bluuebunny/crossref_metadata_2025 huggingface dataset:
GS08 RISK FACTORS AND QUALITY OF LIFE IN 137 PATIENTS WITH INTESTINAL STOMA COMPLICATIONS
Authors: Richter K. K. , Krug M. , Settmacher U. , Pfeifer M. , Thompson‐fawcett M.
Published: April 2009

Purpose:   Stoma formation is a standard procedure in gastrointestinal surgery; however, the incidence seems to remain high. Here, we performed a prospective study on 137 patients with ileostomy or colostomy in order to identify potential risk factors.

Methodology:   137 patients received stomas and were prospectively followed up four times after surgery. Early and late stoma complications, potential risk factors, and QOL were recorded using a modified SF‐36 form. Results were subjected to statistical analysis and discussed with the view onto the current literature.

Results:   72 patients received a colostomy and 65 patients an ileostomy. There was a complication rate of 55.5% (n = 76). 53 patients had early, 44 patients had late, and some had both early and late complications. Early complications occurred less than two months after surgery and included necrosis (16.1%), abscess (13.9%), and dehiscence (10.9%). Late complications included parastomal hernia (11.7%), chronic peristomal skin alteration (8.8%), stenosis (6.6%), prolaps (3.6%), and retraction 0.7%). 15 patients with late stoma complications needed surgery. High body mass index, emergency procedure, and omitted preoperative stoma marking were associated with significant higher risks for developing stoma complications. The availability of a stoma nurse greatly influenced outcome and QOL.

Conclusion:   Stoma complications are not rare and the surgeon should pay special attention to details of the technique. QOL of stoma patients is greatly influenced by specially trained stoma nurses. The identified risk factors have to be considered in order to reduce the incidence of stoma complications in the future.
GS09 RESULTS OF SURGERY FOR INTESTINAL FAILURE
Authors: Tonkin D. M. , Tandon R. , Vaizey C. J. , Philips R. K. S. , Gabe S. , Nightingale J.
Published: April 2009

Background:   The main aims of intestinal failure (IF) surgery are to reduce the severity of IF in patients by repairing fistulae and restoring continuity in those with short gut, and to restore body image. We report on the surgical management of IF patients at a major tertiary referral institution, in order to evaluate current management practises and outcomes.

Methods:   Retrospective review of outcomes between July 2005 and December 2007.

Results:   60 patients (36 male; median age 47 yrs) underwent 78 operations. On presentation 42 (70%) required parenteral nutrition (PN) and 34 (57%) had stomas. IF was secondary to short gut in 19 (30%) or enterocutaneous fistulae in 42 (70%). Median number of procedures before referral was 4 (1–14). Median time from last operation to our intervention was 365 days (25–3534). Median length of stay postoperatively was 16 days, and at a median follow‐up of 268 days, 54 (90%) had been discharged from surgical care. 7 (12%) required ICU care postoperatively but 30 day/inpatient mortality rates were 0%. Re‐fistulation occurred in 5 patients. 23 (56%) became independent of PN. Residual small bowel length was the only significant contributing factor identified (p = 0.007).

Conclusion:   Surgical management of IF is safe when performed in a dedicated unit and when time is allowed for patient optimisation.
HS01 IMPROVING FUNCTIONAL OUTCOME POST‐REPLANTATION OF THE WRIST
Authors: Ting J. W. , Blake W.
Published: April 2009

The first published successful clinical replantation of the upper limb was first described by Malt and McKhan in 1962. Together with the refinement of reconstructive microsurgical technique, replantation of the upper limb at various levels has progressed at an astonishing rate and is now widely practiced worldwide. The vast majority of research into replantation of upper limb focuses on the digit. At the level of the wrist, the problems of failure of microsurgical anastomosis and tendon adhesions to pulley systems are less pronounced. However functional impairment as a result of the laceration of all tendons and nerves to the hand and bony misalignment is more marked. We outline theses issues with a case report of a 33 years old man who, in a self harm attempt amputated his left hand with a saw. He underwent a primary surgery to replant his hand, and subsequent surgery to improve function to his hand. In particular, we describe the dilemma of tendon transfer to improve opposition of the thumb, vital to fine pincer grip.
HS11P LONGEST RETAINED FOREIGN BODY IN THE HAND – AN 80‐YEAR FOLLOW‐UP
Authors: Kapila S. , Kapila H. B.
Published: April 2009

While it is most often considered that foreign bodies in the hand should be removed, this case demonstrates that it is possible to have good functional and cosmetic result despite multiple foreign bodies embedded in tissues for long periods of times. Reasons to remove foreign bodies include to minimize risk of infection, foreign body reaction, mechanical interference, damage to deeper structures, psychological effects and medico‐legal sequelae and these are discussed in the context of this 80 year follow‐up for retained multiple foreign bodies in the hand. Upon literature review, there was no evidence of any other person living longer with foreign body in‐situ in the hand.

With food scarce in Russia in World War I, this 93 year old man, aged 13 at the time, was given a gun to shoot rabbits for food but accidently shot through the volar surface of his hand. Treated only by the village senior, he had his hand dressed and continued without further examination or assessment, and without treatments including antibiotics or tetanus. Remaining fully‐functional his whole life, he was only referred to hand clinic with hand pain diagnosed as unrelated osteoathritis of the carpometacarpal joint of the ipsilateral hand. Thus, this unique case was encountered by chance upon examination and later verified through history and confirmed subsequently by x‐ray. Though having mild skin changes related to the palpable remnant metal, he has no obvious deformity and has full range of movement. X‐ray showed multiple shrapnel pieces embedded in the soft tissue of the dorsum of the hand. This unique case demonstrates it is possible to have good functional and cosmetic result despite long standing foreign bodies in the hand.
HS12P THE DONA TECHNIQUE FOR FDP AND EDC TENDON FIXATION TO THE DISTAL PHALANX
Authors: Millar M. J. , Dona E.
Published: April 2009

Purpose:   Common methods of repair of zone 1 flexor digitorum profundus (FDP) or extensor tendon avulsion or laceration are the modified Bunnell pullout and suture anchor techniques. While these techniques have extensive use clinically, results show a 75% fair to poor outcome. We present a simple technique for repairing these injuries and discuss its rationale.

Methodology:   A retrospective analysis was undertaken on a consecutive cohort of 5 patients that were treated by the relatively simple method of (1) securing the FDP tendon stump with a 4‐0 Fibreloop suture in a standard Kessler suture configuration (2) creation of transosseous tunnels and (3) passing the sutures through the base of the distal phalanx and then tying them volar to the FDP tendon stump, which effectively results in a 4 strand tendon and 4 strand transosseous suture repair.

Results:   Six month follow up of MCP, PIP, and DIP joint flexion was 99%, 95%, and 86% of that of the uninjured side, respectively, with no complications. All patients were able to return to their pre‐injury level of functioning and employment, with no further operations required. This technique has also been employed when repairing open mallet finger injuries. Additionally, similar principles are used when repairing volar plate avulsion injuries.

Conclusion:   The technique avoids the morbidity associated with both the pullout button and suture anchor techniques, while providing an inexpensive, and highly reproducible, four‐strand biomechanically sound repair that allows an early active mobilization protocol to maximize return of function.
HS13P TOTAL WRIST ARTHROPLASTY‐A REVIEW OF PATIENTS WITH DYSFUNCTIONAL WRISTS
Authors: Lai C. C. , Conolly B. W.
Published: April 2009

Background:   The wrist is essential for augmentation of fine motor control of the hand and fingers. The normal wrist motion involves a complex interaction of articulations from the radius, ulna and carpal bones. Hence, when a disease process disrupts any one of these elements, a painful, deformed and dysfunctional wrist arises. Total wrist arthroplasty is considered an alternative surgical option to wrist fusion for the management of advanced wrist arthritic diseases. Though less commonly performed in comparison to lower‐limb arthroplasty, wrist arthroplasty has its role as a salvage procedure to alleviate pain and preserve function in the wrists.

Method:   Four patients were collected from the Centre of Hand Surgery, Sydney. Medical records of these patients were reviewed. The patient's pre‐and post‐operative functional status via clinical and radiographic assessments were closely followed over an average period of five years to ensure the continuity of progress. A table was formulated to provide an objective survey of both quantitative and qualitative improvement of a patient's wrist function.

Result:  

The four patients received different types of prostheses. This is an indication of a lack of universal acceptance of wrist anatomy and biomechanics. Regardless, all patients in this study had improved functional outcomes. Pain‐relief was the most successful aspect of wrist arthroplasty during post‐operative follow‐ups. The successful outcome of these patients has proven that total wrist arthroplasty can provide pain relief and an improvement in hand function through appropriate patient selections, careful peri‐operative planning, sound operative technique and well‐designed post‐operative hand therapy.
HS14P TRANSCARPAL MIGRATION OF A BROKEN KIRSCHNER WIRE CAUSING ULNAR NEUROPRAXIA
Authors: Dhillon R. S. , Williams K. , Alkadhi A.
Published: April 2009

Kirschner wires have been used for fracture osteosynthesis since 1909. Migration, extrusion and breakage of Kirschner wires are recognized complications with reports of migration to the thorax, spinal cord and abdomen. Several reasons have been postulated for wire migration including gravity, electrolysis and bony resorption, prolonged implantation time and repetitive joint motion.

A 33 year old right hand dominant lumberjack sustained a fracture‐dislocation of the right ring and little finger metacarpals treated with closed reduction and percutaneous Kirschner wire fixation. The proximal oblique Kirschner wire broke following a fall. The asymptomatic retained broken wire was left in‐situ. Ten weeks postoperatively he developed paraesthesia in the Ulnar nerve distribution with associated pain and reduced grip strength.

Repeat radiographic examination revealed that the broken wire had migrated to the palmar and Ulnar aspect of the hand through the intercarpal space which explained the clinical findings. At surgery for wire removal he had developed Median neuropraxia. Image intensification confirmed migration towards carpal tunnel area. A standard open carpal tunnel approach showed the wire to be located at the transverse carpal ligament.

This unusual case illustrates the benefit of having a low threshold for repeat radiographic evaluation of retained broken Kirschner wires in the hand. Due to repetitive joint motion, the risk of retained wires migrating, even when asymptomatic, may be reduced if the involved joint is immobilized during the healing phase and removed as soon as practicable.
HS04 SURGICAL PROCEDURES FOR ADULT UPPER LIMB SPASTICITY
Authors: Gschwind C. R.
Published: April 2009

Purpose:   Despite the growing number of patients with acquired brain injury with upper limb spasticity (ULS) in our community, hand surgery involvement in their management is rare and the literature on this topic is sparse. This presentation endeavours to promote more knowledge on the clinical assessment and surgical options of patients with ULS, including the use of Botulinum Toxin A as a pre‐operative diagnostic tool.

Methodology:   The data of 20 patients operated at Royal North Shore Hospital and North Shore Private Hospital over the last two years are reviewed.

Results:   The results of surgery and outcome measures are presented.

Conclusion:   There is an important role for surgery in the functional and non‐functional spastic upper limb.
HS05 THE HAND ASSESSMENT PRO‐FORMA: IMPROVED COMMUNICATION AND DOCUMENTATION FOR BETTER MEDICAL AND LEGAL OUTCOMES
Authors: Kapila S. , Kapila H. B.
Published: April 2009

Hand cases are common presentations to Emergency Departments and often pose complex clinical challenges in assessment especially by junior doctors. The purpose of the hand assessment pro‐forma is to arm the examining doctors with skills for better assessment, management and documentation of hand cases.

Upon surveying 20 metropolitan emergency departments, it was found that only two had hand specific reference material, four had orthopaedic or general surgical texts, and the rest had only emergency texts immediately available to the perplexed junior doctor. The high demands of emergency departments increase the need for more efficient hand injury management and referral to equally busy on‐call hand services. This standardized, universal, user‐friendly hand assessment pro‐forma proficiently records each component of the assessment in a two‐page examination chart. This ensures timely and complete documentation as it guides the medical officer through assessment in a step wise manner.

The assessment pro‐forma, including the diagrams, can be faxed to the on‐call hand surgeon at the time of referral. Through improved communication and reduced reliance on cumbersome oral description, greater understanding of a case discussed over the phone will allow early intervention, optimised outcome, and minimised costs. Maximum expected standards of documentation are achieved with the completion of each part of the pro‐forma, which reduces possible medical and legal complications.

A readily implemented and simple model with potential for aid to junior doctors is now available which increases efficiency for emergency departments, allowing thorough assessment of patients with reduced hospital costs and risks of litigation.
HS06 EXPLOSIONS IN THE HAND: A CONSISTENT INJURY PATTERN AND AN INDICATION FOR END‐TO‐SIDE NEURORRHAPHY
Authors: Prasad V. , Van zyl N. , Kimble F. W.
Published: April 2009

The pattern of injury to the radial side of the hand produced by an exploding object is constant and well described1–4. The typical patient presents with a degloving laceration over the thenar eminence and first web space. Adductor pollicis is most severely injured with opponens pollicis, flexor pollicus brevis and abductor pollicus brevis sustaining relatively less damage. The skeletal and ligamentous components are also injured in a predictable way. The most common findings are a dislocation of the thumb carpometacarpal joint and/or a Bennett's‐type fracture. The neurovascular bundles are invariably damaged by explosions in the hand but the nerve injury presents us with an interesting problem. The palmar digital nerves are often avulsed from within the substance of the parent nerve leaving no suitable proximal end for repair. In addition the devitalised distal segment requires debridement which produces a nerve gap. Previous authors have not reported on their management of the nerves in this type of injury. We present three cases, illustrating a consistent injury pattern and with management of the digital nerve injuries by end‐to‐side nerve neurorrhaphy. As far as we are aware, this technique has not been described for this particular injury.
HS07 COMPARISON OF BETADINE PAINT AND PLASTIC BAG IMMERSION TECHNIQUES FOR SURGICAL SITE SKIN PREPARATION IN HAND SURGERY
Authors: Dhillon R. S. , Choudhary A. , Chou J.
Published: April 2009

Introduction:   The aim of this study was to compare two techniques for surgical site skin preparation in hand surgery.

Methods:   We compared the standard sponge paint technique versus a plastic bag immersion technique using a 10% povidone iodine with alcohol solution (Betadine) to prepare surgical site skin for hand surgery. This plastic bag immersion technique involves using a sterile plastic bag filled with 60 ml of Betadine solution to immerse the subjects’ hand. Samples were taken from ten subjects for bacteria colony forming unit (CFU) counts before and three minutes after surgical site preparation in each group. Outcome measures were preparation time and CFU reduction with a finger impression test using commercially available agar slides.

Results:   The plastic bag immersion technique significantly reduced (p < 0.0001) the time required for surgical site skin preparation (28 seconds) compared to the standard technique (86 seconds). Both techniques were found to have similar efficacy in the reduction of CFU.

Discussion:  

The plastic bag immersion technique is a quicker alternative method for surgical site preparation in hand surgery and has comparable efficacy to the widely practiced standard paint‐on technique. This technique can be applied across the disciplines of orthopaedic, plastic and vascular surgery involving the hand.
HS08P “THE HAND INJURY WALL CHART”: A TEACHING TOOL FOR THE EMERGENCY DEPARTMENTS
Authors: Kapila S. , Kapila H. B.
Published: April 2009

Teaching has been an integral part of the role of the surgeon since ‘time in memorial’. It can easily be performed in a day‐to‐day, case‐by‐case manner to members of the surgeon's own team but formal teaching to other departments, an equally important responsibility, remains a significant challenge with increasing demands on the current‐day surgeon.

Emergency departments manage a large number of hand injuries and junior doctors are often confronted with these clinical challenges, equipped only with limited knowledge and experience. Upon surveying twenty metropolitan emergency departments, it was found that only two had hand specific reference material, four had orthopaedic or general surgical texts, and the rest had only emergency texts immediately available to the junior doctor of the emergency department. That‐withstanding, time is often wasted reading through pages and pages of reference material in search of a few salient features. Hence, there is a need to design a ‘ready reckoner’.

The Hand Injury Wall Chart proposed is a readily implementable, cost and time effective, simple, poster‐sized chart with point form information, operative pictures and diagrams for early management of common hand injuries (soft tissue, fractures), infection and burns that ensures all important points of management are performed. It can easily be placed on the wall of treatment rooms of all Emergency Departments. It minimises time spent on formal teaching sessions and supplements the prior knowledge of the treating doctor as it is available for review at all times. This helps to improve the approach to management for common hand cases that present to the emergency department and their subsequent functional and cosmetic result.
HN01 TEN YEAR REVIEW OF HEAD AND NECK FREE FLAP SURGERY IN AUCKLAND
Authors: Li S. S. , Chaplin J.
Published: April 2009

Purpose:   Free tissue transfer, pioneered in late 1970s, revolutionized reconstruction of defects created by surgical extirpation of head and neck cancers. Over the subsequent decades an enormous experience with these techniques has been gained. We report our experience of head and neck free flap reconstruction at Auckland Head and Neck unit.

Methodology:   Operative and clinical notes of all head and neck free flap reconstructions from Jan 1999 to 2008 were reviewed. The techniques, flap survival and complications are discussed.

Results:   During the ten year period, total of 320 free flap reconstructions were performed for 294 patients. Of these, 16 patients had two flaps, five patients had three flaps, and these were performed for recurrence of disease, flap losses, and complex defects. Radial forearm flaps were most commonly performed to reconstruct soft tissue defects, particularly in oral cavity defects; whereas bony defects were most commonly reconstructed with fibular flaps. Postoperatively 19 patients (5.9%) were explored for vascular compromise with 84% salvage rate. 14 flap (4.4%) loss was reported, total loss in 8 flaps, the overall flap survival rate was 95.6%.

Conclusion:   Free flap reconstruction have been performed with high standard at Auckland Head and Neck unit, our results are comparable to other international units.
HN02 THE RATE OF PATHOLOGIC OCCULT NECK DISEASE IN PATIENTS WITH METASTATIC SQUAMOUS CELL CARCINOMA TO THE PAROTID OF CUTANEOUS ORIGIN IN THE CLINICALLY NEGATIVE NECK
Authors: Kirke D. N. , Porceddu S. , Wallwork B.
Published: April 2009

Background:   The aim of this study was to document the rate of pathologic neck disease in patients presenting with metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid gland following parotidectomy and neck dissection in the clinically and radiologic negative neck.

Method:   The study involved a retrospective chart review from 1999–2008 of patients presenting with metastatic CSCC to parotid at the Princess Alexandra Hospital.

Results:   Eighty‐one patients with metastatic parotid disease were identified. Seventy (86%) were male, median age was 69 (range 42–91) years and the median follow up was 14 (range 0–101) months. A total of 51 (63%) patients had no clinical or radiological evidence of cervical nodal disease. Thirty‐four of these patients underwent a parotidectomy and neck dissection with/without post‐operative radiotherapy. Occult pathological cervical nodal disease was found in 5 patients. 3 patients relapsed in the parotid, 1 in the neck alone and 1 distantly.

Conclusions:   Our series has shown that the rate of pathologically involved neck nodes in patients with metastatic CSCC to the parotid in the clinically node negative neck is low. Given many of these patients warrant post‐operative radiotherapy to the parotid bed, and the neck can be treated concurrently, an elective neck dissection may not be warranted.
HN03 HEAD AND NECK SECOND PRIMARY TUMORS IN LARYNGEAL SCC ARE NOT ASSOCIATED WITH POORER OVERALL SURVIVAL: A SINGLE CENTER STUDY IN 987 PATIENTS
Authors: Farhadieh R. D. , Rees C. G. , Salardini A. , Lin J. , Russell P. J. , Smee R.
Published: April 2009

Objectives:  

Second Primary Tumours (SPTs) have been implicated in poor Overall Survival (OS) of Head and Neck Squamous Cell Carcinomas (HNSCCs). The incidence of SPTs; the SPT diagnostic time lag; the impact on OS; and the mean annual risk was assessed.

Methods:   987 consecutive patients treated for primary larynx SCC (1967–2004) were analysed in this study. 96.3% and 91.4% of patients reached a minimum follow up period of 3 and 5 years.

Results:   208 (21.1%) patients were diagnosed with SPTs. 143 (14.5%) patients developed upper aero‐digestive tract UAD‐SPTs, 83 (8.4%) were HNSCCs, 56 (5.7%) were lung, and 4 (0.41%) were oesophageal SPTs. Survival analysis demonstrated unexpected but clear superior OS rates for the UAD‐SPT (p < 0.008) and HNSCC‐SPTs (p < 0.001). Patients with synchronous SPTs had a poorer overall survival (p < 0.001). The mean annual risk of developing UAD‐SPTs was 2.4%.

Conclusion:   These results suggest that HNSCC‐SPT should not be viewed as an adverse prognostic factor. Reclassifications of UAD‐SPTs into HNSCC‐SPT and non HNSCC‐SPT better reflects their clinical behaviour and prognosis.
HN05 ADVANCES IN THE MANAGEMENT OF LARYNGEAL DYSPLASIA AND CARCINOMA IN‐SITU
Authors: Broadhurst M. S.
Published: April 2009

Introduction:   Pre‐cancerous lesions of the larynx are common and can progress to invasive carcinoma. Such lesions, usually of the true vocal folds, may then require surgical resection or irradiation with subsequent morbidity of treatment. There is currently no gold standard treatment of glottal dysplasia. Instead, one adopts “watchful waiting” until intervention is deemed necessary at the point of malignant degeneration. Recently, evolving photoangiolytic laser techniques utilizing the pulsed potassium‐titanyl‐phosphate (KTP) laser have provided a successful treatment modality in place of “watchful waiting” minimizing progression to invasive carcinoma.

Methods:   The treatment process and outcome in 4 months of consecutive patients with dysplasia/carcinoma in‐situ was studied. Videophotographic analysis was performed at presentation, during treatments and with follow‐up. Acoustic voice measurements were conducted. Patient treatment consisted of operating theatre and office‐based pulsed‐KTP laser photoangiolysis to involute the disease. The end point was percentage of macroscopic disease regression.

Results:   Five patients underwent initial office assessment, 1–2 operating theatre treatments and 1–2 office‐based treatments depending on disease response. All patients showed complete or near‐complete involution of dysplasia/CIS and the underlying pliability was preserved or improved. Since the institution of this treatment in Australia 6 months ago, no patient has progressed to invasive cancer.

Discussion:  

Pulsed‐KTP photoangiolysis provides a new approach to manage pre‐malignant lesions of the true vocal folds. This enables the trained surgeon to adopt cancer prevention in place of currently practiced watchful waiting.
HN06P COMBINED LASER SURGERY AND ADJUVANT RADIATION THERAPY FOR EARLY LARYNGEAL CANCER
Authors: Mistry R. M. , Gregor R. T.
Published: April 2009

Objective:   The primary objective of this study was to compare outcomes of patients who underwent combined laser surgery and adjuvant radiation therapy with patients who underwent laser surgery alone for the treatment of early laryngeal cancer.

Methods:   A retrospective review of patients who underwent endoscopic laser surgery for early laryngeal cancer between 2000 and 2005 at Waikato Hospital. We compared outcomes for patients who underwent laser surgery alone with those who underwent laser surgery and adjuvant radiation therapy. We reviewed these patients with regards to their demographics, disease stage, treatment, and post‐operative outcomes.
HN07P SMOKING CESSATION IN PATIENTS UNDERGOING TREATMENT FOR HEAD AND NECK CANCER
Authors: Rajpal K. , Mackinnon C. A. , Tan S. T.
Published: April 2009

Aim:   Advice on smoking cessation is part of our overall management for head and neck cancer patients. This study determined the effectiveness of smoking cessation strategy, contributing factors, and long‐term abstinence in these patients.

Method:   Consecutive patients who smoked at the time of diagnosis were culled from our head and neck database. Demographic data, diagnosis and tumour location were recorded. The patients were sent a questionnaire to document their smoking habits, factors that influenced cessation and the interval of abstinence. A follow‐up telephone interview was conducted for non‐responders.

Results:   57 of the 116 patients had deceased. 59 with cancers in the oral cavity (n = 31), oropharynx (n = 5), paranasal sinus (n = 3), bone (n = 4), salivary gland (n = 7), skin (n = 7), and neck metastasis with unknown primary (n = 1). Of the 50 (85%) responders 37 (74%) stopped smoking, with 27 (75%) doing so around the time of diagnosis and treatment. The most influential factor for quitting smoking were the diagnosis of cancer (n = 20), hospitalisation (n = 14), medical (n = 13) and family (n = 8) advice, Quit Line (n = 2) and nicotine replacement therapy (n = 1). The latter 2 factors were ranked 6 and 5 times respectively as the least important factor. Of the 18 (49%) who quitted and restarted smoking, 5 (28%) did so within one month, 7 (39%) 1–12 months, 2 (11%) 1–5 years, and 4 (22%) at unknown interval.

Conclusion:   Most patients undergoing treatment of head and neck cancer quitted smoking in response to a personal “crisis”, reinforced by the non‐smoking hospital environment and consistent medical and family advice. Strategies are needed for the high rate of restarting smoking for successful quitters.
HP01 A SURVEY OF SURGEONS ATTITUDE TO LAPAROSCOPIC LIVER RESECTIONS
Authors: Patel B. M. , O’rourke N. A.
Published: April 2009

Introduction:   Is laparoscopic liver surgery widely performed? What are the attitudes of Australasian surgeons towards laparoscopic liver surgery?

Methods:   An On‐line survey of 143 liver surgeons (all members of ANZHPBA) throughout Australia and New Zealand was performed in mid 2008.

Results:   61 responses were analysed. Two were trainees, 21 fellows and 38 practicing surgeons. 50 respondents (80%) performed more than 10 open liver resections annually. 57 (90%) performed advanced laparoscopic surgery requiring suturing. 48 respondents performed laparoscopic liver resection. 30 have attempted major hepatectomy but only three of these have performed more than five. 37 surgeons have performed left lateral sectionectomy and 15 of them have performed more than 10. All but three surgeons felt that malignancy was not a contraindication to laparoscopic liver resection. The following reasons were given as deterrence stopping surgeons from more frequent laparoscopic liver resections: fear of bleeding (44%), skills not adequate (39%), time constraints (33%), availability of equipment (15%), cost of equipment (13%) and fear of gas embolism (10%). 22 (36%) have attended a laparoscopic liver resection course and 13 (55%) of them found that it influenced their attitude towards laparoscopic liver surgery.

Conclusions:   Many surgeons are performing laparoscopic liver surgery for malignant conditions of the liver, but major hepatectomy is rarely performed. Fear of bleeding, time and skill constraints remain major deterrents.
HP10 POSTOPERATIVE NOMOGRAM FOR DISEASE SPECIFIC SURVIVAL AFTER SURGERY FOR OESOPHAGEAL CANCER
Authors: Thomson I. G. , Waters B. , O’rourke P. , Barbour A. , Smithers M. , Gotley D.
Published: April 2009

Purpose:   The individual predictive ability of the current AJCC staging system for oesophageal cancer has been questioned. The ability to predict disease specific survival would enable treatment to be tailored for individual patients. The aim was to develop and validate a prognostic nomogram for disease specific survival based on patients receiving surgery alone as treatment for oesophageal cancer.

Methodology:   A prospectively maintained database identified patients identified 257 patients whom underwent complete gross resection for oesophageal cancer, without adjuvant therapy, at a single institution over 20 years. Univariate analyses were performed to identify significant factors associated with disease specific survival. Subsequently a series of backward eliminations identified 5 variables as significant. Survival probabilities for each combination of prognostic factors were calculated for incorporation into the nomogram. The predictive accuracy of the nomogram was compared to the current AJCC staging system to assess for improved individual risk stratification.

Results:   The median follow‐up was 35 months, the median disease specific survival was 31 months. The 5 significant prognostic factors identified were; age (>70), odynophagia, number of positive nodes (0 / 1–5 / >5), number of negative nodes (<20/20+) and pathological T stage (T1/T2/T3&4). These variables were combined in a nomogram which allowed prediction of disease specific survival.

Conclusion:   Disease free survival after surgery for oesophageal cancer can be predicted using a nomogram combining age, odynophagia, number of positive nodes, number of negative nodes and T stage allowing individual risk stratification.
HP11 THE SUGSS DATABASE; A WEB BASED UPPER GI CANCER DATABASE
Authors: Smith G. S. , Minehan E.
Published: April 2009

Purpose:   The relative infrequency of oesophago‐gastric (OG) resection for malignancy limits the generation of meaningful clinical data by single surgeons or institutions. The Sydney Upper GI Surgical Society (SUGSS) has established a secure, comprehensive internet based database of patients undergoing OG resection. The aim of this paper is to outline logistical and technical information regarding the database and present recruitment and utilisation data.

Methodology:   In early 2008 general surgeons in NSW and the ACT were invited to participate in the database. The approach to recruitment was inclusive and involved presentations at local meetings and correspondence to surgeons who had previously participated in the Australian Cancer Study. Clinical, operative, pathological and follow‐up data is collected prospectively and may be entered by participating surgeons or their staff remotely or by the SUGSS data manager. Data is entered via a website and is stored on a secure server. Participating surgeons have the facility to review their own data and collective data via periodic reports generated by the website/database host.

Results:   In February forty letters of invitation were sent. There were 25 responses of willingness to participate. Data entry commenced in April 2008. 20 surgeons have contributed data on a total of 122 patients, 66 oesophageal cancer, 45 gastric cancer and 11 GISTs.

Conclusion:   The SUGSS database, while in its infancy has been well supported by local surgeons and may form the basis for Australasian data collection. Practical and ethical issues will be discussed.
HP16P A SYSTEMATIC APPRAISAL OF THE QUALITY OF CLINICAL GUIDELINES FOR ACUTE PANCREATITIS
Authors: Srinivasa S. , Vather R. , Loveday B. , Phillips A. , Windsor J. A.
Published: April 2009

Purpose:   Patient management decisions are increasingly based on clinical guidelines, and guideline quality influences patient outcome. Many guidelines for the management of acute pancreatitis exist, but their quality has not been formally evaluated. This study aimed to appraise the quality of acute pancreatitis guidelines.

Methodology:   A literature search identified relevant guidelines using MEDLINE, EMBASE, CINAHL and National Guidelines Clearinghouse. Two reviewers independently appraised guideline quality using three validated instruments: Grilli, Shaneyfelt and AGREE, with maximum scores of 4, 25, and 92 respectively.

Results:   Thirty‐one guidelines from 1988–2008 were analysed, of which 22/31 (71%) were endorsed by official bodies and 9/31 (29%) did not have official endorsement. Twelve specialties were included in guideline development, and 21/31 (67%) guidelines involved multiple specialties. Only 8 (26%) guidelines included evidence grading. The median (range) quality scores were: Grilli, 2 (0–4); Shaneyfelt, 13 (5–23); AGREE, 59 (37–82). There was good correlation between instruments (r = 0.85–0.96, p < 0.001). Guideline quality did not increase with the year of publication (r2 = 0.05, p = 0.3). Guidelines endorsed by official bodies scored more highly than those without endorsement (AGREE 62.5 vs. 45.0, p < 0.001), while those developed by multiple specialties did not score more highly than those developed by a single specialty (AGREE 59.0 vs. 50.0, p = 0.36).

Conclusion:   Current acute pancreatitis guidelines range widely in quality, and have not improved over time. Their quality is higher if endorsed by official bodies. While higher quality guidelines do not ensure better patient outcome, there is room for improvement.
HP02 LESSONS LEARNT FROM 170 LAPAROSCOPIC LIVER RESECTIONS
Authors: Hatzifotis M. , Hopkins G. , Fielding G. , Martin I. , Nathanson L. , O’rourke N.
Published: April 2009

Introduction:   Laparoscopic liver surgery is being practiced more widely. We would like to report an experience of 170 laparoscopic liver resections.

Methods:   Data was collected in a prospective fashion from five surgeons, beginning in 1997 with left lateral sectionectomy, and right hepatectomy in 1999. Parenchymal transection was effected with linear cutting staplers, harmonic shears, and most recently, the Ligasure bipolar device.

Results:   We attempted 27 major resections, 63 sectionectomies, and 80 minor resections. Only rarely were procedures hand‐assisted, or “hybrid”. The conversion rate was 8%. Median blood loss was 250 ml. (Range 0–41) Median operative time was 120 minutes. Fifty‐one percent of resections were for malignancy. Margins were positive in 5 patients. The overall post operative morbidity was 12%. There were 4 bile leaks. There was one death.

Discussion:  

The indications for surgery should be the same as for open liver resection, however tempting it may be to offer definitive diagnosis by removing peripheral, probably benign, lesions. Approximately 20% of our liver resections are attempted laparoscopically. Most left lateral sectionectomies are performed this way. Major hepatectomies should be attempted only if the tumour is well clear of the plane of transection. Non‐anatomic resections require intraoperative ultrasound to ensure adequate margins and to identify large vessels. The ability to suture laparoscopically is essential.

Conclusion:   The evolving technology of parenchymal transection devices makes laparoscopic liver surgery an exciting frontier. Surgeons must be skilled in open liver surgery and advanced laparoscopy before attempting more than the simplest of procedures.
HP22P INTRA‐OPERATIVE MAPPING OF HUMAN GASTRIC SLOW WAVE ACTIVITY: INITIAL RESULTS
Authors: O’grady G. , Du P. , Lammers W. J. , Cheng L. K. , Pullan A. J. , Windsor J. A.
Published: April 2009

Purpose:   The stomach has an underlying slow wave activity that coordinates contractions. Human gastric slow wave activity is poorly understood, as existing descriptions rely on recordings from very few sites (typically ≤4). We aim to develop an improved description, in order to guide diagnostic and therapeutic strategies for dysmotility syndromes, such as post‐operative delays in gastric emptying.

Methodology:   Two novel electrode platforms were developed and validated for this study: a high‐resolution flexible printed circuit board (PCB) array (4 × 8 electrodes), and a laparoscopic device (2 × 2). Five patients have undergone intraoperative gastric mapping to date, using up to 6 tessellated PCBs (total of 192 electrodes; 96 cm2). Signals were recorded using the ActiveTwo System (Biosemi, Netherlands).

Results:   Slow wave frequencies were 2.85 ± 0.18 cycles per minute, with at least 3 distinct slow wave fronts being simultaneously active. Compared to corpus activity, antral activity was of greater amplitude (0.10 ± 0.03 mV vs. 0.04 ± 0.01 mV) and higher velocity (7.4 ± 1.1 mm s<συπ>−1 vs. 2.8 ± 0.8 mm s<συπ>−1), with a sharp transition between regions. Isochronal mapping showed consistent aboral propagation. A relatively high amplitude / high velocity pacemaker area was localised high along the greater curvature.

Conclusion:   Initial mapping results suggest the need to revise existing descriptions of human gastric slow wave activity. The findings of multiple synchronous slow wave fronts, sharp regional variations in slow wave characteristics, and a high‐amplitude pacemaker zone need to be confirmed in a larger cohort of patients before the physiological, pathophysiological, diagnostic and therapeutic implications can be fully understood.
HP24P LAPAROSCOPIC LEFT LATERAL SECTIONECTOMY – CONTROLLING INDICATIONS AND AVOIDING PITFALLS
Authors: Hatzifotis M. , Patel B. , Fielding G. , Martin I. , Nathanson L. , O’rourke N.
Published: April 2009

Introduction:   Laparoscopic left lateral sectionectomy has been described as the gold standard and is the most frequently performed laparoscopic liver resection, particularly early in ones experience. This operation can be very simple and quick but there remains the potential for significant morbidity and even mortality. The laparoscopic approach should not significantly broaden the indications for surgery.

Methods:   This paper reports a consecutive series of 60 laparoscopic left lateral sectionectomies. We describe our technique which avoids any formal dissection of inflow or outflow. The mobilized left lateral section is separated from the liver using multiple firings of a linear cutting stapler device, in one, two, or occasionally three layers for bulky livers.

Results:   The median procedure time was 90 min (30–310 min). Median blood loss was 200 ml (0–1400 ml), with six patients requiring laparoscopic suturing. There were 3 conversions, with one for bleeding. Sixty percent of lesions were benign, reflecting early enthusiasm and referral bias. However in the last two years all lesions removed have been malignant. Median length of hospital stay was 4 days (1–19). Our overall morbidity was 15%. There was one post operative death.

Conclusion:   This approach offers all the benefits of laparoscopic surgery. Despite these good results we have still had significant problems and recommend strongly that it should only be performed by experienced liver surgeons, also skilled in laparoscopic surgery. The ability to suture laparoscopically is essential, and one must not view conversion as a technical failure. The indications for surgery should not be broadened.
HP26P MANAGEMENT OF PERFORATED GASTRIC ULCERS IN A SYDNEY TERTIARY REFERRAL CENTRE
Authors: Vanguru V. R. , Suen M. , Hollands M. , Richardson A. , Pleass H. , Lam V.
Published: April 2009

Background:   Traditional surgical teaching recommends partial gastrectomy rather than omental patch repair for the management of perforated gastric ulcer. This study analysed the outcome of these two operative procedures in a tertiary referral centre.

Methods:   A retrospective analysis of a prospective collected database was performed on all patients who presented to Westmead Hospital with perforated gastric ulcer between January 1992 and December 2008.

Results:   All 21 patients with perforated gastric ulcers underwent surgical management. Omental patch repair was performed in 15 patients (71%) and 6 patients (29%) underwent a partial gastrectomy. There was no significant difference in premorbid illnesses and risk factors other than smoking being higher in the omental patch repair group (p = 0.02). The operating time was significantly lower in the omental patch repair group compared to that of partial gastrectomy group (87 minutes versus 150 minutes; p = 0.02). Partial gastrectomies were performed more often when the consultant surgeons were performing the surgery (p = 0.04). The overall mortality rate was 14% with no significant difference in mortality rate between the two groups. (1/6 versus 2/16; p = 0.84). Omental patch repair group had a significantly lower (p = 0.04) morbidity rate compared to partial gastrectomy group (53% versus 100%; p = 0.04). None of these patients had malignant perforated gastric ulcers.

Conclusion:   Perforated gastric ulcer is uncommon. Omental patch repair was associated with faster operating time, lower morbidity rate and similar mortality rate compared to that of partial gastrectomy. Omental patch repair merits consideration as the first line therapy in patients with perforated gastric ulcer.
HP28P MINIMALLY INVASIVE MANAGEMENT OF PANCREATIC ABSCESS, PSEUDOCYST AND NECROSIS: A SYSTEMATIC REVIEW OF CURRENT GUIDELINES
Authors: Loveday B. , Mittal A. , Phillips A. , Windsor J. A
Published: April 2009

Purpose:   Minimally invasive techniques have been used to manage infected pancreatic necrosis and its local complications, although no randomised trials exist to evaluate these techniques. This study aims to review the scope and quality of recommendations in current clinical guidelines on the role of percutaneous catheter drainage and endoscopic techniques for pancreatic abscess, pseudocyst, and infected pancreatic necrosis; and identify the degree of consensus between guidelines.

Methodology:   A MEDLINE search identified current guidelines published in English from any professional body. Guidelines were analysed to determine their recommendations for using percutaneous catheter drainage and endoscopic techniques to manage pancreatic abscess, infected pseudocyst, and infected necrosis.

Results:   Sixteen guidelines were reviewed. Percutaneous catheter drainage was recommended by eight guidelines for pancreatic abscess; for infected pseudocysts, one guideline did not recommend its use, and six recommended its use; for infected necrosis, two guidelines did not recommend its use, and four recommended its use. Endoscopic management of both pancreatic abscess and infected pseudocyst was recommended by seven guidelines; for infected necrosis endoscopic management was recommended by ten guidelines. Ten guidelines did not include levels of evidence to support their recommendations.

Conclusion:   Guidelines lacked consensus in their recommendations for minimally invasive management of pancreatic abscess, infected pseudocyst and infected necrosis, and few recommendations included evidence grading. More prospective trials are needed to provide evidence where it is lacking, which should be incorporated into clinical practice guidelines.
HP29P SIGNIFICANT IMPACT OF 18F‐FDG‐PET ON THE DIAGNOSTIC EVALUATION AND TREATMENT OF NEWLY DIAGNOSED OESOPHAGEAL CANCER
Authors: Aly A. , Azad A. , Koh S. , Gibson R. , Pendulbury A.
Published: April 2009

Background:   Accurate staging of newly diagnosed oesophageal cancer is important for optimising management. Previous studies have demonstrated that FDG‐PET scanning can alter management by upstaging patients with newly diagnosed oesophageal cancer. However, few studies have evaluated whether the use of PET alters management by downstaging patients and have also not considered the impact of PET upon the diagnostic evaluation process itself. Furthermore, most data comes from the pre multidisciplinary team (MDT) era and may not be relevant currently where co‐ordinated standardised approaches are more common. We aimed to evaluate the potential impact of PET upon the diagnostic, staging and treatment pathways in an MDT setting by applying a standardised algorithm.

Methods:   We retrospectively reviewed 34 consecutive patients undergoing PET during staging for newly diagnosed oesophageal cancer at Austin Health between 2002 and 2007. PET scans were reviewed by an experienced nuclear medicine physician blinded to clinical outcome. Cases were evaluated using a standard algorithm with and without PET scanning to determine potential differences in management.

Results:   Discordance between pre‐PET imaging and PET was identified in 13 of 34 (38%) patients. PET changed the stage classification in 11 of 34 (32%) of patients, including three patients with oligometastatic disease on pre‐PET staging. PET changed diagnostic evaluation in 5 of 34 (15%) and altered management in 7 of 34 (21%) patients.

Conclusion:   Incorporating PET into the staging of newly diagnosed oesophageal cancer had a major impact on stage classification, diagnostic evaluation and management.