Pelvic mesh in colorectal pelvic floor surgery-implications of recent developments.

The use of mesh prostheses in pelvic surgery is under significant scrutiny. There are justifiable concerns around the transvaginal use of mesh products for POP surgery. The latter part of 2017 saw the announcement of wide-ranging regulatory actions relating to transvaginal mesh products, by the Therapeutic Goods Administration in Australia and subsequently Medsafe in New Zealand. In colorectal surgery, pelvic mesh is predominantly used in the treatment of rectal prolapse, with ventral mesh rectopexy (VMR) becoming popularised in recent years. The available evidence suggests that despite the current mesh controversy, VMR is an acceptable procedure, with functional advantages over other colorectal prolapse procedures. With only short-term outcome data available however, comparative studies and longer follow-up are required to answer the question of long-term mesh safety. In the meantime, there are areas where surgical practice can be optimised, in particular around reporting, training and patient education. The aims of this paper are to summarise the current status of pelvic floor mesh surgery and examine how this will impact colorectal pelvic floor surgery.

Timely cholecystectomy for acute gallstone disease: an ongoing challenge in a New Zealand provincial centre.

AIMS: To review the prior management of patients who underwent cholecystectomy for gallstone disease at a provincial centre over a 1-year period, with a particular focus on potentially preventable morbidity by performing index cholecystectomy (IC). METHODS: Retrospective case note review was performed for patients who underwent cholecystectomy at Hawke's Bay's hospitals between 1 March 2009 and 1 March 2010. RESULTS: 148 cholecystectomies were performed over the study period. Ninety-one patients (61%) were admitted acutely prior to receiving cholecystectomy. The IC rate was 15%. Seventy-seven patients who were admitted acutely could have been suitable for IC, but were discharged. These 77 patients subsequently had an additional 17 readmissions (72 bed-days), 26 ED presentations and 51 outpatient clinic (OPC) visits prior to receiving their eventual operation. Ten patients (13%) developed a complication or recurrence of their acute gallstone disease whilst awaiting surgery. CONCLUSION: Hawke's Bay has a low rate of IC and fails to meet current international standards for timely surgical management of acute gallstone disease. A large proportion of those not operated on during their index admission re-present with further morbidity. There are significant barriers to improving these standards in a provincial centre with limited acute surgical resources.

Composition of volatile organic compounds in diathermy plume as detected by selected ion flow tube mass spectrometry.

BACKGROUND: There is some evidence that surgical plume may pose a risk to health professionals, but the risks posed by volatile organic compounds have not been thoroughly investigated. METHODS: The composition of volatile organic compounds in diathermy plume produced during surgery was analysed by selected ion flow tube mass spectrometry. RESULTS: Hydrogen cyanide (3-51 parts per million), acetylene (2-8 parts per million), and 1,3-butadiene (0.15-0.69 parts per million) were identified in the plume. CONCLUSION: Although there is no evidence of adverse health effects from the volatile organic compound in diathermy plume, the evidence that it is safe to breathe this plume is lacking. Therefore, we would recommend the use of smoke evacuators where practical.

Men with colorectal cancer are predisposed to prostate cancer.

BACKGROUND: The objective of the present study was to investigate the relationship between colorectal and prostate cancer. METHODS: All Victorian men who developed metachronous colorectal and prostate cancer with the first primary diagnosed between 1982 and 1993 were identified retrospectively from the Victorian Cancer Registry and were followed up to the end of 1995. Analyses were stratified by age group and years of follow up. The cause of death in those men who had prostate cancer following colorectal cancer was determined. The stage of colorectal cancer was compared between men with and without second primary prostate cancer and the grade of prostate cancer was compared with men who did not have a prior colorectal cancer. RESULTS: Men who develop colorectal cancer are at increased risk of prostate cancer, with the greatest risk in men under the age of 65 (Relative risk approximately 2). Men with first primary colorectal cancer are more likely to develop prostate cancer than colorectal second primaries, and men who develop second primary prostate cancer are more likely to die of prostate cancer than colorectal cancer. CONCLUSIONS: Younger men diagnosed with colorectal cancer are at increased risk of prostate cancer. However, there is no direct evidence that screening for prostate cancer leads to a reduction in mortality. This should be considered when discussing long-term follow up.