bluuebunny/crossref_metadata_2025_split huggingface dataset:
HP26 PSEUDO‐ACHALASIA FOLLOWING A SLIPPED LAPAROSCOPICALLY PLACED ADJUSTABLE GASTRIC BAND: A CASE REPORT
Authors: Al‐Mozany N. , Booth M. 
Published: April 2007

Purpose  To demonstrate that laparoscopic adjustable gastric banding may promote oesophageal dilatation or interfere with oesophageal motility.Methodology  We report a case of a 67 year old female with a complex medical history who developed secondary achalasia from a slipped laparoscopic adjustable gastric band for weight loss. This led to recurring episodes of aspiration pneumonia requiring multiple admissions at North Shore Hospital, Auckland, New Zealand.Results  A decision was made to remove the gastric band, five years after its initial insertion. At one month follow up, she was swallowing normally and oesophageal manometry had returned to normal.Conclusion  Oesophageal dysmotility is sometimes seen in patients who have bands that are adjusted too tightly or in whom the band has slipped. This can lead to serious complications if unrecognized and incorrectly treated. Oesophageal symptoms in patients with adjustable bands must be considered secondary to the band until proven otherwise ie removal of the band or complete deflation.
HP27 MORTALITY, MORBIDITY AND 2 YEAR SURVIVAL FOLLOWING OESOPHAGECTOMY – DUNEDIN EXPERIENCE
Authors: Popadich A. , Elliott T. B. 
Published: April 2007

Purpose  Oesophagectomy is associated with considerable morbidity, mortality and poor survival of patients who have undergone oesophagectomy for oesophageal carcinoma. Numerous studies have examined the impact of hospital volume on early mortality, most demonstrating a strong inverse relationship between operative mortality and hospital case volume. This study looks at the morbidity, mortality and 2‐year survival of patients following oesophagectomy at Dunedin hospital, a low volume centre, and comparing it to high volume centres.Methods  A retrospective analysis of all patients who had elective oesophagectomy between 1995 and 2004. Otago Surgical Audit database, patient management system database (OraCare) as well as operating theatre database were used.Results  40 patients were identified, which had either transhiatal or Ivor‐Lewis procedure. 50% had pre‐op chemotherapy and 33% pre‐op radiotherapy. 65% had adenocarcinoma, 10% squamous cell carcinoma and 15% had Barrett’s with severe dysplasia. The mortality at Dunedin was 5%. Complications were: respiratory 37.5%, leak 10%, wound 22.5%, oesophageal stricture 2.5% and chylothorax 2.5%. Median length of stay was 15 days (11–94). Median survival of patients with oesophageal carcinoma was 26 months. Median survival of node negative patients was 34.5 months and node positive patients 14 months.Conclusion  Prognosis for patients with node‐positive disease continues to be poor despite oesophagectomy. The complication rates and in‐hospital mortality at Dunedin are similar to high volume centres. This study shows that patients undergoing oesophagectomy at low volume hospital do not have increased risk of operative mortality.
HP03 A NOVEL AND SAFE DEVICE FOR HEPATIC PARENCHYMAL TRANSECTION DURING LIVER RESECTION: THE GYRUS PLASMAKINETIC PULSED BIPOLAR COAGULATION FORCEPS
Authors: Tan J. T. H. , Hunt A. S. , Delriviere L. , Mitchell A. W. S. 
Published: April 2007

Introduction  The Gyrus PlasmaKinetic bipolar coagulation device has been described for use in most types of abdominal surgery. However, its use in liver resection has, to date, not been described. This study has been conducted to evaluate the safety and efficacy of the Gyrus PlasmaKinetic bipolar coagulation device during the parenchymal transection phase of both open and laparoscopic liver resections.Materials and Methods  A retrospective review was undertaken of 30 consecutive liver resections using the Gyrus Plasmakinetic pulsed bipolar coagulation device. The study period was from July 20, 2005 to November 1, 2006. Post‐operative morbidity, mortality, and need for blood transfusion were measured.Results  There were 18 males and 12 females. The average age was 54.8 +/− 13.8 yrs, with a range of 29 to 87 yrs. There were 27 open procedures and 3 laparoscopic procedures. Of these, there were 13 major resections (greater or equal to 3 segments) and 17 minor resections (<3 segments). Six patients had histopathological confirmation of cirrhosis in the adjacent liver. Average operation time was 263.1 +/−117.2 min. Length of stay had a median of 9 days. 16 patients (53.3%) did not require any blood transfusion. There was no difference in the proportion of patients receiving a blood transfusion between the cirrhotic and non‐cirrhotic groups (p = 0.46). There were no post‐operative deaths. 6 patients (20 %) had significant post‐operative complications.Conclusion  The Gyrus PlasmaKinetic system is safe and efficacious for use in hepatic parenchymal transection when used together with Argon beam coagulation and other more traditional haemostatic strategies in both cirrhotic and non‐cirrhotic livers.
HP32P OESOPHAGEAL PH PROFILE FOLLOWING PARTIAL AND TOTAL LAPAROSCOPIC FUNDOPLICATION
Authors: Wong A. S. Y. , Myers J. C. , Jamieson G. G. 
Published: April 2007

Purpose  In Barrett’s oesophagus, it may be that total abolition of reflux will give maximal protection against the development of malignancy. It is not known whether a laparoscopic partial fundoplication gives the same degree of acid reflux control as a Nissen fundoplication. This study was undertaken to answer that question.Methodology  A retrospective analysis of a prospectively followed cohort of patients who had undergone laparoscopic fundoplication as a part of clinical trials that required patients to return for routine oesophageal pH testing within 6 months of surgery. Parameters studied were percentage time pH < 4 and total number of reflux episodes compared against wrap types.Results  A total of 167 patients had routine post‐operative oesophageal pH testing, of which 123 had had laparoscopic Nissen fundoplication and the remaining 44 had partial wraps. The total number of reflux episodes was significantly different between the full and partial wrap types (p = 0.026), with a median of 4 refluxes for full wrap and 6 for partial wraps. However, there was no significant difference in the percentage time pH < 4 between wrap types (p = 0.08). In patients with two post‐operative pH studies done at least 5 years apart, there was no significant difference in the parameters both within and between wrap types over time.Conclusion  Although there was a significant difference in the number of reflux episodes between a full wrap and a partial wrap, it is hard to see this as biologically or clinically significant. Furthermore none of the other parameters showed a statistically significant difference. This study does not support the view that a total fundoplication gives more effective reflux control than a partial fundoplication.
HP33P LAPAROSCOPIC ANTI‐REFLUX SURGERY IN THE ELDERLY
Authors: Grotenhuis B. A. , Wijnhoven B. P. L. , Watson D. I. 
Published: April 2007

Purpose  Elderly patients can experience refractory symptoms of gastroesophageal reflux disease (GORD) with or without a large para‐oesophageal hernia (POH). The aim of this study was to analyse the outcome of laparoscopic anti‐reflux surgery in patients older than 70 years.Methodology  Patients were identified from a prospective database, which documents patients who underwent anti‐reflux surgery between 1992 and 2006. Pre‐operative symptoms and investigations, operative details and post‐operative outcome were analyzed.Results  226 patients (mean age 76 yrs; 77 males,149 females) were included. In 92 patients GORD and in 134 patients a large POH was the primary indication for surgery. Nissen fundoplication was performed in 90 (40%), 90 anterior in 70 (31%), Dor in 59 (26%), Toupet in 1 (0.4%) and no fundoplication was performed in 6 patients (3%). Conversion rate was 10%. There were more intra‐operative complications in the large POH group than in the GORD group (8% vs. 1%; p = 0.03), operation time was longer (109 vs. 78 minutes; p < 0.001), and mortality post‐operatively was higher (1.5% vs. 0%; p = 0.24). Overall short‐term re‐operation rate was 6% and did not differ between both groups. Mean follow‐up was 3.7 years. The symptom scores for heartburn and dysphagia improved significantly in both groups with subjective outcome in the POH group being slightly better. Overall mean satisfaction score (0–10) was 8.2. The GORD patients used significantly more reflux‐medications post‐operatively (40% vs. 21%; p = 0.007).Conclusion  Anti‐reflux surgery in patients of 70 yrs and older is safe. Patients with a large POH encounter more complications but this does not compromise symptomatic outcome.
HP37 PROGNOSTIC FACTORS IN OESOPHAGEAL CANCER: NUMBER OF LYMPH NODES AND EXTRACAPSULAR LYMPH NODE INVASION – AN INTERIM ANALYSIS
Authors: Thompson S. K. , Ruszkiewicz A. R. , Jamieson G. G. , Wijnhoven B. P. , Watson D. I. , Devitt P. G. 
Published: April 2007

Purpose  Controversy exists over the 2nd edition of the TNM staging system introduced by the American Joint Committee in Cancer in 1988, and revised in 2002. Prognostic pathological factors such as the number of positive lymph nodes and any extracapsular lymph node invasion may refine this current staging system and optimize patient treatment.Methodology  All patients who underwent surgical resection for oesophageal cancer were identified in a prospectively‐maintained database. Patients without invasive adenocarcinoma or squamous cell cancer were excluded. Pathology slides were reviewed by a single pathologist. Survival data was calculated using Kaplan‐Meier curves, and prognostic factors were examined using the log rank test.Results  235 surgical specimens met inclusion criteria, and 95 specimens have been reviewed so far. The 5‐yr overall survival rate was 43% (median 31.4 months). Subdividing pN‐stage into 1–2 positive nodes and >2 positive nodes showed significant differences in 5‐yr survival between both groups: 41% vs. 6.0%, respectively (P = 0.0003). Similarly, including absence and presence of extracapsular lymph node invasion into our pathology review showed significant differences in 5‐yr survival: 40% vs. 7.8%, respectively (P < 0.01). A negative circumferential margin, and the absence of both vascular and perineural invasion were also found to significantly improve survival rates.Conclusions  The number and characteristics of metastatic invasion of lymph nodes should be included in current oesophageal cancer staging systems. Clinicians will then have more accurate prognostic information, and treatment can be better tailored to patients’ needs.
HP38P MANAGEMENT OF TRAUMATIC PANCREATIC INJURY
Authors: Warwick A. M. , Goonewardene K. , Burton P. R. , Usatoff V. , Evans P. M. 
Published: April 2007

Background  Trauma to the pancreas is a challenging area both in initial diagnosis and longer‐term management. The retroperitoneal location makes clinical diagnosis of injury difficult and delayed diagnosis has morbid complications.Methods  A review of patients with a diagnosis of traumatic pancreatic injury was performed, over a period of five years, from 2002 to 2006. We assessed the type of injury that occurred in the pancreas after both blunt and penetrating trauma; the diagnosis and timing of pancreatic injury; the need for operative/radiological intervention; and the complications of these injuries. Specifically patients with complex injuries were evaluated and these cases were critically reviewed.Results  We identified 45 of cases of pancreatic trauma, aged 16–85, with a mean ISS of 27.8. Minor injury to the pancreas was found in 29 patients, and 16 patients had severe trauma to the pancreas, either major laceration or transection. Four particularly complex cases were identified, two of which required a Whipple’s procedure following gunshot wounds involving the pancreatic head. Two patients with abdominal crush injuries required multiple interventions.Conclusions  Patients with pancreatic trauma often have other significant injuries and one should have a high degree of suspicion of pancreatic injury in multiply injured patients. Penetrating injury to the pancreas can result in catastrophic injury requiring radical surgery. Blunt injury should be assessed by magnetic resonance cholangio‐pancreatography or at laparotomy. The management of pancreatic trauma is complex and these patients should be managed in a tertiary hospital with involvement by both specialised pancreatic and trauma surgeons.
HP40P A SYSTEMATIC REVIEW AND META‐ANALYSIS OF THE RANDOMISED CONTROLLED TRIALS ON ADJUVANT INTRAPERITONEAL CHEMOTHERAPY FOR ADVANCED GASTRIC CANCER
Authors: Yan T. D. , Black D. , Sugarbaker P. H. , Zhu J. , Petrou G. , Morris D. L. 
Published: April 2007

Purpose  The purpose of this systematic review and meta‐analysis was to determine the effectiveness and safety of adjuvant intraperitoneal chemotherapy for patients with advanced gastric cancer.Methodology  Studies eligible for this systematic review included those in which patients with gastric cancer were randomly assigned to receive surgery combined with intraperitoneal chemotherapy versus surgery without intraperitoneal chemotherapy. The end‐points of the meta‐analysis were overall survival, incidence of recurrence, morbidity and mortality.Results  Thirteen reports of RCTs were included for appraisal and data extraction. Ten reports were judged fair‐quality and subjected to the meta‐analysis. A significant improvement in survival was associated with hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) alone (HR = 0.60; 95% CI = 0.43 to 0.83; p = 0.002) or combined with early postoperative intraperitoneal chemotherapy (EPIC) (HR = 0.45; 95% CI = 0.29 to 0.68; p = 0.0002). Survival improvement was marginally significant (p = 0.06) with normothermic intraoperative intraperitoneal chemotherapy, but not significant with EPIC alone or delayed postoperative intraperitoneal chemotherapy. Intraperitoneal chemotherapy was also found to be associated with higher risks for intra‐abdominal abscess (RR = 2.37; 95% CI = 1.32 to 4.26; p = 0.003) and neutropenia (RR = 4.33; 95% CI = 1.49 to 12.61; p = 0.007).Conclusions  The present meta‐analysis indicates that HIIC with or without EPIC after resection of advanced gastric primary cancer is associated with an improved overall survival. However, increased risks of intra‐abdominal abscess and neutropenia are demonstrated.
HP06 PANCREATIC ABSCESS: RESULTS OF A SURGEON’S PROTOCOL
Authors: Smith R. C. , Pender S. 
Published: April 2007

A standardized management has been adopted for management of pancreatic abscess, where TPN was used to maintain nutritional status and ICU for maintenance of homeostasis until the junction between the abscess and viable tissue demarcated. Surgical intervention was undertaken if resolution was unlikely after 2 weeks and the patient was deteriorating. This involved a complete sequestrectomy with careful drainage. Flagyl was preferred for prophylaxis when cholangitis was not a factor and gut rest with TPN was used to maintain nutritional status. A review of the results over the last 7 years is presented.31 (16 male and 15 female) patients required surgical intervention. Their ages ranged from 18 to 88 years with a mean (sd) of 58 (18) years. The aetiology was biliary in 17, alcohol in 11 postoperative in 3 and 2 had other causes. The Apache II scores on admission was 13.8 (5.0) and 14.5 (5.2) preoperatively.There were 5 deaths (13%) which occurred in patients aged 34, 58, 83, 76, and 78 years. They presented with ApacheII scores of 20, 18, 15, 24, 16 respectively and 3 had significant co‐morbidities. The median hospital stay was 47 (7–132) days. Only 3 patients required a re‐operation for incomplete sequestrectomy. They required TPN for from 7 to 64 days (median 20 IQR 11–32 days).Conclusion: Delaying surgery until there is good demarcation between the sequestrum and the normal tissue allows for a more aggressive surgical approach even in patients with severe pancreatitis and high ApacheII scores. Age is an important determinant of death but some elderly patients survive this serious illness.
HP09 REFLUX AFTER OESOPHAGECTOMY: CAN A FUNDOPLICATION PREVENT IT?
Authors: Aly A. , Jamieson G. , Watson D. , Devitt P. , Ackroyd R. , Stoddard C. 
Published: April 2007

Introduction  Oesophagectomy for oesophageal carcinoma is a major undertaking with a definite morbidity and mortality. Long term survival rates are low and post operative quality of life becomes increasingly important. When the anastomosis is in the thorax, gastro‐oesophageal reflux, particularly volume reflux symptoms are common and may significantly affect quality of life. It is proposed that a fundoplication at the anastomosis may help prevent reflux symptoms.Aims  The aim of this study was to compare reflux after a fundoplication type anastomosis with a standard anastomosis in patients undergoing Ivor – Lewis Oesophagectomy.Study Design  Prospective randomised trial utilising standardised symptom questionnaires applied in blinded fashion.Results  The fundoplication anastomosis was associated with a significant reduction in the incidence of reflux (30% vs 70%) as well as reducing the incidence of severe reflux (7% vs 25%). A total fundoplication was more effective than a partial fundoplication in preventing severe reflux. Disturbance of sleep due to reflux was significantly reduced in the fundoplication group (18% vs 47%) as was the incidence of respiratory symptoms. The fundoplication anastomosis was not associated with an increase in dysphagia.Conclusion  The fundoplication anastomosis protects patients from the symptoms of reflux after oesophagectomy and improves quality of life particularly with regard sleep disturbance.
ML01 COMPETENCE REVIEWS IN NEW ZEALAND AND THE AFTERMATH
Authors: Blair R. 
Published: April 2007

The inquiry into allegations concerning the treatment of cervical cancer at National Womens Hospital in 1987 and 1988 was one of the most significant medical controversies of the 20th century in New Zealand. This event brought the legal and medical professions into close contact, and the legal profession has been involved with further developments in the assessment of medical competence.Since the inquiry in 1988 the government in New Zealand has moved to provide “further protection to the community”: The appointment of a Health and Disability Commissioner to act as an advocate for the community and changes in legislation. As a result, the self regulating privilege of the medical profession has been lost.The profession was initially stunned by the outcomes of the National Womens Review, but on the positive side there has been a response by the profession to improve the standards of practice. The department of Continuing Professional Development in the RACS has been a major step forward.Over the next two days the Medico‐Legal Section will examine our response to competence reviews. The changes over the last twenty years have brought about considerable change in our professional status within the community, but we must continue to address those matters which have resulted in a loss of community trust.
ML03 WORK INJURIES – NOT ALWAYS WHAT THEY SEEM
Authors: Strack C. 
Published: April 2007

We all know that work can be associated with health risks and injuries. Assessing whether a patient has a work related injury can be problematic at times, especially with conditions that are common in the general population. This is an area where common basic clinical assumptions and clinical “common sense” may sometimes be at odds with the epidemiological evidence.Some times the extent to which a condition is reported as being due to work or injury may seem to have more to do with compensation and legal issues rather than work or injury related factors.Two common conditions, carpal tunnel syndrome and lumbar spondylosis, will be discussed with respect to the extent to which they may, (or may not) be caused by work.
NS11 POSTERIOR APPROACHES FOR THORACO‐LUMBAR FRACTURES
Authors: Inglis G. S. 
Published: April 2007

The controversies remain in the management of thoraco‐lumbar fractures. These include who should receive surgical intervention, what constitutes instability of the thoraco‐lumbar spine, should an anterior or posterior approach be used to stabilise thoraco‐lumbar spine fractures, what length of instrumentation should be used and should bracing be utilised?At the present time there is a paucity of level 1 evidence to support a best practice recommendation for the management of thoraco‐lumbar spine trauma. Various classification systems have been introduced over the last 30–40 years to assist in the decision making process. These include the Holdsworth classification in 1970, the Dennis classification in 1983 and the Magerl AO classification in 1994.Very recently the thoraco‐lumbar injury classification and severity score has been introduced to try and further assist in the decision making on surgical intervention. The Burwood Spinal Injuries Service has also utilised the double ring concept of spinal instability in decision making. Various fracture patterns including burst fractures, flexion/distraction injuries and complex fracture dislocations, the indications for surgical intervention and the posterior approach to stabilising these fractures will be presented. A short segment posterior fixation with or without fusion for burst fractures and flexion/distraction injuries is recommended. Complex fracture dislocations and neurologically complete patients frequently require longer fixation with short or long fusion depending on fracture comminution and inherent stability. Recent developments with the use of image guided surgery, bone morphogenic protein and the potential for spinal cord regeneration are adding to our ability to deal surgically with thoraco‐lumbar spine trauma.
NS16 RECENT DEVELOPMENTS IN THE TREATMENT OF CRANIOSYNOSTOSIS
Authors: Davis C. 
Published: April 2007

For many decades the treatment of single suture craniosynostosis was believed to be primarily for aesthetic reasons. SPECT scanning demonstrates that 70% of cases have cortical perfusion defects adjacent to the synostosis and these defects are corrected after early reconstructive surgery. Meta‐analysis of neurodevelopmental studies demonstrate a three – to five fold increase in the risk for cognitive deficits or learning and language disabilities. It is now widely accepted that surgery is performed for both functional and aesthetic reasons.Osseodistraction has revolutionized midfacial advancement surgery to overcome maxillary hypoplasia secondary to cranial base synostosis. Our craniofacial program uses external distractors for better vector control, increased facial convexity and to maximize the nasopharyngeal airway dimensions. Case examples will be presented.Our craniofacial program is one of four world wide using springs for craniofacial remodeling.This technique was pioneered by Professor Claes Lauritzen in Sweden in 1997. The provision of a low grade continuous force that causes ongoing biomechanical remodeling in the postoperative period is a novel therapeutic modality in craniofacial surgery. It has allowed minimalization of the extent of surgery without compromising clinical outcomes. This paper summarizes the experience with the first 100 consecutive cases in Sweden and the first 18 cases in New Zealand. We will discuss the way clinical experience has led to an evolution of the way springs are currently incorporated into clinical use. We have shown the use of this technique to be safe and in selected situations to offer significant advantages over other current methods of treatment.