ANZ Journal of Surgery最新文献

Introduction: Presentation with breast symptoms in the paediatric population is common but there is little existing literature on the workup and management of breast disease in this population.

Methods: Retrospective series of 140 cases of breast disease in the paediatric population managed by a single surgeon in Adelaide, South Australia between 2004 and 2024. Review of patient demographics, presentation, investigation, management and outcomes of various breast symptoms and pathologies using descriptive analysis.

Results: We reviewed 140 cases including 135 females and 5 males, aged 8-18 years (median = 15). The most common reason for presentation was breast lump (n = 86, 61%), followed by large breasts (n = 13, 9%), asymmetry (n = 11, 8%), abnormal development (n = 8, 6%). Most patients were investigated with ultrasound (n = 101, 71%) and FNA biopsy was performed in cases of non-diagnostic ultrasound or to distinguish fibroadenoma from phyllodes tumour (n = 17, 12%). There was a single case of malignancy and the most common diagnoses were developmental breast cyst (n = 36, 26%) and fibroadenoma (n = 33, 24%). Gynaecomastia was the only diagnosis in males (n = 5, 4%). Majority of patients were managed non-operatively (n = 101, 72%), indications for surgery included fibroadenoma (n = 18, 13%), breast hypertrophy (n = 8, 6%) or abnormal breast development (n = 4, 3%).

Conclusion: We reviewed 140 cases of breast disease in the paediatric population over a 20-year period. Malignancy in this population is rare but requires exclusion with history, examination and ultrasound where appropriate. Developmental breast cysts are the most common pathology, require early identification to avoid unnecessary invasive investigation and should be managed expectantly where possible.

Background: Laparoscopic sleeve gastrectomy (LSG) is a potentially refluxogenic operation while Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is regarded as an anti-reflux procedure. The aim of this study is to compare long-term incidence of Barrett's Oesophagus (BO) and gastroesophageal reflux disease (GORD) following LSG and LRYGB.

Methods: Participants of a double-blinded randomized controlled trial comparing banded LRYGB and LSG for remission of type 2 diabetes were contacted to take part. A gastroscopy was performed. Primary outcome was endoscopic and histologic evidence of BO. Secondary outcomes included reflux and regurgitation scores, presence of oesophagitis, proton-pump inhibitor (PPI) usage, Body Mass Index (BMI), and percentage excess weight loss (%EWL).

Results: Forty-eight of 109 patients were enrolled into the study (LSG 26 vs. LRYGB 22). Mean follow-up was 7.5 years for the LSG group, and 7.4 years for the RYGB group (P = 0.22). 8 LSG patients had BO while 3 LRYGB patients had BO (30.8%vs13.6%, P = 0.19). There was no significant difference in the mean reflux (8.1 ± 9.4(0-36) vs. 9.3 ± 8.8(0-34), P = 0.47) and regurgitation scores (7.7 ± 6.9(0-22) vs. 11.5 ± 10.5(0-44), P = 0.23) for LSG versus LRYGB patients or between those with and without BO. PPI usage before and after surgery was 6/26 (23.1%) versus 13/26 (50.0%) and 8/22 (36.4%) versus 12/22 (54.5%) for LSG and LRYGB patients respectively. PPI usage in patients with and without BO was 7/11 versus 18/37. EWL was significantly greater (P = 0.0013) in the LRYGB group (74.8 ± 28.1%) compared to LSG group (49.7 ± 18.7%).

Conclusions: Long-term incidence of BO trended towards but was not significantly higher for LSG compared to LRYGB group. We support routine endoscopic surveillance for bariatric patients.

Background: Deep neck space infections (DNSI) are common, potentially life-threatening presentations in otolaryngology. Treatment is often based on the severity of presenting symptoms and surgeon preference. This study aims to evaluate the presentation and predictors of complications in patients presenting with DNSI at an Australian Otolaryngology referral centre.

Method: A retrospective review was conducted for all patients admitted under the Otolaryngology Unit with a DNSI between 2015 and 2020. Patient demographics, presentation, treatment and outcomes were recorded. Factors predictive of surgical intervention and complications were evaluated using univariate and multivariate analyses.

Results: A total of 422 patients were identified. The majority were peritonsillar abscesses (n = 323, 76.5%). The most common management was incision and drainage under local anaesthetic (n = 272, 64.4%). A non-surgical approach was generally less successful for multispace and parapharyngeal abscesses. A median age of 48 years was significantly associated with a complication at presentation in both the peritonsillar abscess and non-peritonsillar abscess group on multivariate analysis (P = <0.001) and P = 0.048, respectively. In the non-peritonsillar abscess group, an elevated CRP at a median of 196 and 180 mg/L were predictive of a complication at admission and following initial treatment, respectively. Patients with multispace abscesses and presenting with dysphagia are more likely to experience a complication after initial treatment, P < 0.00001 and P = 0.031, respectively.

Conclusion: Understanding predictors of complications in patients presenting with DNSI will ensure timely, aggressive treatment upfront to minimize potential morbidity and mortality. Surgeons should maintain a close index of suspicion for complications in those with multispace abscesses.

Background: Australia has the highest global incidence of keratinocyte cancer. Surgically managing keratinocyte cancers in regional Australia presents geographic and economic challenges, which necessitate cost-effective resource allocation. Previous work has outlined the cost benefit for outpatient day surgical excision of head and neck skin lesions that can be closed primarily. We expand on this analysis with the inclusion of graft and local flap reconstructions.

Methods: A retrospective analysis was completed in a single regional centre across 24 months from July 2022 to June 2024. Patient demographics, lesion characteristics, margin status, cost comparison, and complication rates were recorded.

Results: There were 256 excisions for proven or suspected keratinocyte cancers. Basal cell carcinomas comprised 73.1% of lesions, squamous cell carcinoma for 21.9% of lesions, and intra-epidermal carcinoma for 5.1%. Lesion defects were closed primarily in 63.8% while 23.0% underwent full thickness graft reconstruction and 13.2% required local flaps. Involved margins were reported in 8.1% of excisions. Follow-up wound review was undertaken in primary care for 26.1% of all lesion excisions. Average indicative costs were three-to-four times higher for procedures performed in theatre compared to the outpatient setting, and these savings were greatest for graft and local flap reconstructions. There were 20 recorded complications including 16 partial or complete graft failures and one partial flap failure.

Conclusion: This study demonstrates further cost effectiveness for graft and local flap reconstruction of head and neck skin excisions under local anaesthetic in the regional outpatient setting, while maintaining low complication and incomplete excision rates.

Purpose: To investigate the safety and efficacy of endovascular embolization combined with external drainage for poor-grade ruptured cerebral aneurysms and risk factors.

Materials and methods: Forty-six patients with poor-grade ruptured cerebral aneurysms treated with endovascular embolization combined with decompressive craniectomy and drainage were retrospectively enrolled.

Results: Coil embolization alone was performed in 29 (63.0%) patients, stent-assisted coiling in 14 (30.4%), and coiling with the assistance of two microcatheters in three (6.5%). Immediately after embolization, aneurysm occlusion degree was Raymond-Roy grade I in 88% (44/50), II in 8% (4/50), and III in 4% (2/50). Periprocedural complications occurred in four (8.7%) patients. Forty-two (91.3%) patients had lumbar cistern drainage (n = 29 or 63.0%), extraventricular drainage (n = 11 or 23.9%), or decompressive craniectomy (n = 2 or 4.3%). At discharge, six (13.0%) patients died, and hydrocephalus took place in 16 (34.8%) patients. Better outcomes (mRS 0-2) were achieved in 31 (67.4%), including 23 (50.0%) patients below 60 years and eight (17.4%) over 60 years. Better clinical outcomes were achieved in patients below 60 years and with lumbar cistern drainage, and age was the only significant independent risk factor for better clinical outcomes. Receiver characteristics curve analysis of age for better clinical outcomes revealed that the cutoff value was 61 years, with the AUC 0.73, sensitivity 0.69, and specificity 0.73.

Conclusion: Endovascular embolization combined with decompressive craniectomy and drainage may be safe and efficient for poor-grade ruptured cerebral aneurysms, and older age and drainage modality may significantly affect the clinical outcomes.