bluuebunny/crossref_metadata_2025_split huggingface dataset:
ES19P LAPAROSCOPIC ADRENALECTOMY FOR PHAEOCHROMOCYTOMA IS SAFE AND EFFECTIVE
Authors: Meyer‐Rochow G. Y. , Sidhu S. B. , Soon P. S. , Sywak M. S. , Bambach C. P. 
Published: April 2007

Purpose  The management of phaeochromocytomas (PC) can present a significant medical and technical operative challenge, however, few studies have assessed whether the outcome of LA of PC differs from other adrenal tumour types. The aim of this study was to determine whether there is any demonstrable difference in outcome for patients undergoing laparoscopic adrenalectomy (LA) for PC compared to other functioning or non‐functioning adrenal tumours.Methodology  A retrospective review of all patients undergoing transperitoneal LA at our institution from 1995–2006 was performed. Outcome of laparoscopic PC resections was compared to the remaining LA resections.Results  A total of 176 LA operations (106 left, 68 right, 2 bilateral) were identified of which 36 were performed for PC (18 left, 16 right and one bilateral). Median tumour size was greater in the PC group (35 mm, range 17–80 mm vs 25 mm, range 7–100 mm). 7 PC were considered to be of uncertain malignant potential and 29 to be histologically benign. There were 6 malignant tumours in the remaining cohort. There were 7 conversions to an open procedure of which one was a PC resection. There was one local recurrence of PC after LA in a patient with VHL disease during a median follow up of 6 years. Median operating time (173 vs 145 mins) and length of hospital stay (5 vs 3 days) for the PC patients were significantly longer compared to the remaining patients (p < 0.05). There were no increased complications in the PC group.Conclusions  Our results demonstrate that LA for PC is safe and effective. There is no increased morbidity when LA is performed for PC compared to other functional and non functional adrenal tumours.
ES20P THE SURGICAL APPROACH TO THE ADRENAL GLAND – THE CHANGING PRACTICE
Authors: Rohana A. , Hisham A. N. 
Published: April 2007

Introduction  Adrenal surgery in our institution has evolved from open surgery to laparoscopic approach. The aim of this paper was to evaluate the feasibility and changes in the practice of adrenal surgery.Methods  A total of 129 consecutive patients who had adrenal surgery from October 1998 to 2006 were included in this study. The patient’s demographic data, clinical manifestation, tumour characteristics and duration of hospitalization were reviewed. The main outcome measures were operation time and perioperative complications.Results  There were 77(59.7%) women and 52(40.3%) men with the mean age of 41.5 years (ranged 13 to 88 years old). All our patients were closely evaluated and monitored by endocrinologist. CT scan or MRI was routinely used to localize the adrenal lesions. 67(51.9%) patients had open transabdominal adrenalectomy (Group 1), 22(17.1%) patients had open posterior approach (Group 2) and 40(31.0%) patients had laparoscopic adrenalectomy (Group 3). The mean weight of the tumour in Group 1 was 312 grams (ranged10 to 1800 grams), Group 2 was 20 grams (ranged 5 to 200 grams) and Group 3 was 20 grams (ranged 10 to 70 grams). The average hospitalization for Group 1 was 6.5 days (ranged 3 to 14 days), Group 2 was 4.5 days (ranged 4 to 6 days) and Group 3 was 3.3 days (ranged 2 to 8 days).Conclusions  Laparoscopic adrenalectomy is today the treatment of choice for most small benign adrenal tumour. Nonetheless in larger adrenal lesions and in adrenal malignancy open transabdominal adrenalectomy inevitably may still be the desired approach.
ES05 ROUTINE PARAFIBROMIN IMMUNOHISTOCHEMISTRY OF LARGE PARATHYROID ADENOMAS IS NOT AN EFFECTIVE SCREENING STRATEGY FOR CARCINOMA
Authors: Meyer‐Rochow G. Y. , Gill A. J. , Delbridge L. W. , Sidhu S. B. , Sywak M. S. 
Published: April 2007

Purpose  Parathyroid carcinoma (PC) is rare and accounts for less than 1% of all cases of primary hyperparathyroidism (PHPT). The definitive histopathologic diagnosis of PC requires unequivocal invasion or metastasis which may be absent at first presentation. As a result, many cases of PC can only be diagnosed retrospectively. Parafibromin is the protein encoded by HRPT2 which is mutated and not expressed in many parathyroid carcinomas. Given that PCs generally weigh more than parathyroid adenomas (PA)s, we hypothesized that amongst large PAs there may be a high incidence of occult PC which could be identified by negative staining for parafibromin.Methodology  57 parathyroid glands weighing greater than 2 grams excised from 1998–2006 were identified from the University of Sydney Endocrine Surgical Database. Two specimens with a histopathologic diagnosis of PC were excluded. Immunohistochemical staining for parafibromin was performed on the remaining 55 PAs.Results  Of the 55 specimens stained for parafibromin only one definite negative stain was detected. This case was originally classified as an “atypical adenoma” because it showed nuclear and architectural atypia without unequivocal evidence of invasive growth. In view of the negative staining for parafibromin it therefore probably represents occult carcinoma. There has been no evidence of recurrence or metastasis after 6.5 years.Conclusions  Complete loss of staining for parafibromin is very rare in giant parathyroid adenomas suggesting that occult carcinoma is equally rare. As a result routine immunohistochemical staining for parafibromin does not appear to be an effective screening test for carcinoma in large PA without histopathologic features of PC.
ES06 ADRENALECTOMY IN THE LAPAROSCOPIC ERA
Authors: Boldery J. , Gough I. 
Published: April 2007

Background  Laparoscopic adrenalectomy is now the accepted standard of care in surgical treatment of most forms of adrenal pathology. This study aims to review our experience with both the laparoscopic and open techniques over a 12 year period.Methods  A retrospective review of patients who underwent adrenalectomy by the same surgeon between January 1995 and December 2006 was performed. Laparoscopic and open adrenalectomy were compared in terms of operating time, length of stay and peri‐operative morbidity. Patient demographics and tumour characteristics were also studied.Results  There were 82 adrenalectomies performed over the 12 year period. Sixty‐one were completed laparoscopically, 17 were performed open and four were converted from a laparoscopic to an open procedure. The indications for surgery included 30 phaeochromocytomas, 20 non‐functioning cortical adenomas, 9 aldosteronomas, 6 cortisol‐producing adenomas, 3 adrenocortical carcinomas, 3 pseudocysts, 3 cortical hyperplasias, 2 cortical cysts, and one each of heamangioma, angiolipoma, myelolipoma, haematoma, lymphoma and adrenal metastasis. The average operating time for laparoscopic adrenalectomy was 114 minutes vs 159 minutes for open procedures. Laparosopic adrenalectomy was associated with significantly shorter length of stay (2.6 vs 7.4 days) and decreased post‐operative morbidity (6.4% vs 42%). There was no peri‐operative mortality.Conclusion  Our results concur with other retrospective reviews comparing laparoscopic and open adrenalectomy, demonstrating unequivocal advantages in terms of reduced operating time, length of stay and post‐operative morbidity.
GS10 AN ACUTE CARE SURGICAL SERVICE – A CHANGE IN PARADIGM
Authors: Parasyn A. , Truskett P. , Bennett M. 
Published: April 2007

Background  The provision of acute surgical care in the public sector is becoming increasingly more difficult due to the limitation of resources. The lack of predictability of access to theatres during the working day has the effect of displacing elective cases or forcing some acute cases to be performed after hours. An Acute Care Surgical Service was constructed at the Prince of Wales Hospital so as to provide acute surgery in a more timely and efficient manner.Methods  A roster of 8 general surgeons was constructed to provide onsite service during the working day and on call service after hours for a 52 week period. An acute care ward of 4 beds and an operating theatre was placed under the control of the Acute Care Surgeon (ACS). At the end of the ACS roster all patients whose treatment was incomplete were handed on to the next rostered ACS. Patient data and theatre utilisation data was prospectively collected and compared to the preceding 52 week period. Data was analysed using unpaired t‐test.Results  Emergency theatre utilization during the day increased from 55% to 70%. There was a 15% reduction in acute care operating after hours. Fewer cases were done between midnight and 0800. There was more efficient use of the entire theatre block suggesting a significant cultural change. Staff satisfaction was high.Conclusion  On site consultant driven surgical leadership has provided significant positive change to the provision of Acute Surgical Care in our institution. The paradigm shift in acute surgical care has improved patient and theatre management and stimulated a cultural change of efficiency.
GS17P SIMPLIFIED SURGERY FOR PILONIDAL SINUS
Authors: Claxton R. C. 
Published: April 2007

A simplified operation suitable for most cases of straightforward pilonidal sinus is described in detail, and results of a personal series over 10 years are presented.The operation involves simple excision with closure using deep tension sutures tied over a Telfa or Melolin roll after closing the skin with a separate layer of sutures. it may be carried out in the left or right lateral position or the prone position.The operation is done as a day surgery procedure. 1–2 weeks off work may be necessary. Results compare favourably with other operations.This operation has the advantages of simplicity, minimal post‐operative care and short time off work.
GS18P CASE SERIES: OBTURATOR HERNIA
Authors: Fernando M. A. P. , Strang J. 
Published: April 2007

Obturator hernia is a very rare cause of small bowel obstruction accounting for only 0.073–1% of all hernias(1). Here we report two such cases.A 69 year old female presents with 11/2 day history of colicky abdominal pain, vomiting and left medial thigh pain.Past history includes an admission 2 year ago with small bowel obstruction treated conservatively, diverticular disease and no previous abdominal surgery.At presentation she was unwell with recurrent faeculent vomiting. The abdomen was soft but generally tender. The left medial thigh was tender. No femoral hernia.Abdominal films revealed a dilated loop of small bowel. Blood results: raised WCC 18.7 (4.0–10.0), CRP 66 (<5). Obturator hernia was suspected and CT confirmed this.Laparotomy revealed a Richter’s hernia and viable small bowel. The defect was primarily closed. Patient was discharged 4 days post operatively.An 89 year old female presented with several days of colicky abdominal pain and no bowel motions. She had multiple co‐morbidities including advanced Vascular Dementia, Asthma and Hypertension.At presentation she was unwell. Abdominal exam revealed right illiac fossa guarding with a normal WCC and a raised CRP 78. Arterial blood gas analysis revealed a metabolic alklosis with respiratory compensation.CT abdomen reported a small bowel obstruction due to right Obturator hernia with perforation. Due to her co‐morbidities she was managed conservatively and she passed away a week later.The management of Obturator hernias is still open to debate with a wide variety of methods being described.
GS02 LATERAL LAPAROSCOPIC SPLENECTOMY: THE AUCKLAND CITY HOSPITAL EXPERIENCE
Authors: Windsor J. A. , Ranasinghe A. 
Published: April 2007

Purpose  To review the experience with laparoscopic splenectomy, to determine it’s efficacy for treating immune thrombocytopaenic purpura (ITP) and to highlight key technical issues with the operation.Methodology  All splenectomies performed between 1992 and 2005 were identified from the Otago Surgical Audit and the clinical notes reviewed, including the laboratory records for follow‐up data related to the haematologic cases.Results  There were 289 splenectomies performed over the 13 year period. The indications were trauma (111, 38%), haematologic disease (93, 32%), incidental (40, 14%) splenic malignancy (39, 13%), and other (8, 3%). Of the 68 patients with ITP, 49 (72%) had a lateral laparoscopic splenectomy (LLS) with no conversions, a 5% complication rate and one mortality. Based on platelet counts and the requirement for maintenance steroids there was a complete response in 44 (68%) patients at >6 months, a partial response in 16 (24%) and no response in 5 (8%) patients. A short video presentation will highlight the key steps for the safe and efficient performance of the LLS, including patient and port positioning, the use of ultrasonic dissection, splenic pedicle stapling, and morcellation. The indications for hand‐port assisted laparoscopic and open splenectomy will be discussed.Conclusions  The LLS is the preferred approach to splenectomy for all but massive splenomegaly and can be performed safely with careful attention to key technical issues.
GS25P POSTOPERATIVE NIL BY MOUTH – SIMPLY A SURGICAL DOGMA OR SCIENTIFICALLY SOUND PRACTICE?
Authors: Ashrafi A. N. , Pochin R. 
Published: April 2007

Purpose  Traditionally, the postoperative management of patients undergoing gastrointestinal (GI) surgery has been to keep them ‘nil by mouth’ (NBM) until the postoperative ileus resolves. There is an evolving viewpoint that this practice is not based on sound evidence. This review examines the recent literature addressing this issue and aims to evaluate the role of early commencement of postoperative feeding compared to traditional NBM management.Methodology  Three electronic databases (Ovid Medline, PubMed and Cochrane Reviews) were searched for randomised controlled trials (RCTs), reviews or meta‐analyses. Key words used included ‘nil by mouth’, ‘postoperative feeding’, and ‘early feeding’. Reference lists were crosschecked for additional studies.Results and Conclusions  The practice of mandatory postoperative starvation and bowel rest is not supported by evidence. There is evidence from several RCTs that early postoperative feeding in patients is safe and tolerable. Some studies have shown that early feeding is beneficial in terms of postoperative complications, ileus and hospital stay. Although most of the literature is on colon surgery, similar evidence also exists for gut perforation and upper GI surgery with a trend towards reduced hospital stay and postoperative complications. In summary, this review identifies an important disparity between common clinical practice in New Zealand and evidence from several small RCTs. There does not appear to be any obvious clinical benefit in keeping patients NBM following GI surgery. The authors suggest that patients and the surgical community alike would benefit from a large scale, high quality, high‐powered RCT to address this issue definitively.
GS27P TECHNIQUES FOR CLOSURE OF MIDLINE ABDOMINAL INCISIONS
Authors: Ali A. , Tait N. , Sanfilippo F. 
Published: April 2007

Background  A recent meta‐analysis of randomised controlled trials of abdominal fascial closures concluded that in order to reduce incisional hernia rates without increasing wound pain, or the rate of dehiscence slowly absorbable continuous sutures appear to achieve the best results in abdominal fascial closures. We surveyed the techniques for abdominal fascial closure among general surgeons in Canberra, Australia.Methodology  49 out of 80 surgeons responded to the survey by form. The information collected included the seniority of the surgeon, the frequency of laparotomy closure, surgical technique and suture material utilised in abdominal fascial closure.Results  34 (69%) of the surgeons surveyed preferred a non‐absorbable monofilament suture material for abdominal fascial closure with nylon being the most popular. Most (38, 78%) also preferred a non‐absorbable monofilament suture in emergency surgery. 12 (24%) surgeons preferred to use slowly absorbable suture. The majority of surgeons (37, 76%) preferred continuous suture technique, whilst only 2 (4%) used continuous followed by interrupted suture closures. Only 5 (10%) complied with the dual recommendation of continuous suture technique and slowly absorbable suture.Conclusion  The majority of surgeons preferred non‐absorbable monofilament suture rather than slowly absorbable suture. Only 1 in 10 surgeons complied with both components of evidence base, which supports the use of slowly absorbable suture material and a continuous technique in abdominal fascial closure. A definitive RCT would confirm this observation.
GS03 TIMING OF SURGERY FOR ACUTE SYMPTOMATIC BILIARY DISEASE
Authors: Short H. L. , Zargar Shoshtari K. , Lee D. , Poole G. H. , Hill A. G. 
Published: April 2007

Purpose  To evaluate surgical management of patients presenting with symptomatic gallstone disease to Middlemore Hospital in 2005.Method  Retrospective case review of acute presentations of symptomatic gallstone disease between Jan 1st and Dec 31st 2005.Results  Four hundred and two patients were included in the final analysis. Forty six of these patients were unfit for surgery, 26 were solely admitted to the emergency department without being referred to a surgical team and 22 declined surgery. Therefore 308 patients (77%) were eligible for surgery at index admission (IA). Sixty six percent (204) of these received surgery during IA with an average time to surgery of 4 days. Of the remaining 104 eligible patients who did not receive surgery during IA, 54% (56) received public surgery at a later date with an average wait of 85 days. Fourteen percent (42) never received surgery despite being eligible during IA. There was no significant difference in duration of total acute hospital stay between those with surgery at IA and those who did not receive surgery at IA. For those who had acute surgery the conversion rate was 2% (4). There were no biliary injuries or perioperative deaths and post‐operative readmission rate was 4% (9). Sixty two percent (64) of the 104 eligible patients who did not receive surgery at IA were subsequently readmitted acutely within 24 months. The average wait time for US, MRCP and ERCP was 0.9, 3.1 and 3.4 days respectively.Conclusion  Acute surgery remains the treatment of choice for acute biliary disease. This approach requires a committed team approach but is safe and cost effective.
GS31P PROSPECTIVE OCTOGENERIAN GENERAL SURGICAL AUDIT: PREDICTING POST‐OPERATIVE AND NON‐OPERATIVE MORTALITY USING MINIMUM CLINICAL DATA SET
Authors: Nichols K. G. , Mosquera D. A. , Fancourt M. F. , Kyle S. M. , Gilkison W. T. C. 
Published: April 2007

Background  A national minimum clinical data set for predicting non‐operative and post‐operative mortality at discharge was developed by Prytherch et al. Our aim to audit the octogenerian surgical admissions in our hospital for complications, discharge outcomes and discharge mortality.Method  Prospective audit from the 1st January 2006–30th November. Data collected for 243 consecutive admissions: 91 non‐operative, 82 elective and 70 emergency, using standardized pro forma.Results  In total 223 surgical patients (re‐admission 8.2%) included 70 emergency admissions (28.8%), 82 elective admissions (33.8%) and 91 non‐operative admissions (37.5%). Complications rate of 47.1% Emergency, 18.3% Elective and 23.3% Non‐operative admissions. Discharged home: 52% Emergency, 92% Elective and 57% Non‐operative patients. Mortality: Emergency 7.1% (n = 5), Elective 0% (n = 0) and Non‐operative 5.5% (n = 5) patients. Emergency laparotomy 35% (n = 2) mortality. When minimum clinical data compared predicted to observed mortality emergency ?2 = 10.95 (p < 0.001), elective ?2 = 6.22 (p < 0.0025) non‐operative ?2 = 6.51 (p < 0.025).Conclusion  The audit overall mortality data was acceptable when compared to published work. Emergency, elective and non‐operative patient groups differed significantly (p < 0.025) from predicted deaths and did not fit this model according to risk stratification.
GS05 SINGLE SURGEON EXPERIENCE WITH RETROMUSCULAR (PREPERITONEAL) MESH REPAIR OF INCISIONAL AND VENTRAL HERNIAS
Authors: Theophilus M. N. , Ooi S. M. , Tan P. 
Published: April 2007

Objective  Repair of incisional (and large ventral) abdominal hernias pose a challenge for many surgeons. Numerous techniques have been described. This series reports a single surgeon’s experience using the retromuscular (pre‐peritoneal) mesh repair technique.Method  Data was collected on 70 consecutive incisional (n = 23) and ventral (n = 47) hernia repairs using retromuscular (pre‐peritoneal) lightweight polypropylene mesh.Results  The median follow‐up was 26 months (range 10 – 66 months). Overall recurrence rate was 1.4%. There were seven major (10%) and four minor (7%) post‐operative infections. One patient developed post‐operative seroma requiring percutaneous aspiration, and one patient had chronic pain.Conclusion  Retromuscular mesh repair is a good alternative to traditional onlay mesh repairs. Morbidity and outcomes are acceptable and comparable with literature, with lower rates of seroma formation and hernia recurrence.
GS07 ABDOMINAL WALL COMPONENTS SEPARATION TECHNIQUE FOR CLOSURE OF VENTRAL DEFECTS – INITIAL EXPERIENCE AND LESSONS LEARNT
Authors: Waxman B. P. , Jassal S. 
Published: April 2007

Purpose  The Abdominal Wall Components Separation Technique (AWCST), allows closure of ventral defects by transposition of the abdominal wall muscle(1). The aim of this audit of our initial experience was to evaluate the technique for repairing defects after removal of infected mesh or for uncomplicated incisional hernia.Methodology  A prospective audit was conducted on the initial experience of 9 consecutive patients under the care of one surgeon (BPW) from August to December 2006.Results  Of the 9 patients, 5 had infected mesh and 4 had large incisional hernias. The median follow up was 62 days range 7–125 days. Significant wound infections occurred in 4 patients requiring re‐operation. In all 4 abdominal wall repair remained in tact. 1 patient has developed a recurrent incisional hernia.Conclusion  AWCST is an useful procedure for the closure of large defects, particularly for incisional hernia and may avoid the use of mesh. We recommend avoiding primary skin closure after removing infected mesh and follow the principle of delayed primary closure. No specific conclusions can be made from this small series with a short follow up, but the technique has merit and requires further evaluation.