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Kanakaratne S, Hong J, Solomon MJ, Young CJ. Ileal pouch-anal anastomosis provides good functional and quality of life outcomes following proctocolectomy: A 33-year single centre experience. ANZ J Surg 2024; 94:404-411. [PMID: 38105626 DOI: 10.1111/ans.18827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Restorative proctocolectomy (RP) with ileal pouch-anal anastomosis (IPAA) remains the gold standard for the surgical management of patients with medically refractive mucosal ulcerative colitis. We aimed to identify functional and quality of life (QOL) outcomes in RP and IPAA surgery patients at our institution. METHODS A retrospective observational study was performed including all patients who had undergone RP and IPAA between August 1984 and November 2017 at Royal Prince Alfred Hospital (RPAH). RESULTS 316 consecutive patients were identified, median age 39 (range 5 to 81) years. The median duration of disease was 60 (range 1 to 528) months. Ulcerative colitis was the main preoperative diagnosis with the main RP indication being failure of medical treatment. The median postoperative stay post-IPAA was 11 (range of 5 to 67) days. Pouchitis was the most common late complication (22.1%), bleeding pouch (3.5%) the earliest, with a 6.8% rate of symptomatic anastomotic leak. Visual analogue scale QOL measure (P-value <0.001), St Marks incontinence score (P-value = 0.001) and Cleveland clinic score (P-value = 0.002) all revealed significant improvement in functional outcomes and QOL. CONCLUSION QOL and functional outcomes following RP with IPAA in patients at our institution are excellent and comparable to institutions with larger patient numbers.
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Affiliation(s)
- Shaveen Kanakaratne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Jonathan Hong
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Christopher J Young
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Sydney, New South Wales, Australia
- Department of Surgery, University of Kansas School of Medicine, Abilene, Kansas, USA
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Young CJ. The monkey chased the weasel: is it irritable bowel syndrome or faecal incontinence we find following obstetric anal sphincter injuries? Colorectal Dis 2024; 26:515-517. [PMID: 38514446 DOI: 10.1111/codi.16950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Christopher J Young
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, University of Kansas School of Medicine, Abilene, Kansas, USA
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Lyle V, Young CJ. Anal fissures: An update on treatment options. Aust J Gen Pract 2024; 53:33-35. [PMID: 38316476 DOI: 10.31128/ajgp/05-23-6843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Anal fissure (AF) is the second most common anorectal complaint in healthcare settings. The presentation might be acute or chronic, characterised by severe pain with defaecation that persists for one to two hours. Non-surgical and surgical interventions are available based on the severity and persistence of the fissure. OBJECTIVE The aim of this article is to review the pathophysiology, clinical presentation and management of AF under current guidelines. DISCUSSION The aetiology of AF is unclear, although it is commonly associated with local trauma or associated chronic conditions. Acute AF is first treated with conservative therapy, including dietary fibre and sitz baths. Addition of topical nitrates, topical calcium channel blockers or botulinum toxin injection is indicated with failure of conservative treatment or at medical discretion. Surgical options are considered if AF persists despite treatment. Most present as hypertonic, but special consideration is needed for hypotonic or secondary presentations.
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Affiliation(s)
- Veronica Lyle
- BSc, University of Kansas School of Medicine, Salina, KS, USA
| | - Christopher J Young
- MBBS, MBA, MS, FRACS, FACS, FASCRS, Associate Professor, Department of Surgery, University of Kansas School of Medicine, Abilene, KS, USA; Associate Professor, Faculty of Medicine and Health, The University of Sydney, Sydney Medical School, Sydney, NSW
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Naseem Z, Hong J, Young CJ. Procedure-based assessment implementation in colorectal surgery: a scoping review. ANZ J Surg 2023; 93:2337-2343. [PMID: 37264703 DOI: 10.1111/ans.18555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/13/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Competency-based training (CBT) programs use procedure-based assessments (PBAs) to evaluate trainees' abilities to perform specific procedures in clinical settings, similar to Entrustable Professional Activities (EPAs). PBAs help determine trainees' readiness for advanced training levels. However, there is limited evidence on implementing colorectal-specific PBAs in surgical training schemes. This review aims to identify observed and perceived challenges to implementing PBAs in workplace settings. METHODS A scoping review following the Joanna Briggs Institute Protocol for Scoping Reviews (JBI-ScR) was conducted. Eligible studies provided evidence on the implementation, feasibility, and challenges of PBAs in colorectal surgery, including various study designs from retrospective to prospective. RESULTS Of the 80 screened studies, 75 were excluded based on exclusion criteria. Most of the included studies were conducted in national training institutions in the United Kingdom, assessing 778 colorectal procedures with specific PBAs. The main facilitators of implementing PBAs were structured assessments, focused assessors' training, and electronic forms usage. CONCLUSION This review offers insight into the practicality and feasibility of implementing PBAs in colorectal surgery. Identified challenges include the need for adequate assessor training and the time-consuming nature of the assessment. These findings could improve PBA implementation in colorectal surgery and enhance surgical education quality. However, the limited number of studies and existing literature heterogeneity call for more research to identify other gaps.
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Affiliation(s)
- Zainab Naseem
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Sydney, New South Wales, Australia
- Department of Colorectal Surgery and RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jonathan Hong
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Northern Hospital, Epping, Victoria, Australia
| | - Christopher J Young
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Sydney, New South Wales, Australia
- Department of Surgery, University of Kansas School of Medicine, Abilene, Kansas, USA
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Ahmadi N, Ahmadi N, Ravindran P, Kim TJ, Byrne CM, Young CJ. Acute diverticulitis in immunosuppressed patients: a 12-year management experience. ANZ J Surg 2023; 93:2161-2165. [PMID: 37079781 DOI: 10.1111/ans.18370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Diverticular disease of the colon occurs commonly in developed countries. Immunosuppressed patients are thought to be more at risk of developing acute diverticulitis, worse disease, and higher complications secondary to therapy. This study aimed to assess outcomes for immunosuppressed patients with acute diverticulitis. METHOD A retrospective single-centre review was conducted of all patients presenting with acute diverticulitis at a major tertiary Australian hospital from 2006 to 2018. RESULT A total of 751 patients, comprising of 46 immunosuppressed patients, were included. Immunosuppressed patients were found to be older (62.25 versus 55.96, p = 0.016), have more comorbidities (median Charlson Index 3 versus 1, P < 0.001), and undergo more operative management (13.3% versus 5.1%, P = 0.020). Immunosuppressed patients with paracolic/pelvic abscesses (Modified Hinchey 1b/2) were more likely to undergo surgery (56% versus 24%, P = 0.046), while in patients with uncomplicated diverticulitis, there was no difference in immunosuppressed patients undergoing surgery (6.1% versus 5.1% P = 0.815). Immunosuppressed patients were more likely to have Grade III-IV Clavien-Dindo complication (P < 0.001). CONCLUSION Immunosuppressed patients with uncomplicated diverticulitis can be treated safely with non-operative management. Immunosuppressed patients were more likely to have operative management for Hinchey 1b/II and more likely to have grade III/IV complications.
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Affiliation(s)
- Navid Ahmadi
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nima Ahmadi
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Praveen Ravindran
- Department of Colorectal Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Tae Jun Kim
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher M Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Staiger RD, Rössler F, Kim MJ, Brown C, Trenti L, Sasaki T, Uluk D, Campana JP, Giacca M, Schiltz B, Bahadoer RR, Lee KY, Kupper BEC, Hu KY, Corcione F, Paredes SR, Spampati S, Ukegjini K, Jedrzejczak B, Langer D, Stakelum A, Park JW, Phang PT, Biondo S, Ito M, Aigner F, Vaccaro CA, Panis Y, Kartheuser A, Peeters KCMJ, Tan KK, Aguiar S, Ludwig K, Bracale U, Young CJ, Dziki A, Ryska M, Winter DC, Jenkins JT, Kennedy RH, Clavien PA, Puhan MA, Turina M. Benchmarks in colorectal surgery: multinational study to define quality thresholds in high and low anterior resection. Br J Surg 2022; 109:1274-1281. [PMID: 36074702 DOI: 10.1093/bjs/znac300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/15/2022] [Accepted: 07/31/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Benchmark comparisons in surgery allow identification of gaps in the quality of care provided. The aim of this study was to determine quality thresholds for high (HAR) and low (LAR) anterior resections in colorectal cancer surgery by applying the concept of benchmarking. METHODS This 5-year multinational retrospective study included patients who underwent anterior resection for cancer in 19 high-volume centres on five continents. Benchmarks were defined for 11 relevant postoperative variables at discharge, 3 months, and 6 months (for LAR). Benchmarks were calculated for two separate cohorts: patients without (ideal) and those with (non-ideal) outcome-relevant co-morbidities. Benchmark cut-offs were defined as the 75th percentile of each centre's median value. RESULTS A total of 3903 patients who underwent HAR and 3726 who had LAR for cancer were analysed. After 3 months' follow-up, the mortality benchmark in HAR for ideal and non-ideal patients was 0.0 versus 3.0 per cent, and in LAR it was 0.0 versus 2.2 per cent. Benchmark results for anastomotic leakage were 5.0 versus 6.9 per cent for HAR, and 13.6 versus 11.8 per cent for LAR. The overall morbidity benchmark in HAR was a Comprehensive Complication Index (CCI®) score of 8.6 versus 14.7, and that for LAR was CCI® score 11.9 versus 18.3. CONCLUSION Regular comparison of individual-surgeon or -unit outcome data against benchmark thresholds may identify gaps in care quality that can improve patient outcome.
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Affiliation(s)
- Roxane D Staiger
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Rössler
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Carl Brown
- Department of Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Loris Trenti
- Bellvitge University Hospital, Department of General and Digestive Surgery, and IDIBELL, University of Barcelona, Barcelona, Spain
| | - Takeshi Sasaki
- Department of Colorectal Surgery and Surgical Technology, National Cancer Centre Hospital East, Kashiwa, Chiba, Japan
| | - Deniz Uluk
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Juan P Campana
- Section of Colorectal Surgery, Hospital Italiano de Buenos Aires and Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), Buenos Aires, Argentina
| | - Massimo Giacca
- Department of Colorectal Surgery, Beaujon Hospital and University of Paris, Clichy, France
| | - Boris Schiltz
- Department of Colorectal Surgery, Cliniques Universitaires St-Luc - UCL, Brussels, Belgium
| | - Renu R Bahadoer
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Kai-Yin Lee
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, University Surgical Cluster, National University Health System, Singapore
| | | | - Katherine Y Hu
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Francesco Corcione
- Department of General Surgery and Specialty, University Federico II of Naples, Naples, Italy
| | - Steven R Paredes
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sebastiano Spampati
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Kristjan Ukegjini
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Daniel Langer
- Surgery Department, Charles University and Central Military Hospital, Prague, Czech Republic
| | - Aine Stakelum
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - P Terry Phang
- Department of Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Sebastiano Biondo
- Bellvitge University Hospital, Department of General and Digestive Surgery, and IDIBELL, University of Barcelona, Barcelona, Spain
| | - Masaaki Ito
- Department of Colorectal Surgery and Surgical Technology, National Cancer Centre Hospital East, Kashiwa, Chiba, Japan
| | - Felix Aigner
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carlos A Vaccaro
- Section of Colorectal Surgery, Hospital Italiano de Buenos Aires and Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), Buenos Aires, Argentina
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital and University of Paris, Clichy, France
| | - Alex Kartheuser
- Department of Colorectal Surgery, Cliniques Universitaires St-Luc - UCL, Brussels, Belgium
| | - K C M J Peeters
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ker-Kan Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, University Surgical Cluster, National University Health System, Singapore
| | | | - Kirk Ludwig
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Umberto Bracale
- Department of General Surgery and Specialty, University Federico II of Naples, Naples, Italy
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Adam Dziki
- Centre for Bowel Diseases, Brzeziny, Poland.,Department of General and Colorectal Surgery, Medical University, Lodz, Poland
| | - Miroslav Ryska
- Surgery Department, Charles University and Central Military Hospital, Prague, Czech Republic
| | - Des C Winter
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - John T Jenkins
- Department of Colorectal Surgery, St Mark's Hospital, London, UK
| | - Robin H Kennedy
- Department of Colorectal Surgery, St Mark's Hospital, London, UK
| | - Pierre-Alain Clavien
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Matthias Turina
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
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Rajan V, Srinath H, Bong CYS, Cichowski A, Young CJ, Hewett PJ. Software Analysis of Colonoscopy Videos Enhances Teaching and Quality Metrics. Cureus 2022; 14:e23039. [PMID: 35464512 PMCID: PMC9001872 DOI: 10.7759/cureus.23039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Machine learning algorithms were hypothesized as being able to predict the quality of colonoscopy luminal images. This is to enhance training and quality indicators in endoscopy. Methods A separate study involving a randomized controlled trial of capped vs. un-capped colonoscopies provided the colonoscopy videos for this study. Videos were analyzed with an algorithm devised by the Australian Institute for Machine Learning. The image analysis validated focus measure, steerable filters-based metrics (SFIL), was used to assess luminal visualization quality and was compared with two independent clinician assessments (C1 and C2). Goodman and Kruskal's gamma (G) measure was used to assess rank correlation data using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, NY). Results A total of 500 random colonoscopy video clips were extracted and analyzed, 88 being excluded. SFIL scores matched with C1 in 45% and C2 in 42% of cases, respectively. There was a significant correlation between SFIL and C1 (G = 0.644, p < 0.005) and SFIL and C2 (G = 0.734, p < 0.005). Conclusion This study demonstrates that machine learning algorithms can recognize the quality of luminal visualization during colonoscopy. We intend to apply this in the future to enhance colonoscopy training and as a metric for quality assessment.
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De Robles MS, Young CJ. Transperineal Rectocele Repair Is Ideal for Patients Presenting With Fecal Incontinence. Ann Coloproctol 2021; 38:376-379. [PMID: 34663063 DOI: 10.3393/ac.2021.00157.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/01/2021] [Indexed: 10/31/2022] Open
Abstract
Purpose Rectocele can be associated with both obstructed defecation and fecal incontinence. There exists a great variety of operative techniques to treat patients with rectocele. The purpose of this study was to evaluate the clinical outcome in a consecutive series of patients who underwent transperineal repair of rectocele when presenting with fecal incontinence as the predominant symptom. Methods Twenty-three consecutive patients from April 2000 to July 2015 with symptomatic rectocele underwent transperineal repair by a single surgeon. Results All patients had a history of vaginal delivery, with or without evidence of associated anal sphincter injury at the time. The median age of the cohort was 53 years (range, 21-90 years). None were fully continent preoperatively. However, continence improved to just rare mucus soiling or loss of flatus in all patients 6 months after their surgery. There was no operative mortality. Postoperative complications including urinary retention and wound dehiscence occurred in 3 patients. Conclusion Fecal incontinence associated with rectocele is multifactorial and may be caused by preexisting anal sphincteric damage and attenuation. Our experience suggests that transperineal repair provides excellent anatomic and physiologic results with minimal morbidity in selected patients presenting with combined rectocele and anal sphincter defect.
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Affiliation(s)
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,The University of Sydney, Discipline of Surgery, Sydney, NSW, Australia
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Hong JSY, Brown KGM, Waller J, Young CJ, Solomon MJ. Author's reply to commentary on "The role of MRI pelvimetry in predicting technical difficulty and outcomes of open and minimally invasive total mesorectal excision: a systematic review". Tech Coloproctol 2021; 25:983. [PMID: 34181153 DOI: 10.1007/s10151-021-02478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Affiliation(s)
- J S-Y Hong
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia. .,The Institute of Academic Surgery at RPA, Sydney, Australia. .,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia. .,University of Sydney, Sydney, Australia.
| | - K G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - J Waller
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - C J Young
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
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10
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Ebrahimi N, Ng KS, Young CJ. Superior mesenteric vein thrombosis in a pregnant woman: Diagnostic and management challenge. ANZ J Surg 2021; 92:265-267. [PMID: 34060201 DOI: 10.1111/ans.16998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nargus Ebrahimi
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kheng-Seong Ng
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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11
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De Robles MS, Young CJ. Real world outcomes of lateral internal sphincterotomy vs botulinum toxin for the management of chronic anal fissures. Asian J Surg 2021; 45:184-188. [PMID: 33965321 DOI: 10.1016/j.asjsur.2021.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Lateral internal sphincterotomy (LIS) remains the gold standard surgical approach for the management of chronic anal fissures (CAF). The procedure however, is complicated by the risk of postoperative incontinence. Intrasphincteric Botulinum Toxin (BT) has gained popularity as an alternative approach, despite being inferior to LIS with regards to cure rates. In the real world, patients at high risk for postoperative incontinence are likely to be offered BT as a preliminary procedure. The aim of this study was to explore the real-world outcomes of LIS and BT for a cohort of CAF patients. METHODS 251 consecutive patients treated with either BT or LS for CAF by a single surgeon were reviewed. Patients were offered BT as a preliminary procedure if they had risk factors for faecal incontinence, whereas all other patients underwent LIS. Primary outcomes included rates of recurrence and faecal incontinence. RESULTS LIS was superior to BT with regards to recurrence rates throughout the mean follow up period of five years (5% vs 15%, p = 0.012). A total of 17 patients experienced a minor degree of flatal incontinence at the 6-week follow up, although there was no difference between LIS and BT (7% vs 6%, p = 1.000). Four LIS patients (2%) continued to experience some minor incontinence to flatus at the 12-month follow up and were managed with biofeedback. CONCLUSION For patients with CAF, individualizing the treatment approach according to risk factors for incontinence could mitigate this risk in LIS. High risk patients should be offered BT as a preliminary procedure.
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Affiliation(s)
- Marie Shella De Robles
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; The University of Sydney, Discipline of Surgery, Sydney, New South Wales, Australia
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12
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De Robles MS, Young CJ. Surgical technique is the main predictor of recurrence in the management of haemorrhoids. ANZ J Surg 2021; 91:1854-1858. [PMID: 33724701 DOI: 10.1111/ans.16738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The pursuit of better management for haemorrhoidal disease (HD) is far from over, and even with the latest surgical procedures, none of the treatment options is close to perfect. The aims of this study were to review our experience with patients treated for symptomatic HD, compare the different treatment strategies in terms of complication and recurrence rates and determine predictors of recurrence. METHODS A total of 1958 patients who underwent a procedure for HD performed by a single colorectal consultant surgeon between 2000 and 2015 were reviewed. RESULTS The treatment performed was rubber band ligation (RBL) in 73%, excisional haemorrhoidectomy (EH) in 16% and stapled haemorrhoidopexy (SH) in 11%. After a mean follow-up of 42.1 months, 242 patients (12%) developed recurrence. Logistic regression analysis of multiple factors showed that treatment received was a significant predictor of recurrence. RBL had the lowest post-operative complication rate but had the highest recurrence rate. EH had the lowest recurrence rate. SH had the highest complication rate but with similar recurrence rates to EH. Complications included pain, anal fissure, bleeding and urinary retention. CONCLUSION Low-grade HD can initially be treated with RBL with good results. Although conventional EH remains a mainstay operation for recurrent and complicated HD, SH can also be considered in selected cases particularly when performed by a surgeon with adequate experience. Treatment should be tailored to the individual based on patient preference, suitability, degree of haemorrhoids and symptomatology.
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Affiliation(s)
- Marie Shella De Robles
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
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13
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Brown KGM, Ansari N, Solomon MJ, Austin KKS, Hamilton AER, Young CJ. Pelvic exenteration combined with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for advanced primary or recurrent colorectal cancer with peritoneal metastases. Colorectal Dis 2021; 23:186-191. [PMID: 32978813 DOI: 10.1111/codi.15378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 07/25/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
AIM The aim was to report early outcomes of six patients who underwent combined pelvic exenteration (PE), cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced or recurrent colorectal cancer with colorectal peritoneal metastases at a single centre. The literature contains limited data on the safety and oncological outcomes of patients who undergo this combined procedure. METHODS Six patients who underwent combined PE, CRS and HIPEC at Royal Prince Alfred Hospital, Sydney, between January 2017 and February 2020 were identified and included. Data were extracted from prospectively maintained databases. RESULTS Three patients underwent surgery for advanced primary rectal cancer, while two patients had recurrent sigmoid cancer and one had recurrent rectal cancer. All patients had synchronous peritoneal metastases. Two patients required total PE and two patients had a central (bladder-sparing) PE. The median peritoneal carcinomatosis index was 6 (range 3-12) and all patients underwent a complete cytoreduction. The median operating time was 702 min (range 485-900) and the median blood loss was 1650 ml (range 700-12,000). The median length of intensive care unit and hospital stay was 4.5 and 25 days, respectively. There was no inpatient, 30-day or 90-day mortality. Three patients (50%) experienced a major (Clavien-Dindo III/IV) complication. At a median follow-up of 11.5 months (range 2-18 months), two patients died with recurrent disease, one patient was alive with recurrence, while three patients remain alive and disease-free. Of the three patients who developed recurrent disease, one had isolated pelvic recurrence, one had pelvic and peritoneal recurrences and one had bone metastases. CONCLUSION Early results from this initial experience with simultaneous PE, CRS and HIPEC suggest that this combined procedure is safe and feasible; however, the long-term oncological and quality of life outcomes require further investigation.
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Affiliation(s)
- Kilian G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia.,The Institute of Academic Surgery at RPA, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia.,The Institute of Academic Surgery at RPA, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia.,The Institute of Academic Surgery at RPA, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Kirk K S Austin
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia.,The Institute of Academic Surgery at RPA, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Auerilius E R Hamilton
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- The Institute of Academic Surgery at RPA, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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14
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Ng KS, Kwok AMF, Young CJ. Factors associated with healing, reoperation and continence disturbance in patients following surgery for fistula-in-ano. Colorectal Dis 2020; 22:2204-2213. [PMID: 32947650 DOI: 10.1111/codi.15372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/22/2020] [Indexed: 02/08/2023]
Abstract
AIM Fistula-in-ano (FIA) is associated with high treatment costs and has a deleterious impact on quality of life. A wide range of healing, incontinence and recurrence rates have been reported. This study aimed to identify operative, patient and disease factors that influence these outcomes after surgery for FIA. METHOD An observational cohort study of consecutive patients who were managed for FIA at a tertiary colorectal practice (1999-2019) was performed. Outcome measures included healing, impaired continence and the need to reoperate. Clinico-pathological variables, including patient comorbidities, fistula anatomy and operative approach, were assessed for their association with these outcomes. RESULTS Some 411 procedures were performed on 263 patients [median age 41.8 years (range 17.8-79.7 years), 184 men (70.0%)]. Some 77.9% of patients achieved complete healing, 9.5% experienced some deterioration in continence postoperatively and 37.6% required reoperation at a median time of 19.0 weeks. Poorer healing was associated with Crohn's disease, high trans-sphincteric fistulas, extrasphincteric fistulas and steroid usage. Poorer continence was associated with female sex, age > 40 years, posterior location, suprasphincteric fistulas, seton insertion and having more than three subsequent procedures. The need to reoperate was associated with female sex, high trans-sphincteric fistulas, suprasphincteric fistulas, inflammatory bowel disease and previous operations for FIA. CONCLUSION Minimizing recurrence of FIA and preservation of continence can be competing management goals. More than one in three patients require reoperation, one in five fails to heal completely and one in ten suffers worsened continence following surgery. Awareness of the factors that contribute to these outcomes is important to the process of informed consent and managing patient expectations before surgery.
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Affiliation(s)
- K-S Ng
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - A M F Kwok
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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15
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Scott BP, Candido J, Young CJ, Hong J. A Pilot Study Evaluating the Effectiveness of Biofeedback-Based Anal Strengthening Exercises in Treating Radiotherapy-Related Faecal Incontinence. Cureus 2020; 12:e11285. [PMID: 33274159 PMCID: PMC7707912 DOI: 10.7759/cureus.11285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Radiotherapy to the pelvis and especially the anal sphincters can result in long-term faecal incontinence. The aim of this study was to assess the effectiveness of biofeedback anal strengthening exercises in radiotherapy-related faecal incontinence. Methods A retrospective cohort study was performed on seven patients with radiotherapy-related faecal incontinence. Education and biofeedback based anal strengthening exercises were provided. Baseline and follow-up measurements were performed assessing anal sphincter fatigue time, resting, squeeze, and cough pressure. Continence scores and quality of life measures were assessed. Patients were followed up at five months. Results The radiotherapy target varied between prostate, uterus, and rectum. Four of the seven patients were female. Pescatori (0-10) and St Mark’s (0-10) continence scores had a median improvement of 2 (range 0-5) and 1 (range 0-8) respectively. Self-completed patient continence scores (0-10mm) had a median improvement of 2mm (1-6mm). Anal fatigue time measurements (Isotonic Fatigue Time (seconds) and Isometric Fatigue Time (Cycles)) showed a median improvement of three seconds (-4 - 36 seconds) and three seconds (-1 - 6 seconds), respectively. Resting Pressure (mmHg), Squeeze Pressure (mmHg) and Cough Pressure (mmHg) showed median improvement of 10mmHg (-10-21mmHg), 15mmHg (-16 - 100mmHg) and 21mmHg (-3 - 53mmHg), respectively. Patient-defined quality of life (QOL) measures showed a median change of 0.2 (range 0-0.5). Conclusion Patients in this pilot study with radiotherapy-related faecal incontinence had improved anal pressure metrics, continence, and QOL following biofeedback based anal strengthening exercises. These early results suggest a benefit for anal strengthening in patients undergoing pelvic radiotherapy.
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16
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Oh D, Wright C, Young CJ. Management of obstetric anal sphincter injury: Colorectal surgeons' perspectives in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2020; 61:16-21. [PMID: 33058142 DOI: 10.1111/ajo.13261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstetric anal sphincter injuries (OASIs) are a significant complication of vaginal delivery, and a leading cause of anal incontinence in women. AIMS The aims were to explore the management of OASIs in Australia and New Zealand (ANZ) by colorectal surgeons and how this compares with current recommendations and international experience, and to identify the deterrents to the provision of best-practice care among colorectal surgeons. MATERIALS AND METHODS Three hundred colorectal surgeons of the Colorectal Surgical Society of ANZ were mailed questionnaires. Areas of interest included: surgeon demographics; exposure to OASIs; understanding of current recommendations; and opinions regarding the importance of symptoms and assessment tools in OASIs. RESULTS There were 94 completed questionnaires (response rate 31.3%). Fifty-seven surgeons (60.6%) reported low exposure to OASIs during their fellowship training. Greater than 90% believed patients with grade three tears and above should have anal sphincter assessment. Sixty-six (70.2%) reported that they routinely review women who have had OASIs. However, 56.4% were unaware if their obstetrics department followed a standard protocol for OASIs. Surgeons practising in metropolitan centres reported higher rates of their obstetrics department following a protocol (P = 0.013), and greater access to investigative tools (P < 0.001), when compared to rural-based surgeons. CONCLUSIONS Most ANZ colorectal surgeons have had minimal training in OASI management. Colorectal surgeons are more commonly involved with OASI patients in the non-acute setting. Management protocols involving a multidisciplinary team of both colorectal surgeons and obstetricians should be clearly defined, and the gap between metropolitan and rural centres needs to be reviewed.
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Affiliation(s)
- Daniel Oh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Caroline Wright
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
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17
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McBride KE, Steffens D, Solomon MJ, Koh C, Ansari N, Young CJ, Moran B. Cost-analysis of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal malignancy: An Australian perspective with global application. Eur J Surg Oncol 2020; 47:828-833. [PMID: 32972815 DOI: 10.1016/j.ejso.2020.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/13/2020] [Accepted: 09/10/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cost-effective cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of patients with peritoneal malignancy remains an ongoing financial challenge for healthcare systems, hospitals and patients. This study aims to describe the detailed in-hospital costs of CRS and HIPEC compared with an Australian Activity Based Funding (ABF) system, and to evaluate how the learning curve, disease entities and surgical outcomes influence in-hospital costs. METHODS A retrospective descriptive costing review of all CRS and HIPEC cases undertaken at a large public tertiary referral hospital in Sydney, Australia from April 2017 to June 2019. In-hospital cost variables included staff, critical care, diagnosis, operating theatre, and other costs. Univariate and multivariate analyses were conducted to investigate the differences between actual cost and the provision of funding, and potential factors associated with these costs. RESULTS Of the 118 CRS and HIPEC procedures included in the analyses, the median total cost was AU$130,804 (IQR: 105,744 to 153,972). Provision of funding via the ABF system was approximately one-third of the total CRS and HIPEC costs (p < 0.001). Surgical staff proficiency seems to reduce the total CRS and HIPEC costs. Surgical time, length of intensive care unit and hospital stay are the main predictors of total CRS and HIPEC costs. CONCLUSION Delivery of CRS and HIPEC is expensive with high variability. A standard ABF system grossly underestimates the specific CRS and HIPEC funding required with supplementation essential to sustaining this complex highly specialised service.
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Affiliation(s)
- Kate E McBride
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Solomon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Cherry Koh
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nabila Ansari
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christopher J Young
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Brendan Moran
- Peritoneal Malignancy Institute, Basingstoke, Basingstoke, United Kingdom
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18
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Moore D, Young CJ. A systematic review and meta-analysis of biofeedback therapy for dyssynergic defaecation in adults. Tech Coloproctol 2020; 24:909-918. [PMID: 32372153 DOI: 10.1007/s10151-020-02230-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dyssynergic defaecation is a common form of functional constipation that responds poorly to conservative interventions. This systematic review and meta-analysis assesses the effectiveness of biofeedback therapy for dyssynergic defaecation using global clinical improvement as the primary outcome, and resolution of the dyssynergic pattern on anorectal physiology and quality of life as secondary outcomes. METHODS MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, Scopus, and Web of Science were searched from inception to March 2019 using a predefined strategy. Randomised controlled trials of adult patients with dyssynergic defaecation and a biofeedback treatment arm were eligible for review. Studies including patients with secondary forms of constipation were excluded. Data abstraction and risk of bias assessments were conducted by consensus between two authors. RESULTS Eleven trials including 725 participants were included in the narrative review. Sixty-three percent of patients treated with biofeedback reported clinical improvement. Six studies included in the meta-analysis showed biofeedback superior to non-biofeedback therapy for the primary outcome (OR 3.63, CI 1.10-11.93, p = 0.03). Heterogeneity between trials and overall risk of bias was high. CONCLUSIONS Biofeedback therapy is recommended for patients referred to tertiary units with dyssynergic defaecation who fail conservative therapy. Future research should be directed towards identifying validated outcomes and the optimum method for delivering biofeedback therapy. Home biofeedback therapy may improve accessibility and recruitment to future clinical trials.
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Affiliation(s)
- D Moore
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia. .,Department of Surgery, The University of Sydney, Sydney, NSW, Australia. .,RPAH Medical Centre, Suite G07/100 Carillon Ave, Newton, NSW, 2042, Australia.
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19
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Zahid A, Rajan V, Hong J, Young CJ. Surgical Competencies Required in Newly Commencing Colorectal Surgeons: an Educational and Training Spectrum. Med Sci Educ 2020; 30:1043-1047. [PMID: 34457766 PMCID: PMC8368516 DOI: 10.1007/s40670-020-01005-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Surgical training models have changed from master-apprentice to competency-based training. We aimed to determine the relative importance and peak periods of acquiring these competencies in newly commencing colorectal surgeons. METHODS A mailed questionnaire to all current Colorectal Surgical Society of Australia and New Zealand (CSSANZ) members was conducted between October and December 2016 assessing the relative importance of each competency and the period or activity of learning or training contributing most to achieving that competency. RESULTS The response rate was 43% (90/208) with 87% (n = 75) agreed or strongly agreed to the relevance and applicability of the nine RACS competencies. Competencies varied in perceived importance (strongly agreed: judgment-clinical decision-making (JU) 63%, collaboration/teamwork (CT) 53%, technical expertise (TE) 47%, communication (CO) 44%, medical expertise (ME) 34%, scholarship/teaching (ST) 33%, professionalism (PR) 33%/ethics (ET) 24%, health advocacy (HA) 18%, management (MX) 13%/leadership (LE) 17%), and the peak period for acquiring them (registrar: CO 39%, ST 30%; fellow: TE 62%, CT 44%, ME 40%, JU 38%; consultant: MX/LE 52%, HA 48%, PR/ET 33%). CONCLUSION Surgical competencies for colorectal surgeons are accumulated and acquired at varying degrees and periods across a spectrum of continuing registrar, fellow, and consultant education and training. These findings serve as a baseline for further refinement of current and continuing educational and training programs.
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Affiliation(s)
- Assad Zahid
- Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW Australia
- Discipline of Surgery, University of Sydney, Sydney, NSW Australia
| | - Vasant Rajan
- Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW Australia
- Discipline of Surgery, University of Sydney, Sydney, NSW Australia
| | - Jonathan Hong
- Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, University of Sydney, Missenden Rd, Camperdown, Sydney, NSW 2050 Australia
| | - Christopher J. Young
- Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW Australia
- Discipline of Surgery, University of Sydney, Sydney, NSW Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, University of Sydney, Missenden Rd, Camperdown, Sydney, NSW 2050 Australia
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20
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Ahmadi N, Ravindran P, Kim T, Ayoubi SE, Byrne CM, Young CJ. C-reactive protein trajectory in the first 48 hours predicts the need for intervention in conservative management of acute diverticulitis. ANZ J Surg 2020; 90:2036-2040. [PMID: 32755032 DOI: 10.1111/ans.16176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/27/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND C-reactive protein (CRP) is a useful marker for monitoring response to treatment in sepsis. The aim of this study was to examine the use of CRP trajectory in predicting the need for intervention in conservatively managed patients with acute diverticulitis (AD). METHODS A retrospective review of patients with AD who were managed conservatively was performed. They were divided into four groups based on CRP relative to the median at day 0 and 2: 'Low rise' (levels below median at day 0 and 2), 'High rise' (levels above median at day 0 and 2), 'Rapid rise' (levels below median at day 0 but above median at day 2) and 'Decline' (levels above median at day 0 but below median at day 2). RESULTS Intervention was required in 64 of 456 (14%) with 30 (48%) of these performed after day 2 of admission. There were 150 patients (54%) in the 'Low rise', 76 (27%) in the 'Decline', 26 patients (9%) in the 'Rapid rise' and 25 patients (9%) in the 'High rise' groups. Within these groups 5%, 8%, 19% and 32% of patients required intervention (P = 0.001). On multivariate analysis, patients with a pelvic abscess were more likely to need intervention (odds ratio 19.1 (confidence interval 6.2-59.4), P < 0.0001). CONCLUSION The CRP trajectory during the initial 48 h of admission can predict the need for intervention in AD patients being managed conservatively. Patients with a 'Rapid rise' or 'High rise' in CRP from day 0 to 2 are more likely to need intervention.
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Affiliation(s)
- Nima Ahmadi
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Praveen Ravindran
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Taejun Kim
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Salah E Ayoubi
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher M Byrne
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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21
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Williams ML, Hutchinson AG, Oh DD, Young CJ. Trends in Australian inguinal hernia repair rates: a 15‐year population study. ANZ J Surg 2020; 90:2242-2247. [DOI: 10.1111/ans.16192] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/28/2020] [Accepted: 07/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michael L. Williams
- Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Adam G. Hutchinson
- Department of General Surgery Bendigo Hospital Bendigo Victoria Australia
| | - Daniel D. Oh
- Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Christopher J. Young
- Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
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22
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Hong JSY, Brown KGM, Waller J, Young CJ, Solomon MJ. The role of MRI pelvimetry in predicting technical difficulty and outcomes of open and minimally invasive total mesorectal excision: a systematic review. Tech Coloproctol 2020; 24:991-1000. [PMID: 32623536 DOI: 10.1007/s10151-020-02274-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The difficulty of performing total mesorectal excision (TME) for rectal cancer partly relies on the surgeon's subjective assessment of the individual patient's pelvic anatomy and tumour characteristics, which generally influences the choice of platform used (open, laparoscopic, robotic or trans-anal surgery). Recent studies have found associations between several anatomical pelvic measurements and surgical difficulty. The aim of this study was to systematically review existing data reporting the use of magnetic resonance imaging (MRI)-based pelvic measurements to predict technical difficulty and outcomes of TME, and determine whether pelvimetry could optimise patient-specific selection of a particular surgical approach. METHODS MEDLINE, Embase and Cochrane Library databases were systematically searched for studies reporting MRI-based pelvic measurements in patients undergoing surgery for rectal cancer, and the effect of these measurements on surgical difficulty. RESULTS Eleven studies reporting the association between MRI-pelvimetry measurements and rectal cancer surgical outcomes were included. Indicators for surgical difficulty used in the included studies were involved circumferential resection margin, longer operative time, incomplete TME, higher blood loss, anastomotic leak, conversion to open surgery and overall complications. Bony pelvic measurements which were associated with increased surgical difficulty in more than one study were a smaller interspinous distance, a smaller intertubercle distance, a smaller pelvic inlet and larger pubic tubercle height. Two studies identified larger mesorectal fat area as a predictor of surgical difficulty. CONCLUSIONS Bony pelvic measurements may predict surgical difficulty during TME, however, use of different indicators of difficulty limit comparison between studies. Early data suggest MRI soft tissue measurements may predict surgical difficulty and warrants further investigation.
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Affiliation(s)
- J S-Y Hong
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia. .,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia. .,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia. .,Central Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, Australia.
| | - K G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - J Waller
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - C J Young
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
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23
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Steffens D, Koh C, Ansari N, Solomon MJ, Brown K, McBride K, Young J, Young CJ, Moran B. Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Early Results from a Prospective Cohort Study of 115 Patients. Ann Surg Oncol 2020; 27:3986-3994. [PMID: 32285283 DOI: 10.1245/s10434-020-08443-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study aimed to describe short- and medium-term longitudinal quality-of-life (QoL) outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS Consecutive patients undergoing CRS and HIPEC were recruited. The primary outcome was QoL, measured using the short-form 36 questionnaire and expressed as a physical component score (PCS) and a mental component score (MCS), with higher scores representing better QoL. Data were collected prospectively at baseline and before discharge, then 3, 6, and 12 months postoperatively. Trajectories of the PCS and MCS were described for the study period and grouped according to a peritoneal carcinomatosis index (PCI) (≤ 12 vs. ≥ 13) and a completeness of cytoreduction (CC) score (CC0 vs. CC1-CC3). RESULTS Overall, 117 patients underwent CRS and HIPEC and 115 (98.3%) of the 117 patients participated in the study. The main primary pathology was colorectal in 52 (45%) of the 115 patients and appendiceal in 27 (23.5%) of the 115 patients. The median baseline PCS [48.16; interquartile range (IQR), 38.6-54.9] had decreased at pre-discharge (35.34; IQR, 28.7-41.8), then increased slightly at 3 months (42.54; IQR, 37.6-51.6), before returning to baseline within 6 months (48.35; IQR, 39.1-52.5) and remaining unchanged 12 months after surgery (48.55; IQR, 40.8-55.5). The MCS remained unchanged during the study period. The patients with a PCI of 13 or higher had worse PCS and MCS during the postoperative period than the patients with a PCI of 12 or lower. CONCLUSIONS The CRS and HIPEC procedures impaired PCS, with scores returning to baseline within 6 months after surgery, whereas MCS remained unchanged. The patients with a lower PCI had better postoperative QoL outcomes. For patients with peritoneal malignancy, CRS and HIPEC can be performed with acceptable short- to medium-term QoL outcomes.
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia. .,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kilian Brown
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia.,Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kate McBride
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jane Young
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christopher J Young
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Brendan Moran
- Peritoneal Malignancy Institute, Basingstoke, Basingstoke, UK
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24
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Siddiqui J, Young CJ. Thirteen-year experience with hand-assisted laparoscopic surgery in colorectal patients. ANZ J Surg 2019; 90:113-118. [PMID: 31828890 DOI: 10.1111/ans.15578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND We report outcomes on 324 consecutive cases of hand-assisted laparoscopic surgery (HALS) in colorectal patients over 13 years performed by a single surgeon. METHODS A prospectively maintained database was used to identify all patients undergoing HALS colorectal procedures for benign or malignant indications from September 2004 to February 2018, at two major tertiary centres in Sydney, Australia. RESULTS Median age was 64 years, 51% were female and median body mass index was 26. Colorectal cancer (55%), diverticular disease (13%) and polyp related conditions (13%) were common indications. Anterior resection (65%) and right hemicolectomy (18%) were most commonly performed. Median operative time was 244 min (190-300) and 75% of Gelport incisions were Pfannenstiel. Sixty-three percent of colorectal cancer patients had a T3 or T4 cancer. Median tumour size was 35 mm (25-45). Seven percent required conversion to open and 4% a re-operation in the early post-operative period. Thirty-six percent had a post-operative complication, and 11% were major complications. Follow-up extended to 12.8 years and there were 33 late deaths. Being in a high dependency unit or intensive care unit was significant for late mortality (odds ratio 2.8, 95% confidence interval 1.06-7.78, P = 0.037). Three percent developed an incisional hernia and 6% had small bowel obstruction at long-term follow-up. CONCLUSION HALS is an effective technique for both benign and malignant colorectal indications with the added advantage of tactile feedback and a lower rate of conversion to open.
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Affiliation(s)
- Javariah Siddiqui
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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25
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Oh DD, Bains H, Agostinho N, Young CJ, Storey D, Hong JS. Utility of digitally supported surgical competency assessments in a work‐based setting: a systematic review of the literature. ANZ J Surg 2019; 90:970-977. [DOI: 10.1111/ans.15472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/15/2019] [Accepted: 08/18/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Daniel D. Oh
- Division of Surgery, Royal Prince Alfred Hospital Sydney New South Wales Australia
- Institute of Academic SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
- Central Clinical SchoolThe University of Sydney Sydney New South Wales Australia
| | - Harinder Bains
- Division of Surgery, Royal Prince Alfred Hospital Sydney New South Wales Australia
- Institute of Academic SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Nelson Agostinho
- Division of Surgery, Royal Prince Alfred Hospital Sydney New South Wales Australia
- Institute of Academic SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Christopher J. Young
- Division of Surgery, Royal Prince Alfred Hospital Sydney New South Wales Australia
- Institute of Academic SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
- Central Clinical SchoolThe University of Sydney Sydney New South Wales Australia
| | - David Storey
- Division of Surgery, Royal Prince Alfred Hospital Sydney New South Wales Australia
- Institute of Academic SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
- Central Clinical SchoolThe University of Sydney Sydney New South Wales Australia
| | - Jonathan S. Hong
- Division of Surgery, Royal Prince Alfred Hospital Sydney New South Wales Australia
- Institute of Academic SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
- Central Clinical SchoolThe University of Sydney Sydney New South Wales Australia
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26
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Cheong JY, Chami B, Fong GM, Wang XS, Keshava A, Young CJ, Witting P. Randomized clinical trial of the effect of intraoperative humidified carbon dioxide insufflation in open laparotomy for colorectal resection. BJS Open 2019; 4:45-58. [PMID: 32011809 PMCID: PMC6996635 DOI: 10.1002/bjs5.50227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/28/2019] [Indexed: 01/20/2023] Open
Abstract
Background Animal studies have shown that peritoneal injury can be minimized by insufflating the abdominal cavity with warm humidified carbon dioxide gas. Methods A single‐blind RCT was performed at a tertiary colorectal unit. Inclusion criteria were patient aged 18 years and over undergoing open elective surgery. The intervention group received warmed (37°C), humidified (98 per cent relative humidity) carbon dioxide (WHCO2 group). Multiple markers of peritoneal inflammation and oxidative damage were used to compare groups, including cytokines and chemokines, apoptosis, the 3‐chlorotyrosine/native tyrosine ratio, and light microscopy on peritoneal biopsies at the start (T0) and end (Tend) of the operation. Postoperative clinical outcomes were compared between the groups. Results Of 40 patients enrolled, 20 in the WHCO2 group and 19 in the control group were available for analysis. A significant log(Tend/T0) difference between control and WHCO2 groups was documented for interleukin (IL) 2 (5·3 versus 2·8 respectively; P = 0·028) and IL‐4 (3·5 versus 2·0; P = 0·041), whereas apoptosis assays documented no significant change in caspase activity, and similar apoptosis rates were documented along the peritoneal edge in both groups. The 3‐chlorotyrosine/tyrosine ratio had increased at Tend by 1·1‐fold in the WHCO2 group and by 3·1‐fold in the control group. Under light microscopy, peritoneum was visible in 11 of 19 samples from the control group and in 19 of 20 samples from the WHCO2 group (P = 0·006). The only difference in clinical outcomes between intervention and control groups was the number of days to passage of flatus (2·5 versus 5·0 days respectively; P = 0·008). Conclusion The use of warmed, humidified carbon dioxide appears to reduce some markers related to peritoneal oxidative damage during laparotomy. No difference was observed in clinical outcomes, but the study was underpowered for analysis of surgical results. Registration number: NCT02975947 (
http://www.clinicaltrials.gov/).
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Affiliation(s)
- J Y Cheong
- Colorectal Unit, Concord Repatriation General Hospital, Concord Clinical School, Concord, New South Wales, Australia.,Department of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - B Chami
- Department of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - G M Fong
- Department of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - X S Wang
- Department of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - A Keshava
- Colorectal Unit, Concord Repatriation General Hospital, Concord Clinical School, Concord, New South Wales, Australia
| | - C J Young
- Colorectal Unit, Concord Repatriation General Hospital, Concord Clinical School, Concord, New South Wales, Australia
| | - P Witting
- Department of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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27
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Agostinho N, Hamilton AE, Young CJ. Could it be an anastomotic leak? A pelvic abscess of unknown aetiology. ANZ J Surg 2019; 90:1169-1171. [PMID: 31578785 DOI: 10.1111/ans.15443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nelson Agostinho
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Auerilius E Hamilton
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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28
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Siddiqui J, Cheong JY, Young CJ. Blame the drain: early post-operative small bowel obstruction due to drain. ANZ J Surg 2019; 90:927-930. [PMID: 31566276 DOI: 10.1111/ans.15433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Javariah Siddiqui
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ju Yong Cheong
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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29
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Ansari N, Brown KGM, McBride KE, Steffens D, Koh CE, Young CJ, Solomon MJ, Moran BJ. Accelerating the learning curve in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy using an external mentor model. ANZ J Surg 2019; 89:1097-1101. [PMID: 31280498 DOI: 10.1111/ans.15331] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an accepted therapeutic approach in selected patients with peritoneal malignancy. The aim of this study was to describe early outcomes in the first 50 patients managed with CRS and HIPEC in a newly established peritoneal malignancy centre in Sydney, Australia, under the guidance of an experienced peritoneal malignancy mentor. METHODS This is a retrospective review of a prospective maintained database of early outcomes in the first 50 patients who underwent CRS and HIPEC between April 2017 and April 2018 at a newly established peritoneal malignancy centre. Type of primary, surgery time, length of hospital stay, blood loss, peritoneal carcinomatosis index, completeness of surgery, complications, recurrence rate and 30-day mortality were reviewed. RESULTS A total of 135 patients were referred and reviewed at the multidisciplinary team meeting with 50 (26 male) patients undergoing CRS and HIPEC. Of these 50 patients, 47 (94%) underwent complete cytoreduction while three (6%) had maximal tumour debulking surgery. Tumour pathology was of appendix origin (44%) and colorectal peritoneal metastases (44%). Median surgical time was 7.4 h (interquartile range 5.7-10.0). Median length of hospital stay was 13 days (interquartile range 9.7-19.0). Six (12%) patients experienced a grade III or IV Clavien-Dindo complication. There was no 30-day mortality. CONCLUSION This study reports the successful establishment of a peritoneal malignancy centre under the guidance of an experienced peritoneal malignancy mentor. The short-term surgical outcomes observed in the first 50 cases are promising and comparable to other more experienced centres.
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Affiliation(s)
- Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kilian G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate E McBride
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Cherry E Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brendan J Moran
- Peritoneal Malignancy Institute, North Hampshire Hospital, Basingstoke, UK
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30
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Ahmadi N, Howden WB, Ahmadi N, Byrne CM, Young CJ. Increasing primary anastomosis rate over time for the operative management of acute diverticulitis. ANZ J Surg 2019; 89:1080-1084. [PMID: 31272133 DOI: 10.1111/ans.15321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/01/2019] [Accepted: 05/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over the past two decades, there has been mounting evidence that primary anastomosis (PA) is a safe alternative to Hartmann's procedure (HP) in acute diverticulitis. In addition, specialized colorectal surgeons are more likely to perform PA. This study aimed to analyse if this evidence has led to an increase in the rate of PA in a major tertiary institution over time. METHODS A retrospective observational study of patients requiring operative management of acute diverticulitis from 1 January 2001 to 31 December 2015 at a tertiary teaching hospital. RESULTS One hundred and eighteen patients underwent surgery for acute diverticulitis. Patients who failed initial conservative management were more likely to have PA (43% versus 21%, P = 0.044). There was no difference in medical or surgical complications, readmission rate or mortality between patients who had a PA compared with HP. Patients were more likely to have a PA if a colorectal surgeon was operating compared with a colorectal surgery fellow or general surgeon (36% versus 19% versus 10%, P = 0.039). In patients with modified Hinchey 0-2, there was an increased PA rate within the study period, 21%, 43%, 63% to 57% from the first to the fourth quartile of patients (P = 0.038). CONCLUSIONS The mounting evidence for the safety of performing PA has led to an increase in the PA rates for acute diverticulitis. Patients who were operated by a colorectal surgeon were more likely to have a PA. The morbidity and mortality were similar in patients who had PA compared with HP.
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Affiliation(s)
- Nima Ahmadi
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - William B Howden
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nazanin Ahmadi
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher M Byrne
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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31
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Abstract
Background Surgeons use the Internet and social media to provide health information, promote their clinical practice, network with clinicians and researchers, and engage with journal clubs and online campaigns. While surgical patients are increasingly Internet-literate, the prevalence and purpose of searching for online health information vary among patient populations. We aimed to characterise patient and colorectal surgeon (CRS) use of the Internet and social media to seek health information. Methods Members of the Colorectal Society of Australia and New Zealand and patients under the care of CRS at the Royal Prince Alfred Hospital, Sydney, were surveyed. Questions pertained to the types of information sought from the Internet, the platforms used to seek it, and the perceived utility of this information. Results Most CRS spent 2–6 h per week using the Internet for clinical purposes and an additional 2–6 h per week for research. 79% preferred literature databases as an information source. CRS most commonly directed patients to professional healthcare body websites. 59% of CRS use social media, mainly for socialising or networking. Nine percent of surgeons spent > 1 h per week on social media for clinical or research purposes. 72% of surgeons have a surgical practice website. 43% of patients searched the Internet for information on their doctor, and 75% of patients sought information on their symptoms or condition. However, 25% used health-specific websites, and 14% used professional healthcare body websites. Around 84% of patients found the information helpful, and 8% found it difficult to find information on the Internet. 12% of patients used social media to seek health information. Conclusions Colorectal surgery patients commonly find health information on the Internet but social media is not a prominent source of health information for patients or CRS.
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Affiliation(s)
- Leonora E Long
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Christopher Leung
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Jonathan S Hong
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Caroline Wright
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Christopher J Young
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia. .,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia. .,Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
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32
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Zahid A, Hong J, Young CJ. Response to Comments by Hathaway and Heinsohn. Surg Innov 2019; 26:267. [DOI: 10.1177/1553350619827150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Assad Zahid
- University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Hong
- University of Sydney, Sydney, New South Wales, Australia
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33
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Abstract
Memory for numbers improves with age. One source of this improvement may be learning linear spatial–numeric associations, but previous evidence for this hypothesis likely confounded memory span with quality of numerical magnitude representations and failed to distinguish spatial–numeric mappings from other numeric abilities, such as counting or number word-cardinality mapping. To obviate the influence of memory span on numerical memory, we examined 39 3- to 5-year-olds’ ability to recall one spontaneously produced number (1–20) after a delay, and the relation between numeric recall (controlling for non-numeric recall) and quality of mapping between symbolic and non-symbolic quantities using number-line estimation, give-a-number estimation, and counting tasks. Consistent with previous reports, mapping of numerals to space, to discrete quantities, and to numbers in memory displayed a logarithmic-to-linear shift. Also, linearity of spatial–numeric mapping correlated strongly with multiple measures of numeric recall (percent correct and percent absolute error), even when controlling for age and non-numeric memory. Results suggest that linear spatial–numeric mappings may aid memory for number over and above children’s other numeric skills.
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Affiliation(s)
- John Opfer
- Department of Psychology, The Ohio State University, Columbus, OH, United States
| | - Dan Kim
- Department of Psychology, The Ohio State University, Columbus, OH, United States
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34
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Chapuis PH, Bokey E, Chan C, Keshava A, Rickard MJFX, Stewart P, Young CJ, Dent OF. Recurrence and cancer-specific death after adjuvant chemotherapy for Stage III colon cancer. Colorectal Dis 2019; 21:164-173. [PMID: 30253025 DOI: 10.1111/codi.14434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/12/2018] [Indexed: 12/14/2022]
Abstract
AIM The recommended standard of care for patients after resection of Stage III colon cancer is adjuvant 5-fluorouracil based chemotherapy - FOLFOX (fluorouracil, leucovorin with oxaliplatin) - or CAPOX (capecitabine, oxaliplatin). This may be modified in older patients or depending on comorbidity. This has been challenged recently as the apparent benefit of adjuvant chemotherapy may arise from improvements in surgery or preoperative imaging or pathology staging. This study compares recurrence and colon-cancer-specific death between patients who received postoperative adjuvant chemotherapy and those who did not. METHOD Prospectively recorded data from 363 consecutive patients who had a resection for Stage III colonic adenocarcinoma between 1995 and 2010 inclusive were analysed. Surviving patients were followed for at least 5 years. The suitability of patients for chemotherapy was discussed routinely at multidisciplinary team meetings. The incidence of recurrence and colon-cancer-specific death was evaluated by competing risk methods. RESULTS After adjustment for the competing risk of non-colorectal cancer death, there was no significant difference in recurrence between the 204 patients who received chemotherapy and the 159 who did not [hazard ratio (HR) 0.94, 95% CI 0.66-1.32, P = 0.700) and no significant difference in colon-cancer-specific death (HR 0.73, 95% CI 0.50-1.04, P = 0.084; HR 0.88, 95% CI 0.57-1.36, P = 0.577 after adjustment for relevant covariates). CONCLUSION These findings question the routine use of chemotherapy after complete mesocolic excision for Stage III colon cancer. Recurrence and cancer-specific death, assessed by competing risk methods, should be the standard outcomes for evaluating the effectiveness of adjuvant chemotherapy after potentially curative resection.
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Affiliation(s)
- P H Chapuis
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - E Bokey
- Departments of Colorectal Surgery and Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - C Chan
- Division of Anatomical Pathology, Concord Hospital, Sydney, New South Wales, Australia.,Discipline of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - A Keshava
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - M J F X Rickard
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - P Stewart
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - C J Young
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - O F Dent
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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35
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Siddiqui J, Fowler GE, Zahid A, Brown K, Young CJ. Treatment of anal fissure: a survey of surgical practice in Australia and New Zealand. Colorectal Dis 2019; 21:226-233. [PMID: 30411476 DOI: 10.1111/codi.14466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/19/2018] [Indexed: 12/19/2022]
Abstract
AIM The aim was to determine whether or not the clinical management of anal fissure in Australia and New Zealand accords with published guidelines. METHODS A comprehensive survey based on common clinical scenarios was distributed to 206 colorectal surgeons in Australia and New Zealand. RESULTS The response rate was 44% (91 surgeons). For 19 topic areas, only seven (37%) reached consensus (defined as > 70% majority opinion). Of these, six (86%) agreed with guideline recommendations. Twelve (63%) topic areas demonstrated community equipoise (defined as less than or equal to 70% majority opinion), of which five (42%) agreed with guideline recommendations and seven (58%) disagreed with guidelines. Of the seven topics that disagreed with guidelines, three were based on moderate quality evidence (first line management of acute anal fissure in a young patient, fissure healing and faecal incontinence rates following anocutaneous flap) and four were based on low quality evidence (length of sphincter division during a lateral sphincterotomy in women, management of chronic low-pressure anal fissures postpartum, fissure healing rate following anoplasty with botulinum toxin or sphincterotomy and faecal incontinence rates following repeat sphincterotomy for recurrence). Consensus and/or agreement with guidelines were more prevalent in management when medical therapy failed. CONCLUSION While areas of consensus mostly agreed with guideline recommendations, there remain many areas of community equipoise which warrant further research.
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Affiliation(s)
- J Siddiqui
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - G E Fowler
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - A Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - K Brown
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
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De Robles MS, Bakhtiar A, Young CJ. Obesity is a significant risk factor for ileostomy site incisional hernia following reversal. ANZ J Surg 2019; 89:399-402. [PMID: 30684304 DOI: 10.1111/ans.14983] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/21/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Incisional hernia following ileostomy reversal can cause significant morbidity, impaired quality of life, and burden on the healthcare system. This study aimed to determine the prevalence of ileostomy site incisional hernia following reversal and to identify possible risk factors for its development. METHODS This was a retrospective cohort study involving consecutive patients who underwent ileostomy reversal between November 1999 to February 2015 by a single surgeon. Primary outcome analysed was incisional hernia occurrence at the previous stoma site. RESULTS Two hundred and twenty-four ileostomy reversals were identified. The most common indication for ileostomy construction was colorectal cancer, followed by inflammatory bowel disease and diverticulosis. The stomas were either a loop (75%), end-loop (24%) or end ileostomy (1%). The mean time interval from the stoma creation to reversal was 6.1 months (range 2-69, SD 7.1). After a mean follow-up of 30.7 months (range 10-89, SD 15.1), 12 patients (5%) developed a hernia at the previous stoma. The mean time for hernia occurrence was 25.2 months (range 3-126, SD 32). Patients who developed ileostomy site incisional hernia were more likely to have a higher body mass index (28.1 versus 26.3, P = 0.007). CONCLUSION Although we found a lower rate of incisional hernias after reversal of ileostomies than reported elsewhere in the literature, it remains a significant clinical problem. Obesity is a significant risk factor for ileostomy-site incisional hernia.
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Affiliation(s)
- Marie Shella De Robles
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Arsalan Bakhtiar
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney Central Clinical School, Sydney, New South Wales, Australia
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Ly MMG, De Robles MS, Mckenzie C, Young CJ. Colonic lymphangioma presenting with intermittent pain and intussusception. J Surg Case Rep 2019; 2019:rjy336. [PMID: 30651966 PMCID: PMC6329364 DOI: 10.1093/jscr/rjy336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/29/2018] [Indexed: 11/13/2022] Open
Abstract
Background Cystic lymphangiomas are rare benign tumours and their actual incidence in the colon is unclear. Within the large bowel, these lesions are often submucosal and are incidental findings on colonoscopy. Case report A 43-year-old man with colonic lymphangioma presented with a 7-month history of abdominal pain and altered bowel habits. Computed tomography showed a cystic mass lesion at the distal descending colon. Colonoscopy revealed a smooth, polypoid mass, initially thought as an inverting diverticulum. He underwent laparoscopic high anterior resection. The pathological analysis revealed the descending colon mass to be a lymphangioma with no evidence of diverticulosis. Conclusion There is increasing incidence in lymphangioma due to the increasing accessibility to colonoscopy, particularly for asymptomatic or subacute disease. Although colonoscopic excision, sclerotherapy and use of steroids or fibrin glue have been advocated as possible modes of treatment, surgical excision is still considered to be the treatment of choice.
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Affiliation(s)
- Mark M G Ly
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Marie Shella De Robles
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Catriona Mckenzie
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, New South Wales, Australia
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De Robles MS, Young CJ. Rubber Band Ligation of Hemorrhoids is often a Necessary Complement in the Management of Hemorrhagic Radiation Proctitis. Scand J Surg 2019; 109:108-114. [PMID: 30632450 DOI: 10.1177/1457496918822619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Management of radiation proctitis presents a treatment challenge. Limited data exist on the management of symptomatic hemorrhoids in radiated patients. This study aims to present a practical approach to the management of radiation proctitis, particularly in patients with synchronous hemorrhoids. METHODS A total of 52 consecutive cases of radiation proctitis managed between September 1999 and October 2017 were retrospectively reviewed. The primary treatment was formalin application, plus rubber band ligation in conjunction with formalin when hemorrhoids were a significant component of bleeding, and occasionally argon plasma coagulation. RESULTS The primary indication for radiotherapy was for the treatment of prostate cancer (71%), anal squamous cell carcinoma (10%), and gynecological malignancies (18%). More than half of the patients (52%) presented with radiation proctitis and concomitant internal hemorrhoids. The hemorrhoids were managed with rubber band ligation (56%) and stapled hemorrhoidectomy (7%), at the same procedure as formalin application. At a median follow-up of 12 months, no recurrent rectal bleeding occurred, and no further treatment was needed for most patients. One patient experienced a short period of perianal pain, which was treated with analgesics. CONCLUSION Formalin application has consistently demonstrated an excellent cure rate and safety profile comparable with the published results as a primary treatment for radiation proctitis. The prolapse of irradiated mucosa over the internal hemorrhoids appears to exacerbate bleeding. Local hemorrhoid treatment is often required as an adjunct in the management of these patients.
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Affiliation(s)
- M S De Robles
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia.,RPAH Medical Centre, Newtown, NSW, Australia
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Hamilton AER, Young CJ. Surveys still teach vital non-technical lessons in General Surgery. ANZ J Surg 2018; 89:159-164. [PMID: 30485674 DOI: 10.1111/ans.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/23/2018] [Accepted: 09/29/2018] [Indexed: 11/27/2022]
Abstract
In general surgery, observational studies are disregarded and often seen as non-noteworthy research. We intend to defend the use of surveys in general surgery and colorectal surgery. This review highlights the historical importance and contemporary utility of surveys internationally and in our region, thus reminding Australasian surgeons and clinicians in numerous disciplines of the usefulness of this research tool. Well-constructed surveys often successfully capture qualitative data otherwise impossible to collect through randomized controlled trial. The results of these surveys may advise national policies and medical registration agencies thus having a direct influence on individuals and their public health. Samples from contemporary survey-based research publications from international and Australasian authors are used to illustrate some of the vital non-technical lessons learned in recent times.
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Affiliation(s)
- Auerilius E R Hamilton
- Colorectal Surgery Unit, Royal Prince Alfred Hospital, Institute of Academic Surgery, Sydney, New South Wales, Australia
| | - Christopher J Young
- Colorectal Surgery Unit, Royal Prince Alfred Hospital, Institute of Academic Surgery, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
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Young CJ. ASO Author Reflections: Metastatic Melanoma to the Large Bowel. Ann Surg Oncol 2018; 25:675-676. [PMID: 30406486 DOI: 10.1245/s10434-018-6972-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia. .,Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia. .,RPAH Medical Centre, Newtown, NSW, Australia.
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Sharp G, Young CJ. Point‐of‐care viscoelastic assay devices (rotational thromboelastometry and thromboelastography): a primer for surgeons. ANZ J Surg 2018; 89:291-295. [DOI: 10.1111/ans.14836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 05/28/2018] [Accepted: 06/24/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Gary Sharp
- Department of Colorectal SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Christopher J. Young
- Department of Colorectal SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
- Discipline of SurgeryThe University of Sydney Sydney New South Wales Australia
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De Robles MS, Seyfi D, Zahid A, Young CJ. Karydakis procedure can be effectively performed in the lateral position. ANZ J Surg 2018; 89:E10-E14. [PMID: 30239096 DOI: 10.1111/ans.14844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 06/17/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Karydakis published a large pilonidal series in 1992, reporting a recurrence rate of less than 1% and complication rate of 8.5%. The aim of this study was to compare the outcomes of Karydakis procedure (KP) performed in the lateral versus the prone position in a consecutive series. METHODS Ninety-seven consecutive patients undergoing a KP between March 2000 and February 2018 were retrospectively assessed. Patients with disease sinuses or fistulas extending from the midline to either left or right sides only were considered for KP in the contralateral side position. RESULTS Surgery was carried out for primary pilonidal disease in 71 patients (73%) and for recurrent disease in 26 patients (27%). The majority (62%) of pilonidal tracts veered off from the midline to either the left or right side only. Wound complications, mostly minor skin separation, occurred in 37 patients (38%). Disease recurrence occurred in eight patients (8%). There was no difference between patients who had KP in a lateral position compared with those operated in a prone position regarding wound complications (41% versus 35%, P = 0.675), disease recurrence (9% versus 7%, P = 1.000), mean operating time (64.6 min versus 66.6 min, P = 0.259) and mean length of hospital stay (1 day for both groups). CONCLUSIONS Pilonidal surgery in the lateral position has potential benefits for patient safety, patient comfort and theatre efficiency. The clinical results of this series show that the KP can be performed safely and effectively with the patient in the lateral position for most cases of pilonidal disease.
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Affiliation(s)
- Marie S De Robles
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Doruk Seyfi
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Assad Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
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Young CJ. 'To a man with a hammer, everything looks like a nail' (Abraham Maslow). ANZ J Surg 2018; 88:816-817. [PMID: 30182416 DOI: 10.1111/ans.14757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/06/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
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Toh JWT, Young CJ, Rickard MJFX, Keshava A, Stewart P, Whiteley I. Peristomal pyoderma gangrenosum: 12-year experience in a single tertiary referral centre. ANZ J Surg 2018; 88:E693-E697. [DOI: 10.1111/ans.14707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/17/2018] [Indexed: 11/26/2022]
Affiliation(s)
- James W. T. Toh
- Division of Colorectal Surgery, Department of Surgery; Concord Hospital, Concord Clinical School, The University of Sydney; Sydney New South Wales Australia
- Division of Colorectal Surgery, Department of Surgery; Westmead Hospital, Westmead Clinical School, The University of Sydney; Sydney New South Wales Australia
| | - Christopher J. Young
- Division of Colorectal Surgery, Department of Surgery; Concord Hospital, Concord Clinical School, The University of Sydney; Sydney New South Wales Australia
- Division of Colorectal Surgery, Department of Surgery; Royal Prince Alfred Hospital, RPAH Clinical School, The University of Sydney; Sydney New South Wales Australia
| | - Matthew J. F. X. Rickard
- Division of Colorectal Surgery, Department of Surgery; Concord Hospital, Concord Clinical School, The University of Sydney; Sydney New South Wales Australia
| | - Anil Keshava
- Division of Colorectal Surgery, Department of Surgery; Concord Hospital, Concord Clinical School, The University of Sydney; Sydney New South Wales Australia
| | - Peter Stewart
- Division of Colorectal Surgery, Department of Surgery; Concord Hospital, Concord Clinical School, The University of Sydney; Sydney New South Wales Australia
| | - Ian Whiteley
- Division of Colorectal Surgery, Department of Surgery; Concord Hospital, Concord Clinical School, The University of Sydney; Sydney New South Wales Australia
- Division of Colorectal Surgery, Department of Surgery; Royal Prince Alfred Hospital, RPAH Clinical School, The University of Sydney; Sydney New South Wales Australia
- Stoma Therapy; Concord Hospital, Concord Clinical School, The University of Sydney; Sydney New South Wales Australia
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Abstract
In this article, we review approaches to modeling a connection between spatial and mathematical thinking across development. We critically evaluate the strengths and weaknesses of factor analyses, meta-analyses, and experimental literatures. We examine those studies that set out to describe the nature and number of spatial and mathematical skills and specific connections between these abilities, especially those that included children as participants. We also find evidence of strong spatial-mathematical connections and transfer from spatial interventions to mathematical understanding. Finally, we map out the kinds of studies that could enhance our understanding of the mechanisms by which spatial and mathematical processing are connected and the principles by which mathematical outcomes could be enhanced through spatial training in educational settings.
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Affiliation(s)
| | - Susan C Levine
- Department of Psychology, University of Chicago, Chicago, IL, United States
| | - Kelly S Mix
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, United States
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46
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Burnett D, Smith SR, Young CJ. The Surgical Management of Pilonidal Disease is Uncertain Because of High Recurrence Rates. Cureus 2018; 10:e2625. [PMID: 30027017 PMCID: PMC6044486 DOI: 10.7759/cureus.2625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/14/2018] [Indexed: 11/09/2022] Open
Abstract
Background Pilonidal disease is a common condition with no consensus for the best management of chronic disease or current practice in Australia and New Zealand. Methods A survey was distributed among 190 colorectal and 592 general surgeons in Australia and New Zealand. Data was obtained regarding pilonidal surgery volume, procedures performed, non-operative management and recurrence rates. Three clinical scenarios were also presented. Results The response rate was 58% among colorectal surgeons, 18% among general surgeons. Nineteen percent of surgeons were high-volume (>23 operations per year), 47% low-volume (<12 operations per year). The commonest procedure was the Karydakis procedure (77%), with many others performed including rhomboid flaps (36%), Bascom cleft lift (13%), Z-plasty (7%), and gluteal rotation flaps (5%). Fifty-five percent of high-volume surgeons offered more than one operation while only 16% of low-volume surgeons did. Nineteen percent operated on all patients with pilonidal disease, 89% believing off-midline closure to be superior to midline. Disease extent was the main driver for non-operative management; patient factors such as cosmesis and time-off work being the least important. Sixty-four percent reported recurrence rates above 5%, and 37% recurrence rates >10%. Six percent reported no recurrences ever. Five percent reported recurrence rates over 20%, but 24% stated that over one-fifth of their practice consists of recurrent disease. Conclusions This study reports higher recurrence rates than in published series, suggesting many surgeons do not see their own recurrences, with current treatment not as successful as previously thought. Combined with the widespread variation in practice, optimal management of this disease remains unclear.
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Affiliation(s)
- David Burnett
- Department of Colorectal Surgery, John Hunter Hospital, New Lambton Heights, AUS
| | - Stephen R Smith
- Department of Colorectal Surgery, John Hunter Hospital, New Lambton Heights, AUS
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Byrne CM, Young CJ, Zahid A. Reply to response to 'Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomized controlled trial'. Colorectal Dis 2018; 20:450-451. [PMID: 29406594 DOI: 10.1111/codi.14041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/29/2018] [Indexed: 02/08/2023]
Affiliation(s)
- C M Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - A Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
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Byrne CM, Zahid A, Young JM, Solomon MJ, Young CJ. Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomized controlled trial. Colorectal Dis 2018; 20:438-448. [PMID: 29053219 DOI: 10.1111/codi.13930] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 09/11/2017] [Indexed: 12/21/2022]
Abstract
AIM The aim was to compare the effectiveness of chewing sugar-free gum after bowel resection on bowel function and length of stay. METHOD This was a randomized controlled trial of patients undergoing elective open or laparoscopic bowel surgery, who were allocated into two groups: a chewing gum group (CG); or a nonchewing gum group (NG). Primary outcomes were time to discharge (length of hospital stay [LOS]), time to first flatus (TFF) and time to first bowel motion (TBM). Secondary outcomes were complication rates, pain and total morphine equivalent (TMEq) medication for 7 days after the procedure. RESULTS Between 2010 and 2013, 162 patients were randomized; four were excluded, leaving 158 in the study (82 in the CG and 76 in the NG). There was no difference in LOS between the CG (5.8 days) and the NG (6.1 days) (P = 0.403) or in the median TFF between the CG (42.0 h) and the NG (58.0 h) (P = 0.076). The median TBM was lower in the CG (40.0 h) than in the NG (90.0 h) (P = 0.002). There was no difference in intra-operative complications between the CG (9%) and the NG (9%) (P = 0.901) or in early postoperative complications (44% for CG and 55% for NG) (P = 0.131). There was no difference in TMEq at 24 h postprocedure, but the CG had reduced TMEq from days 2 to 7 post procedure and for the 7-day total. Pain was higher among patients in the NG on day 3. CONCLUSION Chewing sugar-free gum resulted in an earlier return to bowel function and decreased analgesic requirements. There was no decrease in overall LOS or postoperative complications.
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Affiliation(s)
- C M Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - J M Young
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Park JS, Ng KS, Saw RPM, Thompson JF, Young CJ. Metastatic Melanoma to the Colon, Rectum, and Anus: A 50-Year Experience. Ann Surg Oncol 2018; 25:2178-2183. [PMID: 29691736 DOI: 10.1245/s10434-018-6451-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Melanoma metastatic to the large bowel (colon, rectum, and anus) is rarely diagnosed, with more than 95% of large bowel metastases identified post-mortem. The incidence, natural history, and survival rates of patients with large bowel melanoma metastases are poorly documented in the literature. OBJECTIVE This study aimed to identify the incidence, clinical characteristics, and survival of patients with large bowel melanoma metastases. METHODS A review was undertaken of all patients with melanoma treated over a 50-year period (1964-2014) at a tertiary referral center. Cases selected for study were those diagnosed with melanoma metastases in the colon, rectum, and anus. Primary colorectal and anal melanomas were excluded. Data were retrieved relating to patient demographics, clinical features, and survival. RESULTS Of 38,279 patients with primary melanoma, 106 patients (0.3%, mean age 51.0 years [standard deviation 16.3], 64 males) developed large bowel metastases. The median interval between diagnosis of primary melanoma and large bowel metastasis was 62.8 months (range 1-476). The most common symptom was rectal bleeding (29.2%), and the large bowel was the sole site of metastasis in 47.2% of patients. Median survival from diagnosis of large bowel metastasis was 31.7 months (range 1-315), and overall survival at 1, 2, and 5 years was 68.1, 45.9, and 26.5%, respectively. CONCLUSION Our study provides insights into melanoma metastatic to the colon, rectum, and anus, which had an incidence of 0.3%. There are potentially long intervals between diagnosis of primary melanoma and large bowel metastasis. The most common symptom was rectal bleeding, although some patients were asymptomatic.
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Affiliation(s)
- Jin-Soo Park
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kheng-Seong Ng
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Robyn P M Saw
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia. .,Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia. .,RPAH Medical Centre, Newtown, NSW, Australia.
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Young CJ, Zahid A. Randomized controlled trial of colonic stent insertion in non-curable large bowel obstruction: a post hoc cost analysis. Colorectal Dis 2018; 20:288-295. [PMID: 29091349 DOI: 10.1111/codi.13951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/18/2017] [Indexed: 12/13/2022]
Abstract
AIM In view of the increasing burden on the healthcare system, this study aims to perform a cost-effectiveness analysis of the management of incurable large bowel obstruction comparing the cost of a stent vs surgery. METHOD A prospective randomized controlled trial was conducted at two major teaching hospitals in Australia between September 2006 and November 2011. Fifty-six patients with malignant incurable large bowel obstruction were randomized to stent insertion or surgical decompression, of whom 52 were included in the final analysis. Data were collected at all points during the patient journey and quality of life data were obtained by patient surveys. All data points were analysed and a cost-effectiveness study was performed to compare the costs between the two treatment groups. RESULTS Stenting as a procedure was significantly more expensive than surgery (A$4462.50 vs A$3251.50; P < 0.001). Post-procedure stay for stented patients was significantly lower (median 7 vs 11 days; P = 0.03). Combined costs of stent group ward stay, multidisciplinary team discussion and complication management were significantly lower (P = 0.013). Overall cost difference between the two treatment groups was A$3902.44 (P = 0.101). European Quality of Life - 5 Dimensions (EQ-5D) scores for the first 4 weeks gave mean area under the curve adjusted weeks of 2.411 vs 2.271 for the stent and surgery groups respectively (P = 0.603). The incremental cost-effectiveness ratio between the surgery and the stent group was $22 955.53 in favour of stenting. CONCLUSIONS Treatment with stenting is cheaper than open surgery and provides quicker discharge from hospital.
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Affiliation(s)
- C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - A Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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