Pilonidal Sinus Disease surveys

Introduction: A number of international guidelines have recently been developed to minimize variability in the treatment of pilonidal sinus disease (PSD). The aim of this study was to identify surgeon opinions and current practice in relation to technical aspects of elective surgery for PSD.Methods: A nine-question survey, focusing on clinical decision-making and operation selection, was sent to authors whose PSD publications were indexed by the PubMed database. Additional relevant PSD surveys were identified by literature search of Internet databases.Results: 56 surgeons responded to our survey (15%). The most common techniques employed were off-midline flap procedures (38%) followed by excision with midline closure (16%). 83% of surgeons excise all secondary sinuses when possible. Literature review identified one contemporary patient and two surgeon response surveys.Conclusion: PSD surgery and outcomes remain highly variable. Many surgeons continue to perform midline excision with or without closure

Inter-surgeon Variability in Cystic Artery Lymph Node Excision during Laparoscopic Cholecystectomy

Introduction: Expert opinion recommends that surgeons perform a laparoscopic cholecystectomy (LC) in a standardized manner by dissecting the hepatobiliary triangle lateral to the cystic artery lymph node (LN) to minimize the rate of a major bile duct injury. Methods: To determine whether surgeons performed a laparoscopic cholecystectomy in a standardized manner, the study assessed the variability in the frequency of an LN excision. All LCs that were performed at a single hospital were identified from a prospective dataset. The presence of an LN was retrospectively determined from the histology report. Results: Twenty-seven surgeons were recorded to have performed 2332 laparoscopic cholecystectomies. Out of the total number of patients, 76.8% were female. The median patient age was 42.4 years. About 60.8% of the LCs were elective, while 39.2% of them were acute. Nineteen pathologists reported that in 99% of the specimens - the LN status of 1831 (78.5%) gallbladders was reported and analyzed. Overall, the LN yield per surgeon varied from 0% to 50% (mean 18.7%).Conclusion: The high inter-surgeon variability in the rate of LN excision during laparoscopic cholecystectomy shows that surgeons dissect the hepatobiliary triangle differently. The LN yield may also represent a surrogate marker of surgical technique (which is easy to measure)

Is cystic artery lymph node excision during laparoscopic cholecystectomy a marker of technique?

Background: In order to minimize bile duct injury, experts suggest that dissection during laparoscopic cholecystectomy (LC) should be performed lateral to the lymph node (LN). This study aims to determine whether the frequency of excision of the LN is related to patient factors, disease severity or surgical difficulty. Methods: All LCs performed or supervised by one surgeon were identified from a prospective database. The presence of LN was retrospectively determined by reviewing the gallbladder histology report. Results: The LN was identified in 10.4% of 1332 cholecystectomies. The American Society of Anesthesiologists class 3 was associated with a lower rate of LN excision compared with class 1 (odds ratio: 0.36; P = 0.049) as was the presence of a senior surgical trainee (odds ratio: 0.18; P < 0.001). Rate of LN excision was independent of patient demographic and clinical characteristics, including indication for cholecystectomy, conversion to open, gallbladder perforation, cholangiography, bile duct exploration and overall surgical difficulty. Conclusions: The frequency with which the LN is excised during LC by the one surgeon is independent of the majority of clinical and surgical factors and may represent a surrogate marker of surgical technique. Whether this is related to the rate of bile duct injury remains to be determined

Establishing a successful perioperative geriatric service in an Australian acute surgical unit

Background: The purpose of this study was to assess the impact of a perioperative geriatric service (PGS) in an acute surgical unit (ASU) on patient and organizational outcomes.Methods: Single centre retrospective cohort study. Inclusion criteria were patients over the age of 65 admitted to the ASU between January and June 2014 (pre-PGS) and 2015 (post-PGS). Chart reviews were performed to identify outcomes of interest including in-hospital morbidity and mortality, length of stay (LOS), 30-day representation and mortality.Results: Geriatric admissions increased by 32% over the two study periods (154 pre-PGS and 203 post-PGS). Surgical intervention increased by 11% (P = 0.01). Significantly more medical complications (14% versus 33%, P < 0.001) were identified after the implementation of the PGS. Recognition of delirium in the over 80s also increased by 57%. Rate of surgical complications was unchanged over the study (28% pre-PGS and 34% post-PGS, P = 0.6). In-hospital

An Australian Approach to Managing Traumatic Abdominal Wall Hernias

Traumatic abdominal wall hernias (TAWH) occur in less than one percent of trauma presentations. In the absence of clinical guidelines, management is centre-specific and largely dependent on surgeon experience. This study describes the management of TAWH in a high volume Australian trauma centre. A single centre retrospective cohort study was performed. Adults with TAWH as a result of blunt trauma, between January 2016 and July 2020, were included. Primary outcomes were the mechanism of injury, presentation, timing of repair, and operative technique used. A total of 16 patients (63% male; median age 36 years; median Injury Severity Score [ISS] 19.5) were identified. In total, 75% were the result of a motor vehicle accident. A total of 13 patients (81%) underwent repair. Eight patients received repair during emergency exploration undertaken for concurrent injuries. Three patients had a delayed repair during index admission, and two patients had an elective repair. Primary tissue repair was performed in seven patients. Mesh repair was used in six. Patients were followed for a median of 55.5 days. One patient had a recurrence of hernia following primary repair. This local series demonstrates that traumatic abdominal wall hernias may be successfully repaired during index admission using tissue or mesh techniques

Formation of functional areas in the cerebral cortex is disrupted in a mouse model of autism spectrum disorder

Background: Autism spectrum disorders (ASD) are a group of poorly understood behavioural disorders, which have increased in prevalence in the past two decades. Animal models offer the opportunity to understand the biological basis of these disorders. Studies comparing different mouse strains have identified the inbred BTBR T + tf/J (BTBR) strain as a mouse model of ASD based on its anti-social and repetitive behaviours. Adult BTBR mice have complete agenesis of the corpus callosum, reduced cortical thickness and changes in early neurogenesis. However, little is known about the development or ultimate organisation of cortical areas devoted to specific sensory and motor functions in these mice that may also contribute to their behavioural phenotype

An Australian Approach to Managing Traumatic Abdominal Wall Hernias

Traumatic abdominal wall hernias (TAWH) occur in less than one percent of trauma presentations. In the absence of clinical guidelines, management is centre-specific and largely dependent on surgeon experience. This study describes the management of TAWH in a high volume Australian trauma centre. A single centre retrospective cohort study was performed. Adults with TAWH as a result of blunt trauma, between January 2016 and July 2020, were included. Primary outcomes were the mechanism of injury, presentation, timing of repair, and operative technique used. A total of 16 patients (63% male; median age 36 years; median Injury Severity Score [ISS] 19.5) were identified. In total, 75% were the result of a motor vehicle accident. A total of 13 patients (81%) underwent repair. Eight patients received repair during emergency exploration undertaken for concurrent injuries. Three patients had a delayed repair during index admission, and two patients had an elective repair. Primary tissue repair was performed in seven patients. Mesh repair was used in six. Patients were followed for a median of 55.5 days. One patient had a recurrence of hernia following primary repair. This local series demonstrates that traumatic abdominal wall hernias may be successfully repaired during index admission using tissue or mesh techniques