Jeremy I. Rossaak

Management of sigmoid volvulus: is early surgery justifiable?

Sigmoid volvulus typically occurs in older patients who have multiple co‐morbidities. Therefore, often, a conservative approach to management is chosen. However, there is little data on long‐term outcomes of this approach in Australasia. The aim of this study was to review the recurrence and mortality outcomes of patients admitted to Dunedin Hospital with sigmoid volvulus.

A Comprehensive Classification of Invasive Procedures for Treating the Local Complications of Acute Pancreatitis Based on Visualization, Route, and Purpose

Background/Aims: The lack of a system to classify invasive procedures to treat local complications of acute pancreatitis is an obstacle to comparing interventions. This study aimed

Survey of trends in minimally invasive intervention for necrotizing pancreatitis

Background:  Minimally invasive techniques to manage infected pancreatic necrosis have been recently developed and changes in their pattern of use are unknown. The aims of this survey were to determine the trends in the role of minimally invasive techniques to manage infected complications of necrotizing pancreatitis and the barriers to performing minimally invasive necrosectomy in Australia and New Zealand.

A unique approach to thoracic duct leak after esophagectomy.

Chylothorax is a severe complication of esophagectomy. Those who do not respond to conservative measures require reoperation. We have described a minimally invasive technique to control a late postoperative chyle leak. A 41-year-old patient underwent an Ivor-Lewis esophagectomy. Day 4 after surgery he was found to have an esophageal leak. He underwent thoracotomy and esophageal stent insertion. On day 20, a radiologic drain was placed to control a small supradiaphragmatic collection. The collection was found to be chyle, and 2.5 L was drained per day. As this was 3 weeks after thoracotomy, a technique of sinus track dilatation and cavity visualization was carried out with clipping of the chyle channel. The patient recovered well from the procedure. He was extubated postoperatively and only required simple analgesia.

Response to Re: Management of sigmoid volvulus: is early surgery justifiable?: Letters to the editor

clinical evaluation exercise (CEX) demonstrate face and content validity (and indeed reliability), albeit in a population of medical rather than surgical trainees. We accept that the earlier versions of CBD and CEX used within the Intercollegiate Surgical Curriculum Programme (ISCP) do not demonstrate reliability and indeed, that was one of the real messages in our paper. However, the paper also describes how ISCP has introduced construct-aligned scales, similar to those used by the physicians, and we would envisage improved validity and reliability as a consequence. We clearly cannot be complacent in relation to ISCP. It continues to undergo continuous evaluation and review. Its utility as a curriculum management tool has improved considerably since its launch, and the syllabi within it continue to evolve. As we conclude the original paper by saying we will need to continue to re-evaluate and reassess the assessment system so that is fit for purpose, namely that it has reliability, validity, acceptability and utility.

Response to Re: Management of sigmoid volvulus: is early surgery justifiable?

clinical evaluation exercise (CEX) demonstrate face and content validity (and indeed reliability), albeit in a population of medical rather than surgical trainees. We accept that the earlier versions of CBD and CEX used within the Intercollegiate Surgical Curriculum Programme (ISCP) do not demonstrate reliability and indeed, that was one of the real messages in our paper. However, the paper also describes how ISCP has introduced construct-aligned scales, similar to those used by the physicians, and we would envisage improved validity and reliability as a consequence. We clearly cannot be complacent in relation to ISCP. It continues to undergo continuous evaluation and review. Its utility as a curriculum management tool has improved considerably since its launch, and the syllabi within it continue to evolve. As we conclude the original paper by saying we will need to continue to re-evaluate and reassess the assessment system so that is fit for purpose, namely that it has reliability, validity, acceptability and utility.