Perioperative outcomes of emergency and elective colorectal surgery: a bi-institutional study.

BACKGROUND: Emergency colorectal surgery tends to be associated with poorer outcomes compared to elective colorectal surgery. This study assessed the morbidity and mortality in patients undergoing emergency and elective colorectal resection in two metropolitan hospitals. METHODS: Patients were identified retrospectively from two institutions between April 2018 and July 2020. Baseline, operative and postoperative parameters were collected for comparative analysis between emergency and elective surgery groups. A binary logistic regression was performed to identify independent predictors of postoperative complications. RESULTS: During the study period, 454 patients underwent colorectal resection, 135 were emergency cases (29.74%) and 319 were elective cases (70.26%). Compared with elective resections, patients undergoing emergency resections were observed to have a higher American Society of Anesthesiologists (ASA) score of III to IV (53.33% vs. 38.56%) (P = 0.004). The mortality rate was similar between the emergency and elective group (1.48% vs. 0.63%, P = 0.369). The overall complication rate was higher in patients undergoing emergency resections (64.44% vs. 36.68%, P < 0.001), but the major complication rate was similar between groups (12.59% vs. 10.34%, P = 0.484). Independent predictors for postoperative complications included emergency surgery (Odds Ratio (OR) 2.77, 95% Confidence Interval (CI): 1.66 to 4.61) and an ASA Score of III to IV (OR 2.87, 95% CI: 1.84 to 4.47). CONCLUSION: The overall complication rate was higher in patients undergoing emergency colorectal resection, however, rates of major complications and mortality were similar between groups. Higher complication rates reflect advanced disease pathology in patients who are more comorbid.

Delivery of an Incidental Appendiceal Mucinous Neoplasm.

Low-grade appendiceal mucinous neoplasms (LAMNs) are rare and non-invasive tumors of the appendix, and their unexpected discovery during surgery can pose challenges to management. To date, only two cases pertaining to LAMNs without peritoneal spread in pregnancy exist in the literature. Here, we present a literature review of appendiceal mucinous neoplasms and discuss our management and operative approach to a large, incidental appendiceal mucinous neoplasm discovered during an emergency cesarean section of a 38-year-old female.

Handlebar hernia - A rare complication from blunt trauma.

INTRODUCTION: Handlebar hernias are rare; they result from blunt force impacting the abdomen. This focal blunt trauma causes a tear of the underlying abdominal muscle and fascia without necessarily disrupting the skin. The site of the hernia is usually remote from the site of trauma so clinicians may be falsely reassured if they locally explore the site of bruising. The physical examination of such patient may not obviously suggest such an injury and the diagnosis can be easily missed. CASE PRESENTATION: A fit and well 10-year-old boy presented to the emergency department with left sided abdominal pain following a pushbike accident. He fell from his bicycle resulting in an impact of the handlebar to the left side of his abdomen. No obvious hernia was found on physical examination but there was a circular-shaped bruise in the left lower quadrant. An abdominal CT scan was then performed and the unusual diagnosis of a handlebar hernia was made. A prompt laparoscopic herniorrhaphy was performed and his post-operative recovery was uneventful. DISCUSSION: A high level of suspicion is required to diagnose handlebar hernias. Even relatively low-speed trauma can result in this insidious injury. Laparoscopic repair has been demonstrated to be successful in this case. CONCLUSION: Despite being a rare entity, handlebar hernias should be suspected when significant blunt force is applied to the abdominal wall from a handle bar injury. They may not be obvious on physical examination and therefore further imaging is often important. Management involves prompt surgical repair to prevent complications.

The perils and triumphs of night surgical residents across South Australia.

INTRODUCTION: The training of junior medical officers on surgical night shifts is difficult. We aimed to evaluate the training and support provided to these junior doctors during the course of their night rotations across the state of South Australia in 2011. METHOD: Standardised questionnaires were anonymously completed aimed at assessing the strengths and weaknesses of training provided to surgical night residents. Results were analysed using a host of predictors and outcomes to assess for the significance of responses across the state and between institutions. RESULTS: Twenty eight of the thirty two residents (87.5%) who completed surgical night rotations in South Australia in 2011 responded. Based on a visual analogue scale (0 to 10) residents described their level of job satisfaction ranging between 3 to 9, mean 6.5 and median 7.5. Seventeen (53.57%) experienced bullying at some time during their night rotation. A quarter of the residents reported the frequency of bullying as being "occasional". We found that twenty three (82.14%) of the respondents experienced some reluctance in calling senior staff. This correlated with a large number of residents (twenty- 71.43%) who felt their calls were at times unwelcome. The majority of the night residents felt that their exposure to teaching was inadequate (eighteen -64.29%). Seventeen of the residents (60.71%) reported that their exposure was never, very rare or rare. DISCUSSION: Several concerning issues were highlighted by our study. The most significant of these were: perceived patient compromise from a reluctance to call senior staff, the presence of workplace bullying and a paucity of teaching. A number of areas for improvement have been suggested which aim to provide RMOs with greater access to teaching, support and orientation.

Russell Strong and the history of reduced-size liver transplantation.

On the basis of their innovation and experience with reduced-size grafts in children, 20 years ago, Russell Strong and his team in Brisbane, Australia, performed the first successful living donor liver transplant in the world from a mother to her son. The mismatch between supply and demand for deceased donor organs has fueled the expansion of all forms of reduced-size grafts, including split-liver and living donor transplantation. This review outlines the story of Russell Strong, reduced-size liver transplantation techniques, and the development of living donor liver transplantation.