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Publisher: John Wiley and Sons   (Total: 1577 journals)

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Showing 1 - 200 of 1577 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 12, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 64, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 46, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 49, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 148, 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: 15, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 5, 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: 35, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 6, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 3)
Addiction     Hybrid Journal   (Followers: 35, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 13, 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: 50, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 13, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 255, 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: 5, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 17, 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: 19)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 12)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 9)
African Development Review     Hybrid Journal   (Followers: 35, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 15, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 10, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 6, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 14, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 45, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 30, 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: 50, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 135, 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: 89, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 27, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 33, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 12, 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: 16, 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: 37, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 262, 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: 3, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 17, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 125, 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: 16)
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: 219)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 212, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 37, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 9, 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: 48, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 2, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 9, 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: 13)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 24, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 17, 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: 91, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 47, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 7, 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: 68, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 152, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 48, 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: 31, 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: 27, 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: 25, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 4)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 12, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 229, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 51, 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: 14)
Asia & the Pacific Policy Studies     Open Access   (Followers: 15)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 312, 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   (SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 4, 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: 2, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 13, 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: 7, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 13, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 4, 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: 44, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 7, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 4, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 27, 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: 14, 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: 401, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 4, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 69, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 11, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 19, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 31, 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: 10, 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: 24, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 9, 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: 16, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 3, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 42, 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: 36, 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: 45, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 187, 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: 19, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 9, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 37, 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: 5, 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: 225, SJR: 2.083, h-index: 125)

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Journal Cover Anz Journal of Surgery
  [SJR: 0.432]   [H-I: 59]   [7 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  [1577 journals]
  • Benchmarking against the National Emergency Laparotomy Audit
    • Authors: Yiu Ming Ho; Julie Cappello, Ramin Kousary, Brian McGowan, Arkadiusz P. Wysocki
      Abstract: BackgroundThe Royal College of Anaesthetists published the National Emergency Laparotomy Audit (NELA) to describe and compare inpatient care and outcomes of major emergency abdominal surgery in England and Wales in 2015 and 2016. The purpose of this article is to compare emergency abdominal surgical care and mortality in a regional hospital (Logan Hospital, Queensland, Australia) with NELA results.MethodsData were extracted from two databases. All deaths from May 2010 to April 2015 were reviewed and patients who had an emergency abdominal operation within 30 days of death were identified. The health records of all patients who underwent abdominal surgery were extracted and those who had an emergency laparotomy were identified for analysis.ResultsThree hundred and fifty patients underwent emergency laparotomy and were included in the analysis. The total 30-day mortality during this 5-year period was 9.7%. Factors affecting mortality included age, Portsmouth-Physiological and Operative Severity Score (P-POSSUM) and admission source. Timing of antibiotic administration, use of perioperative medical service and frequency of intensive care admission were the same in patients who died and survived.ConclusionMortality in patients following emergency laparotomy at Logan Hospital compares favourably with 11.1% reported by NELA. This may be partly attributable to case mix distribution as for each P-POSSUM risk Logan Hospital mortality was at the upper end of that reported by NELA. Further Australia data are required. Improved compliance with NELA recommendations may improve outcomes.
      PubDate: 2017-09-19T19:06:22.055228-05:
      DOI: 10.1111/ans.14164
  • Caval wall injury secondary to inferior vena cava filter removal: a rare
    • Authors: Hani Saeed; Kenneth Buxey, Mark Fitzgerald
      PubDate: 2017-09-19T19:05:44.661575-05:
      DOI: 10.1111/ans.14181
  • Accidental intra-arterial injection of methylphenidate into the radial
    • Authors: Michael Pannett; Katherine Goodall, Sherab Bhutia
      PubDate: 2017-09-18T18:51:01.6926-05:00
      DOI: 10.1111/ans.14214
  • Functional outcome of low rectal resection evaluated by anorectal
    • Authors: Peter Ihnát; Petr Vávra, Jiří Prokop, Anton Pelikán, Lucia Ihnát Rudinská, Igor Penka
      Abstract: BackgroundLow anterior resection syndrome (LARS) covers disordered bowel function after rectal resection, leading to deterioration in patients’ quality of life. The aim of this study was to evaluate anorectal function after laparoscopic low anterior resection (LAR) by means of standardized instruments.MethodsThis was a prospective clinical cohort study conducted in a single institution to assess functional outcome of patients 1 year after laparoscopic LAR by means of LARS score and high-resolution anorectal manometry.ResultsIn total, 65 patients were enrolled in the study. Mean tumour height was 9.4 ± 1.8 cm; total mesorectal excision during laparoscopic LAR with low end-to-end colorectal anastomosis was performed in all patients. One year after the surgery, minor LARS was detected in 33.9% of patients, major LARS in 36.9% of patients. Anorectal manometry revealed decreased resting pressure and normal squeeze pressure of the anal sphincters in the majority of our patients. Rectal compliance and rectal volume tolerability (first sensation, urge to defaecate and discomfort volume) were significantly reduced. The statistical testing of the correlation between LARS and manometry parameters showed that with increasing seriousness of LARS, values of some parameters (resting pressure, first sensation, urge to defaecate, discomfort volume and rectal compliance) were reduced.ConclusionThis study indicates that the majority of patients after laparoscopic LAR experience symptoms of minor or major LARS. These patients have decreased resting anal sphincter pressures, decreased rectal volume tolerability and decreased rectal compliance.
      PubDate: 2017-09-18T18:50:24.252608-05:
      DOI: 10.1111/ans.14207
  • From ancient to avant-garde: a review of traditional and modern multimodal
           approaches to surgical anatomy education
    • Authors: Minhao Hu; David Wattchow, Dayan de Fontgalland
      Abstract: The landscape of surgical anatomy education is progressively changing. Traditional methods, such as cadaveric dissection and didacticism are being increasingly phased out in undergraduate courses for multimodal approaches incorporating problem-based learning, radiology and computer-based simulations. Although effective at clinically contextualizing and integrating anatomical information, these approaches may be a poor substitute for fostering a grasp of foundational ‘pure’ anatomy. Dissection is ideal for this purpose and hence remains the cornerstone of anatomical education. However, novel methods and technological advancements continually give way to adjuncts such as cadaveric surgery, three-dimensional printing, virtual simulation and live surgical streaming, which have demonstrated significant efficacy alone or alongside dissection. Therefore, although divergent paradigms of ‘new versus old’ approaches have engulfed and divided the community, educators should seek to integrate the ancient and avant-garde to comprehensively satisfy all of the modern anatomy learner's educational needs.
      PubDate: 2017-09-18T18:50:21.668326-05:
      DOI: 10.1111/ans.14189
  • Paediatric mild head injury: is routine admission to a tertiary trauma
           hospital necessary'
    • Authors: Krishna Tallapragada; Ratna Soundarya Peddada, Mark Dexter
      Abstract: BackgroundPrevious studies have shown that children with isolated linear skull fractures have excellent clinical outcomes and low risk of surgery. We wish to identify other injury patterns within the spectrum of paediatric mild head injury, which need only conservative management. Children with low risk of evolving neurosurgical lesions could be safely managed in primary hospitals.MethodsWe retrospectively analysed all children with mild head injury (i.e. admission Glasgow coma score 13–15) and skull fracture or haematoma on a head computed tomography scan admitted to Westmead Children's Hospital, Sydney over the years 2009–2014. Data were collected regarding demographics, clinical findings, mechanism of injury, head computed tomography scan findings, neurosurgical intervention, outcome and length of admission. Wilcoxon paired test was used with P value 
      PubDate: 2017-09-18T18:48:01.591521-05:
      DOI: 10.1111/ans.14175
  • Bronchoesophageal fistula due to metastatic mediastinal lymphadenitis
    • Authors: George Stavrou; Vasileios Rafailidis, Konstantinos Kouskouras, Katerina Kotzampassi
      PubDate: 2017-09-18T18:48:00.115598-05:
      DOI: 10.1111/ans.14173
  • Non-drainage versus drainage in tourniquet-free knee arthroplasty: a
           prospective trial
    • Authors: Kai Zhou; Haoyang Wang, Jinglong Li, Duan Wang, Zongke Zhou, Fuxing Pei
      Abstract: BackgroundIt is still unknown whether drainage is necessary and non-drainage is safe and acceptable after tourniquet-free total knee arthroplasty (TKA). We aim to investigate whether non-drainage use is accepted in TKA that is performed without a tourniquet.MethodsClinical data of 80 adult patients who did or did not receive drainage in our centres from August 2015 to December 2015 were prospective investigated.ResultsThe drainage group exhibited reduced hidden blood loss (47.6 ± 43.6 mL versus 151.1 ± 97.1 mL, P 
      PubDate: 2017-09-18T18:47:41.862453-05:
      DOI: 10.1111/ans.14183
  • Changing face of robot-assisted radical prostatectomy in Melbourne over
           12 years
    • Authors: Niranjan J. Sathianathen; Alastair Lamb, Nathan L. Lawrentschuk, Jeremy R. Goad, Justin Peters, Anthony J. Costello, Declan G. Murphy, Daniel A. Moon
      Abstract: BackgroundThis study aims to characterize the trends in disease presentation for robot-assisted radical prostatectomy (RARP) over a 12-year period in Melbourne, Australia.MethodsAll patients undergoing an RARP between 2004 and October 2016 while under the care of six high-volume surgeons were included in this study. Data were collected prospectively regarding patient demographics and clinical details of their cancer.ResultsOver the 12-year time span of the study, 3075 men underwent an RARP with a median age of 63.01 years. Temporal analysis demonstrated that the median age of patients undergoing prostatectomy advanced with time with the median age in 2016 being 65.51 years compared with 61.0 years in 2004 (P 
      PubDate: 2017-09-18T18:47:39.886136-05:
      DOI: 10.1111/ans.14169
  • Comparison of perioperative, renal and oncologic outcomes in
           robotic-assisted versus open partial nephrectomy
    • Authors: Jo-Lynn Tan; Mark Frydenberg, Jeremy Grummet, Uri Hanegbi, Ross Snow, Sarah Mann, Kirobel Begashaw, Daniel Moon
      Abstract: BackgroundTo compare perioperative, renal and oncological outcomes after robotic-assisted partial nephrectomy (RAPN) versus open partial nephrectomy (OPN) for the treatment of renal tumours.MethodsAll partial nephrectomies performed at a Metropolitan Urology Centre between 2010 and 2016 were analysed. Baseline data was collected for patient demographics, tumour characteristics (tumour size, laterality and polarity, RENAL scores), and perioperative variables (e.g. warm ischaemic time, operation time, estimated blood loss (EBL), length of stay). Tumour characteristics included malignancy, clinical stage, Fuhrman nuclear grade and surgical margin status. Day-1 post-operative serum creatinine, estimated glomerular filtration rate (eGFR) and 6-month eGFR stage were used for assessing renal function.ResultsTwo hundred patients underwent partial nephrectomy between 2010 and 2016 (n = 200; 55 OPN versus 145 RAPN). Baseline data was similar between groups, except for lower age (P = 0.0001) and higher RENAL scores (P = 0.001) in the RAPN group. RAPN demonstrated significantly lower complication rates (P = 0.015), lesser EBL (P = 
      PubDate: 2017-09-18T18:47:35.109073-05:
      DOI: 10.1111/ans.14154
  • Acquired exostosis: a case report and review of literature
    • Authors: Chandrakanta Nayak; Barada Prasanna Samal, Sasmita Pradhan
      PubDate: 2017-09-18T18:47:33.372483-05:
      DOI: 10.1111/ans.14032
  • Wound tension and ‘closability’ with keystone flaps, V-Y flaps and
           primary closure: a study in fresh-frozen cadavers
    • Authors: Lewis C. Donovan; Charles D. Douglas, Dirk Van Helden
      Abstract: BackgroundPrevious publications have implied that the keystone flap provides mechanical benefits compared to primary closure. This has not been objectively demonstrated.MethodsElliptical defects were created in ‘fresh-frozen’ cadaveric specimens. Two approaches were used to investigate the potential mechanical benefits of keystone flaps. Experiment 1 (wound closure): 18 defects were incrementally enlarged until they could not be closed primarily either with a single ‘midpoint’ suture or with a continuous suture. Attempts were then made to close these wounds with island flaps: 13 keystone flaps (seven ‘type IIA’ and six ‘Sydney Melanoma Unit (SMU) modification’) and five V-Y flaps. Experiment 2 (tension reduction): 28 defects were fashioned to be ‘closable’ under high tension. The ‘pre-flap tension’ was measured with a single midpoint suture and tensiometer. Fourteen keystone flaps (seven type IIA and seven SMU modifications) and seven V-Y flaps were then developed and mobilized with no flap constructed on the remaining seven ‘primary closure’ wounds. The secondary defects resulting from flap mobilization were closed leaving the primary defect unsutured. The primary defect ‘post-flap tension’ was then measured using the same technique.ResultsFor Experiment 1, V-Y flaps enabled closure in four of five ‘unclosable’ defects. Keystone flaps did not enable closure in any of the 13 cases (P 
      PubDate: 2017-09-18T18:47:16.613616-05:
      DOI: 10.1111/ans.14163
  • Medium-term outcomes of fenestrated endovascular repair of juxtarenal
           abdominal aortic aneurysms
    • Authors: Timothy P. Shiraev; Trevor M. Y. Kwok, Steven R. Dubenec
      Abstract: BackgroundAbdominal aortic aneurysms pose a substantial clinical burden, and a significant proportion are not anatomically suitable for open repair or standard endovascular aneurysm repair (EVAR), instead requiring fenestrated EVAR (fEVAR). We sought to compare clinical outcomes and trends over time in patients undergoing fEVAR in Australia.MethodsWe conducted a retrospective analysis of all patients undergoing fEVAR at a tertiary referral centre between 2010 and 2015, including outcomes and complications, both as inpatients and after discharge.ResultsThirty-nine patients underwent fEVAR during the study period, with mean age of 75 years and mean aneurysm size of 61 mm. One hundred and thirty-four target vessels were treated and inhospital mortality was 5% (two patients). There were nine inhospital, eight Type II and one Type III endoleaks. Ten patients suffered acute kidney injury, one of whom required dialysis. Mean follow-up was 14.5 months (range: 0–46.7). Target vessel patency was 99.2% at follow-up. There were six Type II endoleaks at follow-up, and two patients died during the follow-up period (of non-aneurysm-related causes).ConclusionfEVAR is an effective treatment with low morbidity and mortality, and we have demonstrated excellent survival and target vessel patency at a mean follow-up of 14 months. Endoleak rates were low, despite the high complexity of the aneurysms treated.
      PubDate: 2017-09-18T18:47:13.705053-05:
      DOI: 10.1111/ans.14162
  • Survival improvements with adjuvant therapy in patients with glioblastoma
    • Authors: Dasantha Jayamanne; Helen Wheeler, Raymond Cook, Charles Teo, David Brazier, Geoff Schembri, Marina Kastelan, Linxin Guo, Michael F. Back
      Abstract: BackgroundEvaluate survival of patients diagnosed with glioblastoma multiforme (GBM) managed with adjuvant intensity modulated radiation therapy and temozolomide since the introduction of the European Organisation for Research and Treatment of Cancer and National Cancer Institute of Canada Clinical Trials Group (EORTC-NCIC) protocol.MethodsAll patients with GBM managed between May 2007 and December 2014 with EORTC-NCIC protocol were entered into a prospective database. The primary endpoint was the median survival. Univariate predictors of survival were evaluated with respect to tumour resection, age and Eastern Cooperative Oncology Group (ECOG) performance status using log-rank comparisons.ResultsTwo hundred and thirty-three patients were managed under the protocol and analysed for outcome. The median age was 57 years; the rate of gross total resection, subtotal resection and biopsy were 47.2%, 35.2% and 17.6%, respectively. At progression, 49 patients had re-resection, and in addition to second-line chemotherapy, 86 patients had Bevacizumab including 26 with re-irradiation. Median survival was 17.0 months (95% CI: 15.4–18.6). On univariate evaluation, extent of resection (P = 0.001), age, ECOG performance status and recursive partitioning analysis class III were shown to significantly improve survival (P 
      PubDate: 2017-09-18T18:47:11.312196-05:
      DOI: 10.1111/ans.14153
  • Survival outcomes in elderly men undergoing radical prostatectomy in
    • Authors: Weranja Ranasinghe; Luke L. Wang, Raj Persad, Damien Bolton, Nathan Lawrentschuk, Shomik Sengupta
      Abstract: BackgroundTo investigate the outcomes of patients older than 75 years of age in Victoria undergoing radical prostatectomy for prostate cancer.MethodsData on all men undergoing radical prostatectomy in Victoria between 1 January 2004 and 31 December 2014 were obtained from the Victorian Cancer Registry. Tumour characteristics including Gleason grade, stage of disease and cause of death were obtained. Statistical analysis was performed using chi-squared test, Cox proportional hazards method and Kaplan–Meier analysis.ResultsA total of 14 686 men underwent radical prostatectomy during the defined period, with a median follow-up of 58 months. Of these, 332 were men over the age of 75. All parameters are comparisons between patients>75 years of age and men 75 years had a higher proportion of Gleason grade ≥8 disease (16.6% versus 11.4%, P 75 years had lower rates of 5- and 10-year overall survival (67.3% versus 96.3% and 27.7% versus 89.1%) and lower rates of 5- and 10-year prostate cancer-specific survival (96.2% versus 99.3% and 94.3% versus 97.4%), respectively. Age was an independent risk factor for prostate cancer specific and overall mortality on multivariate analysis (hazard ratio 1.49, 95% confidence interval 1.32–1.68; P 
      PubDate: 2017-09-18T18:47:07.442956-05:
      DOI: 10.1111/ans.14166
  • Adrenal ganglioneuroblastoma in an adult
    • Authors: James Lonie; Rachael Boles, Jason Boldery
      PubDate: 2017-09-18T18:47:03.623823-05:
      DOI: 10.1111/ans.14157
  • Impending abdominal compartment syndrome from a giant ovarian cyst torsion
    • Authors: Tae-Jun Kim; Yu-Ting Yeh, Karishma Zobair
      PubDate: 2017-09-18T18:46:37.418997-05:
      DOI: 10.1111/ans.14147
  • Neoadjuvant systemic therapy for breast cancer: the Westmead experience
    • Authors: Annelise M. Cocco; David Messer, Alexander Brown, Nina Sriram, Jenny Gilchrist, Loma Al-Mansouri, Richard Kefford, Farid Meybodi, James French, Jeremy Hsu, Elisabeth Elder
      Abstract: BackgroundNeoadjuvant systemic therapy (NAST) can be used to treat breast cancer. Pathologic complete response (pCR) is a surrogate marker for improved survival. This study examined response in the breast and axilla to NAST and identified features associated with pCR.MethodsPatients undergoing NAST and surgery between January 2012 and June 2016 by surgeons at Westmead Breast Cancer Institute were identified. Patients with inflammatory or metastatic disease were excluded. Data were analysed to identify factors predictive of pCR.ResultsNinety-one patients were identified. Mean age was 49 years. Forty-one patients had axillary metastases identified prior to NAST. Eighty-three patients received chemotherapy alone, six endocrine therapy alone and two had both. Thirty-seven patients had mastectomy and 54 had breast-conserving surgery. The overall breast pCR rate was 29% higher in patients with triple-negative (50%) or HER2-positive (39%) disease and lower in luminal disease (11.6%, P = 0.001). Forty percent of node-positive patients became node negative. The only variable associated with pCR was tumour biology. Patients with HER2-positive breast cancer were more likely to have axillary pCR than those with luminal cancer (odds ratio: 28, P = 0.00005).ConclusionpCR in either the breast or axilla was most likely to be achieved in patients with HER2-positive or triple-negative breast cancers. In patients with luminal cancers, the goal of NAST is best considered to facilitate surgical options rather than obtaining a pCR.
      PubDate: 2017-09-18T18:46:30.634586-05:
      DOI: 10.1111/ans.14158
  • Unicortical and bicortical plating in the fixation of comminuted fractures
           of the clavicle: a biomechanical study
    • Authors: John M. Looft; Lincoln Corrêa, Minoo Patel, Mathew Rawlings, David C. Ackland
      Abstract: BackgroundIntraoperative neurovascular complications with clavicle fracture fixation are often due to far cortex penetration by drills and screws, but could be avoided using a unicortical construct. The objective of this study was to compare the bending and torsional strength of a unicortical locking screw plate construct and a hybrid (with central locked and outer non-locked long oblique screws) unicortical plate construct for clavicle fracture fixation with that of a conventional bicortical locking screw construct of plate fixation.MethodsTwenty-four human clavicle specimens were harvested and fractured in a comminuted mid-shaft butterfly configuration. Clavicles were randomly allocated to three surgical fixation groups: unicortical locking screw, bicortical locking screw and hybrid unicortical screw fixation. Clavicles were tested in torsion and cantilever bending. Construct bending and torsional stiffness were measured, as well as ultimate strength in bending.ResultsThere were no significant differences in bending stiffness or ultimate bending moment between all three plating techniques. The unicortical locked construct had similar torsional stiffness compared with the bicortical locked construct; however, the hybrid technique was found to have significantly lower torsional stiffness to that of the bicortical locking screw construct (mean difference: 87.5 Nmm/degree, P = 0.028).ConclusionsUnicortical locked screw plate fixation and hybrid unicortical plating fixation with centrally locked screws and outer long, oblique screws may alleviate far cortex penetration, protecting nearby anatomical structures, and may ease implant removal and conversion to bicortical fixation for revision surgery; however, use of long oblique screws may increase the risk of early loosening under torsion.
      PubDate: 2017-09-18T18:46:13.069049-05:
      DOI: 10.1111/ans.14139
  • Why do surgeons receive more complaints than their physician peers'
    • Authors: Holly M. Tibble; Nigel S. Broughton, David M. Studdert, Matthew J. Spittal, Nicola Hill, Jennifer M. Morris, Marie M. Bismark
      Abstract: BackgroundCompared with other doctors, surgeons are at an increased risk of medicolegal events, including patient complaints and negligence claims. This retrospective study aimed to describe the frequency and nature of complaints involving surgeons compared with physicians.MethodsWe assembled a national data set of complaints about surgeons and physicians lodged with medical regulators in Australia from 2011 to 2016. We classified the complaints into 19 issues across four domains: treatment and procedures, other performance, professional conduct and health. We assessed differences in complaint risk using incidence rate ratios (IRRs). Finally, we used a multivariate model to identify predictors of complaints among surgeons.ResultsThe rate of complaints was 2.3 times higher for surgeons than physicians (112 compared with 48 complaints per 1000 practice years, P 
      PubDate: 2017-09-09T19:50:33.802638-05:
      DOI: 10.1111/ans.14225
  • Rare finding of a giant ischioanal lipoma
    • Authors: Vignesh Narasimhan; Daniel Wein, Amrish Rajkumar, Chip Farmer, Satish Warrier
      PubDate: 2017-09-04T20:07:58.792213-05:
      DOI: 10.1111/ans.14197
  • Transperineal rectocele repair: a systematic review
    • Authors: Eleanor F. Zimmermann; Richard S. Hayes, Ian R. Daniels, Neil J. Smart, Andrea M. Warwick
      Abstract: BackgroundTransperineal rectocele repairs, either as isolated fascial repair or in combination with mesh augmentation, are hypothesized to reduce the risk of complications compared with alternative techniques.AimThe aim of this study was to ascertain long-term success and complication rates following transperineal rectocele repairs.MethodA literature search of PubMed and Embase was performed using the terms ‘transperineal rectocele’, ‘rectocele’, ‘transperineal’ and ‘repair’. Prospective studies, case series and retrospective case note analyses from 1 January 1994 to 1 December 2016 were included. Those that detailed outcomes of the transperineal approach or compared it to transanal/transvaginal approaches were included. The main outcome measures were reported complications and functional outcome scores.ResultsA total of 14 studies were included. Of 566 patients, 333 (58.8%) underwent a transperineal rectocele repair and 220 (41.2%) a transanal repair. Complications were identified in 27 (12.3%) of the 220 transanal repairs and in 41 (12.3%) of the 333 transperineal repairs. A significant complication following transperineal repair was noted in eight studies. There are not enough data to make a reliable comparison between mesh and non-mesh transperineal repairs or to compare biological and synthetic mesh use.LimitationsOutcome reporting differed between studies, precluding a full meta-analysis.ConclusionTransperineal rectocele repair offers an effective method of symptom improvement and appears to have a similar complication rate as transanal rectocele repair. Concomitant use of synthetic and biological mesh augmentation is becoming more common; however, high-quality comparative data are lacking, so a direct comparison between surgical approaches is not yet possible.
      PubDate: 2017-09-04T20:06:55.994452-05:
      DOI: 10.1111/ans.14068
  • Resection accuracy of patient-specific cutting guides in total knee
    • Authors: Gregory C. Wernecke; Scott Taylor, Penny Wernecke, Samuel J. MacDessi, Darren B. Chen
      Abstract: BackgroundPatient-specific guides (PSGs) have been thoroughly investigated with regards to reconstitution of mechanical alignment in total knee arthroplasty (TKA). The ability to replicate the preoperative surgical plan is essential for optimal outcomes but intraoperative measurements to confirm accurate progression through the operation are limited. This leads to our clinical question: can PSGs replicate the planned bone resection depth during TKA'MethodsThis is a prospective case series of 118 patients who underwent TKA using magnetic resonance imaging-based patient-specific cutting guides. Intraoperative bone resection thickness was measured and compared with the preoperative planned bone resections as a primary outcome. Secondary outcomes included the need for additional bone resections, the number of cases for which the PSG technique was abandoned, final component sizes and mechanical alignment.ResultsPSGs could not accurately recreate preoperative plan. PSGs resulted in over-resection in all bone cuts compared with the preoperative surgical resection plan. Secondary osteotomies were required in 37% of patients. PSGs had to be abandoned in 10.5% of cases, mostly due to suboptimal fit of the femoral block. The tibial component size was altered more frequently than the femoral.ConclusionIntraoperatively, PSGs could not accurately recreate the preoperative plan. PSGs are marketed as user-friendly tools to simplify TKA but our research demonstrates the need for surgeons to monitor surgical progression and compensate for errors occurring during the use of PSGs.
      PubDate: 2017-08-29T22:40:32.564982-05:
      DOI: 10.1111/ans.14143
  • Risk factors for multidrug-resistant Gram-negative infection in burn
    • Authors: Mark L. Vickers; Joel M. Dulhunty, Emma Ballard, Paul Chapman, Michael Muller, Jason A. Roberts, Menino O. Cotta
      Abstract: BackgroundInfection with multidrug-resistant (MDR) Gram-negative organisms leads to poorer outcomes in the critically ill burn patient. The aim of this study was to identify the risk factors for MDR Gram-negative pathogen infection in critically ill burn patients admitted to a major tertiary referral intensive care unit (ICU) in Australia.MethodsA retrospective case–control study of all adult burn patients admitted over a 7-year period was conducted. Twenty-one cases that cultured an MDR Gram-negative organism were matched with 21 controls of similar age, gender, burn size and ICU stay. Multivariable conditional logistic regression was used to individually assess risk factors after adjusting for Acute Burn Severity Index. Adjusted odds ratios (ORs) were reported. P-values 
      PubDate: 2017-08-29T22:40:29.63526-05:0
      DOI: 10.1111/ans.14144
  • Mental training in surgical education: a systematic review
    • Authors: Sara Davison; Nicholas Raison, Muhammad S. Khan, Prokar Dasgupta, Kamran Ahmed
      Abstract: BackgroundPressures on surgical education from restricted working hours and increasing scrutiny of outcomes have been compounded by the development of highly technical surgical procedures requiring additional specialist training. Mental training (MT), the act of performing motor tasks in the ‘mind's eye’, offers the potential for training outside the operating room. However, the technique is yet to be formally incorporated in surgical curricula. This study aims to review the available literature to determine the role of MT in surgical education.MethodsEMBASE and Medline databases were searched. The primary outcome measure was surgical proficiency following training. Secondary analyses examined training duration, forms of MT and trainees level of experience. Study quality was assessed using Consolidated Standards of Reporting Trials scores or Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group.ResultsFourteen trials with 618 participants met the inclusion criteria, of which 11 were randomized and three longitudinal. Ten studies found MT to be beneficial. Mental rehearsal was the most commonly used form of training. No significant correlation was found between the length of MT and outcomes. MT benefitted expert surgeons more than medical students or novice surgeons.ConclusionThe majority studies demonstrate MT to be beneficial in surgical education especially amongst more experienced surgeons within a well-structured MT programme. However, overall studies were low quality, lacked sufficient methodology and suffered from small sample sizes. For these reasons, further research is required to determine optimal role of MT as a supplementary educational tool within the surgical curriculum.
      PubDate: 2017-08-29T05:05:44.833244-05:
      DOI: 10.1111/ans.14140
  • Left renal vein ligation for large splenorenal shunt during liver
    • Authors: Rui Tang; Dongdong Han, Modan Li, Shan Shen, Xin Huang, Wenping Zhao, Jiahong Dong
      Abstract: Adequate hepatopetal portal vein blood flow is obligatory to ensure proper liver function after liver transplantation. Large collateral veins as shunts impair portal vein flow and even cause hepatofugal blood flow and portal steal syndrome. In particular, splenorenal shunts in liver transplant recipients can lead to allograft dysfunction and possible allograft loss or hepatic encephalopathy. Restoration of portal flow through left renal vein ligation (LRVL) is a treatment option, which is much easier compared to splenectomy, renoportal anastomosis and shunt closure, but bears the risk of moderate and temporary impairment of renal function. In addition, a patent portal vein is mandatory for LRVL. However, although LRVL has been reported to be an effective, safe and easy method to control portacaval shunts and increase hepatopetal flow in some studies, indications and safety are still not clear. In this review, we summarize existing studies on LRVL during liver transplantation.
      PubDate: 2017-08-29T05:05:40.027377-05:
      DOI: 10.1111/ans.14044
  • The Perth Emergency Laparotomy Audit
    • Authors: Katherine J. Broughton; Oscar Aldridge, Sharin Pradhan, R. James Aitken
      Abstract: BackgroundEmergency laparotomies (ELs) are associated with high mortality and substantial outcome variation. There is no prospective Australian data on ELs. The aim of this study was to audit outcome after ELs in Western Australia.MethodsA 12-week prospective audit was completed in 10 hospitals. Data collected included patient demographics, the clinical pathway, preoperative risk assessment and outcomes including 30-day mortality and length of stay.ResultsData were recorded for 198 (76.2%) of 260 patients. The 30-day mortality was 6.5% (17/260) in participating hospitals, and 5.4% (19 of 354) across Western Australia. There was minimal variation between the three tertiary hospitals undertaking 220 of 354 (62.1%) ELs. The median and mean post-operative lengths of stay, excluding patients who died, were 8 and 10 days, respectively. In the 48 patients with a prospectively documented risk of ≥10%, both a consultant surgeon and anaesthetist were present for 68.8%, 62.8% were admitted to critical care and 45.8% commenced surgery within 2 h. The mortality in those retrospectively (62; 31%) and prospectively risk-assessed was 9.5% and 5.2%, respectively.ConclusionThis prospective EL audit demonstrated low 30-day mortality with little inter-hospital variation. Individual hospitals have scope to improve their standards of care. The importance of prospective risk assessment is clear.
      PubDate: 2017-08-23T22:11:10.136662-05:
      DOI: 10.1111/ans.14208
  • Enterolithiasis as a complication of a jejunal diverticulum: an unusual
           case of small bowel obstruction
    • Authors: Scott Hoskin; Douglas MacKenzie, Monzir Osman, Raymond Oliphant
      PubDate: 2017-08-20T19:10:45.299958-05:
      DOI: 10.1111/ans.14150
  • National surgical mortality audit may be associated with reduced mortality
           after emergency admission
    • Authors: Andreas Kiermeier; Wendy J. Babidge, Glenn A. J. McCulloch, Guy J. Maddern, David A. Watters, R. James Aitken
      Abstract: BackgroundThe Western Australian Audit of Surgical Mortality was established in 2002. A 10-year analysis suggested it was the primary driver in the subsequent fall in surgeon-related mortality. Between 2004 and 2010 the Royal Australasian College of Surgeons established mortality audits in other states. The aim of this study was to examine national data from the Australian Institute of Health and Welfare (AIHW) to determine if a similar fall in mortality was observed across Australia.MethodThe AIHW collects procedure and outcome data for all surgical admissions. AIHW data from 2005/2006 to 2012/2013 was used to assess changes in surgical mortality.ResultsOver the 8 years surgical admissions increased by 23%, while mortality fell by 18% and the mortality per admission fell by 33% (P 
      PubDate: 2017-08-20T19:10:32.102994-05:
      DOI: 10.1111/ans.14170
  • Ilizarov technique and limited surgical methods for correction of
           post-traumatic talipes equinovarus in children
    • Authors: Xiao Jian Wang; Feng Chang, Yunxing Su, Bin Chen, Jie-Fu Song, Xiao-Chun Wei, Lei Wei
      Abstract: BackgroundThe objective of this study was to evaluate the efficacy and safety of using Ilizarov invasive distraction technique combined with limited surgical operations in the treatment of post-traumatic talipes equinovarus in children.MethodsEighteen cases of post-traumatic deformed feet in 15 patients who received the treatment of Ilizarov frame application, limited soft-tissue release or osteotomy were selected in this study. After removal of the frame, an ankle–foot orthosis was used continuously for another 6–12 months. Pre- and post-operatively, the International Clubfoot Study Group (ICFSG) score was employed to evaluate the gait and range of motion of the ankle joint. Radiographical assessment was also conducted.ResultsPatients were followed up for 22 (17–32) months. Ilizarov frame was applied for a mean duration of 5.5 (4–9) months. When it was removed, the gait was improved significantly in all the patients. The correction time was 6–8 weeks for patients who underwent soft-tissue release and 8–12 weeks for those with bone osteotomy. At the last follow-up assessment, the differences between pre- and post-operative plantar-flexion angle, dorsiflexion, motion of ankle joint and talocalcaneal angle were significant (all P 
      PubDate: 2017-08-16T19:06:51.081408-05:
      DOI: 10.1111/ans.14123
  • Who, where, what and where to now' A snapshot of publishing patterns
           in Australian orthopaedic surgery
    • Authors: Nicholas Croker; Abhirup Lobo, Anne Croker, Zsolt J. Balogh, David Dewar
      Abstract: BackgroundDevelopment of core research competency is a principle of orthopaedic surgical training in Australia. This paper aims to provide an objective snapshot of publications by Australian orthopaedic trainees and surgeons, to contribute to the discussion on how to identify and build on research capability in the Australian Orthopaedic Association (AOA).MethodsBy analysing journals with a journal impact factor>1 from 2009 to 2015, data were gathered to explore scientific journal publications by Australian orthopaedic surgeons and trainees in relation to who are the authors, what they are reporting and where they are publishing.ResultsOne thousand five hundred and thirty-nine articles were identified with 134 orthopaedic trainees and 519 surgeons as authors. The publication rate for both trainees and surgeons was just over two in five. The majority of studies were of level three or four evidence (Oxford's Centre for Evidence-Based Medicine guidelines). Only 5% of trainee papers were published without surgeons’ co-authorship. Eighty-six percent of papers published by surgeons did not involve a trainee. The rates of trainees publishing with other trainees were low.ConclusionOnly 5% of trainee papers were published without surgeons' co-authorship, highlighting the importance of surgeon mentorship in developing trainee research capability. The 86% of papers published by surgeons without trainee co-authorship raises the question of missed mentoring opportunities. Low rates of trainee co-authorship highlight potential for trainees to work together to support each other's research efforts. There is scope for more studies involving higher levels of evidence. This paper raises discussion points and areas for further exploration in relation to AOA trainee research capability.
      PubDate: 2017-08-15T01:11:15.103206-05:
      DOI: 10.1111/ans.14177
  • 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
      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
  • Colonoscopic surveillance: quality, guidelines and effectiveness
    • Authors: Timothy J. Chittleborough; Joseph C. Kong, Glen R. Guerra, Robert Ramsay, Alexander G. Heriot
      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
  • Laparoscopic hepatectomy combined with endoscopic papillary balloon
           dilation for complex bile duct stones
    • Authors: Jian Yang; Fabiao Zhang, Xuefeng Du, Aidong Wang, Shangdong Lv, Zheping Fang
      Abstract: BackgroundWe evaluated the feasibility and efficacy of laparoscopic hepatectomy (LH) combined with endoscopic papillary balloon dilation (EPBD) for removing intra- and extrahepatic bile duct stones.MethodsA total of 26 patients with intra- and extrahepatic bile duct stones underwent LH and EPBD. Selective hemi-hepatic vascular occlusion was used to complete the LH. EPBD was performed under the guidance of a guidewire, and stones were removed with a stone basket or balloon.ResultsA one-stage LH with EPBD lithotomy was successfully performed in 26 cases. No residual bile duct stones, intestinal or bile duct perforations were found. In addition, no severe post-operative bleeding, severe pancreatitis or mortality occurred. Post-operative hyperamylasemia was observed in five cases and bile leakage in one case. Post-operative hospital stays lasted 7–11 days.ConclusionLH combined with EPBD applied to intra- and extrahepatic bile duct stones was feasible, effective and safe, resulting in rapid recovery and few post-operative complications.
      PubDate: 2017-08-13T18:51:14.96045-05:0
      DOI: 10.1111/ans.14132
  • Prospective comparison between magnetic resonance imaging and computed
           tomography in colorectal cancer staging
    • Authors: Frederick H. X. Koh; Ker-Kan Tan, Lynette L. S. Teo, Bertrand W. L. Ang, Yee-Liang Thian
      Abstract: BackgroundDiffusion-weighted (DW) imaging is a functional magnetic resonance imaging (MRI) technique that detects lesions with high cellularity, such as malignant tumours. This prospective study was performed to compare the accuracy of DW-MRI with multidetector computed tomography (MDCT) in staging of colorectal cancer.MethodsThirty patients with histologically proven colorectal cancer were prospectively recruited. Each patient underwent both MDCT and DW-MRI of the abdomen–pelvis for primary staging. Images were evaluated for nodal and distant metastases. The reference standard was histopathological findings for nodal involvement and surveillance imaging for suspected hepatic metastases.ResultsThe primary cancers were located in the rectum (n = 16, 53.3%), sigmoid colon (n = 9, 30%) and right colon (n = 5, 16.6%). For nodal metastases, the sensitivity and specificity of DW-MRI were 84.6% (95% confidence interval (CI): 54.6–98.1%) and 20.0% (95% CI: 2.5–55.6%) compared with 84.6% (95% CI: 54.6–98.1%) and 40.0% (95% CI: 12.2–73.8%) for MDCT. For liver metastases, the sensitivity and specificity for DW-MRI were 100.0% (95% CI: 63.1–100.0%) and 100% (95% CI: 84.6–100%) compared with 87.5% (95% CI: 47.4–99.7%) and 95.5% (95% CI: 77.2–99.9%) for MDCT. DW imaging altered the clinical management in three (10.0%) patients by detecting missed hepatic metastases in two patients and accurately diagnosing another patient with a hepatic cyst, mistaken for metastasis on MDCT.ConclusionDW-MRI is more accurate for detecting hepatic metastases in colorectal cancer compared with MDCT.
      PubDate: 2017-08-13T18:50:47.479717-05:
      DOI: 10.1111/ans.14138
  • Development of a proficiency-based virtual reality simulation training
           curriculum for laparoscopic appendicectomy
    • Authors: Pramudith Sirimanna; Marc A. Gladman
      Abstract: BackgroundProficiency-based virtual reality (VR) training curricula improve intraoperative performance, but have not been developed for laparoscopic appendicectomy (LA). This study aimed to develop an evidence-based training curriculum for LA.MethodsA total of 10 experienced (>50 LAs), eight intermediate (10–30 LAs) and 20 inexperienced (
      PubDate: 2017-08-13T18:50:38.082492-05:
      DOI: 10.1111/ans.14135
  • Serum carbohydrate antigen 19-9 in pancreatic adenocarcinoma: a mini
           review for surgeons
    • Authors: Su Kah Goh; Grace Gold, Christopher Christophi, Vijayaragavan Muralidharan
      Abstract: The optimal management of oncological conditions is reflected by the careful interpretation of investigations for screening, diagnosis, staging, prognostication and surveillance. Serum tumour markers are examples of commonly requested tests in conjunction with other imaging and endoscopic tests that are used to help clinicians to stratify therapeutic decisions. Serum carbohydrate antigen 19-9 (CA19-9) is a key biomarker for pancreatic cancers. Although this biomarker is considered clinically useful and informative, clinicians are often challenged by the accurate interpretation of elevated serum CA19-9 levels. Recognizing the pitfalls of normal and abnormal serum CA19-9 concentrations will facilitate its appropriate use. In this review, we appraised the biomarker, serum CA19-9, and highlighted the clinical utility and limitations of serum CA19-9 in the investigation and management of pancreatic cancers.
      PubDate: 2017-08-13T18:50:26.12593-05:0
      DOI: 10.1111/ans.14131
  • 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
  • Gallbladder mucosal lesions associated with high biliary amylase
           irrespective of pancreaticobiliary maljunction
    • Authors: Jason Free; Frank Wang, Nick Williams, Justin S. Gundara, Ralph F. Staerkle, Thomas J. Hugh, Jaswinder S. Samra
      Abstract: BackgroundPrevious studies have focused on the presence of reflux in selected cohorts with pancreaticobiliary maljunction (PBM), but little is known regarding the wider incidence of occult reflux and associated mucosal changes. We aimed to correlate gallbladder mucosal abnormalities with objective evidence of PBM and occult pancreaticobiliary reflux (PBR) in an Australian population undergoing cholecystectomy.MethodsPatients undergoing cholecystectomy between September 2010 and September 2012 were eligible for inclusion. Demographic and pre-operative clinical data were collated and entered into a pre-defined database. Operative cholangiograms were routinely performed and the presence of PBM noted. Gallbladder bile samples were analysed for bilirubin (
      PubDate: 2017-08-07T06:23:19.177964-05:
      DOI: 10.1111/ans.14136
  • Sclerosing peritonitis post liver transplantation: a rare condition where
           surgery is an important treatment option
    • Authors: Yvonne X. Kong; Simone I. Strasser, Geoffrey W. McCaughan, Michael Crawford, Deborah J. Verran
      Abstract: BackgroundSclerosing peritonitis (SP) is a rare but potentially fatal complication following orthotopic liver transplantation (OLT). The definitive surgical management is via a laparotomy peritonectomy and enterolysis procedure, but this carries risks particularly in the immunosuppressed transplant patient population. The natural history of SP is known from a handful of case reports and series, which mostly report de novo cases arising early on following OLT. The aim of this study was to identify all cases of de novo SP following OLT and the outcomes of management.MethodsCases of SP post OLT were identified from the Australian National Liver Transplantation Unit (New South Wales) database of all 1393 adult patients.ResultsThree cases of SP were diagnosed between 2 and over 9 years post-transplantation. Two patients proceeded to laparotomy and a peritonectomy and enterolysis procedure of the cocooned bowel. The third was managed conservatively due to a relatively indolent course and their medical co-morbidities.ConclusionSP should be considered in the differential diagnosis in patients post OLT presenting with symptoms of bowel obstruction, even years following transplantation. Surgery may be required in order to achieve a satisfactory outcome in some cases.
      PubDate: 2017-08-07T06:23:04.236894-05:
      DOI: 10.1111/ans.14128
  • Open surgical mitral valve replacement with a transcatheter Edwards
           Sapien-XT valve
    • Authors: Tanveer Ahmad; Prakash M. Ludhani, Ronen Gurvitch, John Goldblatt, James Tatoulis
      PubDate: 2017-08-04T05:33:04.477675-05:
      DOI: 10.1111/ans.14133
  • Intraoperative ultrasound for the colorectal surgeon: current trends and
    • Authors: Thomas L. J. Walker; Richard Bamford, Margaret Finch-Jones
      Abstract: Up to two thirds of patients diagnosed with colorectal cancer (CRC) develop colorectal liver metastases (CRLMs) and one quarter of patients present with synchronous metastases. Early detection of CRLM widens the scope of potential treatment. Surgery for CRLM offers the best chance of a cure. Current preoperative staging of CRC relies on computerized tomography and magnetic resonance imaging. Intraoperative ultrasound (IOUS) scans and contrast-enhanced IOUS (CE-IOUS) have been demonstrated to detect additional metastases not seen on routine preoperative imaging. IOUS is not widely used by colorectal surgeons during primary resection for CRC. Confident use of IOUS/CE-IOUS during primary resection of CRC may improve decision-making by providing the most sensitive form of liver staging even when compared with magnetic resonance imaging. This may be particularly important in the era of laparoscopic resections, where the colorectal surgeon loses the opportunity to palpate the liver. There are several implied barriers to the routine use of IOUS/CE-IOUS by colorectal surgeons. These include time pressure, familiarity with techniques, a perceived learning curve, cost implications and limitation of the modality due to operator variations. Inclusion of IOUS in the training of colorectal surgeons and further investigation of potential benefits of IOUS/CE-IOUS could potentially reduce these barriers, enabling usage during primary resection for CRC to become more widespread.
      PubDate: 2017-08-03T03:20:36.880146-05:
      DOI: 10.1111/ans.14124
  • Importance of preoperative diagnosis for management of patients with
           suspected retroperitoneal sarcoma
    • Authors: David E. Gyorki; Peter F. M. Choong, John Slavin, Michael A. Henderson
      Abstract: Soft tissue sarcoma is an umbrella term which encompasses over 60 histological tumour types. Approximately 15% of soft tissue sarcomas arise in the retroperitoneum. This complex group of tumours poses unique management challenges due to their often large size, histological heterogeneity and complexity of anatomical relationships. This review discusses the management of retroperitoneal tumours including the need for preoperative diagnosis, the evidence for neoadjuvant radiotherapy, the role of multivisceral resection and the importance of a multidisciplinary team approach.
      PubDate: 2017-08-02T18:28:29.080809-05:
      DOI: 10.1111/ans.14125
  • Semi-Automatic Electronic Stent Register: a novel approach to preventing
           ureteric stents lost to follow up
    • Authors: James W. H. Macneil; Peter Michail, Manish I. Patel, Julie Ashbourne, Simon V. Bariol, David A. Ende, Tania A. Hossack, Howard Lau, Audrey C. Wang, Andrew J. Brooks
      Abstract: BackgroundUreteric stents are indispensable tools in modern urology; however, the risk of them not being followed-up once inserted poses medical and medico-legal risks. Stent registers are a common solution to mitigate this risk; however, manual registers are logistically challenging, especially for busy units.MethodsWestern Sydney Local Health District developed a novel Semi-Automatic Electronic Stent Register (SAESR) utilizing billing information to track stent insertions. To determine the utility of this system, an audit was conducted comparing the 6 months before the introduction of the register to the first 6 months of the register.ResultsIn the first 6 months of the register, 457 stents were inserted. At the time of writing, two of these are severely delayed for removal, representing a rate of 0.4%. In the 6 months immediately preceding the introduction of the register, 497 stents were inserted, and six were either missed completely or severely delayed in their removal, representing a rate of 1.2%. A non-inferiority analysis found this to be no worse than the results achieved before the introduction of the register.ConclusionThe SAESR allowed us to improve upon our better than expected rate of stents lost to follow up or severely delayed. We demonstrated non-inferiority in the rate of lost or severely delayed stents, and a number of other advantages including savings in personnel costs. The semi-automatic register represents an effective way of reducing the risk associated with a common urological procedure. We believe that this methodology could be implemented elsewhere.
      PubDate: 2017-08-02T18:28:14.076751-05:
      DOI: 10.1111/ans.14126
  • Triple site intussusceptions in Peutz–Jeghers syndrome
    • Authors: Amit Singh; Shivaji H. Vidyarthi, Neena Kasliwal, Shweta Khandelwal, Vivek K. Sharma
      PubDate: 2017-08-02T18:28:12.121306-05:
      DOI: 10.1111/ans.14119
  • Umbilical endometriosis: a potential encounter for general surgeons
    • Authors: Samantha S. Mooney; Lenore Ellett
      PubDate: 2017-08-02T18:27:48.774949-05:
      DOI: 10.1111/ans.14118
  • Implementing entrustable professional activities: the yellow brick road
           towards competency-based training'
    • Authors: David Moore; Christopher J. Young, Jonathan Hong
      Abstract: BackgroundWe describe implementation of competency-based postgraduate surgical training, using an entrustable professional activities (EPAs) programme. The programme aims to improve patient outcomes by optimizing supervision of surgical trainees, creating opportunities for additional teaching and feedback. The curriculum was designed to maximize feasibility for implementation within a colorectal surgical department.MethodsThe curriculum was developed using previously described methods by consensus between two consultants within the department. Seven EPAs were identified and described for each grade of trainee. A consultant within the teaching faculty or a delegate is required to assess each EPA and provide formal feedback until the trainee is given permission to act autonomously.ResultsIt is hoped the programme can progress with minimal disruption to key stakeholders. We will record trainee assessment data anticipating that performance of trainees on other tasks in the future may provide some evidence of validity for the EPA assessments.ConclusionsThere are perceived benefits and problems evident in the EPA model at this early stage of implementation. The programme should result in an increase in the number of formative assessments and feedback opportunities for trainees. The assessment process is familiar to supervisors, which should facilitate implementation of the curriculum. There is concern that supervisors may require further training to ensure the assessment process is objective and reproducible. The EPA programme could make the process of delegating patient care to trainees more transparent, but we have not identified a method of widely disseminating trainee assessment data without the potential to prejudice trainees unfairly.
      PubDate: 2017-08-02T18:26:53.03248-05:0
      DOI: 10.1111/ans.14120
  • General surgery primary operator rates: a guide to achieving future
    • Authors: Cameron Law; Jonathan Hong, David Storey, Christopher J. Young
      Abstract: BackgroundCompetency in surgical training is a topic of much recent discussion, with concern regarding the adequacy of current training schemes to achieve competency. Most programmes use caseload and primary operator rates to assess trainee progression. Some trainees still lack technical competence even when recommended procedural numbers are met. It is possible that current measures of individual's capabilities used in surgical education are outdated.MethodsLogbook data of New South Wales general surgical trainees between 2010 and 2012 was obtained through General Surgeons Australia. The top 10 most common operations recorded in trainee logbooks were identified. Individual trainee data were grouped by the surgical education and training year and primary operator versus assistant experience. The data were analysed focusing on the primary operator rate, comparing between trainee levels to identify progression.ResultsA total of 183 319 operations were recorded in New South Wales general surgery trainee logbooks. A positive association was demonstrated between trainee seniority and primary operator rates for the most common procedures, indicating trainee's continual progression in experience as they advance. However, laparoscopic inguinal hernia repair, oversew of gastroduodenal ulcer, open cholecystectomy and right hemicolectomy showed poor primary operator rates among trainees regardless of trainee year, despite these operations being among the 10 most common.ConclusionGeneral surgical trainees accumulate operative experience with progression through the surgical education and training programme, highlighting expected technical progression and competency of trainees for common procedures. For less common or more complicated procedures, the use of entrustable professional activities and accompanying simulation training could be used to achieve the necessary technical expertise.
      PubDate: 2017-08-02T18:26:50.025217-05:
      DOI: 10.1111/ans.14121
  • Paediatric surgical services in remote northern Australia: an integrated
           model of care
    • Authors: Liam Quinn; David Read
      Abstract: BackgroundSurgical services for children in the Northern Territory of Australia are routinely performed by general surgeons with specific paediatric training, supported by paediatric surgeons. In Australasia, indications for appropriate transfer of elective routine surgery in children to tertiary paediatric surgical centres have been contentious. To transfer all elective paediatric cases from rural locations would have significant social and financial consequences for families and the health system. This study reviews clinical outcomes for elective surgery for two common conditions managed by an integrated service of general surgeons and visiting paediatric surgeons, and compares them with published outcomes from paediatric centres.MethodA retrospective audit of children undergoing orchidopexy under the age of 5 years or inguinal herniotomy under the age of 1 year at the Royal Darwin Hospital and Darwin Private Hospital between January 2005 and 2016 was conducted.ResultsDuring the study period, 66 boys underwent 80 orchidopexies at a mean age of 22.3 months (±20.4 SD). A recurrence rate of 5.5%, severe atrophy rate of 1.3% and total atrophy rate of 5.5% were achieved. Sixty-three children underwent 65 inguinal herniotomies at a mean age of 2.5 months (±4.2). A testicular maldescention and atrophy rate of 1.8% and recurrence rate of 0% was achieved.ConclusionChildren managed with this model of care had complication rates equivalent to or slightly higher than published gold standards. Considering the family disruption, cultural, financial implications and threat to compliance that transfer across vast distances entails, this model provides acceptable outcomes.
      PubDate: 2017-07-31T18:51:27.572844-05:
      DOI: 10.1111/ans.14116
  • Impact of health utility after thrombotic complications following total
           hip and knee arthroplasty
    • Authors: Bikram Karmakar
      Abstract: BackgroundMedical complications and preexisting conditions frequently place the surgeon in the unenviable position of choosing between the serious and potentially life-threatening effects of thrombosis, or the issue of bleeding and surgical site complications. The aim of this research was to determine if health utility could be a consideration before choosing to therapeutically anticoagulate in the hip and knee arthroplasty patient.MethodsThe quantitative risks and effectiveness of treatment options for venous thromboembolism, atrial fibrillation, acute coronary syndromes, ischaemic stroke and mechanical heart valves were evaluated from previously published data. Previously calculated health utility values were obtained from published studies for both thrombotic events and anticoagulant-related complications at the site of arthroplasty. An impact score was generated through a multiplication of 1 − utility with the rate of the event occurring.ResultsImpact scores associated with revision surgery and deep infection at the arthroplasty site following anticoagulation are higher compared to impact scores in subsets of non-treated venous thromboembolism, low CHADS2 (congestive heart failure, hypertension, age >75, diabetes (1 point each), stroke/transient ischaemic attack (2 points)) atrial fibrillation and potentially some acute coronary syndrome patients. Some anticoagulation strategies in mechanical heart valves are of definite overall patient value due to the significant complications otherwise.ConclusionObjective calculation of both the benefit and risks of anticoagulation in the post-operative patient is significantly altered by including the effect on patient's quality of life utility value. Therapeutic anticoagulation in some common situations is probable to be of more detriment than benefit when considering health utility.
      PubDate: 2017-07-31T18:51:25.08007-05:0
      DOI: 10.1111/ans.14122
  • Intrapericardial dermoid cyst presenting with acute coronary syndrome
    • Authors: Jaideep K. Trivedi; Guddati V. Raman Kumar, Kodem Damodar Rao
      PubDate: 2017-07-28T01:15:58.417099-05:
      DOI: 10.1111/ans.14090
  • Rare case of a massive staphylococcal prostatic abscess presenting as an
           ischio-rectal abscess
    • Authors: Jonathan Kam; Yuigi Yuminaga, Kieran Beattie, Matthew Winter
      PubDate: 2017-07-27T04:37:18.094322-05:
      DOI: 10.1111/ans.14112
  • Adult Bochdalek hernia in a pregnant woman
    • Authors: Thomas S. Suhardja; Ashish Vaska, Daniel Foley, John Gribbin
      PubDate: 2017-07-27T04:35:45.262419-05:
      DOI: 10.1111/ans.14145
  • Factors related to recurrence of idiopathic granulomatous mastitis: what
           do we learn from a multicentre study'
    • Authors: Erdal Uysal; Atilla Soran, Efe Sezgin,
      Abstract: BackgroundIdiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of the breast with unknown aetiology. Its treatment is controversial and the recurrence rate is high. The objectives of this study were to examine the demographic, sociocultural and clinical characteristics observed among a large cohort of IGM patients from Turkey and to identify factors related to the recurrence of IGM.MethodsThe study was designed as a multicentre retrospective study including 22 breast centres in Turkey. A total of 720 IGM patients are included in the study. Patient data were obtained from the patient's files and electronic records based on the study protocol. Patients’ demographic, clinical, radiological, treatment and recurrence of IGM related characteristics were recorded.ResultsOur results revealed a statistically significant association between IGM recurrence and history of pregnancy, breastfeeding, breast infection and smoking (P  0.05).ConclusionOur findings show that history of pregnancy, breastfeeding, breast infection and smoking were the risk factors for IGM recurrence. As current treatment methods did not affect IGM recurrence, recurrence-related factors, such as breast infection and smoking, should be considered to eliminate while focusing on less invasive local treatment research.
      PubDate: 2017-07-27T04:35:26.321811-05:
      DOI: 10.1111/ans.14115
  • Long-term effectiveness of the preoperative smoking cessation programme at
           Western Health
    • Authors: Hugh Taylor; Amalia Karahalios, David Bramley
      Abstract: BackgroundSmoking is associated with adverse effects in the perioperative period, including elevated risk of death. The perioperative period provides an opportunity to engage with patients who are smokers to encourage smoking cessation, often referred to as a ‘teachable moment’. We developed a smoking intervention model for the pre-admission clinic (PAC) at Western Health, Victoria, Australia. This case series aimed to assess the impact of the smoking intervention model, which is standard of care, on the participant's smoking habits over four time points.MethodsWe enrolled 50 consecutive participants for elective surgery who were smokers and had attended PAC at Western Health, Footscray. All smokers were offered a standard intervention package to address their smoking. Participants underwent a brief interview to elicit their current smoking behaviour on their day of surgery, 3 and 12 months post-operatively.ResultsWe found a reduction at each time point post-intervention in the average number of cigarettes smoked per day by all participants with a 43% reduction at 12 months compared with PAC. We found that the number of participants who had quit increased at each time point, with 29% abstinent at 12 months post-operatively. At 12 months, we found 71% of participants had either quit or reduced the number of cigarettes smoked compared with the amount reported at PAC.ConclusionThis study adds to the evidence that a simple intervention preoperatively can contribute to long-term changes in smoking behaviour.
      PubDate: 2017-07-21T23:41:16.558608-05:
      DOI: 10.1111/ans.14113
  • Laparoscopic repair of a left paraduodenal hernia
    • Authors: Krish Kulendran; Cian Keogh, Heng-Chin Chiam
      PubDate: 2017-07-21T02:06:07.068381-05:
      DOI: 10.1111/ans.14172
  • Hartmann's reversal: a comparative study between laparoscopic and open
    • Authors: Han Deok Kwak; Jin Kim, Dong Woo Kang, Se-Jin Baek, Jung Myun Kwak, Seon-Hahn Kim
      Abstract: BackgroundA reversal of Hartmann's procedure can be performed using either a laparoscopic or open approach. However, laparoscopic reversal (LR) of Hartmann's procedure is challenging. This study was designed to compare the results between open and laparoscopic approaches.MethodsThis was a retrospective study of prospectively collected data. We analysed 29 patients who received Hartmann's reversal at Korea University Anam Hospital between April 2007 and September 2014. All patients underwent either LR (n = 17) or open reversal (OR, n = 12).ResultsPatient characteristics were similar between the LR and OR groups. There was also no difference in mean operation time (212.5 versus 251.8 min), diversion ileostomy, length of hospital stay, postoperative analgesic days, time to diet resumption (3.9 versus 6.2 days) or complication rate. Although the time to resuming a solid diet was not different between the two groups (P = 0.053), bowel movement occurred faster in LR patients (LR versus OR, 1.8 versus 2.8 days, P = 0.020). Patients in the LR group also had less blood loss during surgery (114.1 versus 594.2 mL, P = 0.026). There were no mortalities in this study.ConclusionLR of Hartmann's procedure resulted in faster bowel function recovery than the open method. Laparoscopic approaches are feasible even for patients who received an open Hartmann's procedure.
      PubDate: 2017-07-21T02:05:22.604638-05:
      DOI: 10.1111/ans.13979
  • Pre-hydrated sterile acellular dermal matrix allograft in breast
           reconstruction: review of a single unit's experience
    • Authors: Justin James; Brigid Corrigan, Christobel Saunders
      Abstract: BackgroundThe acellular dermal matrix (Flex HD) (FHD) became available for use in Western Australia in 2014 to aid prosthetic breast reconstruction and this descriptive study aims to review and discuss a single institution's experience since its introduction.MethodsBy retrospective case note, review data were collected for all patients who underwent prosthetic breast reconstruction with the aid of FHD between January 2014 and August 2015 in our institution. Data on basic demographic parameters, risk factors, surgery-related factors, post-operative factors and follow-up information were collected. All complications were recorded and described in detail.ResultsFHD was used in 42 breast reconstructions in 26 patients. Procedure-related complications were seen in 26% (n = 11) of cases. A major complication requiring return to theatre was seen in 11% (n = 5) of cases. Cellulitis of the reconstructed breast (red breast syndrome) was seen in 16.67% (n = 7) cases. Overall implant loss was 2.4% (n = 1). Of the six possible risk factors for any complication, only current smoking was found to increase the risk of complications (odds ratio = 9.667, 95% confidence interval = 1.429–65.377).ConclusionFHD is associated with a relatively high overall complication rate. Use of this optional expensive material has to be carefully selected balancing its perceived advantages against this possible risk. The red breast syndrome merits further studies considering its frequent occurrence with FHD use.
      PubDate: 2017-07-20T05:12:48.917436-05:
      DOI: 10.1111/ans.13857
  • Re: Review of knee arthroscopic practice and coding at a major
           metropolitan centre
    • Authors: Chris Dalton; Emma Blanusa, Martin Anfinsen
      PubDate: 2017-07-17T22:50:32.931033-05:
      DOI: 10.1111/ans.14167
  • 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
      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.Methodss 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 
      PubDate: 2017-07-13T19:30:38.339702-05:
      DOI: 10.1111/ans.14108
  • Impact of pre-operative health-related quality of life on outcomes after
           heart surgery
    • Authors: Ieva Norkienė; Indre Urbanaviciute, Greta Kezyte, Vaidas Vicka, Tomas Jovaisa
      Abstract: BackgroundLong-term improvement in health-related quality of life (HRQOL) is one of the most important outcomes of cardiac surgery. The aim of this study is to define the impact of perioperative patient and procedural variables on HRQOL dynamics, a year after cardiac surgery.MethodsConsecutive patients undergoing elective on-pump cardiac surgery were enrolled in this prospective observational cohort study. Patients completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire a day before surgery and once again a year after surgery. The effect size method was used to determine whether treatment resulted in the improvement of HRQOL.ResultsA total of 67.3% of patients achieved long-term improvement in HRQOL. Significant negative association was identified between Physical and Mental Component Summary scores (PCS/MCS) and long-term outcomes. Pre-operative PCS were 40.7 ± 13.7 for improvers and 56.6 ± 14.4 for non-improvers; MCS were 45.8 ± 12.1 and 65.2 ± 13.7, respectively (P 
      PubDate: 2017-07-12T20:11:46.654769-05:
      DOI: 10.1111/ans.14061
  • Pathological prognostic factors of recurrence in early stage lung
    • Authors: Eunjue Yi; Mi-Kyeong Bae, Sukki Cho, Jin-Haeng Chung, Sanghoon Jheon, Kwhanmien Kim
      Abstract: BackgroundHistological heterogeneity is thought to be important for prognosis of lung adenocarcinoma. We investigated to determine pathological features with prognostic value for recurrence of early stage lung cancer.MethodsA total of 368 patients who underwent curative surgical resection for early stage lung adenocarcinoma between 2009 and 2012 were enrolled. Pathologic characteristics including the presence of visceral pleural invasion, micropapillary patterns, aerogenous spread, lymphovascular invasion, perineural invasion and necrosis were examined. The correlations between pathological factors and clinical outcomes were analysed to determine prognostic significance.ResultsMean follow-up was 43.0 months (±14.56, ranging from 0.0 to 73.9 months). Three-year overall survival was 95.2% and disease-free survival was 89.8%. The recurrence rate was 9.0% (33 patients) and the mortality rate was 6.0% (22 patients). The presence of a micropapillary pattern (P 
      PubDate: 2017-07-12T20:11:36.12553-05:0
      DOI: 10.1111/ans.14033
  • Gender, ethnicity and smoking affect pain and function in patients with
           rotator cuff tears
    • Authors: Anthony Maher; Warren Leigh, Matt Brick, Simon Young, James Millar, Cameron Walker, Michael Caughey
      Abstract: BackgroundThis study is a collation of baseline demographic characteristics of those presenting for rotator cuff repair in New Zealand, and exploration of associations with preoperative function and pain. Data were obtained from the New Zealand Rotator Cuff Registry; a multicentre, nationwide prospective cohort of rotator cuff repairs undertaken from 1 March 2009 until 31 December 2010.MethodsA total of 1383 patients were included in the study. This required complete demographic information, preoperative Flex-SF (functional score) and pain scores. Following univariate analysis, a multivariate model was used.ResultsThe average age was 58 years (69% males and 11% smokers). New Zealand Europeans made up 90% and Maori 5%. The average preoperative Flex-SF was significantly lower (poorer function) in those over 65 years, females, smokers and Maori, in the non-dominant patients, using a multivariate model. Average preoperative pain scores were significantly worse (higher scores) in females, Maori, Polynesians, smokers, using a multivariate model.ConclusionThis is the largest reported prospective cohort of patients presenting for rotator cuff surgery. Results can be used to understand the effect of rotator cuff tears on the different patients, for example Maori patients who are under-represented, present younger, with more pain and poorer function.
      PubDate: 2017-07-12T20:11:33.633154-05:
      DOI: 10.1111/ans.13921
  • Fitness plus American Society of Anesthesiologists grade improve outcome
           prediction after endovascular aneurysm repair
    • Authors: Margaret Boult; Prue Cowled, Mary Barnes, Robert A. Fitridge
      Abstract: BackgroundAlthough the American Society of Anesthesiologists (ASA) grade was established for statistical purposes, it is often used prognostically. However, older patients undergoing elective surgery are typically ASA III, which limits patient stratification. We look at the prognostic effect on early complications and survival of using ASA and self-reported physical fitness to stratify patients undergoing endovascular repair of abdominal aortic aneurysms.MethodsData were extracted from a trial database. All patients were assigned a fitness level (A (fit) or B (unfit)) based on their self-reported ability to walk briskly for 1 km or climb two flights of stairs. Fitness was used to stratify ASA III patients, with fitter patients assigned ASA IIIA and less fit patients ASA IIIB. Outcomes assessed included survival, reinterventions, endoleak, all early and late complications and early operative complications.ResultsA combined ASA/fitness scale (II, IIIA, IIIB and IV) correlated with 1- and 3-year survival (1-year P = 0.001, 3-year P = 0.001) and early and late complications (P = 0.001 and P = 0.05). On its own, ASA predicted early complications (P = 0.0004) and survival (1-year P = 0.01, 3-year P = 0.01). Fitness alone was predictive for survival (1-year P = 0.001, 3-year P = 0.001) and late complications (P = 0.009).ConclusionThis study shows that even a superficial assessment of fitness is reflected in surgical outcomes, with fitter ASA III patients showing survival patterns similar to ASA II patients. Physicians should be alert to differences in fitness between patients in the ASA III group, despite similarities based on preexisting severe systemic disease.
      PubDate: 2017-07-10T03:05:26.250957-05:
      DOI: 10.1111/ans.14106
  • Emergency appendicectomy in Australia: findings from a multicentre,
           prospective study
    • Authors: Thomas Arthur; Richard Gartrell, Bavahuna Manoharan, David Parker,
      Abstract: BackgroundEmergency appendicectomy is the most common emergency surgical procedure performed in Australia. Despite this frequency, there is a relative paucity of contemporary, broad-based, local data that examine how emergency appendicectomies are currently performed and what are the outcomes from these operations.MethodsA multicentre, prospective, observational study was performed. Patients were recruited by local investigators for a period of 2 months with 30-day follow-up. Patients were eligible for study inclusion if they underwent an emergency appendicectomy for suspected acute appendicitis. The primary outcome of the study was the negative appendicectomy rate (NAR), with secondary outcomes including 30-day complication rates, method of operation and conversion rates.ResultsA total of 1189 patients were recruited across 27 centres. The NAR across all centres was 19.0%. 98.2% of appendicectomies were performed with a laparoscopic-first approach. The rate of conversion from laparoscopy to open operation was 2.4%. 9.4% of patients were recorded as having one or more of the following complications: readmission (6.6%), surgical site infection (1.9%), intra-abdominal abscess (2.7%) or further intervention (1.5%). Patients who had an open operation had higher rates of readmission and surgical site infection.ConclusionThe NAR found in this study is within the traditional measures of acceptance; however, this rate is high when measured against modern international benchmarks.
      PubDate: 2017-07-07T18:55:34.447636-05:
      DOI: 10.1111/ans.14088
  • How to do it: use of the Alexis wound protector as a laparostomy device
    • Authors: Alison Rutledge; Georgia Carroll, Stephen Smith, Jonathan Gani
      PubDate: 2017-07-05T05:21:21.75549-05:0
      DOI: 10.1111/ans.14097
  • Issue information - JEB
    • Pages: 641 - 641
      PubDate: 2017-09-05T19:07:45.310846-05:
      DOI: 10.1111/ans.14209
  • Issue information - TOC
    • Pages: 644 - 645
      PubDate: 2017-09-05T19:07:45.628641-05:
      DOI: 10.1111/ans.13781
  • Surgeons and big data
    • Authors: Ian C. Bennett
      Pages: 647 - 648
      PubDate: 2017-09-05T19:07:50.311984-05:
      DOI: 10.1111/ans.14063
  • Collaborate or treat intra-abdominal metastatic colon cancer of the liver
           and peritoneum: which is practical for the colorectal surgeon'
    • Authors: Ram Ganesalingam; David Z. Lubowski
      Pages: 648 - 649
      PubDate: 2017-09-05T19:07:51.550313-05:
      DOI: 10.1111/ans.14111
  • Administrative data: what surgeons should know about big data
    • Authors: Michael K.-Y. Hong; Anita R. Skandarajah, Ian P. Hayes
      Pages: 650 - 651
      PubDate: 2017-09-05T19:07:47.050567-05:
      DOI: 10.1111/ans.13978
  • Laboratory methods cause ultrasensitive prostate-specific antigen
    • Authors: Alfin Okullo; Peter Penkoff, Manish I. Patel
      Pages: 651 - 652
      PubDate: 2017-09-05T19:07:48.585391-05:
      DOI: 10.1111/ans.14043
  • Medicine in small doses
    • Authors: Erwin Loh; Bruce P. Waxman
      Pages: 653 - 653
      PubDate: 2017-09-05T19:07:52.459534-05:
      DOI: 10.1111/ans.14160
  • 25, 50 & 75 years ago
    • Authors: John P. Harris
      Pages: 654 - 655
      PubDate: 2017-09-05T19:07:52.336643-05:
      DOI: 10.1111/ans.14137
  • Modern cardiac surgery: the future of cardiac surgery in Australia
    • Authors: Nikki Stamp; Emily Granger, Robert Larbalestier
      Pages: 661 - 664
      Abstract: Cardiac surgery is a relatively young specialty and is undergoing many changes presently. The advent of catheter-based technology, minimally invasive surgery and better information regarding the roles of cardiac surgery in the management of common cardiac disease is changing the way we provide services. In Australia, attention must be turned to the way cardiac surgical services are provided to enable delivery of modern procedures. This has implications for the provision of training. We explore the face of modern cardiac surgery and how this may be taken up in Australia.
      PubDate: 2017-05-16T19:55:51.390261-05:
      DOI: 10.1111/ans.14031
  • Treatment of peritoneal carcinomatosis with hyperthermic intraperitoneal
           chemotherapy in colorectal cancer
    • Authors: Corina Behrenbruch; Frédéric Hollande, Benjamin Thomson, Michael Michael, Satish K. Warrier, Craig Lynch, Alexander Heriot
      Pages: 665 - 670
      Abstract: The peritoneum is the second most common site of metastasis after the liver and the only site of metastatic disease in approximately 25% of patients with colorectal cancer (CRC). In the past, peritoneal carcinomatosis in CRC was thought to be equivalent to distant metastasis; however, the transcoelomic spread of malignant cells is an acknowledged alternative pathway. Metastasectomy with curative intent is well accepted in patients with liver metastasis in CRC despite the paucity of randomized trials. Therefore, there is rationale for local treatment with peritonectomy to eliminate macroscopic disease, followed by hyperthermic intraperitoneal chemotherapy to destroy any residual free tumour cells within the peritoneal cavity. The aim of this paper is to summarize the current evidence for cytoreduction and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis in CRC.
      PubDate: 2017-06-30T01:50:58.850941-05:
      DOI: 10.1111/ans.14077
  • Orthopaedic research in Australia: a bibliographic analysis of the
           publication rates in the top 15 journals
    • Authors: Erik Hohmann; Vaida Glatt, Kevin Tetsworth
      Pages: 709 - 713
      Abstract: BackgroundTo investigate the publications rates and characteristics of the authors for manuscripts originating from Australia in the 15 highest ranked orthopaedic journals over a 5-year period.MethodsThe 15 highest ranked journals in orthopaedics, based on their 2015 impact factor, were used to establish the total number of publications and cumulative impact factor points between January 2010 and December 2014. The affiliations of the primary author and co-authors were used to determine the involvement of Australian trained orthopaedic surgeons. Study location, research topic and anatomic areas were recorded.ResultsA total of 478 publications were identified; 110 of these manuscripts were principally authored by Australian trained orthopaedic surgeons or medical professionals affiliated with orthopaedics. In addition, 158 articles were published with orthopaedic surgery involvement where one of the co-authors was an Australian trained surgeon. Australian orthopaedic surgeon (FRACS) involvement was most commonly observed in the knee (n = 90; 33.6%) followed by the hip (n = 69; 25.7%) and basic sciences (n = 27; 10.1%). Surgeons in Sydney had the highest number of publications (n = 95; 35.4%), followed by Adelaide (n = 55; 20.5%) and Melbourne (n = 54; 20.1%).ConclusionThe results of this study demonstrate that the minority (23%) of the publications originating from Australia in the 15 highest-ranking orthopaedic journals were principally authored by either an Australian trained surgeon or a trainee surgeon. A total of 59% of the publications focused on the hip and knee. Sydney was the leading region, followed by Adelaide and Melbourne. These three regions published 76% of all manuscripts identified during the 5-year study period.
      PubDate: 2017-03-15T04:11:00.246902-05:
      DOI: 10.1111/ans.13932
  • Routine magnetic resonance imaging is not the panacea to common duct
    • Authors: David Burnett; Jonathan S. Gani
      Pages: 743 - 744
      PubDate: 2017-09-05T19:07:47.131549-05:
      DOI: 10.1111/ans.14105
  • Cholangiocarcinoma after choledochoduodenostomy
    • Authors: Darius Ashrafi; Kellee Slater
      Pages: 743 - 743
      PubDate: 2017-09-05T19:07:45.114885-05:
      DOI: 10.1111/ans.14083
  • Re: Outcome of bridge to surgery stenting for obstructive left colon
    • Authors: Charles Sabbagh; Cyril Cosse, Jean-Marc Regimbeau
      Pages: 744 - 745
      PubDate: 2017-09-05T19:07:45.552925-05:
      DOI: 10.1111/ans.14130
  • Response to Re: Outcome of bridge to surgery stenting for obstructive left
           colon cancer
    • Authors: Bong-Hyeon Kye; Min Ki Kim, Won-Kyung Kang
      Pages: 746 - 746
      PubDate: 2017-09-05T19:07:43.877834-05:
      DOI: 10.1111/ans.14185
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