Alan De Costa

MAKING A VIRTUE OF NECESSITY: MANAGING THE OPEN ABDOMEN

Background:  The open abdomen, or laparostomy, is becoming increasingly used in the management of critically ill surgical patients.

External validation of the Cairns Prediction Model (CPM) to predict conversion from laparoscopic to open cholecystectomy

BACKGROUND Valid and user-friendly prediction models for conversion to open cholecystectomy allow for proper planning prior to surgery. The Cairns Prediction Model (CPM) has been in use clinically in the original study site for the past three years, but has not been tested at other sites. METHODS A retrospective, single-centred study collected ultrasonic measurements and clinical variables alongside with conversion status from consecutive patients who underwent laparoscopic cholecystectomy from 2013 to 2016 in The Townsville Hospital, North Queensland, Australia. An area under the curve (AUC) was calculated to externally validate of the CPM. RESULTS Conversion was necessary in 43 (4.2%) out of 1035 patients. External validation showed an area under the curve of 0.87 (95% CI 0.82-0.93, p = 1.1 × 10-14). CONCLUSIONS In comparison with most previously published models, which have an AUC of approximately 0.80 or less, the CPM has the highest AUC of all published prediction models both for internal and external validation.

Selective Cholecystectomy: using an evidence-based prediction model to plan for cholecystectomy: Selective cholecystectomy

Symptomatic gall stones are treated safely and efficiently with laparoscopic cholecystectomy. Conversion to open cholecystectomy may be associated with adverse outcomes. Accurate prediction of conversion should decrease the incidence of conversion and improve patient care.

Anatomy of surgical exposure course: does it add to trainee experiences?

Journal Surgical Education SE001 DEVELOPING AND MAINTAINING MASTERY AS A SURGEON

Evaluation of general surgical outreach on Thursday Island

Journal Rural Surgery RS001 VASCULAR INJURY

The quality of life of patients with redundant colon

Journal General Surgery GS001 CANCER SURVIVORSHIP: ROLE OF EXERCISE

Validation of the Cairns prediction model for conversion of laparoscopic to open cholecystectomy

Journal General Surgery GS001 CANCER SURVIVORSHIP: ROLE OF EXERCISE

A novel cadaver-based dissection course for open general surgery

Anatomy courses based on cadaver dissection are designed to teach anatomic details and relationships, with those provided for surgical trainees/surgeons reflecting the practical application to operative surgery. The Anatomy of Surgical Exposure is a new cadaver-based dissection course where participants perform simulated surgical procedures in order to learn how to expose body regions for surgical intervention and to avoid anatomic hazards. These techniques of surgical exposure underpin the performance of open surgery. As this was a simulation-based course, educational principles involving briefing and debriefing were used throughout with good effect. Over a three-day period, participants perform a range of common and anatomically challenging open procedures on cadavers, including carpal tunnel decompression, axillary clearance, femoral hernia repair, cholecystectomy, thyroidectomy and sub-xiphoid drainage of the pericardium, with the assistance and supervision of experienced general surgeons. A detailed manual outlines the steps to be achieved and anatomical features to be identified, all of which contribute to assessment and debriefing. This presentation outlines the organization, methods and outcomes of the first course in the Anatomy of Surgical Exposure.

The management of the open abdomen: 11 years experience in the tropics

Purpose: The management of the open abdomen (OA) has changed over the last 11 years with Topical Negative Pressure (TNP) systems now the first line of treatment in our institution. We share our experiences with the use of TNP systems in contrast to the previous Planned Ventral Hernia (PVH) approach. Methodology: 92 consecutive patients with OA were reviewed from operating theatre and intensive care unit (ICU) databases from 2001 to 2011 at the Cairns Base Hospital, Queensland, Australia. Mortality rates were compared in relation to APACHE III scores as well as the incidence of adverse outcomes such as entero-cutaneous fistulas (ECF), anastomotic leaks, and intra-abdominal abscesses within the two management systems. These results were analysed using chi-squared test for categorical variables, with statistical significance being identified as p value less than 0.05. Results: Peritonitis accounted for 58% of cases of an open abdomen. There was observed increased mortality associated with PVH (16% vs. 29%) when APACHE III scores ranged from 46–126. There was no statistical significance between the two management systems in relation to incidence of ECF rate, anastomotic leaks or intra-abdominal abscesses. Patients with TNP spent less time in ICU (24.3 days vs. 31.6 days). Conclusions: The TNP systems have replaced the previously used PVH systems in the management of the OA in our institution. Analysis suggests that TNP systems can be safely employed in the management of OA as com-pared to the PVH approach.