procedure-related morbidities, and perioperative data were analysed.ResultsNo haematomas or seromas occurred in any of the 133 patients studied. Minor morbidities associated with prolonged use of mastoid pressure dressings were avoided.ConclusionRemoval of mastoid pressure dressings 2 h following ear surgery is safe and effective. Furthermore, a mastoid dressing should not be a factor in the decision as to whether to treat a patient as a day case or overnight admission.
      PubDate: 2018-01-23T20:30:52.995393-05:
      DOI: 10.1111/ans.14370
  • Uptake of adjuvant breast cancer treatments recommended by
           multi-disciplinary meetings
    • Authors: Melinda Pattanasri; Kenneth Elder, Carolyn Nickson, Samuel Cooke, Dorothy Machalek, Allison Rose, Arlene Mou, John P. Collins, Allan Park, Richard De Boer, Claire Phillips, Vicki Pridmore, Helen Farrugia, G. Bruce Mann
      Abstract: BackgroundAdjuvant therapy for breast cancer is routinely discussed and recommended in multi-disciplinary meetings (MDMs). Current literature explores how treatments received by patients differ from national guidelines; however, it does not explore whether treatment is concordant with MDMs. This study provides an Australian perspective on the uptake of MDM recommendations and reasons for non-concordance.MethodsA retrospective cohort study of patients with breast cancer presented at The Royal Melbourne Hospital MDM in 2010 and 2014 to investigate the concordance between MDM recommendations and treatment received.ResultsThe study group comprised 441 patients (161 from 2010 and 280 from 2014). A total of 375 patients were included in the analyses. Overall, 82% of patients had perfect concordance between recommended and received treatment for all modes of adjuvant therapy. Concordance to endocrine therapy was higher for invasive cancers than ductal carcinoma in situ (97% versus 81%, P 
      PubDate: 2018-01-23T20:30:48.589296-05:
      DOI: 10.1111/ans.14368
  • Liver resection for hepatocellular carcinoma: personal experiences in a
           series of 1330 consecutive cases in China
    • Authors: Jing Li; Liang Huang, Jianjun Yan, Maixuan Qiu, Yiqun Yan
      Abstract: BackgroundLiver resection to treat early stage hepatocellular carcinoma (HCC) is widely practised but surgery for intermediate and advanced stages of HCC is not included in the treatment algorithm of the Barcelona Clinic Liver Cancer, which has been adopted in official guidelines; nevertheless, resection beyond early stages is frequently undertaken and documented.MethodsBetween January 2001 and December 2014, all the HCC patients who underwent liver resection for the first time by Dr Yiqun Yan and his surgical team were enrolled. Clinical data were prospectively collected as well as the follow-up results.ResultsA total of 1330 consecutive patients were included in the study, of which 452 (34.0%) suffered complications after liver resection with a mortality of 0.7%. The overall survival rates at 1-, 3- and 5-year were 91.2, 63.3 and 36.9%, respectively, while the disease-free survival rates at 1-, 3- and 5-year were 67.7, 33.7 and 13.8%, respectively. Cases were classified into Barcelona Clinic Liver Cancer stage A (548 patients, 41.2%), stage B (613 patients, 46.1%) and stage C (169 patients, 12.7%). The overall survival time at 5-year were 49.8, 32.8 and 10.6%, respectively, in patients with stage A, B and C tumours.ConclusionLiver resection to treat HCC is safe in patients with preserved liver function and good functional status. Liver resection should be the first line therapy in patients with single (regardless of tumour size) and resectable 2–3 tumours as well as vascular tumour thrombus if the tumour thrombus does not invade the major trunks.
      PubDate: 2018-01-23T20:30:46.794389-05:
      DOI: 10.1111/ans.14381
  • Transvaginal evisceration of small bowel
    • Authors: James W. T. Toh; Taina Lee, Corinna Chiong, Grahame Ctercteko, Nim Pathma-Nathan, Toufic El Khoury, Danette Wright, Jennifer King
      PubDate: 2018-01-08T18:07:22.43531-05:0
      DOI: 10.1111/ans.14290
  • Low-grade appendiceal mucinous neoplasm within an Amyand's hernia
    • Authors: Han Boon Oh; Yudong Chen, Yuen Soon
      PubDate: 2018-01-08T18:02:15.667568-05:
      DOI: 10.1111/ans.14358
  • Internal hernia following laparoscopic low anterior resection: a serious
           complication often misdiagnosed
    • Authors: François Rouleau-Fournier; Sebastien Drolet, Alexandre Bouchard, Philippe Bouchard
      PubDate: 2018-01-08T18:02:05.285841-05:
      DOI: 10.1111/ans.14346
  • Idiopathic sclerosing encapsulating peritonitis: a rare surgical
    • Authors: Zhen Hao Ang; Eric H. Y. Lai, Julian C. Y. Ip, Mark Muhlmann
      PubDate: 2018-01-08T18:01:53.003476-05:
      DOI: 10.1111/ans.14347
  • Appendiceal intussusception
    • Authors: Shaani Singhal; Suellyn Centauri, Shanesh Kumar, Asiri Arachchi, Niyaz Naqash
      PubDate: 2018-01-08T18:01:40.219465-05:
      DOI: 10.1111/ans.14349
  • Solid pseudopapillary tumour of the pancreas: clinicopathological analysis
    • Authors: Simon McCluney; Nilukshi Wijesuriya, Vinayata Sheshappanavar, Joanne Chin-Aleong, Roger Feakins, Robert Hutchins, Ajit Abraham, Satyajit Bhattacharya, Roberto Valente, Hemant Kocher
      Abstract: BackgroundWe report on our experience of the surgical management and outcomes of 11 patients with solid pseudopapillary tumour of the pancreas (SPT). We sought to correlate the immunohistochemical staining of these tumours with that previously reported in the literature.MethodsA retrospective analysis of the clinical presentation, radiological findings, surgical treatment, histopathological characteristics and outcomes for patients surgically managed with SPT at The Royal London Hospital. A literature search was performed to analyse the immunohistochemical stains commonly used to diagnose SPT.ResultsBetween August 2006 and April 2016, 10 females and one male patient underwent surgery for SPT. The localization of the tumour was in the pancreatic head in two patients, one in the neck, three in the body and five in the tail. All 11 patients had localised disease. Six patients suffered post-surgical complications. Histopathology shows immunoreactivity for: β-catenin, vimentin, CD-10, CD-56, α1-antitrypsin and negative staining for synaptophysin and chromogranin. At a median of 24 months of follow-up, the disease-free survival rate was 100% and no recurrence was noted. A literature review generated 38 suitable articles with 116 individual cases of SPT, with high expression of vimentin and neuron specific enolase throughout, and low rates of chromogranin and synatophysin positivity.ConclusionSPT is rare and affects mostly young women. An accurate diagnosis is important as the relative indolent behaviour can be managed with surgical resection even when large in size, bringing excellent long-term outcomes.
      PubDate: 2018-01-08T18:01:25.525411-05:
      DOI: 10.1111/ans.14362
  • Acute lumbar paraspinal compartment syndrome: a systematic review
    • Authors: William Alexander; Nelson Low, George Pratt
      Abstract: While still a rare entity, acute lumbar paraspinal compartment syndrome has an increasing incidence. Similar to other compartment syndromes, acute lumbar paraspinal compartment syndrome is defined by raised pressure within a closed fibro-osseous space, limiting tissue perfusion within that space. The resultant tissue ischaemia presents as acute pain, and if left untreated, it may result in permanent tissue damage. A literature search of ‘paraspinal compartment syndrome’ revealed 21 articles. The details from a case encountered by the authors are also included. A common data set was extracted, focusing on demographics, aetiology, clinical features, management and outcomes. There are 23 reported cases of acute compartment syndrome. These are typically caused by weight-lifting exercises, but may also result from other exercises, direct trauma or non-spinal surgery. Pain, tenderness and paraspinal paraesthesia are key clinical findings. Serum creatine kinase, magnetic resonance imaging and intracompartment pressure measurement confirm the diagnosis. Half of the reported cases have been managed with surgical fasciotomy, and these patients have all had good outcomes relative to those managed with conservative measures with or without hyperbaric oxygen therapy. These good outcomes were despite significant delays to operative intervention. The diagnostic uncertainty and subsequent delay to fasciotomy result from the rarity of this disease entity, and a high level of suspicion is recommended in the appropriate setting. This is particularly true in light of the current popularity of extreme weight lifting in non-professional athletes. Operative intervention is strongly recommended in all cases based on the available evidence.
      PubDate: 2018-01-08T18:01:20.423778-05:
      DOI: 10.1111/ans.14342
  • Usefulness of fluorescence vascular imaging for evaluating splenic
    • Authors: Yota Kawasaki; Kosei Maemura, Hiroshi Kurahara, Yuko Mataki, Satoshi Iino, Masahiko Sakoda, Hiroyuki Shinchi, Shoji Natsugoe
      Abstract: BackgroundThe aim of this study was to confirm whether intraoperative fluorescence vascular imaging using indocyanine green (FVI-ICG) is useful for evaluating splenic perfusion after spleen-preserving distal pancreatectomy (SPDP) performed with the Warshaw technique (SPDP-W).MethodsWe evaluated the blood perfusion of the spleen with an intraoperative FVI-ICG system after SPDP-W. All of the patients underwent dynamic computed tomography (CT) scans at one post-operative week and one post-operative month to evaluate the post-operative blood perfusion of the spleen. Then, the post-operative perfusion status of the spleen according to CT and the intraoperative fluorescence status of the spleen were compared.ResultsFive patients were enrolled in this study. None of the patients required secondary splenectomies. We detected a tendency towards a close relationship between the intraoperative fluorescence level of the spleen according to FVI-ICG performed after SPDP-W and post-operative splenic perfusion as evaluated by CT. Improved splenic perfusion was seen at one post-operative month in all cases, including a case in which poor splenic perfusion was initially detected.ConclusionWe detected a close relationship between the fluorescence level of the spleen on intraoperative FVI-ICG and the post-operative perfusion status of the spleen among patients who underwent SPDP-W. Intraoperative FVI-ICG could help surgeons to safely preserve the spleen after SPDP-W.
      PubDate: 2018-01-08T18:00:55.519229-05:
      DOI: 10.1111/ans.14364
  • Transrectal prostate biopsy sepsis rate following reduced quinolone
           antibiotic prophylaxis from six doses to single dose
    • Authors: Haider K. Bangash; Cynthia Hawks, Steve P. McCombie, Matthew Brown, Dickon Hayne
      Abstract: BackgroundThis study aimed to evaluate the rates of infective complication related to transrectal prostate biopsy (TRPB) as our centre changed its protocol from six doses over 3 days to a single pre-procedure prophylactic dose.MethodsThis prospective cohort study identified infective complication in patients who attended and subsequently underwent TRPB at the time of their one-stop prostate clinic at our public tertiary hospital between August 2011 and April 2017. Patients who underwent TRPB between August 2011 and November 2014 received six doses of 500 mg of ciprofloxacin, taken twice daily over 3 days. This protocol was changed to a single dose of 500 mg of ciprofloxacin prior to biopsy from February 2015 to April 2017. Patients who had travelled to South East Asia in the 6 months prior to TRPB received a single dose of 1 g intravenous ertapenem prior to biopsy, and this remained unchanged throughout the study period. The rates of infective complication were recorded and compared between the groups of patients who had undergone six doses versus a single dose of prophylactic ciprofloxacin.ResultsA total of 766 patients underwent TRPB from August 2011 to April 2017. Of these, 357 patients received the 3-day course of prophylaxis (Group 1) and 409 patients received the single dose prophylaxis (Group 2). Fifty-five patients were excluded from analysis. There was no significant difference in infective complications between the two groups (3.4% (11/326) Group 1 versus 4.9% (19/385) Group 2, P = 0.40).ConclusionOur study supports the use of a single dose of ciprofloxacin as sufficient antibiotic prophylaxis prior to TRPB.
      PubDate: 2018-01-08T03:05:47.103501-05:
      DOI: 10.1111/ans.14360
  • Pancreatic hamartoma: a sheep in wolf's clothing
    • Authors: Christopher B. Nahm; Fedaa Najdawi, Jessica Reagh, Antony Kaufman, Anubhav Mittal, Anthony J. Gill, Jaswinder S. Samra
      PubDate: 2018-01-08T03:05:40.007868-05:
      DOI: 10.1111/ans.14332
  • A rare case of gestational gigantomastia
    • Authors: Zeynep Karacor-Altuntas; Mehmet E. C. Yildirim, Sidika Findik
      PubDate: 2018-01-08T03:02:37.840706-05:
      DOI: 10.1111/ans.14363
  • Robotic-assisted radical cystectomy with intracorporeal urinary diversion
           versus open: early Australian experience
    • Authors: Ken Chow; Homayoun Zargar, Niall M. Corcoran, Anthony J. Costello, Justin S. Peters, Philip Dundee
      Abstract: BackgroundThe aim of this study was to describe our initial Australian single surgeon experience with robotic-assisted radical cystectomy (RARC) and intracorporeal urinary diversion (ICUD) and to compare the outcomes with open radical cystectomy (ORC).MethodsBetween January 2014 and June 2016, consecutive patients diagnosed with muscle invasive and high-risk non-muscle invasive bladder cancer undergoing radical cystectomy were included. Treatment modalities included either RARC with ICUD or ORC. ICUD consisted of either intracorporeal ileal conduit or orthotopic neobladder formation. Prospectively collected perioperative and oncological outcomes were analysed.ResultsTwenty-six RARC and 13 ORC were performed. Median operating times were 362 and 240 min for RARC and ORC, respectively (P
      PubDate: 2018-01-08T03:02:10.980217-05:
      DOI: 10.1111/ans.14361
  • Laparoscopic repair of a complex Morgagni hernia in a patient with Marfan
    • Authors: Shanmugam S. Somasundaram; Travis G. Ackermann, Edwin Beenen
      PubDate: 2018-01-08T03:02:09.291951-05:
      DOI: 10.1111/ans.14365
  • How to gain safe entry for laparoscopic cholecystectomy in the
           multi-scarred abdomen
    • Authors: Hasitha Dinesh Balasuriya; Douglas James Dunn, Mark Gregory Joseph
      PubDate: 2018-01-08T03:01:53.198629-05:
      DOI: 10.1111/ans.14366
  • Issue information - TOC
    • Pages: 2 - 3
      PubDate: 2018-02-01T23:20:06.984704-05:
      DOI: 10.1111/ans.14375
  • All ‘complex’ abdominal incisional hernia repairs using mesh must be
           drained: it's the law
    • Authors: Philip G. Truskett
      Pages: 5 - 6
      PubDate: 2018-02-01T23:20:10.025111-05:
      DOI: 10.1111/ans.14376
  • Surviving rejections, revisions and re-submissions
    • Authors: David A. Watters
      Pages: 6 - 7
      PubDate: 2018-02-01T23:20:02.576599-05:
      DOI: 10.1111/ans.14229
  • Ongoing evolution of preoperative chemoradiotherapy for rectal cancer
    • Authors: Hussein Soudy
      Pages: 8 - 9
      PubDate: 2018-02-01T23:20:10.312819-05:
      DOI: 10.1111/ans.14223
  • Hazards of predatory publication
    • Authors: John P. Harris
      Pages: 9 - 9
      PubDate: 2018-02-01T23:20:08.481822-05:
      DOI: 10.1111/ans.14255
  • Dissection should remain a key part of medical education
    • Authors: Holly Morris; Steven Jacques
      Pages: 10 - 11
      PubDate: 2018-02-01T23:20:11.524816-05:
      DOI: 10.1111/ans.14274
  • Stem cell treatments within surgical specialities: what is the
    • Authors: Yasoba N. Atukorale; Robyn S. Lambert, Alun L. Cameron, Guy J. Maddern
      Pages: 11 - 12
      PubDate: 2018-02-01T23:20:03.69066-05:0
      DOI: 10.1111/ans.14238
  • Medicine in small doses
    • Authors: Bruce P. Waxman
      Pages: 13 - 13
      PubDate: 2018-02-01T23:20:10.231907-05:
      DOI: 10.1111/ans.14377
  • 25, 50 & 75 years ago
    • Authors: John P. Harris
      Pages: 14 - 15
      PubDate: 2018-02-01T23:20:01.179924-05:
      DOI: 10.1111/ans.14337
  • To drain or not to drain: Supreme Court has the answer
    • Authors: Arkadiusz P. Wysocki; Brian McGowan
      Pages: 115 - 115
      PubDate: 2018-02-01T23:20:11.452674-05:
      DOI: 10.1111/ans.14285
  • Challenges and recommendations for minimally resourced biobanks in
           tertiary Australian hospitals
    • Authors: Noel Chia; Lechuan Wen, J. Guy Lyons, Michael Elliott, Maggie Lee, Carsten E. Palme, Jonathan R. Clark, Ruta Gupta
      Pages: 115 - 116
      PubDate: 2018-02-01T23:20:02.088792-05:
      DOI: 10.1111/ans.13909
  • Massive rectal bleeding: empiric embolization of the superior rectal
    • Authors: Vamsidhar Rachapalli; Jumkur Nagabhushan
      Pages: 116 - 116
      PubDate: 2018-02-01T23:20:02.372324-05:
      DOI: 10.1111/ans.14188
  • Re: Acute cholangitis: current concepts
    • Authors: Brian Ho Ming Yuen; John Barker, Graham Stewart
      Pages: 117 - 117
      PubDate: 2018-02-01T23:20:06.193692-05:
      DOI: 10.1111/ans.14261
  • Re: Gastric lipoma: a rare cause of gastrointestinal bleeding
    • Authors: Vipul D. Yagnik
      Pages: 118 - 118
      PubDate: 2018-02-01T23:20:06.363529-05:
      DOI: 10.1111/ans.14282
  • Response to Re: Gastric lipoma: a rare cause of gastrointestinal bleeding
    • Authors: Prashant Kumar; Chris Gray
      Pages: 118 - 119
      PubDate: 2018-02-01T23:20:02.701192-05:
      DOI: 10.1111/ans.14298
  • Re: Cholangitis 3 years after laparoscopic cholecystectomy
    • Authors: Vipul D. Yagnik
      Pages: 119 - 119
      PubDate: 2018-02-01T23:20:04.820297-05:
      DOI: 10.1111/ans.14294
  • Corrigendum
    • Pages: 120 - 120
      PubDate: 2018-02-01T23:20:02.177862-05:
      DOI: 10.1111/ans.14336
  • Get SET: aligning anatomy demonstrator programmes with Surgical Education
           and Training selection criteria
    • Authors: Danielle Rhodes; Quentin A. Fogg, Michelle D. Lazarus
      Abstract: BackgroundPrevocational doctors aspiring to surgical careers are commonly recruited as anatomy demonstrators for undergraduate and graduate medical programmes. Entry into Surgical Education and Training (SET) is highly competitive and a unique opportunity exists to align anatomy demonstrator programmes with the selection criteria and core competencies of SET programmes. This study used a qualitative approach to (i) determine what criteria applicants for SET are assessed on and (ii) identify criteria that could be aligned with and enhanced by an anatomy demonstrator programme.MethodsThe selection guidelines of all nine surgical specialties for the 2017 intake of SET trainees were analysed using qualitative content analysis methodology.ResultsThe Royal Australasian College of Surgeons adopted a holistic approach to trainee selection that assessed both discipline-specific and discipline-independent skills. Qualitative content analysis identified eight categories of key selection criteria: medical expertise, scholarly activity, professional identity, interpersonal skills, integrity, self-management, insight and self-awareness and community involvement. The structured curriculum vitae was heavily weighted towards discipline-specific skills, such as medical expertise and scholarly activity. Insufficient information was available to determine the weighting of selection criteria assessed by the structured referee reports or interviews.ConclusionAnatomy demonstrator programmes provide prevocational doctors with unique opportunities to develop surgical skills and competencies in a non-clinical setting. Constructively aligned anatomy demonstrator programmes may be particularly beneficial for prevocational doctors seeking to improve their anatomical knowledge, teaching skills or scholarly activity.
      PubDate: 2017-12-21T18:00:44.138405-05:
      DOI: 10.1111/ans.14359
  • Surgical management of plunging ranulas: a 10-year case series in South
           East Queensland
    • Authors: Jonathan Lomas; Dhinashin Chandran, Bernard C. S. Whitfield
      Abstract: BackgroundPlunging ranulas are rare mucous extravasation pseudocysts that arise in the floor of the mouth and pass into the submandibular space of the neck. The aim of this study was to investigate the diagnosis, surgical management and outcomes of patients with a plunging ranula at our institution in South East Queensland over a 10-year period.MethodsA retrospective analysis of adult patients diagnosed with and treated for plunging ranula between 2006 and 2016 at Logan Hospital was conducted. Patient demographics, preoperative investigations, surgical management and post-operative outcomes were collected from medical records.ResultsA total of 18 adult patients were treated for plunging ranula. Of the 18 cases, 17 were treated via transoral excision of the sublingual gland. The mean age at presentation was 28.8 years with a 3:1 female to male predominance. Fifty-six percent of patients were of Polynesian descent. The success rate was 94% with only one patient experiencing recurrence and requiring re-excision of remnant sublingual gland tissue. Three patients (17%) developed complications related to post-operative bleeding. There was a slight predominance for right-sided disease (56%) compared with left and one case of bilateral plunging ranulas in this series.ConclusionThis study demonstrates that excision of the sublingual gland is an effective and safe treatment for plunging ranula. The majority of plunging ranulas occur in patients aged
      PubDate: 2017-12-21T06:48:40.550778-05:
      DOI: 10.1111/ans.14356
  • Functional significance and risk factors for lymphocele formation after
           renal transplantation
    • Authors: Munish K. Heer; David Clark, Paul R. Trevillian, Philip Sprott, Kerrin Palazzi, Adrian D. Hibberd
      Abstract: BackgroundLymphocele development following renal transplantation is a significant adverse event. It may cause acute graft dysfunction or venous obstruction. There are no consistent risk factors reported in literature. Perioperative fluid balance may lead to increased lymphocele formation and has never been studied. We aimed to analyse incidence and risk factors for lymphocele formation. We hypothesized that overhydration in perioperative period is a risk factor.MethodsWe analysed 250 consecutive renal transplant recipients from 2006 to 2014. All recipients had undergone protocol screening by computerized tomography and ultrasound scan at 3 months post-transplant. We analysed risk factors for lymphocele formation. Comparisons between lymphocele and no-lymphocele groups were made with binary logistic regression analyses. Renal function was compared between treated, untreated and no-lymphocele groups with linear regression analyses.ResultsThirty-one of 250 (12.4%) transplant recipients developed lymphocele. Fourteen of 31 (45.4%) recipients required intervention due to symptoms (venous obstruction being the most common). Surgical drainage was done in all symptomatic patients (11 laparoscopic and three open). Two of 11 (18%) recipients had recurrence after laparoscopic drainage. There were no significant differences in risk factors between the lymphocele and no-lymphocele groups. Renal function was comparable between no-lymphocele and treated lymphocele groups. Untreated lymphocele group trended towards better graft function at 1 year (P = 0.051).ConclusionPost-transplant lymphocele developed one in eight transplant recipients and tended to occur in those with good renal function. Around half of the recipients with lymphocele required intervention with good recovery of long-term renal function. No risk factor for lymphocele development was established.
      PubDate: 2017-12-21T06:47:30.591943-05:
      DOI: 10.1111/ans.14343
  • Caecal volvulus incarcerated in the epiploic foramen
    • Authors: Joshua Lawson; Moheb Ghaly
      PubDate: 2017-12-20T18:02:46.968075-05:
      DOI: 10.1111/ans.14330
  • Adult intussusception involving colonic lipoma: a case study
    • Authors: Seyed Ehsan Panahi; Daniel Mehanna
      PubDate: 2017-12-20T18:02:26.784517-05:
      DOI: 10.1111/ans.14340
  • How to do a structured rectal mobilization in complex pelvic endometriosis
    • Authors: Tegan Ormston; Russell Dalton, Bruce T. Stewart
      PubDate: 2017-12-20T18:02:14.825165-05:
      DOI: 10.1111/ans.14341
  • Improved perioperative outcomes of laparoscopic distal
           pancreatosplenectomy: modified lasso technique
    • Authors: Yota Kawasaki; Ho Kyoung Hwang, Chang Moo Kang, Shoji Natsugoe, Woo Jung Lee
      Abstract: BackgroundSimultaneous division of the splenic artery, splenic vein and pancreatic parenchyma during laparoscopic distal pancreatosplenectomy (LDPS) is known as the lasso technique, which is considered to be simple to perform. However, the original lasso technique carries a risk of post-operative bleeding from the splenic artery. We modified the original lasso technique to improve its technical safety and compared the perioperative outcomes of LDPS performed with the modified lasso technique (ml-LDPS) with those of conventional LDPS (c-LDPS).MethodsFrom August 2006 to July 2016, 30 patients underwent c-LDPS and 31 patients underwent ml-LDPS for distal pancreatectomy involving
      PubDate: 2017-12-20T18:01:55.922706-05:
      DOI: 10.1111/ans.14351
  • Quick eating caused plastic bread bag clip ingestion and severe
           gastrointestinal bleed in young adult: a case report
    • Authors: Auerilius E. R. Hamilton; Adrian A. Sebastian, Craig A. Harris
      PubDate: 2017-12-20T18:00:47.233833-05:
      DOI: 10.1111/ans.14335
  • Jejunal diverticulitis secondary to enterolith: a case report
    • Authors: Jason Cui; Daniel Mehanna
      PubDate: 2017-12-20T18:00:36.318617-05:
      DOI: 10.1111/ans.14329
  • Radial nerve palsy in mid/distal humeral fractures: is early exploration
    • Authors: Geffrey Keighley; Deborah Hermans, Vidya Lawton, David Duckworth
      Abstract: BackgroundRadial nerve palsies are a common complication with displaced distal humeral fractures. This case series examines the outcomes of early operative exploration and decompression of the nerve with fracture fixation with the view that this provides a solid construct for optimisation of nerve recovery.MethodsA total of 10 consecutive patients with a displaced distal humeral fracture and an acute radial nerve palsy were treated by the senior author by open reduction and internal fixation of the distal humerus and exploration and decompression of the radial nerve. Motor function and sensation of the radial nerve was assessed in the post-operative period every 2 months or until full recovery of the radial nerve function had occurred.ResultsAll patients (100%) had recovery of motor and sensation function of their upper limb in the radial nerve distribution over a 12-month period. Recovery times ranged between 4 and 32 weeks, with the median time to recovery occurring at 26 weeks and the average time to full recovery being 22.9 weeks. Wrist extension recovered by an average of 3 months (range 2–26 weeks) and then finger extension started to recover 2–6 weeks after this. Disability of the arm, shoulder and hand scores ranged from 0 to 11.8 at greater than 1 year post-operatively.DiscussionOur study demonstrated that early operative exploration of the radial nerve when performing an open stabilization of displaced distal humeral fractures resulted in a 100% recovery of the radial nerve.
      PubDate: 2017-12-20T07:06:30.756899-05:
      DOI: 10.1111/ans.14259
  • Female adnexal tumour of Wolffian origin presenting as a pouch of Douglas
           mass: a case report and literature review
    • Authors: Darren Chua; Lui Shiong Lee, Hak Koon Tan, Min Hoe Chew
      PubDate: 2017-12-20T07:06:06.579996-05:
      DOI: 10.1111/ans.14334
  • Application of three-dimensional print in minor hepatectomy following
           liver partition between anterior and posterior sectors
    • Authors: Tsuyoshi Igami; Yoshihiko Nakamura, Masahiro Oda, Hiroshi Tanaka, Motoi Nojiri, Tomoki Ebata, Yukihiro Yokoyama, Gen Sugawara, Takashi Mizuno, Junpei Yamaguchi, Kensaku Mori, Masato Nagino
      Abstract: BackgroundMinor hepatectomy following liver partition between the right anterior and posterior sectors requires technical ingenuities. In such hepatectomy, we used three-dimensional (3D) print; therefore, our procedure was introduced.MethodsDigital segmentation of anatomical structures from multidetector-row computed tomography images utilized the original software ‘PLUTO’, which was developed by Graduate School of Information Science, Nagoya University. After changing the final segmentation data to the stereolithography files, 3D-printed liver at 70% scale was produced. The support material was washed and mould charge was removed from 3D-printed hepatic veins. The surface of 3D-printed model was abraded and coated with urethane resin paint. After natural drying, 3D-printed hepatic veins were coloured by injection of a dye. The 3D-printed portal veins were whitish because mould charge remained. All procedures after 3D printing were performed by hand work. A 3D-printed model of the right posterior sector and a 3D-printed model of other parenchyma were produced, respectively. Measuring the length between the main structures on the liver surface and the planned partition line on the 3D-printed model, land mark between the right anterior and posterior sectors on the real liver surface was produced with scale adjustment.ResultsMinor hepatectomy following liver partition between the right anterior and posterior sectors was performed referring to 3D-printed model. The planned liver partition and resection were successful.ConclusionsApplication of 3D-printed liver to minor hepatectomy following liver partition between the right anterior and posterior sectors is easy and a suitable procedure.
      PubDate: 2017-12-20T07:06:00.570659-05:
      DOI: 10.1111/ans.14331
  • Thromboelastography does not provide additional information to guide
           resuscitation in the severely injured
    • Authors: Karlijn J. P. van Wessem; Luke P. H. Leenen
      Abstract: BackgroundHaemostasis assessment is essential to determine the early need for massive transfusion in the treatment of polytrauma. Strategies to guide correction of coagulopathy vary widely. In order to evaluate thromboelastography (TEG) for this goal, a prospective study was performed comparing TEG to conventional coagulation assays (CCAs) in severely injured patients.MethodsConsecutive polytrauma patients admitted to the intensive care unit of a level-1 trauma centre were prospectively included over a 30-month period. All patients had CCA on arrival in emergency department. Patients who needed massive transfusion and underwent urgent surgery had additionally a Kaolin-activated TEG.ResultsOne hundred and thirty-five patients were included, 76% male, median age 45 years, 96% blunt injuries and median injury severity score was 29. One hundred and fourteen patients had CCA only and 21 patients had both CCA and TEG. Patients who had both CCA and TEG were acidotic, hypothermic and coagulopathic on arrival in emergency department. All 21 patients had normal TEG results even though prothrombin time was prolonged.ConclusionsTEGs were normal in all polytrauma patients even though patients were severely injured. They had prolonged prothrombin time, acidosis and hypothermia both on arrival and when TEG was measured. Caution should be exercised in interpretation of TEG results in treating polytrauma patients. In our system, with aggressive early haemostatic resuscitation, TEG does not provide additional information in guiding resuscitation.
      PubDate: 2017-12-20T07:05:29.133979-05:
      DOI: 10.1111/ans.14357
  • Randomized clinical trial to assess the ideal mode of delivery for local
           anaesthetic abdominal wall blocks
    • Authors: Ryan Holmes; Stephen R. Smith, Rosemary Carroll, Phillip Holz, Rahul Mehrotra, Peter Pockney
      Abstract: BackgroundAdequate post-operative analgesia is essential for recovery following abdominal surgery. Abdominal wall nerve blocks have been shown to be beneficial in this respect following surgery. The purpose of this trial was to examine the efficacy of infusional versus intermittent bolus delivery of abdominal wall blocks in patients undergoing abdominal resectional gastrointestinal surgery.MethodsA prospective randomized clinical trial, involving 120 patients undergoing gastrointestinal surgery, was undertaken across three hospitals. Insertion of abdominal wall catheters was performed and patients were randomized to receive ropivacaine 0.2% by either continuous infusion or regular intermittent bolus. The primary outcome was respiratory function, as measured by spirometry on post-operative days 1–3 and 30. Secondary outcomes were pain, mobility, return of gut function, length of hospital stay, complication rates and patient satisfaction with analgesia.ResultsAll 120 patients were followed up to trial completion. Patients were well matched with regards to demographics. There was no difference between groups with regards to the primary outcome of post-operative respiratory function. The bolus group had improved mobility scores on post-operative day 1 (P = 0.025). There were no complications associated with blockade, and no other differences were identified between assessed outcomes.ConclusionsContinuous infusion and intermittent bolus are both safe ways of delivering abdominal wall nerve blockade, with equivalent analgesic outcomes. Bolus delivery appears to provide superior early mobility in comparison with continuous infusion.
      PubDate: 2017-12-19T03:47:05.487025-05:
      DOI: 10.1111/ans.14317
  • Selecting a suitable surgical treatment for hepatic angiomyolipoma: a
           retrospective analysis of 92 cases
    • Authors: Xianwei Yang; Chuanfen Lei, Yiwen Qiu, Shu Shen, Changli Lu, Lunan Yan, Wentao Wang
      Abstract: BackgroundHepatic angiomyolipoma (HAML) is a rare and difficult-to-diagnose liver tumour. The aim of this study was to summarize experiences in the management of HAML and to recommend a practical treatment strategy.MethodsWe retrospectively studied 92 patients who were diagnosed with HAML and analysed the clinical presentation, histopathological features and treatment of the tumours encountered at our institute from May 2009 to June 2016.ResultsThe patients included 67 females and 25 males who underwent at least one radiographic examination. Sixty-eight patients underwent radical hepatectomy, two patients underwent liver biopsy, and 22 patients were treated with radiofrequency ablation after liver biopsy. The tumour cells correspondingly expressed both melanoma cell markers (HMB45, MART-1) and smooth muscle cell markers. Two patients were found to have tumour recurrence (2/92, 2.2%) after radical hepatectomy, and none of the patients died.ConclusionDiagnosis of HAML depends on pathological findings. The treatment strategy for HAML should be selected according to the tumour size, liver biopsy, location and clinical symptoms of HAML. Patients should be followed closely after surgery because of the malignant potential of HAML.
      PubDate: 2017-12-14T18:20:04.408203-05:
      DOI: 10.1111/ans.14323
  • Complications of chest drain insertion in a patient with pleural plaques
    • Authors: Hariette Goldman; Scott Jennings, Peter W. Grant
      PubDate: 2017-12-14T18:17:02.069524-05:
      DOI: 10.1111/ans.14327
  • When the gallbladder is not right
    • Authors: Elizabeth W. Tan; Mohamed Ashour
      PubDate: 2017-08-08T02:12:39.807729-05:
      DOI: 10.1111/ans.14134
  • Soft tissue infections from fish spike wounds: normal commensal bacteria
           are more common than marine pathogens
    • Authors: Hannah Collins; Kin Mun Lee, Paul T.-Y. Cheng, Sarah Hulme
      Abstract: BackgroundA fish spike injury can be sustained by anyone handling fish; during fishing, meal preparation or in retail. Case reports of fish spikes inoculating victims with virulent marine-specific pathogens and causing systemic illness led us to question whether empirical treatment of these injuries with amoxicillin and clavulanic acid is adequate.MethodsThis 2-year prospective observational study was conducted at Middlemore Hospital, Auckland, New Zealand. Wound swabs and tissue samples belonging to patients presenting to the Department of Plastic and Reconstructive Surgery with an upper limb fish spike injury were sent to the laboratory (n = 60). A series of stains and cultures were performed to look specifically for marine bacteria not typically isolated in other soft tissue injuries. Patient demographic data and injury details were collected.ResultsOf the patients with adequate microbiology samples, 12% (6/50) grew clinically relevant bacteria resistant to amoxicillin and clavulanic acid. These included methicillin-resistant Staphylococcus aureus (8%, 4/50), Enterobacter cloacae (2%, 1/50) and an anaerobic sporing bacillus (2%, 1/50). Only one patient grew a true marine-specific bacteria, Photobacterium damselae, which was susceptible to amoxicillin and clavulanic acid.ConclusionThe authors concluded that amoxicillin and clavulanic acid is an adequate first-line antibiotic for fish spike injuries but that flucloxacillin may be more appropriate given most bacteria were from patients’ own skin flora. The authors suggest that clinicians consider the presence of resistant marine-specific bacteria in cases where there is sepsis or inadequate response to initial therapy.
      PubDate: 2017-03-20T18:19:17.948726-05:
      DOI: 10.1111/ans.13850
  • Laboratory Risk Indicator for Necrotizing Fasciitis score for early
           diagnosis of necrotizing fasciitis in Darwin
    • Authors: Vignesh Narasimhan; Geraldine Ooi, Stephanie Weidlich, Phillip Carson
      Abstract: BackgroundSoft tissue infections are a major health burden in the Top End of the Northern Territory of Australia. Necrotizing fasciitis (NF) is associated with mortality rates from 8 to 40%. Early recognition and aggressive surgical debridement are the cornerstones of successful treatment. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, developed by Wong et al., uses six routine biochemical variables to aid early diagnosis. We aim to assess the diagnostic efficacy of the LRINEC score in our population.MethodsA retrospective review of patients with NF between 2005 and 2013 was conducted. A time matched cohort of abscesses/cellulitis was selected. Admission bloods were used to calculate the LRINEC score. An intraoperative finding of NF was used as the gold standard definition for comparison. The diagnostic accuracy of the LRINEC score was assessed.ResultsNinety-eight patients with NF and 205 control patients were identified. The area under the receiver operator curve for the LRINEC score in detecting NF was 0.925 (0.890–0.959, P < 0.001). The sensitivity of the LRINEC ≥5 for NF was 76.3%, with a specificity of 93.1%. The positive and negative predictive values were 95.5 and 88.1%, respectively. The positive and negative likelihood ratios were 11 and 0.25.ConclusionThe LRINEC score is a useful, robust, non-invasive and easily calculated scoring system that can be used as an adjunct to early diagnosis of NF. However, a high degree of clinical suspicion remains the most important factor in early diagnosis of NF.
      PubDate: 2017-03-15T04:10:42.188285-05:
      DOI: 10.1111/ans.13895
  • Randomized trial of laparoscopic cholecystectomy procedure-specific
           consent form
    • Authors: Jack Crozier; Ann Williams, Steven T. F. Chan, Graeme Thompson
      Abstract: BackgroundPrior to all surgical procedures, possible risks are outlined to patients during an informed consent discussion, and they are invited to ask questions. Written consent records this discussion and signals a patient's willingness to proceed with surgery. This study aims to improve the documentation of complications discussed during laparoscopic cholecystectomy consent through the introduction of a procedure-specific consent form.MethodsPhase 1 included a retrospective analysis of possible complications documented on standard consent forms for laparoscopic cholecystectomy. Phase 2 was a prospective randomized comparison of existing standard consent forms versus procedure-specific consent forms measuring the documentation of significant complications as identified from the Royal Australasian College of Surgeons brochure for laparoscopic cholecystectomy. These include bile duct injury, bile leak, bleeding, infection, conversion and damage to other organs. The proportion of participants in each cohort with the documentation of specific complications was assessed using the two-sample test of differences in proportions.ResultsPhase 1 of the study found that the possible risk of bleeding was documented in 82.1% of cases, while damage to other organs was only documented in 7.7%. Phase 2 of the study showed significant improvements in the documentation of specific complications for both standard and procedure-specific consent cohorts; 76.5% of participants in the procedure-specific consent cohort had all complications documented, while no participants in the phase 1 cohort had all complications documented.ConclusionIntroduction of a procedure-specific consent form for laparoscopic cholecystectomy has improved the documentation of a standard set of complications.
      PubDate: 2017-03-14T18:35:45.291785-05:
      DOI: 10.1111/ans.13888
  • Clinico-pathological correlation of hepatic angiomyolipoma: a series of 23
           resection cases
    • Authors: Dong Hwan Jung; Shin Hwang, Seung Mo Hong, Ki Hun Kim, Chul Soo Ahn, Deok Bog Moon, Abdulwahab A  Alshahrani, Sung Gyu Lee
      Abstract: BackgroundAngiomyolipomas are rare neoplasms of mesenchymal origin and are derived from perivascular epithelioid cells. They usually develop in the kidney and rarely in the liver. Due to their rarity, most hepatic angiomyolipomas have been misinterpreted as hepatocellular carcinoma (HCC) or other hypervascular liver tumours on imaging studies. We aimed to assess the clinico-pathological correlation of hepatic angiomyolipoma.MethodsWe identified 23 patients with hepatic angiomyolipoma through an institutional database search.ResultsOf 5680 cases of primary liver tumours, 23 (0.4%) had angiomyolipomas (mean age, 43.6 ± 12.4 years; 16 female patients). Hepatitis B virus infection was noted in four patients, whereas a liver mass was incidentally detected on routine health screening in 13 patients. The preoperative diagnoses, before liver biopsy, included HCC in 14, angiomyolipoma in six, focal nodular hyperplasia in two and hepatic adenoma in one patient. Eventually, the preoperative diagnoses were changed to HCC in 12 and hepatic angiomyolipoma in 11 patients. The tumour size was 5.3 ± 4.6 cm, and 22 patients had a single tumour. All tumours exhibited positive findings for human melanoma black-45 and smooth muscle actin staining. During a follow-up period of 52.2 ± 23.7 months, none of the patients exhibited tumour recurrence or mortality.ConclusionsHepatic angiomyolipoma is a rare form of primary liver tumour and is often misdiagnosed as other hypervascular tumours. Although angiomyolipoma is benign in nature, it also has malignant potential; hence, resection is indicated if the tumour grows or malignancy cannot be excluded. Surgical resection is a definitive curative treatment of hepatic angiomyolipoma.
      PubDate: 2017-01-25T19:05:56.34743-05:0
      DOI: 10.1111/ans.13880
  • Publication rate of General Surgery abstracts presented at the Royal
           Australasian College of Surgeons Annual Scientific Congress
    • Authors: Masoomeh Khajehnoori; Douglas Stupart, David Watters
      Pages: 16 - 19
      Abstract: BackgroundA commonly used metric for evaluating the quality and impact of presentations at a scientific meeting is the frequency with which the findings presented are published as full research papers in peer-reviewed journals. The purpose of this study was to determine the full article publication rates of abstract presentations for General Surgery and related sub-specialities at the Royal Australasian College of Surgeons Annual Scientific Congress (RACS ASC) from 2010 to 2014.MethodsAll General Surgical (including its sub-speciality groups) abstracts presented at the RACS ASC from 2010 to 2014 were identified from the ANZ Journal of Surgery. We determined the rates of full paper publication, time to publication, journals of publication and specialty rates of conversion. Full article publications were identified using the PubMed, MEDLINE and Google Scholar databases.ResultsA total of 1386 abstracts were identified, of which 356 (26%) were converted to full paper publications. The number of abstracts presented annually increased from 206 in 2010 to 386 in 2014, but the percentage of abstracts converted to full paper publications did not follow any temporal trend. The majority (74%) of full papers were published within 2 years of the abstract presentation.ConclusionIn total, 26% of General Surgery abstracts presented at the RACS ASC from 2010 to 2014 were converted to full paper publications. This could provide a baseline against which to judge the quality of presentations at other national General Surgical congresses, as well as at future RACS ASC meetings.
      PubDate: 2017-07-06T06:31:27.817091-05:
      DOI: 10.1111/ans.14103
  • Does the ileal brake mechanism contribute to sustained weight loss after
           bariatric surgery'
    • Authors: Savio G. Barreto; Stijn Soenen, Jacob Chisholm, Ian Chapman, Lilian Kow
      Pages: 20 - 25
      Abstract: Bariatric surgery is currently the most effective strategy for treating morbid obesity. Weight regain following significant weight loss, however, remains a problem, with the outcome proportional to the period of follow-up. This review revisits a well-established physiological neurohormonally-mediated feedback loop, the so called ileal brake mechanism, with a special emphasis on the gut hormone peptide tyrosine tyrosine. The manuscript not only highlights the potential role of the ileal brake mechanism in weight loss and weight maintenance thereafter following obesity surgery, it also provides a compelling argument for using this appetite suppressing feedback loop to enable sustained long-term weight loss in patients undergoing surgery for morbid obesity.
      PubDate: 2017-06-08T01:45:21.258405-05:
      DOI: 10.1111/ans.14062
  • Hepatic cystic echinococcosis in Australia: an update on diagnosis and
    • Authors: Ben Keong; Bruce Wilkie, Tom Sutherland, Adrian Fox
      Pages: 26 - 31
      Abstract: BackgroundEchinococcosis is an uncommonly encountered zoonotic disease caused by the taeniid Echinococcus. The only endemic species in Australia, Echinococcus granulosus, forms cysts in the liver in 70% of cases. The aim of this study was to review the literature to provide an evidence-based narrative update on the diagnosis and management of hepatic cystic echinococcosis in Australia.MethodsWe reviewed the literature, utilizing multiple research databases and citation tracking. Original research and review articles examining the diagnosis and management of hydatid disease in adults, published prior to 2016 and in the English language were included in our review.ResultsUltrasound is the gold-standard screening test, whilst computed tomography has a role in emergency presentations and screening for multi-organ involvement. Magnetic resonance imaging is the preferred second-line imaging and better demonstrates biliary involvement. Medical therapy or PAIR (percutaneous aspiration, irrigation with scolicide and re-aspiration) may be appropriate in selected cases; however, surgery remains the definitive treatment for active, large (>5 cm), symptomatic or complicated cysts. A variety of surgical techniques have been described, including conservative, radical and minimally invasive procedures. There is currently no consensus approach; surgical modality should be tailored to patient factors, relevant anatomy, local facilities and surgeons’ expertise.ConclusionDiagnosis and therapy in hepatic hydatid cysts have been significantly advanced by imaging, interventional radiology and surgical approaches in recent years. Surgery remains the mainstay of treatment for large, active, complicated or symptomatic hepatic hydatid cysts.
      PubDate: 2017-10-11T17:51:01.490545-05:
      DOI: 10.1111/ans.14117
  • Colonoscopic surveillance: quality, guidelines and effectiveness
    • Authors: Timothy J. Chittleborough; Joseph C. Kong, Glen R. Guerra, Robert Ramsay, Alexander G. Heriot
      Pages: 32 - 38
      Abstract: Colonoscopic surveillance in patients with a personal or family history of colorectal carcinoma or colonic polyps represents a significant workload for endoscopy services. Effective colonoscopic surveillance relies on quality endoscopic examination and appropriate surveillance interval. This review will discuss quality in colonoscopy and review guidelines for surveillance.
      PubDate: 2017-08-13T18:51:16.553195-05:
      DOI: 10.1111/ans.14141
  • Predictive factors for publication of abstracts at the Royal Australasian
           College of Surgeons Annual Scientific Congress
    • Authors: Cristian Udovicich; Bryan Soh, Sam Law, Venetia Hoe, Dion Lanfranco, Kalpa Perera, Cuong Duong, Steven Chan
      Pages: 39 - 44
      Abstract: BackgroundA key metric of the research quality of medical conferences is the publication rate of abstracts. The study objective was to determine the publication rate of abstracts presented at the Royal Australasian College of Surgeons Annual Scientific Congress (RACS ASC) and to examine for any predictive factors associated with publication.Methods s presented at the RACS ASC from 2011 to 2013 were analysed. characteristics such as presentation format, study type, study design, study site, cohort size and author origin were recorded. s published were identified by a PubMed search using a strict algorithm. Univariate and multivariable logistic regressions were used to analyse for predictive factors of publication.ResultsOverall, 1438 abstracts were presented and 423 abstracts (29%) were published. The median time to publication was 15.2 months (interquartile range: 8–26) with 110 in Australasian journals (26%). The median number of citations for published abstracts was 6 (interquartile range: 2–16). After multivariable analysis, publication was significantly associated with prospective study design (odds ratio (OR) = 1.34, P = 0.02), multicentre study site (OR = 1.43, P = 0.02), cohort size ≥100 (OR = 2.00, P < 0.001) and New Zealand author origin (OR = 1.50, P = 0.01).ConclusionOur study demonstrates that less than one-third of abstracts presented at the RACS ASC are subsequently published in a peer-reviewed journal. Factors significantly associated with journal publication include prospective studies, multicentre study, a larger cohort size and New Zealand author origin. Advances in surgery may progress from the preliminary findings of conference abstracts. However only after the rigorous peer review offered by journal publication should changes in decision-making of patient care occur.
      PubDate: 2017-07-13T19:30:38.339702-05:
      DOI: 10.1111/ans.14108
  • Development of a surgical trainer assessment questionnaire
    • Authors: Benjamin J. F. Dean; Barrie Keeler, Patrick Garfjeld Roberts, Jonathan L. Rees
      Pages: 45 - 49
      Abstract: BackgroundThe assessment of surgical trainees has become well-established in practice; however, this is not yet the case for surgical trainers. The aim of this study was to develop a trainer assessment questionnaire (OxTrAQ) based on the 12 key trainer attributes identified by a previous systematic review, to then explore this questionnaire's potential domains and test its reliability.MethodsThe OxTrAQ was piloted at two surgical training centres in two surgical sub-specialities. At each centre, every trainee assessed every trainer while under their clinical supervision.ResultsInternal consistency (Cronbach's alpha) was calculated for this 12-item questionnaire as 0.958. Factor analysis revealed two domains which accounted for 77.997% of the variance; these were the general domain (nine items) and the independence domain (three items). Inter-observer reliability was shown by the intraclass correlation coefficients (ICCs) (average measures) for the overall OxTrAQ score, general domain score and independence domain score which were 0.951, 0.945 and 0.955 for centre 1 and 0.857, 0.819 and 0.883 for centre 2, respectively. Intra-observer reliability was shown by the ICCs (average measures) for the overall OxTrAQ score, general domain score and independence domain score which were 0.925, 0.913 and 0.940, respectively. Construct validity was demonstrated by a high correlation (Spearman rho = 0.886, P = 0.019) between trainer scores and the scores predicted by the trainers themselves.ConclusionsThe OxTrAQ is a simple trainer assessment questionnaire which has demonstrated both high inter- and intra-observer reliability.
      PubDate: 2017-11-13T17:30:57.370015-05:
      DOI: 10.1111/ans.14256
  • Arthroscopic, open and mini-open approach for rotator cuff repair: no
           difference in pain or function at 24 months
    • Authors: Elizabeth C. Bond; Lynette Hunt, Matthew J. Brick, Warren B. Leigh, Anthony Maher, Simon W. Young, Michael A. Caughey
      Pages: 50 - 55
      Abstract: BackgroundThe New Zealand Rotator Cuff Registry was established in 2009 to collect prospective functional, pain and outcome data on patients undergoing rotator cuff repair (RCR).MethodsInformation 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.ResultsA 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.ConclusionRCR 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.
      PubDate: 2017-09-21T18:00:44.06191-05:0
      DOI: 10.1111/ans.14176
  • Urgent closed reduction of the dislocated cervical spine in New Zealand
    • Authors: Richard N. Storey; Raj Singhal, Tom Inglis, David Kieser, Rowan Schouten
      Pages: 56 - 61
      Abstract: BackgroundEmergent 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.MethodsRegional 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.ResultsMost (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.ConclusionTo 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 ( This forms part of New Zealand's strategy to achieve urgent cord decompression for appropriate cervical spinal cord injuries.
      PubDate: 2017-09-28T02:30:31.297213-05:
      DOI: 10.1111/ans.14231
  • Comparing pathological complete response rate using oral capecitabine
           versus infusional 5-fluorouracil with preoperative radiotherapy in rectal
           cancer treatment
    • Authors: Narotam Jootun; Tess Evans, Jackie Mak, Greg Makin, Cameron Platell
      Pages: 62 - 65
      Abstract: BackgroundInfusional 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.MethodsA 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.ResultsThe 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).ConclusionThe 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.
      PubDate: 2017-10-05T18:40:34.161892-05:
      DOI: 10.1111/ans.14192
  • Pancreatico-jejunostomy decreases post-operative pancreatic fistula
           incidence and severity after central pancreatectomy
    • Authors: Frédéric Borel; Mehdi Ouaissi, Aude Merdrignac, Aurelien Venara, Valéria De Franco, Laurent Sulpice, Antoine Hamy, Nicolas Regenet
      Pages: 77 - 81
      Abstract: BackgroundsCentral pancreatectomy (CP) is an alternative to pancreaticoduodenectomy and distal pancreatectomy in benign tumours of pancreatic isthmus management. It is known for a high post-operative pancreatic fistula (POPF) rate. The purpose of this study was to compare POPF incidence between pancreatico-jejunostomy (PJ) and pancreatico-gastrostomy (PG).MethodsFifty-eight patients (mean age 53.9 ± 1.9 years) who underwent a CP in four French University Hospitals from 1988 to 2011 were analysed. The distal pancreatic remnant was either anastomosed to the stomach (44.8%, n = 25) or to a Roux-en-Y jejunal loop (55.2%, n = 35) with routine external drainage allowing a systematic search for POPF. POPF severity was classified according to the International Study Group on Pancreatic Fistula (ISGPF) and Clavien-Dindo classifications.ResultsThe groups were similar on sex ratio, mean age, ASA score, pancreas texture, operative time and operative blood loss. Mean follow-up was 36.2 ± 3.9 months. POPF were significantly more frequent after PG (76.9 versus 37.5%, P = 0.003). PG was associated with significantly higher grade of POPF both when graded with ISGPF classification (P = 0.012) and Clavien-Dindo classification (P = 0.044). There was no significant difference in post-operative bleeding (0.918) and delayed gastric emptying (0.877) between the two groups. Hospital length of stay was increased after PG (23.6 ± 3.5 days versus 16.5 ± 1.9 days, P = 0.071). There was no significant difference in incidence of long-term exocrine (3.8 versus 19.2%, P = 0.134) and endocrine (7.7 versus 9.4%, P = 0.575) pancreatic insufficiencies.ConclusionPG was associated with a significantly higher POPF incidence and severity in CP. We recommend performing PJ especially in older patients to improve CP outcomes.
      PubDate: 2017-08-15T01:10:54.579777-05:
      DOI: 10.1111/ans.14049
  • Trends in the surgical treatment of benign prostatic hyperplasia in a
           tertiary hospital
    • Authors: Darren Ow; Nathan Papa, Marlon Perera, Peter Liodakis, Shomik Sengupta, Stephen Clarke, Damien M. Bolton, Nathan Lawrentschuk
      Pages: 95 - 99
      Abstract: BackgroundTo assess current treatment trends and perioperative outcomes of transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP) in a tertiary institution.MethodsWe prospectively collected a database of all patients undergoing TURP and PVP for benign prostatic hyperplasia (BPH) at a tertiary hospital between January 2011 and December 2013. Patient characteristics such as length of stay, readmission, anticoagulation status, American Society of Anesthesiologists (ASA) score and need for blood transfusion were recorded and analysed.ResultsIn total, 560 cases were included: 204 (36.4%) underwent TURP and 356 (63.6%) PVP. Patients undergoing PVP had higher ASA scores (P < 0.001) and were more frequently on continuing anticoagulant therapy (P < 0.001). With regards to non-aspirin/asasantin coagulation therapy, 61 (17.1%) patients underwent PVP with their anticoagulants continued while no patients who received TURP continued anticoagulation. Blood transfusion percentages were similar at 1.0% for TURP and 1.7% for PVP but readmission proportions were higher after PVP (32 patients, 9.0%) compared to TURP (10 patients, 4.9%). These differences were attenuated when excluding patients continuing anticoagulation during the procedure.ConclusionAt our institution, the use of PVP has been increasing on a year-by-year basis. The results of the current study demonstrated that PVP is safe in patients with increased anaesthetic risk or on active anticoagulation when compared to traditional TURP. While this makes PVP an attractive alternative to TURP in high-risk anticoagulated patients, these patients may have complex post-discharge issues that should be addressed during the informed consent process.
      PubDate: 2017-03-19T20:25:54.823551-05:
      DOI: 10.1111/ans.13904
  • The Australian laparoscopic radical prostatectomy learning curve
    • Authors: Marcus Handmer; Charles Chabert, Ronald Cohen, Troy Gianduzzo, Paul Kearns, Daniel Moon, Jason Ooi, Tom Shannon, David Sofield, Andrew Tan, Mark Louie-Johnsun
      Pages: 100 - 103
      Abstract: BackgroundInternational estimates of the laparoscopic radical prostatectomy (LRP) learning curve extend to as many as 1000 cases, but is unknown for Fellowship-trained Australian surgeons.MethodsProspectively collected data from nine Australian surgeons who performed 2943 consecutive LRP cases was retrospectively reviewed. Their combined initial 100 cases (F100, n = 900) were compared to their second 100 cases (S100, n = 782) with two of nine surgeons completing fewer than 200 cases.ResultsThe mean age (61.1 versus 61.1 years) and prostate specific antigen (7.4 versus 7.8 ng/mL) were similar between F100 and S100. D'Amico's high-, intermediate- and low-risk cases were 15, 59 and 26% for the F100 versus 20, 59 and 21% for the S100, respectively. Blood transfusions (2.4 versus 0.8%), mean blood loss (413 versus 378 mL), mean operating time (193 versus 163 min) and length of stay (2.7 versus 2.4 days) were all lower in the S100. Histopathology was organ confined (pT2) in 76% of F100 and 71% of S100. Positive surgical margin (PSM) rate was 18.4% in F100 versus 17.5% in the S100 (P = 0.62). F100 and S100 PSM rates by pathological stage were similar with pT2 PSM 12.2 versus 9.5% (P = 0.13), pT3a PSM 34.8 versus 40.5% (P = 0.29) and pT3b PSM 52.9 versus 36.4% (P = 0.14).ConclusionThere was no significant improvement in PSM rate between F100 and S100 cases. Perioperative outcomes were acceptable in F100 and further improved with experience in S100. Mentoring can minimize the LRP learning curve, and it remains a valid minimally invasive surgical treatment for prostate cancer in Australia even in early practice.
      PubDate: 2017-05-16T19:56:06.022534-05:
      DOI: 10.1111/ans.14025
  • How to do breast reconstruction using free flaps with short pedicles: a
           stepwise technique for easier, safer anastomoses
    • Authors: Scott Ferris; Damien Grinsell, Hans H. M. Nielsen
      Pages: 104 - 105
      PubDate: 2017-11-12T19:52:47.485477-05:
      DOI: 10.1111/ans.14247
  • How I do hanging manoeuvres to facilitate portal vein resection during
           pancreaticoduodenectomy for borderline tumours
    • Authors: Olivier Turrini; Ugo Marchese, Jacques Ewald, Jean-Robert Delpero
      Pages: 106 - 106
      PubDate: 2017-11-30T20:21:16.91598-05:0
      DOI: 10.1111/ans.14272
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