ANZ Journal of Surgery最新文献

Purpose: To determine the prevalence of portal annular pancreas (PAP) in a defined population using multidetector computed tomography (CT) and to assess its potential surgical implications, and to report our experience of three cases.

Methods: A retrospective analysis was conducted on 1000 consecutive triphasic contrast-enhanced abdominal CT scans performed between June 2024 and January 2025, evaluating the presence and subtype of PAP.

Results: PAP was identified in 27 patients (2.7%). The suprasplenic variant was the most common (n = 25), followed by the mixed variety (n = 2). Of the affected individuals, 10 were male and 17 were female. We have noticed three cases of PAP, out of 85 pancreatic resections. One patient underwent Pancreaticoduodenectomy with complete excision of annular part. Other two patients underwent distal pancreatectomy, where annular part was stapled.

Conclusion: PAP, though often asymptomatic, is a critical anatomical variant that carries significant implications for pancreatic resections and outcomes. While its reported prevalence varies, our study suggests that it is not as rare as once believed. Under-recognition of PAP can contribute to higher rates of postoperative pancreatic fistula. The PAP which requires pancreatic resections can be best managed by preoperative identification in the image, meticulous anastomosis depending on the location, stapler resection of annular pancreas, complete excision of annular part, properly placed drain and postoperative vigilance for pancreatic fistula. Radiologists and surgeons must maintain a high index of suspicion and collaborate closely during preoperative evaluations to reduce intraoperative surprises and optimize surgical outcomes.

Background: Giant cell arteritis (GCA) is a large and medium vessel vasculitis that predominantly affects those greater than 70 and is one of the most common idiopathic systemic vasculitis. Permanent visual loss is one of the most feared complications of GCA and results from damage to the ophthalmic, retinal and ciliary arteries. Early diagnosis of GCA is vital to prevent permanent visual loss and maintain quality of life for patients.

Methods: Two population level datasets were used, the Australian Institute of Health and Welfare (AIHW) and Medicare Australia. Patients who had temporal artery biopsy (TAB) procedures between 1994 and 2024 were identified, and procedural trends were analysed over a 31-year period.

Results: Data from the AIHW was available from 2000 to 2023, over which 51 290 patients had a TAB. Over this study period, there was an 85.5% increase in TAB procedures and negative binomial regression demonstrated a 0.7% annual increase in TAB incidence rates. Data from the Medicare dataset was available from 1994 to 2024, over which 31 122 patients had a TAB. Over this study period, TAB procedures showed a 0.6% relative increase, but negative binomial regression demonstrated a 0.8% annual decrease in TAB incidence rates.

Conclusions: This nationwide analysis of TAB trends in Australia over the past 31 years demonstrates divergent procedural trajectories between the AIHW and Medicare datasets. While TAB incidence increased slightly in the AIHW dataset, a decline was observed in the Medicare dataset.

Objective: To explore the value of Mannheim Peritonitis Index (MPI) combined with ASA Classification in predicting mortality of patients with digestive tract perforation (DTP) who underwent surgical treatment.

Methods: A retrospective analysis was conducted on the clinical data of 248 patients with secondary abdominal infection caused by DTP, who were admitted to the Department of Emergency Surgery, The First Affiliated Hospital of Naval Medical University from August 2021 to August 2025. The patients were divided into the mortality group (n = 41) and the non-mortality group (n = 207). Univariate and multivariate analyses were performed to identify the risk factors for mortality in DTP patients. Receiver operating characteristic (ROC) curve was used to determine the cut-off values of continuous variables, and to evaluate the predictive value of MPI score combined with ASA Classification.

Results: The total mortality rate of DTP patients was 16.5%. Univariate regression analysis showed that mortality in DTP patients was significantly associated with age, operative time, perforation site, etiology, septic shock, extent of peritonitis, peritoneal exudate, CRP, PCT, Hb, Alb, SCr, ALT, AST, PT, D-dimer, INR, ASA Classification, and MPI score (all p < 0.05). Multivariate regression analysis and ROC curve analysis indicated that ASA Classification ≥ Grade 4 and MPI score ≥ 27 were potential risk factors for mortality in DTP patients. The area under the ROC curve (AUC) of MPI score combined with ASA Classification was 0.904, which was higher than that of MPI score alone (AUC = 0.790) or ASA Classification alone (AUC = 0.786). For predicting mortality in DTP patients, the combined assessment had a sensitivity of 87.8% and a specificity of 81.6%.

Conclusion: In the prediction of mortality risk in DTP patients, the combined assessment of MPI score and ASA Classification exhibits better predictive performance compared with the application of MPI score or ASA Classification alone.

Introduction: Sleep disturbance is a common issue affecting nearly 78% of cardiothoracic postoperative patients. There are no systematic reviews of randomised controlled trials (RCTs) that evaluate the impact of sleep interventions within this population. This study aims to evaluate the sleeping patterns in post-operative cardiac surgery patients and identify if sleep interventions improve sleep quality. The primary outcomes were subjective and objective measures of sleep using the Pittsburgh Sleep Quality Index (PSQI) in addition to the duration of intensive care unit (ICU) and hospital admission.

Methods: Searches on PubMed, Medline, Embase, Scopus and Cochrane were undertaken from database inception to 24 February 2023. Only RCTs that recorded a sleep intervention in addition to standardised sleep scoring measures in adult cardiac surgical patients were included.

Results: A total of 26 studies were included (n = 2323). Total PSQI score had a statistically significant standardised mean difference (SMD) between intervention and control groups for improved scores as indicated by the SMD of -0.73 (95% CI; -0.93; -0.52, p = 0.04). The duration of ICU admission had a SMD of -0.23 (95% CI; -0.50 to 0.03, p = 0.19) and was not statistically significant. Similarly, the duration of hospital admission had a SMD of -1.10 (95% CI; -2.56 to 0.37, p = < 0.01) and was not statistically significant.

Conclusion: Whilst sleep interventions did not have a statistically significant effect on the duration of ICU or hospital admission, they did show a significant improvement in sleep quality as reported through the PSQI total score.

Background: Hand grip strength is a widely used clinical and research measure, with international normative data well-established. However, regional-specific values are important given demographic and socio-economic differences. In New Zealand, no normative values have previously been published despite the country's unique population profile. This study aimed to establish hand grip strength reference values for a New Zealand cohort.

Methods: We conducted a single-centre retrospective study of preoperative patients undergoing hand surgery between January 2012 and June 2022. Hand grip strength was recorded from the non-operative hand in adults aged 18 years and older. Patients with conditions affecting upper-limb strength in the tested hand were excluded.

Results: A total of 1135 measurements were analysed. In males, peak hand grip strength occurred at ages 30-34 in the dominant hand (52.0 ± 10.2 kg) and 25-29 in the non-dominant hand (48.3 ± 8.9 kg). In females, peak strength was observed at ages 25-29 in the dominant hand (31.0 ± 3.3 kg) and 30-34 in the non-dominant hand (32.1 ± 4.2 kg). Generally, there was a period of maintenance, followed by a general decline after these peaks.

Conclusion: This is the first study to present normative hand grip strength data across the lifespan in a New Zealand population. These values provide a population-specific reference to support clinical practice and research.

Introduction: The presence of colonic adenomatous polyps is a risk factor for colorectal cancer. Australian Guidelines changed in 2019 so that the surveillance colonoscopy intervals and polyp risk stratification were changed to reflect evidence available. The purpose of this research was to understand compliance with the Guidelines and implications for the health system.

Methods: Using routine hospital administrative datasets, all polyp surveillance colonoscopies performed from January 2018 to September 2020 in three government-funded hospitals in Central Queensland, Australia, were analysed. Colonoscopy intervals were calculated and compared with national recommendations. 'Early surveillance' was defined as greater than 6 months earlier than recommended. Logistic regression analyses were used to assess early surveillance or not, adjusted for potential confounding. Interval cancer and adenoma detection rates were also examined.

Results: Surveillance colonoscopies were performed for 294 patients with low-risk polyps, 20 with intermediate-risk polyps, 321 with high-risk polyps and 12 with very high-risk polyps during the study period (total n = 647). Early surveillance occurred in 566 (87.5%). The overall interval cancer rate was 0.9% (6/647), and adenoma detection rates were 62.2% (357/574) before the change of guidelines and 79.1% (53/67) after the change. No examined demographic or clinical factors were associated with early surveillance.

Conclusion: Despite outstanding and high-quality colonoscopy services being provided, higher than recommended colonoscopy surveillance was identified in the regional public hospitals in Central Queensland. Hospital processes should be improved to ensure appropriate intervals between procedures to avoid using scarce healthcare resources.