Modified Supine Percutaneous Nephrolithotomy in the Elderly: Outcomes and Safety.

With increases in the aging population, conditions affecting older people and relevant surgical techniques are becoming more pertinent. Modified supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. There are limited data on the safety of this position in the elderly patient population. We describe our experience of the modified supine position in patients aged 70 years and older. Between April 2011 and March 2021, patients aged 70 years and older undergoing a modified supine PCNL performed by a single surgeon were prospectively evaluated. Data including patient age, operative time, complications, stone clearance, and length of stay were collected and analysed. Sixty-nine procedures were performed on 67 patients with a mean age was 76.5 years. Median total operative time was 95 min with 20 (29%) patients having a combined procedure with ureterorenoscopy. Preoperative mean stone burden was 23.5 mm and complete stone clearance was achieved in 46 (66.7%) patients. Twelve (17.4%) patients had complications during their hospitalisation. Six were Clavien-Dindo class II or less and one Clavien-Dindo class V. The modified supine position for PCNL is safe in the elderly patient population and has advantages including reduced handling of patients and achieving adequate stone-free rates. These benefits are particularly important in the elderly population, which frequently has a reduced tolerance to adaptation.

Encapsulated Papillary Carcinoma in a Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Case Report.

We report a case of a 45-year-old female who developed multi-focal encapsulated papillary carcinoma (EPC) in her left breast. This was on a background of previous left breast high-grade ductal carcinoma in situ, for which she had a skin-sparing mastectomy and deep inferior epigastric perforator (DIEP) reconstruction five years ago. Papillary carcinoma is a rare pathology, and its occurrence in autologous breast reconstruction is even rarer. This is the second reported case of papillary carcinoma in a DIEP reconstruction. Although surgery remains the gold standard for EPC, debate remains with regard to adjuvant endocrine therapy and radiotherapy. We discuss the diagnosis and current management of an EPC.

Mechanical bowel preparation with pre-operative oral antibiotics in elective colorectal resections: an Australian single institution experience.

BACKGROUND: Anastomotic leaks (AL) and surgical site infections (SSI) are serious complications after colorectal resection. Studies have shown the benefits of pre-operative oral antibiotics (OAB) with mechanical bowel preparation (MBP) in reducing AL and SSI rates. We aim to investigate our experience with the short-term outcomes of AL and SSI following elective colorectal resections in patients receiving OAB with MBP versus MBP only. METHODS: A retrospective analysis was performed from our database for patients who underwent elective colorectal resection between January 2019 and November 2021. Prior to August 2020, OAB was not used as part of MBP. After 2020, Neomycin and Metronidazole were used in conjunction with MBP. We evaluated differences in AL and SSI between both groups. RESULTS: Five hundred and seventeen patients were included from our database with 247 having MBP while 270 had OAB and MBP. There was a significantly lower rate of AL in patients receiving MBP and OAB as compared to MBP alone (0.4% versus 3.0%, P-value = 0.03). The SSI rate at our institution was 4.4%. It was lower in patients with MBP and OAB as compared to MBP alone, but this was not clinically significant (3.3% versus 5.7%, P-value = 0.19). CONCLUSION: The association in the reduction of AL with the addition of OAB to the MBP protocol seen here reinforces the need for future randomized controlled trials in the Australasian context. We recommend colorectal institutions in Australian and New Zealand consider OAB with MBP as part of their elective colorectal resection protocol.

Closed Incision Negative Pressure Therapy vs Standard of Care Dressing in Breast Surgery: A Systematic Review.

The implementation of closed incision negative pressure therapy (CINPT) is widely seen in many surgical subspecialties including orthopaedics, vascular surgery, and abdominal surgery. However, research on its use in breast surgery is still in its infancy. We conducted a systematic review on the use of CINPT vs standard of care dressings (SOC) in wound management of post-operative breast surgery. A literature search was conducted on PubMed, MedLine, and Google Scholar for studies that compared CINPT against SOC. Seven studies were included in this systematic review. The results of our systematic review have shown that CINPT has a positive outcome in reducing post-operative wound complication rates as compared to SOC dressings (commonly Steri-Strips and waterproof dressings), which was 1-8% vs 1-30% in CINPT and SOC, respectively. Furthermore, CINPT has the potential to confer additional cost-savings of up to USD218 per patient for a health institution with regards to reduced complications rates that might have required extended management. The use of CINPT in breast surgery remains highly promising. It has many advantages over SOC, including better wound outcomes and added cost savings. Further studies are required to delineate the potential benefits in different sub-sets of patients.

Laparoscopic versus open appendicectomy in pregnancy: experience from a single institution and meta-analysis.

BACKGROUND: Acute appendicitis remains an uncommon cause of non-obstetric abdominal pain during pregnancy, with surgery being the preferred management option. We examined our experience with the surgical management of appendicitis during pregnancy, particularly the risk of foetal loss during the 1st and 2nd trimester and performed a meta-analysis of the available literature. METHODS: We performed a retrospective analysis of all patients who had an appendicectomy during pregnancy (January 2010 to December 2019) and a meta-analysis comparing foetal death in open appendicectomy versus laparoscopic appendicectomy during the 1st and 2nd trimester. RESULTS: Seventy pregnant patients were included in our study (57 laparoscopic, 13 open). There were 4 foetal deaths during the study period (7%), all of which occurred after the laparoscopic approach (P-value = 0.578). Open appendicectomies were associated with an increased risk of pre-term delivery (P-value = 0.038). The meta-analysis of 9 studies, which included 311 patients, showed that there was no significant difference between OA and LA in foetal deaths during the 1st and 2nd trimesters (1st trimester foetal deaths: 9/143 laparoscopic versus 4/57 open, M-H risk difference-0.02, 95% CI, -0.14 to 0.10): 2nd trimester foetal deaths: 7/159 laparoscopic versus 2/154 Open, M-H risk difference 0.03, 95% CI, -0.02 to 0.09). CONCLUSION: Our findings suggest there is no increased risk of foetal loss in pregnant patients undergoing a laparoscopic appendicectomy.

Kimura disease of the breast: Case report and literature review of current management.

We report a rare case of Kimura disease in a 50-year old female patient who attended our tertiary level Breast Surgery Clinic.

Plastic bread clip impacted in gastrointestinal tract: a case report and review of the literature.

A 79-year-old initially presented to her general practitioner for a 6-week history of nausea, intermittent abdominal pain and altered bowel habits. Colonoscopy was performed to investigate her symptoms and revealed a bread clip that was adherent to the sigmoid colon mucosa, unable to be retrieved. A CT scan was performed to exclude any associated complication, which showed no evidence of perforation or collection. A repeat colonoscopy by a more experienced endoscopist again failed to retrieve the bread clip. Eventually, the bread clip had to be removed through a laparotomy and colotomy. We performed a thorough literature review, which revealed 26 studies (totalling 38 cases) of bread clip ingestion. Many of the reported cases presented with abdominal pain, bowel obstruction, or perforation and carried a small mortality risk.