ANZ Journal of Surgery最新文献

Background: Transanal Minimally Invasive Surgery (TAMIS) is a viable technique for local excision of rectal lesions, offering improved access, specimen quality and recurrence rates compared to traditional methods. While most published data are from tertiary centres, this study evaluates the outcomes of TAMIS performed at a regional New Zealand hospital.

Methods: A retrospective analysis was conducted on all patients who underwent TAMIS at Tauranga Hospital between December 2014 and October 2025. Demographic, operative, histopathological, morbidity and 30-day mortality data were collected. Complications were classified using the Clavien-Dindo system.

Results: Sixty five patients (mean age 69; 69% male) underwent TAMIS over the study period. The mean resection size was 41 × 29 mm. Histological diagnoses included adenomas (n = 35), adenocarcinomas (n = 20), carcinoid tumour (n = 1), gastrointestinal stromal tumour (n = 2), benign scar tissue (n = 6) and rectal prolapse (n = 1). R0 resection was achieved in 97% of polyps and 85% of adenocarcinomas. The mean length of stay was 1.5 days. Complications of Clavien-Dindo grade II occurred in 11.0% and grade III in 6%, with postoperative haemorrhage being most common. One mortality occurred within 30 days postoperatively (1.6%). None of the adenocarcinoma patients developed recurrence; two (6%) patients had recurrent adenomas both successfully managed with local treatment.

Conclusion: TAMIS can be performed safely and effectively in a regional centre, providing acceptable morbidity and mortality rates for a wide range of rectal pathologies.

Purpose: To study the anatomic characteristics of internal spermatic veins, at the 2 cm above internal inguinal ring area, in patients with varicocele undergoing laparoscopic varicocelectomy.

Methods: The clinical data of 447 patients with primary varicocele in our hospital from January 2014 to December 2024 were collected and retrospectively analyzed. All patients underwent laparoscopic varicocelectomy, and the ligation of the internal spermatic veins was performed 2 cm above the internal inguinal ring. The number of left and right side internal spermatic veins was recorded, respectively. The locations of the internal spermatic veins and testicular arteries were also recorded.

Results: Under laparoscopy, these internal spermatic veins generally appeared dark red in color, with straight courses, full distension, and the testicular artery often appeared as a tortuous vessel with a bright red color and pulsatility. The lymphatic vessels typically appeared as white, glistening ducts. In 56 patients with left varicocele, the number of internal spermatic veins was 2.29 ± 0.12 at 2 cm above the internal inguinal ring. In 391 patients with bilateral varicocele, the number of internal spermatic veins in the left and right sides was 2.30 ± 0.04 and 2.07 ± 0.04, respectively, and there was a significant difference in the number of internal spermatic veins between these two sides (p ≤ 0.05).

Conclusion: The anatomic structure of internal spermatic veins under laparoscopy is clear at 2 cm above internal inguinal ring, and the number of veins and the distribution of arteries have certain characteristics, which contribute to reducing missed veins ligation and avoiding accidental ligation of arteries and lymphatic vessels. Those findings contribute to offer an anatomical basis for improving treatment efficacy and minimizing surgical complications.

Aim: The primary objective of this study was to determine the prevalence of cervical ossification of the posterior longitudinal ligament (OPLL) among Māori compared to non-Māori populations in the Bay of Plenty (BOP) region of New Zealand.

Methods: Cervical spine and trauma CT scans performed between 2021 and 2025 were retrospectively reviewed for evidence of cervical OPLL. Patients aged ≥ 40 years with available ethnicity data and adequate imaging was included. Cases with a prior diagnosis of OPLL were excluded to reduce selection bias.

Results: A total of 423 CT scans were from the BOP region, comprising 224 Māori and 199 non-Māori patients. Cervical OPLL was identified in 15 Māori patients, with one case excluded due to prior diagnosis. This yielded a statistically significant OPLL prevalence of 6.4% (14/223, p = 0.0133) among Māori in BOP. Māori in BOP were 6.6 times more likely to have cervical OPLL compared to non-Māori (OR: 6.60, 95% CI: 1.48-29.4). In the non-Māori BOP cohort, two cases of cervical OPLL were identified, resulting in a prevalence of 1.0% (2/199).

Conclusions: This study demonstrates a significantly higher prevalence of cervical OPLL in the Māori population of the Bay of Plenty compared to non-Māori.

Introduction: It is widely accepted that definitive surgical treatment for primary cutaneous melanoma should occur promptly, but the effects of a delay between initial diagnosis and definitive surgery remain unclear. In addition, high quality evidence is lacking for an optimal time-to-surgery from initial melanoma diagnosis. The aim of this study was to determine whether the timing of surgical treatment for Stage I & II melanoma was associated with survival outcome and whether there was an optimal time interval between melanoma diagnosis and definitive surgical treatment with respect to survival.

Methods: This was a retrospective cohort study of patients with primary cutaneous melanoma treated at a single institution between 1990 and 2015. The associations between time-to-surgery and clinical outcomes including overall survival (OS) and recurrence-free survival (RFS) were described using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to quantify the relationship between each time-to-surgery cohort and clinical outcome.

Results: In total 18, 242 patients were included in the analysis. Their average age was 57.5 years and 57% were male. The majority of primary melanomas were located on the trunk (32.5%) and upper limb (24.7%). Mean Breslow thickness was 1.8 mm (range 0.1-50 mm) and 64% were of superficial spreading subtype. Time to surgery was divided into ≤ 1 week, 1-4 weeks, 4-8 weeks, 8-12 weeks and > 12 weeks (n = 2453, 8882, 5906, 870 and 126, respectively). Increased delay of definitive surgical treatment was associated with poorer OS and RFS, with an OS HR of 1.23 for the 8-12 week group compared to the 1-4 week group. For RFS HR was 1.36 for the same cohorts.

Conclusion: Definitive surgical treatment of patients with primary cutaneous melanoma between 1-4 weeks post-diagnosis with excision-biopsy was associated with improved OS & RFS compared to those treated within 1 week and greater than 4 weeks in this patient cohort treated prior to the use of adjuvant drug therapy.

Background: The reinforced tension-line suture (RTLS) technique distributes mechanical stress more evenly than traditional closure when closing a laparotomy wound, potentially reducing incisional hernia (IH) risk. We aimed to compare outcomes of RTLS versus standard closure techniques in patients undergoing laparotomy.

Methods: Systematic search of PubMed, MEDLINE, Web of Science, and bibliographic reference lists was conducted (last search: 26 January 2025). The protocol was registered with PROSPERO. Comparative studies reporting outcomes of RTLS versus other closure methods were included and their risk of bias was assessed. IH, Clavien-Dindo (C-D) ≥ III complications, wound dehiscence, wound infection, and procedure time were the evaluated outcome measures. Odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous variables were determined. Heterogeneity was assessed using I² and Cochran's Q test.

Results: Five comparative studies (four randomised and one observational) enrolling 708 patients who had their laparotomy wound closed using RTLS (n = 393) or standard closure (n = 315) were included. Use of RTLS significantly reduced risk of IH compared to standard technique (5.6% vs. 18.1%, OR 0.24; 95% CI: 0.15-0.38; p = 0.005). However, no significant differences were found in C-D ≥ III complications (10.2% vs. 3.2%, OR 0.81; 95% CI: 0.18-3.54, p = 0.62), wound dehiscence (2.3% vs. 6.9%, OR 0.34; 95% CI: 0.06-1.84, p = 0.62), wound infection (9.0% and 10.4%, OR 0.34; 95% CI: 0.06-1.84, p = 0.62) or procedure time (MD 23.50; 95% CI: -59.88-106.87, p = 0.16) between two groups.

Conclusions: RTLS seems to significantly reduce IH incidence after laparotomy without increasing post-operative morbidities or procedure time. Further Level 1 evidence is needed.

Background: The aim of this study was to determine whether the retention of pelvic ring fixation metalware in women of childbearing age following traumatic fractures is associated with increased rates of caesarean section at subsequent childbirth.

Methods: Database searches were conducted across MEDLINE, Embase, CENTRAL and Scopus, spanning 1946-2025. Eligible studies included women of childbearing age with prior traumatic pelvic ring fractures, managed either operatively or non-operatively and compared outcomes between those with and without retained fixation metalware at the time of childbirth. The outcome of interest was the incidence of subsequent caesarean section delivery. Fixed effect meta-analysis using the Mantel-Haenszel method was undertaken, with the resultant pooled odds ratio (OR) presented as a forest plot.

Results: Three studies were included for review, a total of 118 births (51 caesarean section and 67 vaginal) eligible for meta-analysis. Retention of pelvic ring metalware at the time of subsequent childbirth was associated with an increased likelihood of caesarean section (OR 2.39, 95% CI 1.03-5.56; p = 0.04) compared to women giving birth without retained metalware.

Conclusions: Retention of pelvic fixation metalware following pelvic ring fracture may be associated with a higher likelihood of caesarean section among women of childbearing age compared with those without metalware in situ at the time of subsequent childbirth. Further research is warranted to inform counselling and shared decision-making regarding removal of pelvic fixation metalware in this population, given the absence of consensus recommendations from any orthopaedic or obstetric advisory bodies.