ANZ Journal of Surgery最新文献

Background: Major bile duct injury (BDI) is a severe complication of biliary surgery, associated with high morbidity, mortality, and long-term sequelae. This study aimed to identify predictors of outcomes after surgical repair of major BDI in a North African hepatopancreatobiliary center.

Materials and methods: We retrospectively analyzed 147 patients who underwent repair of Strasberg type E BDI at a single HPB department in Oran, Algeria (2014-2024). Outcomes included morbidity, 90-day mortality, and long-term complications (Terblanche grade > 1). Logistic regression identified independent predictors.

Results: Mean age was 49.1 years, 67.3% were female, and 62.6% sustained injury during laparoscopic cholecystectomy; vascular injury occurred in 17.7%. Hepaticojejunostomy was performed in 95.9%, mostly after delayed referral (> 6 weeks in 91.2%). Morbidity occurred in 35.4%, bile leakage in 16.3%, and 90-day mortality in 4.1%. At a median follow-up of 69 months, 95.8% achieved Terblanche grade 1 outcomes. Independent predictors were laparoscopic index surgery for morbidity (OR = 5.41, 95% CI 1.08-27.09; p = 0.040); age (OR = 1.10, 95% CI 1.01-1.19; p = 0.028), vascular injury (OR = 16.45, 95% CI 2.13-127.20; p = 0.007), and bilirubin ≥ 15 mg/dL (OR = 19.74, 95% CI 1.74-224.53; p = 0.016) for mortality. Immediate repair predicted unfavorable long-term outcomes (OR = 10.44, 95% CI 1.60-68.34; p = 0.014).

Conclusion: Hepaticojejunostomy providing durable reconstruction. However, laparoscopic causative surgery, advanced age, vascular injury, and severe hyperbilirubinemia predicted adverse early outcomes, while immediate repair increased the risk of late stricture.

Backgrounds: Enhanced recovery after surgery (ERAS) has revolutionised perioperative care in colorectal surgery with reduced length of stay (LOS), reduced complications and superior patient outcomes. Despite this, colorectal ERAS is still not the standard of care across Australia. A growing body of evidence shows that ERAS is associated with significant cost benefits; however, currently, there is a lack of Australian data. The aim of this study is to retrospectively compare the healthcare system costs for elective colorectal resections utilising ERAS compared with conventional perioperative management.

Methods: A single-centre, retrospective cohort study compared the total cost of an elective colorectal resection to the public healthcare system when utilising the 25 principles of ERAS versus conventional care (CC). The estimated cost of each elective resection was manually calculated, including preadmission, operation, postoperative and readmission costs between the years 2010 and 2022 with the introduction of ERAS at the start of 2015. Cost data were also cross-examined with patient outcomes to assess how variations in patient care impact costs.

Results: A total of 642 patients were included: 237 (36.9%) received conventional perioperative management, and 405 (63.1%) underwent ERAS. The use of ERAS resulted in a median cost reduction of 2010 AUD per patient (20,719 vs. 22,729 AUD, p = 0.008). Overtime, ERAS was associated with a downward cost trend each year as the program matured. This reduction in median cost was also demonstrated in a subgroup analysis of uncomplicated admissions (-961 AUD, p = 0.087) and in the presence of Grades I-II complications (-2049 AUD, p = 0.504); however, neither was statistically significant. The cost benefits of ERAS were not present in the presence of Grades III-V complications or when a patient was readmitted within 30 days. ERAS was associated with a reduced median LOS (5 vs. 6 days, p < 0.001) and a reduction in the overall complication rate (26.42% vs. 37.55%, p = 0.003), which was most appreciable in the reduced rates of Grades I-II complications (22.96% vs. 29.96%).

Conclusion: Colorectal ERAS resulted in a statistically significant reduction in the cost per patient for elective resections at an Australian public hospital. The reported cost benefits stem from the associated reduction in LOS and an improved overall complication rate, particularly in the rates of Grades I and II complications. Additionally, there was a downtrend in median cost each year as the ERAS program matured at this institution, with the potential for further benefit in future years.

Background: TRUS Biopsy (TRUS Bx) can be poorly tolerated under local anaesthetic. Virtual Reality (VR) has been shown to reduce pain and anxiety levels as an adjunct to standard analgesia in a range of settings. This includes paediatric procedures, burn wound debridement and gynaecological procedures. However, its effect in TRUS Bx remains unclear. The aim of this study was to determine if intra-procedure VR improved patient pain and satisfaction during TRUS Bx.

Method: A single-centre, parallel-group randomised controlled trial was conducted at Dunedin Hospital. Two hundred and fifty patients presenting for first TRUS Bx were randomised to either conventional TRUS or VR-assisted TRUS over 36 months. The intervention group wore a VR headset with distraction video software, with the control group having standard care. The primary outcome measured patients' pain scores using a visual analogue scale.

Results: Patients reported similar pain when distracted with VR (mean difference [MD] -2.6, 95% CI -8.5 to 3.2). Similarly, there was no evidence of a difference in 'time thinking about pain' (MD 0.9, 95% CI -7.2 to 9.0) or 'worst pain' (pain intensity) (MD -2.4, 95% CI -8.6 to 3.8). Both groups were equally satisfied with the procedure and would happily accept having the procedure again if needed. VR was not associated with any side effects.

Conclusion: VR technology did not improve patients' pain and overall satisfaction with TRUS Bx. The inherent vulnerability and invasive nature of the procedure may impact the effectiveness of this distraction technique and prevent its analgesic effects proven in non-urological studies.

Subcutaneous abscesses are among the most common soft-tissue infections encountered in acute surgical and emergency practice. While incision and drainage (I&D) remains the cornerstone of treatment, the best post-I&D strategy remains debated. Key questions include whether adjunct antibiotics improve cure rates or prevent recurrence, whether packing the cavity provides any advantage, and whether modern alternatives such as primary closure, drains, or irrigation offer superior outcomes. These issues are particularly relevant to perianal abscesses, where the risk of developing a fistula-in-ano is substantial, and to general cutaneous abscesses, where pain, delayed healing, and recurrence are frequent concerns. Recent randomized trials and contemporary guidelines have begun to clarify these controversies, helping clinicians move beyond traditional dogma toward evidence-based, patient-centered care. Landmark evidence now shows that, for uncomplicated cutaneous abscesses, adding a short course of MRSA-active antibiotics to I&D improves short-term cure and reduces new lesions. For perianal abscesses, the goal shifts to preventing fistula-in-ano: here the trials conflict, pooled estimates hint at a modest benefit from antibiotics, and clinical judgment still matters. Perhaps the clearest evidence-based shift is against routine packing, as it offers no outcome advantage and clearly increases pain. Large randomized data support abandoning it in favor of simple dressings or selective drains. Modern, patient-centered management now emphasizes thorough drainage, selective antibiotics, and avoidance of routine packing; use simple dressings or short-term drains when needed, and arrange reliable follow-up. That combination reduces pain and resource use without sacrificing safety.

Background: Trauma remains a leading cause of morbidity and mortality globally, and New Zealand is no exception, with around 50 000 annual hospitalizations and over NZ$10 billion in associated economic burden. Despite the development of national systems such as the New Zealand National Trauma Network (NTN) and Trauma Registry (NZTR), geographical disparities and inequities in access to trauma care persist. This review aims to better understand the quantity and quality of trauma surgery research in New Zealand, as it remains essential to guide evidence-based improvements.

Methods: A bibliometric analysis of trauma surgery research from 2000 to 2025 was conducted using PubMed and local databases. Studies were included if authored by New Zealand-affiliated researchers and utilized New Zealand data. Articles were classified by study type, design, institutional origin, and international collaboration. Descriptive statistics, linear regression, and univariate analyses were used to identify trends.

Results: From 3103 initial articles, 143 met the inclusion criteria. Clinical studies dominated (69.9%), followed by epidemiological and systematic reviews. Publication volume increased significantly after 2012 from 2.42 ± 1.78 in 2000-12 to 8.77 ± 5.70 in 2013-25 (p = 0.0018), aligning with the development of the NTN. Research output was concentrated in tertiary major trauma centers, although contributions from regional centers increased in later years. The mean number of authors per publication remained similar over time.

Conclusion: New Zealand's trauma research output has grown steadily over the past 25 years, reflecting increasing interest and recognition of trauma surgery as a distinct specialty. Continued investment in infrastructure, training, and multidisciplinary research is vital to develop the trauma system further and support equitable, evidence-based care across all regions.

Background: There is significant interest in identifying indicators to help predict patient outcomes, including tumour recurrence and survival from colorectal cancer (CRC). One such indicator is the primary tumour location. This study aimed to examine the prognostic implications of tumour location in patients undergoing surgery for early (Stages I and II) CRC, assessing its impact on metastatic behaviour and patient survival. The Cabrini Monash Colorectal Neoplasia Database includes complete data on all CRC patients at all Monash University-affiliated hospitals and was the basis for the binational database (https://bowelcanceraudit.com).

Methods: A database review was performed. Patients who underwent surgical resection for early-stage CRC (TNM Stage I or II) from 2010 to 2022 were reviewed. Oncological characteristics, overall survival and disease-free survival rates were examined.

Results: One thousand, seven hundred three patients underwent surgical resection for early-stage CRC; of them, 49.8% were male. The tumour recurrence rate was 3.6%, 5.7% and 7.6% for right-sided, left-sided and rectal cancers, respectively (p = 0.013). While left-sided and rectal cancers were more likely to develop metastases to the lung (p < 0.001), there was no association between the site of the primary tumour and the location of recurrence in the liver (right-sided 2.5%, left-sided 2.7%, rectum 3.7%, p = 0.556), peritoneum (p = 0.423) or other sites (p = 0.387). Lung metastases originating from left-sided colorectal tumours (HR = 0.84, 95% CI: 0.25-2.84, p = 0.779) and rectal tumours (HR = 0.92, 95% CI: 0.26-3.26, p = 0.899) were not significantly associated with overall survival when compared to right-sided tumours.

Conclusions: This study demonstrates that overall recurrence rates during surveillance appear independent of tumour-sidedness in patients with early-stage CRC. Survival after disease recurrence is significantly worse in those with right-sided tumours, especially with a diagnosis of lung metastasis.