Rakesh Quinn, Giuleta Jamsari, Gary Kk Low, Sinan Albayati
Background: Anal fissures are a debilitating benign condition, thought to be due to the hypertonicity of the internal anal sphincter resulting in localized ischaemia inhibiting healing. There are several surgical and non-surgical treatment options for chronic anal fissures. Clinical practice surveys report a trend toward sphincter-sparing options, reserving the more successful treatment of lateral sphincterotomy, with an incontinence rate up to 10%, for refractory fissures.
Methods: A search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE for studies assessing sphincter-sparing treatment with botulinum toxin and fissurectomy was performed following PRISMA guidelines. Outcomes assessed included healing rate, persistence, recurrence, re-intervention and incontinence rates.
Results: Fifteen non-randomized studies assessed 978 patients managed with botulinum toxin and fissurectomy. The mean age was 40.8 years with a female predominance of 58.9%. Healing rate was reported on 14 of the 15 studies, with a healing rate of 81% (95% CI:0.67, 0.90). Persistence rate was reported as 15% (95% CI:0.07, 0.28) and a recurrence rate of 6% (95% CI: 0.01, 0.19). Re-intervention was required in 8% of patients with 55.1% requiring a repeat dose of botulinum toxin with or without fissurectomy. Incontinence appears to be transient with studies reporting a rate of 1% with median long-term follow up 23 months (range: 5-60 months).
Conclusion: Combination fissurectomy and botulinum toxin is a safe and viable sphincter sparing treatment option, with moderate success rate and negligible complications. Randomized controlled trials are required to further strengthen the evidence for its use in chronic anal fissures.
{"title":"Effectiveness of combined botulinum toxin and fissurectomy on chronic anal fissures - a systematic review.","authors":"Rakesh Quinn, Giuleta Jamsari, Gary Kk Low, Sinan Albayati","doi":"10.1111/ans.19248","DOIUrl":"https://doi.org/10.1111/ans.19248","url":null,"abstract":"<p><strong>Background: </strong>Anal fissures are a debilitating benign condition, thought to be due to the hypertonicity of the internal anal sphincter resulting in localized ischaemia inhibiting healing. There are several surgical and non-surgical treatment options for chronic anal fissures. Clinical practice surveys report a trend toward sphincter-sparing options, reserving the more successful treatment of lateral sphincterotomy, with an incontinence rate up to 10%, for refractory fissures.</p><p><strong>Methods: </strong>A search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE for studies assessing sphincter-sparing treatment with botulinum toxin and fissurectomy was performed following PRISMA guidelines. Outcomes assessed included healing rate, persistence, recurrence, re-intervention and incontinence rates.</p><p><strong>Results: </strong>Fifteen non-randomized studies assessed 978 patients managed with botulinum toxin and fissurectomy. The mean age was 40.8 years with a female predominance of 58.9%. Healing rate was reported on 14 of the 15 studies, with a healing rate of 81% (95% CI:0.67, 0.90). Persistence rate was reported as 15% (95% CI:0.07, 0.28) and a recurrence rate of 6% (95% CI: 0.01, 0.19). Re-intervention was required in 8% of patients with 55.1% requiring a repeat dose of botulinum toxin with or without fissurectomy. Incontinence appears to be transient with studies reporting a rate of 1% with median long-term follow up 23 months (range: 5-60 months).</p><p><strong>Conclusion: </strong>Combination fissurectomy and botulinum toxin is a safe and viable sphincter sparing treatment option, with moderate success rate and negligible complications. Randomized controlled trials are required to further strengthen the evidence for its use in chronic anal fissures.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><b>Norris B, Solomon MJ, Eyers AA, West RH, Glenn DC, Morgan BP. Abdominal surgery in the older Crohn's population. <i>ANZ. J. Surg</i>. 1999;69:199–204.</b></p><p>The surgical literature perceives that the elderly cohort of Crohn's patients may have increased risk with surgery. A retrospective review and prospective database analysis of all patients with histologically proven Crohn's disease who had a laparotomy at a single Sydney teaching hospital were performed. The last laparotomy of each patient was included in the analysis for morbidity and mortality to assess whether an older cohort was at an increased risk. A total of 156 patients had 298 laparotomies for histopathologically proven Crohn's disease. The frequency distribution of age at last laparotomy was bimodal, and the statistically determined cut-off age between younger and older cohorts was 55 years. Thirty-three patients were older than 55 years. There was no difference in duration of symptoms before first diagnosis (older, 17 months vs. younger, 25 months), previous number of Crohn's operations (42.4% vs. 39.8%), or duration of known Crohn's disease. Isolated large bowel disease was more common in the elderly cohort (42.4% vs. 18.7%, χ<sup>2</sup> = 8.09, <i>P</i> < 0.01). Small bowel and ileocaecal resections were more common in the younger cohort (72.4% vs. 51.6%, χ<sup>2</sup> = 5.19, <i>P</i> < 0.025). There was one death in each cohort (overall mortality 1.3%) and anastomotic leak rates (defined as the number of leaks per number of patients with anastomoses), were 4.3% (older) vs. 5.3% (younger) despite frank sepsis present in 21.2% of all subjects at the time of surgery. The older group had more cardiac (18.2% vs. 0.8%, <i>P</i> < 0.001) and respiratory complications (18.2% vs. 2.4%, <i>P</i> = 0.0003) and a longer mean but not median postoperative hospital admission. In conclusion, clinical features and presentation are similar in the older and younger Crohn's patients having a laparotomy. However, in the older patient there is a greater likelihood of large bowel disease, ileocaecal resection is done less commonly, there is a higher risk of minor cardiopulmonary postoperative complications, but with similar mortality and anastomotic leak rates to the younger patient.</p><p><b>Rieger N, Collopy B, Fink R, Mackay J, Woods R, Keck J. Total colectomy for Crohn's disease. <i>ANZ. J. Surg</i>. 1999;69:28–30.</b></p><p>Total colectomy for Crohn's disease of the colon may be restorative with ileorectal anastomosis or with an ileostomy and rectal stump. The present paper retrospectively audits the results of total colectomy and in particular assesses the number of patients who had a permanent ileostomy and whether this was related to disease in the rectum at the time of the original operation. A retrospective case note review was undertaken of patients operated upon between 1968 and 1994. Thirty-eight patients were identified (mean age 35 years; range 17–65 years). One pat
{"title":"25, 50 and 75 years ago","authors":"Julian A. Smith MBMS, MSurgEd, FRACS","doi":"10.1111/ans.19244","DOIUrl":"10.1111/ans.19244","url":null,"abstract":"<p><b>Norris B, Solomon MJ, Eyers AA, West RH, Glenn DC, Morgan BP. Abdominal surgery in the older Crohn's population. <i>ANZ. J. Surg</i>. 1999;69:199–204.</b></p><p>The surgical literature perceives that the elderly cohort of Crohn's patients may have increased risk with surgery. A retrospective review and prospective database analysis of all patients with histologically proven Crohn's disease who had a laparotomy at a single Sydney teaching hospital were performed. The last laparotomy of each patient was included in the analysis for morbidity and mortality to assess whether an older cohort was at an increased risk. A total of 156 patients had 298 laparotomies for histopathologically proven Crohn's disease. The frequency distribution of age at last laparotomy was bimodal, and the statistically determined cut-off age between younger and older cohorts was 55 years. Thirty-three patients were older than 55 years. There was no difference in duration of symptoms before first diagnosis (older, 17 months vs. younger, 25 months), previous number of Crohn's operations (42.4% vs. 39.8%), or duration of known Crohn's disease. Isolated large bowel disease was more common in the elderly cohort (42.4% vs. 18.7%, χ<sup>2</sup> = 8.09, <i>P</i> < 0.01). Small bowel and ileocaecal resections were more common in the younger cohort (72.4% vs. 51.6%, χ<sup>2</sup> = 5.19, <i>P</i> < 0.025). There was one death in each cohort (overall mortality 1.3%) and anastomotic leak rates (defined as the number of leaks per number of patients with anastomoses), were 4.3% (older) vs. 5.3% (younger) despite frank sepsis present in 21.2% of all subjects at the time of surgery. The older group had more cardiac (18.2% vs. 0.8%, <i>P</i> < 0.001) and respiratory complications (18.2% vs. 2.4%, <i>P</i> = 0.0003) and a longer mean but not median postoperative hospital admission. In conclusion, clinical features and presentation are similar in the older and younger Crohn's patients having a laparotomy. However, in the older patient there is a greater likelihood of large bowel disease, ileocaecal resection is done less commonly, there is a higher risk of minor cardiopulmonary postoperative complications, but with similar mortality and anastomotic leak rates to the younger patient.</p><p><b>Rieger N, Collopy B, Fink R, Mackay J, Woods R, Keck J. Total colectomy for Crohn's disease. <i>ANZ. J. Surg</i>. 1999;69:28–30.</b></p><p>Total colectomy for Crohn's disease of the colon may be restorative with ileorectal anastomosis or with an ileostomy and rectal stump. The present paper retrospectively audits the results of total colectomy and in particular assesses the number of patients who had a permanent ileostomy and whether this was related to disease in the rectum at the time of the original operation. A retrospective case note review was undertaken of patients operated upon between 1968 and 1994. Thirty-eight patients were identified (mean age 35 years; range 17–65 years). One pat","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 10","pages":"1683-1684"},"PeriodicalIF":1.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.19244","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nasya Thompson, Tamara Glyn, Donna Kerridge, Jonathan Koea
Background: This research investigates the potential for collaboration of Rongoā Māori, the Indigenous healing practices of Māori, with New Zealand's contemporary healthcare system. It aims to bridge the gap between Rongoā Māori and Western medicine by exploring the perspectives of practitioners from both fields, identifying barriers to integration, and highlighting potential areas for collaboration.
Methods: Qualitative interviews were conducted with both Rongoā practitioners and Western surgeons. The data collected were subjected to thematic analysis to extract key themes related to the integration process, challenges faced, and the potential for mutual recognition and respect between the two healing paradigms.
Results: The study reveals a deep respect for Rongoā Māori among Western surgeons but identifies significant systemic barriers that impede its integration. These include bureaucratic challenges and the absence of clear referral pathways. Rongoā practitioners express concerns over being overlooked within the healthcare system and highlight a lack of awareness among healthcare professionals about their practices. Despite these challenges, there is a shared interest in collaborative approaches to healthcare that respect and incorporate Rongoā Māori.
Conclusions: The findings underscore the need for systemic changes to facilitate the integration of Rongoā Māori into mainstream healthcare, including the development of clear referral pathways and initiatives to raise awareness among healthcare professionals. The study highlights the need for a more collaborative healthcare approach that values the contributions of Rongoā Māori, aiming to improve patient care through holistic practices.
{"title":"Fostering collaboration: an exploration of knowledge exchange between Rongoā Māori practitioners and surgical clinicians.","authors":"Nasya Thompson, Tamara Glyn, Donna Kerridge, Jonathan Koea","doi":"10.1111/ans.19238","DOIUrl":"https://doi.org/10.1111/ans.19238","url":null,"abstract":"<p><strong>Background: </strong>This research investigates the potential for collaboration of Rongoā Māori, the Indigenous healing practices of Māori, with New Zealand's contemporary healthcare system. It aims to bridge the gap between Rongoā Māori and Western medicine by exploring the perspectives of practitioners from both fields, identifying barriers to integration, and highlighting potential areas for collaboration.</p><p><strong>Methods: </strong>Qualitative interviews were conducted with both Rongoā practitioners and Western surgeons. The data collected were subjected to thematic analysis to extract key themes related to the integration process, challenges faced, and the potential for mutual recognition and respect between the two healing paradigms.</p><p><strong>Results: </strong>The study reveals a deep respect for Rongoā Māori among Western surgeons but identifies significant systemic barriers that impede its integration. These include bureaucratic challenges and the absence of clear referral pathways. Rongoā practitioners express concerns over being overlooked within the healthcare system and highlight a lack of awareness among healthcare professionals about their practices. Despite these challenges, there is a shared interest in collaborative approaches to healthcare that respect and incorporate Rongoā Māori.</p><p><strong>Conclusions: </strong>The findings underscore the need for systemic changes to facilitate the integration of Rongoā Māori into mainstream healthcare, including the development of clear referral pathways and initiatives to raise awareness among healthcare professionals. The study highlights the need for a more collaborative healthcare approach that values the contributions of Rongoā Māori, aiming to improve patient care through holistic practices.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James D. Stoney FRACS, FAOrthA, Paul N. Smith FRACS, FAOrthA
{"title":"Power of arthroplasty registries in Orthopaedic surgery","authors":"James D. Stoney FRACS, FAOrthA, Paul N. Smith FRACS, FAOrthA","doi":"10.1111/ans.19205","DOIUrl":"10.1111/ans.19205","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 9","pages":"1437-1438"},"PeriodicalIF":1.5,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The coeliac plexus is often approached due to the diagnosis and treatment of the intractable pain associated with cancerous or non-cancerous pathology of the pancreas or neighbouring organs. Various methods of coeliac plexus blocks are used and the variations in its structure are causes of the failures of such procedures.
Methods: Twenty human cadavers (17 male, 3 females, age range 30-86 years, without any abdominal pathology) were dissected in the supine position. The abdominal autonomics was studied bilaterally after the incision of the abdominal wall the peritoneal sac was cut and the abdominal organs were removed. The coeliac plexus becomes visible after removing the hepatogastric and hepatoduodenal ligaments and pulling the stomach to the left and the pancreas downward.
Results: The largest coeliac ganglion was 45 mm on the right and 25 mm on the left. The average distance of the ganglia from the coeliac trunks was 6-9 mm from the right and left. The size of coeliac ganglia varies from 5 to 45 mm and their number from 2 to 12. Ganglia can be diffusely or concentrically organized. The coeliac plexus almost always receives the branches from the greater splanchnic and vagus nerves. Sometimes the contributions from the lesser splanchnic nerve, phrenic nerve, and accessory phrenic nerve (60%) were observed. Very rarely are missing both phrenic nerves.
Conclusion: Sympathectomy (splanchnicectomy), as well as the coeliac blocks (under US, CT control, or laparotomic) aimed at pain relief usually by pancreatic cancer, should consider these possible variabilities.
{"title":"Contribution to the variability in the coeliac plexus structure and formation.","authors":"Zora Haviarová, Roman Kuruc, Viktor Matjčík","doi":"10.1111/ans.19234","DOIUrl":"https://doi.org/10.1111/ans.19234","url":null,"abstract":"<p><strong>Background: </strong>The coeliac plexus is often approached due to the diagnosis and treatment of the intractable pain associated with cancerous or non-cancerous pathology of the pancreas or neighbouring organs. Various methods of coeliac plexus blocks are used and the variations in its structure are causes of the failures of such procedures.</p><p><strong>Methods: </strong>Twenty human cadavers (17 male, 3 females, age range 30-86 years, without any abdominal pathology) were dissected in the supine position. The abdominal autonomics was studied bilaterally after the incision of the abdominal wall the peritoneal sac was cut and the abdominal organs were removed. The coeliac plexus becomes visible after removing the hepatogastric and hepatoduodenal ligaments and pulling the stomach to the left and the pancreas downward.</p><p><strong>Results: </strong>The largest coeliac ganglion was 45 mm on the right and 25 mm on the left. The average distance of the ganglia from the coeliac trunks was 6-9 mm from the right and left. The size of coeliac ganglia varies from 5 to 45 mm and their number from 2 to 12. Ganglia can be diffusely or concentrically organized. The coeliac plexus almost always receives the branches from the greater splanchnic and vagus nerves. Sometimes the contributions from the lesser splanchnic nerve, phrenic nerve, and accessory phrenic nerve (60%) were observed. Very rarely are missing both phrenic nerves.</p><p><strong>Conclusion: </strong>Sympathectomy (splanchnicectomy), as well as the coeliac blocks (under US, CT control, or laparotomic) aimed at pain relief usually by pancreatic cancer, should consider these possible variabilities.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: We aimed to assess whether the risk of disease recurrence in Crohn's disease (CD) patients that undergone ileocolic resection (ICR) with temporary ileostomy and a later stoma reversal is different compared to patients that underwent a one-stage operation.
Methods: A single-center retrospective review of all patients that underwent elective primary ICR for CD between 2010 and 2022 divided into: 2S-ICR group-patients who underwent two-stage ICR. 1S-ICR group-patients who underwent one-stage ICR.
Results: The cohort included 191 patients (mean age 33.4, range 15-70), with 40 and 151 patients in the 2S-ICR and 1S-ICR groups, respectively. The 2S-ICR were more comorbid, with a lower mean BMI (18 vs. 21.3, P < 0.001), higher median ASA score (3 vs. 2, P = 0.036), higher percentage on pre-operative total parenteral nutrition (TPN) (62.5% vs. 24.5%, P < 0.001), and lower levels of pre-operative albumin (3.3 g/dL vs. 3.8 g/dL, P < 0.001). There were no significant differences in the overall postoperative complication rate (47.5% vs. 47.7% respectively, P = 1), nor in the rate of severe complications (17.5% vs. 13.2%, P = 0.6), but, the 2S-ICR had a longer post-operative length-of-stay (14 vs. 6 days, P < 0.001) and higher rates of 30-day readmission (30% vs. 13.2%, P = 0.017). After an overall median follow-up of 63 months, the groups showed similar rates of endoscopic, clinical, and surgical recurrence.
Conclusions: Two-stage ICR with a temporary ileostomy does not change long-term CD recurrence rates compared with one-stage ICR.
{"title":"Ileocolic resection with temporary ileostomy for Crohn's disease: does it affect long-term disease recurrence compared with primary anastomosis?","authors":"Michael Goldenshluger, Lior Segev","doi":"10.1111/ans.19237","DOIUrl":"https://doi.org/10.1111/ans.19237","url":null,"abstract":"<p><strong>Background: </strong>We aimed to assess whether the risk of disease recurrence in Crohn's disease (CD) patients that undergone ileocolic resection (ICR) with temporary ileostomy and a later stoma reversal is different compared to patients that underwent a one-stage operation.</p><p><strong>Methods: </strong>A single-center retrospective review of all patients that underwent elective primary ICR for CD between 2010 and 2022 divided into: 2S-ICR group-patients who underwent two-stage ICR. 1S-ICR group-patients who underwent one-stage ICR.</p><p><strong>Results: </strong>The cohort included 191 patients (mean age 33.4, range 15-70), with 40 and 151 patients in the 2S-ICR and 1S-ICR groups, respectively. The 2S-ICR were more comorbid, with a lower mean BMI (18 vs. 21.3, P < 0.001), higher median ASA score (3 vs. 2, P = 0.036), higher percentage on pre-operative total parenteral nutrition (TPN) (62.5% vs. 24.5%, P < 0.001), and lower levels of pre-operative albumin (3.3 g/dL vs. 3.8 g/dL, P < 0.001). There were no significant differences in the overall postoperative complication rate (47.5% vs. 47.7% respectively, P = 1), nor in the rate of severe complications (17.5% vs. 13.2%, P = 0.6), but, the 2S-ICR had a longer post-operative length-of-stay (14 vs. 6 days, P < 0.001) and higher rates of 30-day readmission (30% vs. 13.2%, P = 0.017). After an overall median follow-up of 63 months, the groups showed similar rates of endoscopic, clinical, and surgical recurrence.</p><p><strong>Conclusions: </strong>Two-stage ICR with a temporary ileostomy does not change long-term CD recurrence rates compared with one-stage ICR.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>A 74-year-old female presented with epigastric pain. A submucosal lesion of the gastric cardia and small hiatus hernia were identified on gastroscopy (Fig. 1). Superficial biopsies were inconclusive. Endoscopic ultrasound identified a 2 cm, well-defined and lobulated submucosal lesion. Sharkcore deep biopsies confirmed a leiomyoma with spindle cells which were positive for desmin on immunohistochemistry (with absence of CD117 and DOG1). Computed tomography (CT) confirmed a gastric cardia submucosal lesion with adherence to the left diaphragmatic crura <b>(</b>Fig. 2<b>)</b>. She underwent laparoscopic enucleation of a 6 × 4 cm gastric leiomyoma with primary repair and achieved a satisfactory functional and histological result. This case underpins the importance of histopathological diagnosis for submucosal lesions and challenges/considerations for those that are near the gastroesophageal junction (GOJ).</p><p>Most submucosal tumours are gastrointestinal stromal tumours (GIST) or leiomyomas.<span><sup>1</sup></span> They are indistinguishable without histological diagnosis as highlighted in Figure 1. Accurate diagnosis is key to applying the correct treatment principles.<span><sup>2</sup></span> Our patient's symptomatic 2 cm leiomyoma prompted enucleation. This was challenging due to lesion mobility – addressed by approaching the lesion from above and below (two myotomies) and retracting it with a silk stitch. Lesion adherence to the mucosa led to two mucosal breaches, likely related to the multiple preoperative biopsies taken, including superficial biopsies which are often non-diagnostic.<span><sup>2</sup></span> ≥2 cm GISTs require resection and being near the GOJ, this can be achieved with a laparo-endoscopic extra-gastric or trans-gastric approach.<span><sup>3, 4</sup></span> There a two key differences between GIST and leiomyoma resectional management. Firstly, the malignant potential of GISTs leads to both a lower threshold for resection and the stronger importance of a clear margin.<span><sup>5</sup></span> Secondly, the option of tyrosine kinase inhibitors (TKI) for GIST in either the neoadjuvant setting to achieve resectability or the adjuvant setting to reduce the risk of recurrence.<span><sup>6</sup></span> A laparo-endoscopic resection (not enucleation) would have been utilized if our case was diagnosed preoperatively as a 2 cm GIST.<span><sup>3, 4</sup></span></p><p>Submucosal tumours near the GOJ are challenging to resect as there is risk of stenosis, reflux and leak.<span><sup>3</sup></span> Surgical approach is impacted by tumour location, size and pathology. The lesion had more than doubled in size at time of surgery (3 months later). Adherence to the left crus and a concurrent hiatus hernia (Fig. 1) meant hiatal and mediastinal mobilization was required to allow assessment and planning of the surgical approach. Neoadjuvant TKI may have been considered if the lesion was known to be >5 cm and potentially locally invasive.<sp
{"title":"Gastric cardia submucosal tumours – histopathological diagnosis and challenges in management","authors":"Preekesh Suresh Patel MSc, FRACS, Michael Rodgers MBChB, FRACS, Suheelan Kulasegaran MBChB, FRACS","doi":"10.1111/ans.19233","DOIUrl":"10.1111/ans.19233","url":null,"abstract":"<p>A 74-year-old female presented with epigastric pain. A submucosal lesion of the gastric cardia and small hiatus hernia were identified on gastroscopy (Fig. 1). Superficial biopsies were inconclusive. Endoscopic ultrasound identified a 2 cm, well-defined and lobulated submucosal lesion. Sharkcore deep biopsies confirmed a leiomyoma with spindle cells which were positive for desmin on immunohistochemistry (with absence of CD117 and DOG1). Computed tomography (CT) confirmed a gastric cardia submucosal lesion with adherence to the left diaphragmatic crura <b>(</b>Fig. 2<b>)</b>. She underwent laparoscopic enucleation of a 6 × 4 cm gastric leiomyoma with primary repair and achieved a satisfactory functional and histological result. This case underpins the importance of histopathological diagnosis for submucosal lesions and challenges/considerations for those that are near the gastroesophageal junction (GOJ).</p><p>Most submucosal tumours are gastrointestinal stromal tumours (GIST) or leiomyomas.<span><sup>1</sup></span> They are indistinguishable without histological diagnosis as highlighted in Figure 1. Accurate diagnosis is key to applying the correct treatment principles.<span><sup>2</sup></span> Our patient's symptomatic 2 cm leiomyoma prompted enucleation. This was challenging due to lesion mobility – addressed by approaching the lesion from above and below (two myotomies) and retracting it with a silk stitch. Lesion adherence to the mucosa led to two mucosal breaches, likely related to the multiple preoperative biopsies taken, including superficial biopsies which are often non-diagnostic.<span><sup>2</sup></span> ≥2 cm GISTs require resection and being near the GOJ, this can be achieved with a laparo-endoscopic extra-gastric or trans-gastric approach.<span><sup>3, 4</sup></span> There a two key differences between GIST and leiomyoma resectional management. Firstly, the malignant potential of GISTs leads to both a lower threshold for resection and the stronger importance of a clear margin.<span><sup>5</sup></span> Secondly, the option of tyrosine kinase inhibitors (TKI) for GIST in either the neoadjuvant setting to achieve resectability or the adjuvant setting to reduce the risk of recurrence.<span><sup>6</sup></span> A laparo-endoscopic resection (not enucleation) would have been utilized if our case was diagnosed preoperatively as a 2 cm GIST.<span><sup>3, 4</sup></span></p><p>Submucosal tumours near the GOJ are challenging to resect as there is risk of stenosis, reflux and leak.<span><sup>3</sup></span> Surgical approach is impacted by tumour location, size and pathology. The lesion had more than doubled in size at time of surgery (3 months later). Adherence to the left crus and a concurrent hiatus hernia (Fig. 1) meant hiatal and mediastinal mobilization was required to allow assessment and planning of the surgical approach. Neoadjuvant TKI may have been considered if the lesion was known to be >5 cm and potentially locally invasive.<sp","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 10","pages":"1869-1870"},"PeriodicalIF":1.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.19233","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"25, 50 and 75 years ago","authors":"Julian A. Smith MBMS, MSurgEd, FRACS","doi":"10.1111/ans.19232","DOIUrl":"10.1111/ans.19232","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 9","pages":"1460-1461"},"PeriodicalIF":1.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.19232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Royal Australasian College of Surgeons 92nd Annual Scientific Congress, Õtautahi Christchurch, Aotearoa New Zealand, 6–10 May 2024. ANZ Journal of Surgery 94 (Suppl. 1) (2024) 5–19. https://onlinelibrary.wiley.com/doi/10.1111/ans.18953
The abstract “BS023P EFFECT OF BIOPSY MARKING CLIP MIGRATION ON RATE OF RE-EXCISION IN WIDE LOCAL EXCISION OF IMPALPABLE BREAST LESIONS” by Nelson Smith, et al. has been removed from online publication.
We apologize for this error.
澳大拉西亚皇家外科学院第 92 届科学年会，新西兰奥特亚罗瓦 Õtautahi Christchurch，2024 年 5 月 6-10 日。https://onlinelibrary.wiley.com/doi/10.1111/ans.18953The 摘要 "BS023P BIOPSY MARKING CLIP MIGRATION EFFECT OF BIOPSY MARKING CLIP MIGRATION ON RATE OF RE-EXCISION IN WIDE LOCAL EXCISION OF IMPALPABLE BREAST LESIONS"（作者：Nelson Smith 等）已从在线出版物中删除。我们对此错误深表歉意。
{"title":"Correction to Royal Australasian College of Surgeons 92nd Annual Scientific Congress, Õtautahi Christchurch, Aotearoa New Zealand, 6–10 May 2024","authors":"","doi":"10.1111/ans.19239","DOIUrl":"10.1111/ans.19239","url":null,"abstract":"<p>Royal Australasian College of Surgeons 92nd Annual Scientific Congress, Õtautahi Christchurch, Aotearoa New Zealand, 6–10 May 2024. <i>ANZ Journal of Surgery</i> 94 (Suppl. 1) (2024) 5–19. https://onlinelibrary.wiley.com/doi/10.1111/ans.18953</p><p>The abstract “BS023P EFFECT OF BIOPSY MARKING CLIP MIGRATION ON RATE OF RE-EXCISION IN WIDE LOCAL EXCISION OF IMPALPABLE BREAST LESIONS” by Nelson Smith, et al. has been removed from online publication.</p><p>We apologize for this error.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 9","pages":"1665"},"PeriodicalIF":1.5,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.19239","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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