ANZ Journal of Surgery最新文献

Restoration of tactile sensation in fingertip reconstruction is essential for hand function. This systematic review aimed to evaluate differences in the outcomes of innervated (IF) and noninnervated local flap (NIF) reconstruction for digital soft tissue defects. PubMed, MEDLINE, Cochrane, and EMBASE databases were systematically searched. English-language articles reporting sensibility outcomes were included. Eleven studies, published between 1983 and 2023, with a total of 591 flaps were included in the analysis. The sensibility outcome of the reconstructed fingers in IF is significantly better than that of NIF. Neurorrhaphy should be performed in local flap fingertip reconstruction to improve the sensory outcome.

Background: Colorectal cancer remains a leading cause of mortality worldwide. We investigated whether adding socioeconomic information to machine learning models can improve the prediction of colorectal cancer-specific mortality.

Methods: Using data from the Fundação Oncocentro de São Paulo (FOSP), we analyzed individuals diagnosed with colorectal cancer between 2000 and 2023; however, predictive models were developed using patients diagnosed from 2000 to 2021, ensuring a minimum follow-up of 24 months for the 2-year mortality outcome. Thirty predictor variables were included, including clinical factors associated with the disease and socioeconomic factors such as income, educational attainment, HDI components, as well as distance and travel time to healthcare facilities. We tested seven machine learning algorithms using a 70/30 training/testing split. Discrimination was measured by the area under the receiver operating characteristic curve (AUC-ROC), comparing versions with and without socioeconomic factors.

Results: The Random Forest algorithm provided the best discrimination for predicting the risk of death due to colorectal cancer within 2 years after diagnosis (AUC-ROC = 0.92). The addition of socioeconomic and access-related predictors (Human Development Index [HDI] components, education, distance/travel time to healthcare facilities, and type of coverage) improved the AUROC by 0.13 (0.79-0.92) compared with the clinical-only model.

Conclusion: The inclusion of socioeconomic variables in conjunction with clinical data in machine learning models has the potential to enhance the ability to predict colorectal cancer-specific mortality in patients with colorectal cancer.

Introduction: Choledocholithiasis detected during laparoscopic cholecystectomy is common. There is no consensus for the best management in this context. Trans-cystic biliary stent insertion is a well described but less commonly used method for managing choledocholithiasis with the gallbladder in situ.

Methods: Retrospective study including all patients undergoing trans-cystic biliary stenting followed by ERCP at Box Hill Hospital, from 2021 to 2024. Outcomes compared to control cohort of native ERCP for choledocholithiasis at the same institution. The primary outcome was post-ERCP pancreatitis.

Results: Trans-cystic stenting was attempted in 49 patients. 45 (92%) were successful. The median age was 52 years, 73.4% were female, and 67% admitted emergently. No episodes of post-ERCP pancreatitis occurred when the trans-cystic stent was in position at ERCP, compared with 5% in the control cohort. Biliary cannulation rate was 97% if a stent was present, compared with 91% in the control cohort. 20% of stents had migrated by the time of ERCP. One patient developed pancreatitis post failed trans-cystic stent attempt. No other complications were recorded. The median length of stay (LOS) was 5.0 days. A 40% of patients were discharged prior to ERCP, resulting in a shorter median LOS: 4.0 versus 6.0 days (p = 0.014). No statistical differences were detected between variables for unsuccessful stenting, stent mis-deployment, or stent migration.

Conclusion: Trans-cystic stenting resulted in a low rate of post-ERCP pancreatitis and a high rate of biliary cannulation. It can be safely implemented by general surgeons and may result in a reduced length of stay.

During robotic right-sided colectomy, although changing body position is required to change the surgical view, it can be a complicated and troublesome procedure in robotic surgery, especially without an integrated table motion. We describe an efficient, simple surgical method to smoothly change the surgical view during robotic right-sided colectomy without changing the body position, called the scope port hopping method (SCOP) method.

Background and aims: With modern healthcare now shifting towards a more patient-centred approach, informed consent and expectation management relies on both easily accessible and accurate information. YouTube is a popular source of medical information for patients, but its lack of regulation, especially on procedures like Ivor-Lewis oesophagectomies, warrants analysis of the quality of content available. This study aims to assess the quality of information on YouTube related to the Ivor-Lewis oesophagectomy for patient education.

Methods: A search of YouTube (www.youtube.com) videos was conducted in May 2025 with the term 'Ivor-Lewis oesophagectomy'. The inclusion criteria required the videos to discuss Ivor-Lewis oesophagectomies, be narrated/subtitled in English, intended for patients and educational in nature. The exclusion criteria removed videos that were non-English, technical surgical videos aimed at healthcare providers, and promotional videos. The videos were evaluated using the DISCERN tool and the Global Quality Score (GQS) and other descriptive statistics.

Results: A total of 226 videos were assessed against the inclusion and exclusion criteria. Twelve videos were deemed eligible as per the criteria and were included for analysis. The median view count was 10 961 views and the median length of the videos were 162 s. The median DISCERN score was 52.5/80 with medical institutions garnering the highest median out of all the source categories (58/80). The median GQS score was 4 points.

Conclusion: YouTube videos on Ivor-Lewis oesophagectomies were largely of poor quality, indicating greater need for regulation and standards for medical information on video-hosting platforms.

Background: Undertriage of women with trauma is associated with preventable deaths. This project was developed to determine whether older women with trauma were less likely to be admitted to a specialist trauma unit.

Methods: The study was undertaken at a specialist, level one trauma service and included all people aged 65 and older admitted following trauma over a twelve-month period. Patients were included if they were admitted to general medicine, trauma or orthopaedics. The primary outcome was admission to general medicine versus trauma. Baseline data included age, sex, Charlson Comorbidity Index (CCI), mechanism of injury (low fall vs. other) and baseline function. Injury Severity Score (ISS) was calculated by trained assessors.

Results: A total of 648 (50.3%) were admitted to trauma, 286 (22.2%) to orthopaedics and 352 (27.4%) to General medicine (GM). 686 (53%) of patients were women. Low fall was the most common mechanism of injury (75.6% of women, 51.3% of men). In a multivariate model to look at admission to GM versus trauma, including age, sex, language other than English, CCI and ISS, women were more likely to be admitted to GM (1.67 (1.14, 2.44)). Low fall was the biggest predictor of general medical admission versus trauma (11.4 (6.7, 18.9)) Low fall was associated with mortality (2.0 (1.11, 3.67)).

Conclusions: Accounting for age and frailty women and people with low falls were more likely to be admitted to a general medical unit than a trauma unit compared to men. This supports the need for standard admission guidelines for trauma.

Background: The diagnosis of choledocholithiasis (CDL) requires balancing timely intervention against the risks of unnecessary invasive procedures. Although liver function tests (LFTs) are widely used for risk stratification, their static values and short-term trends remain poorly defined in predicting persistent common bile duct stones. This study evaluated the association between static and dynamic LFTs and CDL and assessed the diagnostic performance of magnetic resonance cholangiopancreatography (MRCP).

Methods: A retrospective review was conducted at Middlemore Hospital involving 504 acute inpatient MRCP scans within 2022. The collected clinical variables included patient demographics, LFTs and imaging modalities. 2 × 2 tables were constructed for those who had both MRCP and ERCP to assess the diagnostic utility of MRCP. Logistic regression and linear mixed-effects models were used to analyse the association between LFTs and CDL. Receiver operating characteristic curve analysis was performed to assess the diagnostic performance of each LFT.

Results: Of 504 MRCPs, 131 (26%) were positive for stones. Bilirubin, alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) were significantly higher in the CDL group on admission and repeat testing. Paradoxically, CDL was associated with a downward 24-h trend in ALP and GGT. Elevated GGT demonstrated the strongest independent association with CDL (adjusted OR: 5.27, 95% CI: 2.46-13.21; p < 0.001). Discriminatory performance of individual enzymes was modest (AUC: ALP 0.69; GGT 0.68; bilirubin 0.63). Among 157 patients undergoing both MRCP and ERCP, MRCP demonstrated high sensitivity (91.4%) but low specificity (32.7%).

Conclusion: Static and dynamic LFTs provide limited discrimination for persistent CDL and improving biochemical trends do not reliably exclude stones. This study underscores the diagnostic utility of MRCP to prevent both missed CDL and avoidable ERCP, and the need for standardised diagnostic protocols.