Shing W. Wong

Appendicectomy as a therapy for ulcerative proctitis.

OBJECTIVES:Available data regarding whether appendicectomy performed after the onset of ulcerative colitis can modulate its clinical course are currently limited. This study aimed at addressing this issue.METHODS:In this study, we report a prospective case series of 30 adult patients (median age 35 years, range 17–70 years; male/female: 11/19) with ulcerative proctitis (median duration of symptoms 5 years, range 8 months to 30 years; median Simple Clinical Colitis Activity Index score 9, range 7–12), who underwent appendicectomy in the absence of any history suggestive of previous appendicitis. Patients were subsequently followed up clinically with the assessment of the Simple Clinical Colitis Activity Index for a median of 14 months (range 9–32 months).RESULTS:After appendicectomy, the clinical activity index improved significantly to a median score of 2 (range 0–12) (P<0.0005). The improvement in the clinical activity index occurred in 27 of 30 (90%) patients, whereas the index remained unchanged in the remaining 3 of 30 (10%) patients. Furthermore, 12 of 30 (40%) patients experienced a complete resolution of symptoms (clinical activity index score of 0) by 12 months, such that all pharmacological treatments could be withdrawn, and have remained in remission off all previous treatments for a median 9 months (range 6–25 months). The time required for a complete resolution of symptoms post appendicectomy ranged from 1 to 12 months (median 3 months) (Kaplan–Meier analysis). None of the clinical or histological factors analyzed were significantly associated with post-appendicectomy outcome.CONCLUSIONS:This case series, the largest reported so far, provides rationale for controlled trials to properly evaluate the possible role of appendicectomy in the treatment of ulcerative proctitis.

Does an acute care surgical model improve the management and outcome of acute cholecystitis

The aim of this study was to compare the management and outcome of acute cholecystitis in an acute care surgery (ACS) model to that of the traditional home‐call attending surgeon. The ACS model is one in which a consultant led team manage all emergency surgical presentations. The consultant is involved with every decision made including theatre allocation. Records of all patients who underwent an emergency cholecystectomy in the 2 years before and after introduction of an ACS model were reviewed. A total of 202 patients were recruited into this study. The groups were matched for sex, age and insurance status. There was a decrease in the median time to theatre (1 versus 2 days) and total length of stay (4 versus 6 days) in the ACS group. There was no significant difference in the conversion rate between the groups. However, there was a decreased complication rate in the ACS group (8.7 versus 17.2%). There were no differences in the histological findings. Consultant presence in theatre was higher in the ACS group (73.9 versus 56.3%), and they were more often assisting (30.4 versus 4.6%). Results suggest that an ACS model is beneficial to patient care with shorter hospital stay and a decreased complication rate. This may reflects a greater input to patient assessment and management by the on‐site consultant. In addition, the ACS model provides greater consultant supervision to the trainee.

Diverticulectomy is inadequate treatment for short Meckel's diverticulum with heterotopic mucosa.

Background:  Meckels diverticulum is a vestigial remnant of the vitellointestinal duct that may occasionally contain heterotopic gastric mucosa thought to arise from residual yolk sac cells. This may cause significant rectal bleeding, the source of which may be difficult to identify. The present paper addresses the question of whether the choice of resection technique should depend on the macroscopic appearance of the Meckels diverticulum.

Optimizing the operating theatre environment

The operating theatre is a complex place. There are many potential factors which can interfere with surgery and predispose to errors. Optimizing the operating theatre environment can enhance surgeon performance, which can ultimately improve patient outcomes. These factors include the physical environment (such as noise and light), human factors (such as ergonomics), and surgeon‐related factors (such as fatigue and stress). As individual factors, they may not affect surgical outcome but in combination, they may exert a significant influence. The evidence for some of these working environment factors are examined individually. Optimizing the operating environment may have a potentially more significant impact on overall surgical outcome than improving individual surgical skill.

CURE, CONTINENCE AND QUALITY OF LIFE AFTER TREATMENT FOR FISTULA‐IN‐ANO

Background:  The best operation for high anal fistulas is difficult to nominate because they have varying cure and incontinence rates. The objective of this study was to quantify the relative importance of the outcomes of cure, continence and other quality‐of‐life (QOL) factors.

Effect of handover on the outcomes of small bowel obstruction in an acute care surgery model

An acute care surgery (ACS) model was introduced to manage emergency surgical presentations efficiently. The aim of this study was to evaluate the impact of patient handover in an ACS model on the outcomes of adhesive small bowel obstruction (SBO).

Achieving quality in colonoscopy: bowel preparation timing and colon cleanliness

Background:  Colonoscopy is considered the gold standard for investigation of large bowel pathology. Numerous factors influence the efficacy of bowel preparation for colonoscopy. Inadequate bowel preparation can lead to missed pathology. Timing of fasting and bowel preparation, timing of procedure and possibly patient bowel habit and presence of diverticula may have an influence on the quality of the preparation. The aim of this study was to investigate the quality of cleansing of sodium picosulfate (Picoprep‐3™, Pharmatel Fresenius Kabi Pty Ltd, Pymble, NSW, Australia) with different administration schedules and to evaluate whether patients bowel patterns influence the quality of cleansing.

Does presentation at the Registrars' papers day predict future publication?

There are research requirements for trainees to be eligible to present for their final examinations (Fellowship of Royal Australasian College of Surgeons, FRACS). One option is the presentation of a paper or poster at a meeting of which abstracts are subject to review and selection. This includes presentation at the annual Registrars’ Papers Day (RPD) in New South Wales. There has been some debate surrounding whether research requirements are fulfilled by presentation at such meetings. Publication in a peer‐reviewed journal should be the ultimate aim. A high publication rate will validate the quality of the meeting. All abstracts submitted to the RPD in 1998 and 1999 were analysed. A Medline search was performed in 2005 to identify publication of these presentations in a peer‐reviewed journal. Variables of the study that were potentially predictive of subsequent publication were analysed. This included type of presentation, surgical specialty, clinical or laboratory‐based study, study design (prospective or retrospective) and sample size. Chi‐squared test with Yates’ continuity correction was used to compare two independent proportions and significance was set at P < 0.05. The publication rates were: oral presentations 50% (17/34), poster presentations 39% (9/23) and rejected presentations 20% (2/10). The mean and median time to publication was 23.8 and 21.0 months. Prospective design was the only variable identified to have a statistically significant effect on the publication rate (P < 0.002). The most common publishing journal was the Australian and New Zealand Journal of Surgery (12 of 26). Overall consistency (author and study sample consistency) from presentation to publication was 32%. The overall 46% publication rate of this state‐based trainees‐organized meeting compares favourably with international meetings. The research requirement of the Royal Australasian College of Surgeons (RACS), which includes presentation at the RPD in New South Wales, produces good quality papers for publication.

Transanal minimally invasive surgery: an initial experience

Transanal minimally invasive surgery (TAMIS) is a novel approach used for the resection of rectal lesions. The purpose of this study was to review our initial experience with TAMIS.

Ergonomic port placement in laparoscopic colorectal surgery.

Aim  Port placement in laparoscopic surgery has important ergonomic implications. A manipulation angle (MA) of 60° has been shown to maximize task efficiency. We calculated the MA used during various stages of both right hemicolectomy (RH) and high anterior resection (AR).