ANZ Journal of Surgery最新文献

Background: There continues to be an underrepresentation of women in oral and maxillofacial surgery (OMS) despite an increase in the number of female medical and dental students. This study aims to characterize the number of female OMS surgeons and the number of female specialists among surgical and dental specialties in Australia.

Methods: The number of registered dental and medical specialists was publicly available from the Health Workforce (2013-2022). Data was requested from the Royal Australasian College of Dental Surgeons (RACDS) and Australia and New Zealand Association of Oral and Maxillofacial Surgeons (ANZAOMS) regarding distribution by sex, surgical and dental specialty. The results were collated descriptively.

Results: There were 49 registered OMS surgical trainees with RACDS in 2023, 7 (14%) of whom were female. There were a total of 304 members of ANZAOMS in the same year, 33 (10.86%) were female. Female surgical specialists compromised of 16.6% of all registered surgical specialists and female dental specialist compromised of 31.3% of total registered specialists.

Conclusion: While there has been a steady increase in the number of females in OMS, the number remains low; especially when compared to other surgical and dental specialties. There remains a need to further the opportunities for women aspiring to be OMS surgeons.

Adrenocortical carcinomas are rare lesion and R0 surgical resection remain their only chance for cure. They can be diagnosed because of their secretion but also on symptoms in relation with bulky tumours. Large lesion with caval thrombus can be surgically challenging, especially, as in the present case, when hepatic outflow obstruction leads to Budd Chiari syndrome. The present video shows a nephro-adrenalectomy with en-bloc right hepatectomy and caval thrombectomy for adrenocortical carcinoma in a patient with a Budd Chiari syndrome.

Introduction: Without surgical intervention, type A aortic dissection (TAAD) carries a high risk of life-threatening complications and mortality. Due to the low incidence of aortic dissection, case numbers vary significantly between institutions. This study reports outcomes for patients undergoing surgical TAAD repair in Australia between 2001 and 2021, and the impact of institution case numbers on mortality.

Methods: Retrospective multicentre cohort study using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) data, including consecutive adult patients undergoing surgery for TAAD. Patients were divided into groups based on 30-day mortality. Secondary morbidity outcomes are reported.

Results: Between 2001 and 2021, 2604 patients (median age 65; 67% male) underwent operative intervention for TAAD. Over this period, the number of aortic dissections recorded in the database annually increased (from <50 to >200 cases per year), consistent with the increasing number of contributing institutions. Thirty-day mortality rates varied by unit from 0% to 100%, with an average over the period of 18%. Despite unit case numbers ranging from 1 or 2 to over 200 cases, funnel plot analysis demonstrated no units fell outside the accepted 99.7% control level for 30-day mortality. Individual surgeons showed decreased mortality with increased caseload. Non-survivors were more likely to have prior respiratory or cerebrovascular disease, previous myocardial infarction, or severe left ventricular dysfunction. Post-operative stroke, return to theatre for bleeding, renal failure and atrial fibrillation were more common in the non-survivors (P < 0.05).

Conclusion: Mortality outcomes for TAAD in Australia have improved over time, stabilizing at 18% over the last 5 years. Units performing fewer operations for TAAD showed equivalent mortality outcomes to high volume units, while surgeons performing fewer procedures displayed a higher mortality.

Background: Pneumatosis intestinalis, characterised by the presence of intramural bowel gas, is a radiological finding with varied clinical implications, ranging from incidental detection to severe underlying pathology, including bowel ischaemia or perforation. Its association with systemic sclerosis, a connective tissue disorder, remains rare and poorly understood, presenting unique diagnostic and therapeutic challenges.

Methods: A comprehensive literature review was conducted, analysing 34 documented cases of pneumatosis intestinalis associated with systemic sclerosis, examining demographic profiles, clinical features, diagnostic findings, and outcomes of various management strategies.

Results: Pneumatosis intestinalis in systemic sclerosis predominantly occurs in older female patients and is associated with gastrointestinal dysmotility and microvascular damage. Symptoms range from asymptomatic presentations to severe abdominal pain with obstructive symptoms, with the latter increasing the likelihood of surgical intervention. Non-operative management, encompassing antibiotic therapy, oxygen supplementation, and dietary modifications, was associated with favourable outcomes and the lowest mortality. In contrast, surgical intervention, often necessitated by suspected ischemia or perforation, was associated with significantly higher morbidity and mortality.

Conclusion: Pneumatosis intestinalis in systemic sclerosis is a complex clinical entity demanding a nuanced, multi-disciplinary approach to management. Non-operative management should remain the cornerstone of treatment for clinically stable presentations, with surgery reserved for those with clear indications. The absence of standardised guidelines underscores the need for further research to refine diagnostic criteria and therapeutic protocols, ultimately improving long-term outcomes in this complex intersection of gastrointestinal and systemic disease.