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Background: Rectal neuroendocrine tumours (rNETs) are rare but are increasing in incidence. Current management and surveillance recommendations are based on low‐grade evidence. Follow‐up practices are often inconsistent and costly. This retrospective study analyses a single‐centre's experience with rNETs to assess incidence, management practices, outcomes, and guideline adherence. Methods: This is a single‐centre retrospective study from Queensland Australia, spanning from 2012 to 2023. Twenty‐eight rNET cases met inclusion criteria. Examined parameters included incidence, management, outcomes and adherence to European Neuroendocrine Tumour Society (ENETS) guidelines. R1 resection rate was analysed for associations with resection technique and lesion recognition and recurrence rate was assessed in all patients. Results: This study shows an increasing incidence of rNETs during the study period, reflecting a global trend. R1 resection rate at initial endoscopy was 75%. There was a general lack of advanced endoscopic techniques utilized and poor lesion recognition, however a statistically significant correlation was not established between these factors and an R1 result (P < 0.05). Most patients with an R1 result had subsequent re‐resection to render the result R0, however five patients (33%) underwent surveillance with no reports of recurrence on follow‐up. Overall, follow‐up practices in our cohort were inconsistent and did not adhere to guidelines. Conclusion: rNETs are increasing in incidence, emphasizing the need for standardized management and surveillance. Further training is required for rNET recognition and advanced endoscopic resection techniques. Further research is required to assess long‐term outcomes in surveilled R1 cases, understand optimal endoscopic resection techniques and further develop local surveillance guidelines. [ABSTRACT FROM AUTHOR]

Background: Transanal endoscopic microsurgery (TEM) is an established technique for the resection of rectal adenomas and selected malignant tumours. It avoids the morbidity of radical resection for tumours not amenable to endoscopic resection. An important marker of quality is the local recurrence rate. The primary objective was to determine local recurrence rates for benign and malignant rectal tumours. Methods: We identified index TEM excisions of rectal adenomas and adenocarcinomas in patients age 18 and over at Dunedin Hospital, New Zealand, between 2000 and 2020, from a prospective database. Surveillance data were collected via chart review. The primary outcome was recurrence rate for adenomas and adenocarcinomas. Secondary outcomes included time to recurrence, association of recurrence with recognized risk factors, and adverse event rates. Results: We identified 100 patients for analysis. Of 75 benign cases, 11 (14.7%) developed local recurrence, with 63.6% identified within 1 year. Of the 25 malignant cases (19 T1, 5 T2, 1 T3), 9 (36%) developed recurrence, with 77.8% identified within 2 years. Adverse events occurred in 26% of patients, with no reoperations or deaths. Conclusion: Our adenoma recurrence rate was at the higher end of the reported range of 2.4–16%. Minor complications were common, but not major morbidity. The propensity for rectal tumours to recur commonly and early reinforces the importance of regular standardized endoscopic surveillance. [ABSTRACT FROM AUTHOR]

Background: Endoscopic prostate surgery is an established treatment for male lower urinary tract symptoms (LUTS) and is recognized to have low mortality rates. We aimed to describe factors that may have contributed to death following endoscopic prostate surgery using data from the Australia and New Zealand Audits of Surgical Mortality (ANZASM). Methods: All urological related deaths reported to ANZASM from January 1 2012 to December 31 2019 were reviewed. Deaths related to endoscopic prostate resection (transurethral resection of prostate – TURP, laser procedures) were included. Peer reviewers identified up to three clinical management issues (CMIs), and these were analysed. CMIs were classified in order of least to most concerning: area of consideration, area of concern and adverse events. Results: Of 1127 total urological deaths, 77 deaths were related to endoscopic prostate surgery (7.0%). Most procedures were monopolar TURP. The mean age of patients was 80.9 years (range 57.0–96.2). Leading causes of death were cardiovascular events 23/77 (29.9%) and respiratory failure 14/77 (18.2%). Assessors identified 39 CMIs in 26/77 (33.8%) patients. Twenty‐three were areas of consideration, nine were areas of concern and seven identified adverse events. The most common CMIs were regarding post‐operative care (14/39) and the decision to operate (13/39). Conclusion: Most deaths did not elicit concerns from the ANZASM peer assessors. However, the main concerns identified were surrounding decision making and rationale for operating. This highlights the importance of clear counselling and documentation during the treatment decision process. [ABSTRACT FROM AUTHOR]

Background: Endoscopic endonasal surgery (EES) has become a popular approach to deal with skull base pathologies. The most catastrophic intra‐operative complication of EES is internal carotid artery (ICA) injury. We aim to discuss and introduce our institutional experience with ICA injury during EES. Methods: A retrospective review of patients who underwent EES from 2013 to 2022 was performed to determine the incidence and outcomes of intraoperative ICA injuries. Results: There were six patients (0.56%) with intraoperative ICA injury in our institution during the last 10 years. Fortunately, there was no morbidity or mortality in our patients with intraoperative ICA injuries. The sites of injury were equally in paraclival, cavernous sinus, and preclinoidal segments of ICA. Conclusion: Primary prevention is the best solution for this condition. Regarding our institutional experience, the best option for primary management just after an injury is packing the surgical site. In cases where packing is not enough for temporary control of bleeding, common carotid artery occlusion should be considered. We have presented our experience and reviewed previous studies regarding different treatments and suggested our intra and post‐operative management algorithm. [ABSTRACT FROM AUTHOR]

Accidental fishbone ingestion is a relatively common occurrence, with most cases going unnoticed as small bones pass through the gastrointestinal tract without issue. However, fishbones can sometimes cause perforation in the terminal ileum or rectosigmoid, leading to intrabdominal sepsis or walled-off collections. In rare cases, fishbones can penetrate adjacent structures, as seen in a 62-year-old female who presented with bladder wall erosion caused by a fishbone. The patient underwent diagnostic laparoscopy and cystoscopy, and eventually had the fishbone surgically removed. This case adds to the literature on the rare condition of intravesical migration of fishbones and provides insights into its diagnosis and management. [Extracted from the article]

This article describes a laparoscopic-assisted endoscopic procedure called a "clean sweep" for removing small bowel polyps in patients with Peutz Jeghers Syndrome (PJS). The technique combines laparoscopy and intra-operative enteroscopy to completely remove hamartomas from the entire small bowel, reducing the risk of future recurrences. The procedure is minimally invasive, safe, and has good postoperative outcomes. It is intended for patients with PJS who have extensive, symptomatic, and endoscopically-unreachable or unresectable small bowel hamartomas. The article provides detailed technical instructions and includes visual aids to illustrate the procedure. [Extracted from the article]

Background: Carpal tunnel syndrome is a common compressive neuropathy. There is a lack of comprehensive studies evaluating carpal tunnel release (CTR) complications in Australia. This study aimed to evaluate complication rates associated with open and endoscopic CTR in an Australian population, and to identify associated risk factors. Methods: Retrospective cohort study of 1287 CTR from 2015 to 2020. Methods of release were endoscopic, open and surgery concomitant with synovectomy or other. Outcomes included wound infection, dehiscence, nerve injury, complex regional pain syndrome, incomplete release, and re‐operation. Statistical analysis included Chi‐squared test, Fisher's exact test, Odds ratio and logistic regression. Results: There were 71 total complications (5.5%), including 35 Clavien–Dindo IIIb complications. There was no difference in complication rates for endoscopic (3.3%) versus open (8.3%) CTR (P = 0.18). The overall rate of complications was higher in CTR with concomitant surgery (8.5%) compared to CTR alone (5.2%), though this was not statistically significant (P = 0.058). There was no association between rates of complications and immune suppression (p = 0.55), rheumatoid disease (P = 0.61), or smoking status (P = 0.72). Diabetes mellitus was associated with an increased risk of Clavien‐Dindo IIIb complications (P = 0.028, OR 2.15, 95% CI 1.07–4.32). There was no association between surgical experience and complication rate (P = 0.55). Conclusion: Open and endoscopic CTR surgeries have similar rates of complications. Diabetes is associated with higher rates of Clavien‐Dindo IIIb complications. Identification of high‐risk patients allows for the application of risk‐mitigation strategies in the perioperative setting. [ABSTRACT FROM AUTHOR]

Background: Sinonasal epithelial malignancies are uncommon tumours but represent a challenge to treatment given their close proximity to the orbit, brain and cranial nerves. Traditional external surgical approaches have potential for significant functional and cosmetic morbidity. An endoscopic approach provides the surgeon with good access for tumour removal and enables surveillance postoperatively. This study aimed to assess outcomes of an endoscopic approach to sinonasal epithelial malignancy and evaluate factors that may influence its utility. Methods: A case series was performed involving consecutive patients treated with endoscopic or endoscopic‐assisted surgery for epithelial sinonasal malignancy. Stratification included TNM staging, histopathology, surgical approach, margin status, perineural involvement and adjuvant or neoadjuvant therapy. At follow‐up, complications, local control, nodal status and evidence of distant metastases were recorded. Statistical analyses to identify risk factors for developing recurrence and survival differences were performed. Results: Thirty‐five patients were assessed in this study (59.2 ± 11.4 years, 42.9% female). T stage at presentation was T1 in 11.4%, T2 in 17.1%, T3 in 22.9% and T4 in 48.6%. The 3 and 5 year disease specific survival were 91.3% (SE 5) and 71.1% (SE 10). The only factors to influence survival outcomes were perineural invasion of tumour and positive margins at the time of initial surgery. Large tumours did not limit the utility of an endoscopic approach. Conclusion: Endoscopic approach is a safe and oncologically equitable treatment approach to external approaches in the management of epithelial sinonasal malignancy. As with external approaches, perineural invasion of malignance is a poor prognostic factor. [ABSTRACT FROM AUTHOR]

Introduction: Rectal malignant polyps can be managed by use of trans‐anal resections (TAR). Traditional techniques of resection have been replaced by use of platforms such as trans‐anal minimally invasive surgery (TAMIS) or trans‐anal endoscopic microsurgery (TEM). This study reviewed the management of rectal malignant polyps, in particular focussing on when clinicians used TAR. Methods: A population wide cohort study of all malignant rectal polyps diagnosed in Queensland, Australia from 2011 to 2018 was undertaken. Patient and pathological factors were compared across the management strategies of polypectomy, TAR and rectal resection. Results: Overall 430 patients were diagnosed with a malignant rectal polyp during the study period, with 103 undergoing a TAR. There was increasing use of TAR across the study period as a management strategy (P < 0.001). Polypectomy alone was more likely to be the management strategy over TAR or rectal resection if there were clear margins (P < 0.001). The distance to the closest polypectomy margin was also significantly higher in the polypectomy group with mean clearance 2.09 mm in polypectomy group versus 0.86 mm in TAR group and 0.99 mm in resection group (P < 0.001). Rectal resection was more likely to be the management strategy over TAR if there was LVI (P < 0.001), depth of invasion was deeper (P < 0.001) and there was tumour budding (P = 0.001). Conclusion: TAR is an effective management strategy for rectal polyps and is utilized particularly in rectal malignant polyps when there are close or involved margins. Future guideline development should consider incorporation of TAR given the advances in techniques afforded by TAMIS or TEM platforms. [ABSTRACT FROM AUTHOR]

A computed tomography scan demonstrated Mirizzi syndrome with a large cholecystobiliary fistula and obstruction of the common hepatic duct (Fig. A novel endoscopic retrograde cholangiopancreatography technique to reduce stone size in type IV Mirizzi syndrome: avoiding cholangiojejunostomy. [Extracted from the article]

The right maxillary and right sinus is fluid-filled suggesting secondary obstruction. gl Incisional biopsy was discussed with the patient, but due to the high risk of bleeding, he instead elected to undergo endoscopic sinus surgery with stereotactic image guidance for surgical excision of the tumour. (b) A T2-weighted MRI scan of the paranasal sinuses demonstrated an enhancing solid mass centred in the right-side ethmoid cells with central cystic change/necrosis. A 56-year-old male with a history of right nephrectomy for clear cell renal carcinoma diagnosed in 2014 presented with longstanding right nasal obstruction (related to an incidental septal deformity) and new localized right nasal pain. [Extracted from the article]

Hernia 2018; 22: 1 - 65. 11 Hansen DL, Fonnes S, Rosenberg J. Spin is present in the majority of articles evaluating robot-assisted groin hernia repair: a systematic review. There has been a slow but steady rise in Australia over the past 20 years in the proportion of groin hernias repaired using a minimally invasive surgery (MIS) approach. [Extracted from the article]

Background: Despite advances in medical management and endoscopic therapy, gastrectomy remains an important yet high‐risk procedure for a range of benign and malignant upper gastrointestinal pathologies. No study has previously analysed Australian gastrectomy perioperative mortality rate (POMR). This retrospective, population‐based cohort study was conducted to determine the Australian national gastrectomy POMR, allowing state‐based and regional trends and outcomes to be assessed. Methods: Logistic regression models were compared using de‐identified procedural data between 1 July 2005 and 30 June 2017 from the Australian Institute of Health and Welfare. Codes relating to total and subtotal gastrectomy contained in the Australian Classification of Health Interventions were used to extract patient data. Mortality rates were risk adjusted for age and gender. Temporal trends and differences between states/territories and regions were investigated. Results: The national average POMR throughout the study period was 2.1%. For subtotal gastrectomy, the national mean POMR was 1.1%, decreasing from 2.7% (2005) to 1.3% (2017). For total gastrectomy, the national mean POMR was 2.8%, decreasing from 3.3% (2005) to 1.7% (2017). POMR significantly reduced over time without variation between states or regions. Procedure volume steadily reduced in rural centres with a concomitant increase in metropolitan centres over time. Conclusion: Pleasingly, the Australian gastrectomy POMR is favourable when compared to international cohorts. Improved outcomes were consistent between states and territories, and metropolitan and regional centres. Progressive metropolitan centralization of gastrectomy was demonstrated without evidence of improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Endoscopic pilonidal sinus treatment (EPSiT) is a novel minimally invasive technique for treating pilonidal sinus disease (PSD) involving endoscopic assessment and treatment. This retrospective, non‐randomized, observational study is the first Australian study of EPSiT and its largest long‐term study to date. Methods: From January 2014 to November 2019, 137 patients with PSD underwent EPSiT. Seventy‐two had undergone previous surgery for PSD. Specialized Karl Storz video equipment (fistuloscope) was used. The rigid fistuloscope allowed direct visualization of cavities and secondary tracts. Cavities and tracts were then curetted endoscopically to remove all granulation tissues and hair/follicles. Ablation was then carried out under direct vision along with removal of debris. Patients were then followed up for a mean 56.2 months. Results: 72.2% (n = 91) of patients undergoing EPSiT achieved primary healing (needing nil further intervention) at a median of 6 weeks; 13.5% (n = 17) experienced healing followed by recurrence while 14.3% (n = 18) experienced non‐healing. Of the recurrence/non‐healing groups, 20/35 underwent repeat EPSiT with healing occurring in 18/20 patients at a median of 7 weeks. The balance of patients (n = 15) underwent other definitive procedures. The mean operating time was 34 min. There were no major complications and 85% of patients were discharged the same day. Eleven patients were lost to follow‐up. Conclusion: EPSiT combines high efficacy of treatment for PSD along with relatively low rates of recurrence. The minimally invasive nature of the procedure means repeat procedures can be performed (where necessary) with low morbidity and a reasonable rate of success. [ABSTRACT FROM AUTHOR]

Background: Chest drain suction of −20 cm H2O has been used universally after lung resection. After introducing new guidelines,−8 cm H2O was used routinely for all non‐pneumonectomy, thoracoscopic lung resections. We conducted a review to determine outcomes and safety. Methods: After introduction of the guidelines data were collected in the study institutions' thoracic surgical database and subsequently analysed. Results: A total of 155 patients underwent thoracoscopic lung resection. Mean patient age was 61.5 ± 13.6 years. Video‐assisted thoracoscopic surgery was performed in 92.2% (144/155) of patients and robotically‐assisted thoracoscopic surgery was performed in 7.8% (12/155) of patients. Lobectomy was performed in 56.8% (88/155) of patients, segmentectomy was performed in 11.6% (18/155) of patients and wedge resection was performed in 31.6% (49/155) of patients. Median ICC duration time was 1 day (IQR 1–3). Median length of stay was 3 days (IQR 2–6). For patients undergoing lobectomy median ICC time was 2 days (IQR 1–4.5) and median length of stay was 3.5 days (IQR 2–7), for segmentectomy median ICC time was 1 day (IQR 1–5) and median length of stay was 2 days (IQR 1–5) and for wedge resection median ICC time was 1 day (IQR 1–1) and median admission time was 2 days (IQR 1–4). Conclusion: A suction level −8 cm H2O is safe to use for thoracoscopic lung resections from day 0 post‐operatively. A dedicated, prospective study comparing levels of suction should be performed. [ABSTRACT FROM AUTHOR]

Background: There is currently limited data to reassure the technical efficacy, particularly in attaining clear margins, through a transgastric laparo‐endoscopic approach to resecting tumours located near the gastroesophageal junction (GOJ) or the pylorus. Methods: Single institution retrospective analysis of all cases from 1 April 2008 to 31 Dec 2019. Results: Overall, 34 patients (38 tumours) underwent transgastric laparo‐endoscopic resection. Of these, 27 (71.1%) and 5 (14.7%) cases were located close to the GOJ and pylorus respectively. Three (8.0%) cases were converted to conventional laparoscopic excision. No anatomical gastric resection was required. The mean (SD) operative time was 167.5 (64.2) minutes and reduced with increasing experience. The median (IQR) length‐of‐stay was 3.0 (3.0–4.5) days. Major post‐operative complication (Clavian–Dindo ≥3) occurred in 1 (2.9%) patient, which required surgical control of staple line bleeding. The most common pathology was gastrointestinal stromal tumour (71.1%), followed by leiomyoma (10.5%), schwannoma (5.2%), dysplastic polyp (5.2%), and neuroendocrine tumour (2.6%). The mean (SD) tumour diameter was 3.9 (2.1) cm (largest 10.1 cm, 10 cases >5 cm). Resection margins were clear in all cases. We found no evidence of tumour recurrence or gastric stenosis at a median follow‐up of 88 months. Conclusion: Transgastric laparo‐endoscopic resection of junctional and pyloric tumours with low metastatic potential is technically feasible. This approach achieved clear resection margins in all our cases, with acceptable perioperative and longer‐term outcomes. [ABSTRACT FROM AUTHOR]

Image shows concertina'd bowel with typical appearance of intussusception. gl Retrograde gastro-jejunal intussusception is a rare complication post gastric surgery, with an incidence estimated at about 0.1%. Image shows distended stomach containing intussuscepted bowel pre-reduction. gl GLO:HWR/01nov22:ans17561-fig-0003.jpg PHOTO (COLOR): 3 Retrograde gastrojejunal intussusception was confirmed after reducing approximately 80 cm of ischaemic small bowel contained within the stomach. We present a rare case of recurrent retrograde gastrojejunal intussusception post gastric bypass with a failure of non-revisional management. [Extracted from the article]

Background: Bleeding of the gastrointestinal tract (BGIT) is a common gastrointestinal emergency. There is no consensus whether this condition should be admitted to medical or surgical discipline. Timing of presentation may also impact patient outcomes due to differences in healthcare resource availability. This study thus aims to investigate the impact of admitting discipline and timing of admission on patient outcomes in BGIT. Methods: A 2‐year tertiary institution database was retrospectively reviewed. Outcome measures included 30‐day mortality, 30‐day readmissions and rebleeding requiring repeat endoscopic, angiographic or surgical interventions. Secondary outcome measures included time to endoscopy, percutaneous angiographic interventions and surgery. The effect of admission discipline (medical versus surgical) and time of admission (office‐hours versus after office‐hours) were analysed using a propensity‐score‐adjusted estimate. Results: A total of 1384 patients were included for analysis, medical (n = 853), surgical (n = 530); during office‐hours (n = 785) and after office‐hours (n = 595). After propensity‐score‐adjusted analysis, no significant differences in mortality or readmissions were noted between medical or surgical admissions. Patients admitted under surgery were less likely to sustain rebleeding (P = 0.004) for lower BGIT and had an earlier time to endoscopy for upper BGIT (P = 0.04). Patients admitted after office‐hours had similar outcomes with those admitted during office hours apart from a delay in time to endoscopy (P = 0.02). Conclusion: For BGIT patients, admission to a surgical discipline compared to a medical discipline appeared to have at least equivalent patient outcomes. Patients presenting with BGIT after office‐hours were more likely to experience a delay to endoscopy, although it did not affect patient mortality. [ABSTRACT FROM AUTHOR]

If the stricture could be identified, the endoscopic management of the anastomosis stricture tends to favor a better outcome, without the need of surgical resection.1 The damage control strategy for non-trauma emergency laparotomy proposed by Sohn et al.4 was applied in this case. Complete stricture following end-to-side colorectal anastomosis complicated with acute large bowel obstruction post colostomy closure Small bowel and large bowel were severely dilated as a result of a anastomotic stricture at previous colorectal end-to-side anastomosis (Figs 2,3). [Extracted from the article]

The transcribed text was imported onto a readability calculator for analysis.6 Each PIL was assessed using three readability scores: the Flesch Reading Ease (FRE) score, the Flesch-Kincaid Grade Level (FKGL) and the Gunning Fog Index (GFI). Patient information leaflets (PILs) are important tools that help to educate patients about their health, and so can be useful in gaining informed consent for surgery. Otolaryngology-head and neck surgery patient information leaflets produced by the Royal Australasian College of Surgeons: Time for a re-think?. [Extracted from the article]

In this case, the patient developed a large submucosal haematoma at the surgical site 2 days after ESD, which was considered to be the result of delayed postoperative bleeding and may be related to several factors. Submucosal haematoma are recommended to be treated conservatively first, and combined with endovascular embolization therapy may have a better outcome for giant haematoma. [Extracted from the article]

The patient underwent an upper gastrointestinal endoscopy the following day and the fishbone was retrieved from a small diverticulum in the third part of the duodenum. A 76-year-old lady was referred to the Emergency Department by a reporting Radiologist after a foreign body microperforation of a duodenal diverticulum was incidentally found during an oncological staging scan. The patient's abdominal computed tomography (CT) was reviewed and demonstrated fat stranding and extraluminal gas locules in the retroperitoneum. [Extracted from the article]

His routine blood investigations, including complete blood count, random blood sugar, liver and renal blood profile, and serology for viral markers, were normal. A 45-year-old male presented to the surgical outpatient department with complaints of recurrent upper abdominal pain for 6 months following right hemicolectomy performed for carcinoma of the cecum. Tumour marker CEA was also normal. [Extracted from the article]