Introduction: Laparoscopic colorectal surgery is increasingly being offered to patients by general surgeons and has become the standard of care in colorectal surgery. Benefits of laparoscopic colorectal surgery include shorter hospital stay, improved recovery time, cost benefits to health system without compromising oncological outcomes. Rural general surgeons in Australia will face an increasing aging population and with that, an increasing load of cancer surgery. Published work comparing rural surgeons outcomes with that of subspecialised metropolitan colleagues have demonstrated similar outcomes. All laparoscopic and laparoscopically assisted colorectal operations attempted or performed by a single surgeon from 2008 to 2014 were retrieved from the hospital database. Patient demographics, operating time, length of stay, complications, mortality, and transfer to tertiary centres were analysed using sound statistical methods. Results: Mean age was 69.26 years and male to female ratio was 1: 1.3. Mean operating time was 156 minutes with LSC (left sided cancer) operations taking significantly longer than RSC (right sided cancer) operations. Median length of stay was 5 days, with LSC patients staying slightly longer but this was not statistically significant. Conversion rate was 5.8%, stoma rate 12.5%, re-admission rate of 3.3%, re-operation rate of 7.5% and mean lymph node harvest of 14.34. Mortality rate was 2.5%. There was no relationship between length of operating time and complications. There was also no correlation between length of operation and length of stay in hospital. Conclusion: Laparoscopic colorectal surgery can be performed in rural Australia by appropriately trained and supported rural general surgeons with comparable outcomes , benefits and savings to the health system.
Pelvic organ prolapse (POP) affects up to 50% of women worldwide, and 11% of these women will eventually undergo surgical treatment. Transvaginal mesh procedures have thus been part of a surgical evolution attempting to overcome the high failure rates of native tissue repairs and minimize morbidity and invasiveness, however, non-standardized techniques and different materials used have resulted in varied outcomes and complication rates. The authors predisposed to analyze their center experience in pelvic floor surgery using a macroporous monofilament polypropylene transvaginal mesh Prolift®.
Postoperative pain control can be challenging. There are a number of different modalities that can be used to treat postoperative pain. The benefits of good pain control, aside from keeping patients comfortable, are early mobility, decreased incidence of cardiopulmonary complications, decreased ileus, improved sleep, decreased overall complications, and shorter hospital stay1,2. To date there has not been a study comparing the benefit of pain control modalities in enhancing the benefits described above. Another purpose for our study was to evaluate if using both an epidural and elastomeric pump together could be done safely with minimal complications. Adverse effects including skin necrosis, wound infection, and cellulitis have been reported with infusion pump systems12. We wanted to demonstrate that our patients treated with this method of pain control did not suffer additional complications.
A 45-year-old Caucasian female present to the emergency room with severe right lower quadrant pain and abdominal distention. The patient reported that over the last seven days she had experienced pain but in the last four days it has become increasingly severe. The patient endorsed chronic constipation secondary to opioid use and stated that she had a fever. Upon presentation the patient didn’t have abnormal vital signs. On physical exam the patient had abdominal tenderness to palpation, specifically in the right lower quadrant. CT scan with IV contrast was performed which showed abscess formation in the midanterior abdominal wall with intraperitoneal extension and another 4cm intraperitoneal collection in the right lower quadrant. The patient was taken to the operating room and was subsequently found to have an appendicitis with an enterocutaneous fistula. This case report will discuss an atypical presentation of appendicitis with enterocutaneous fistula.
Diaphragmatic hernias complicating nephrectomies are very rare. We report a case of iatrogenic recurrent right diaphragmatic hernia complicating right radical nephrectomy presenting 9 years after the initial surgery and recurring one year after being repaired by thoracotomy and suturing of the diaphragmatic defect.
A 56-year-old Caucasian male presented to the ER with severe epigastric pain and vomiting. The patient had lost 30 pounds over 3 months and for the last two days has been unable to tolerate anything by mouth. The patient reported early satiety over the last few weeks. Over the last nine months the patient developed a left lateral neck mass that progressively increased in size. The mass was nontender. On physical exam the patient had a supraclavicular soft tissue mass on the left side approximately 6cm in diameter without submandibular lymphadenopathy. The abdomen had a soft tissue mass palpable on the anterior wall in the epigastric region. Open lymph biopsy of the neck mass was performed and showed metastatic adenocarcinoma with mucinous features. The patient was found to have mucinous gastric adenocarcinoma with an obstructing mass in the transverse colon. The patient was diagnosed with gastric carcinoma, which in advanced stages metastasizes to various organs in the body. It is rare to see supraclavicular lymph node metastases but gastric cancer can metastasize to Virchow's Node, which was observed in this patient.
This case report describes the presentation of a 70-year old male with asymptomatic gangrenous colonic perforation. The significant history in this patient of an incomplete high spinal cord injury is presumed to have affected his intra-abdominal symptoms. Throughout his whole admission he remained comfortable with no complaints of intra-abdominal pain that would be expected with his pathological process. As a consequence, the diagnosis was difficult to determine clinically and required confirmation by imaging.
Gastric AVMs are a rare cause of upper gastrointestinal bleeding and are difficult to diagnose radiologically, as most are small and submucosal, and even when associated with massive bleeding, are difficult to appreciate endoscopically. Our patient is an unusual case of this phenomenon, presenting with haematemesis and malaena, as well as intraperitoneal bleeding. Furthermore, the histopathological diagnosis revealed not only a gastric AVM but also an incidental leiomyoma, which was mistaken as the culprit lesion intraoperatively. Although endoscopic and endovascular approaches are utilised more and more in the management of these lesions, our case highlights the important of surgery as a definitive procedure in emergencies and a treatment option in elective cases.
Summary: The Lichtenstein technique is the "gold standard" in hernia surgery. The aim of this study was to evaluate the results of this process in our conditions. Patients and methods: we performed descriptive retrospective study over a period of 10 years, with 109 cases of inguinal hernia repair according to the Lichtenstein technique. They were 76 men and 3 women, with an average age of 57.2 years. The hernia was recurrent in 60% of the cases. The seat of the hernia was unilateral in 62% of the cases. Results: spinal anesthesia was used in 93.5% of the cases. The hernia was indirect in 52% of the cases and direct in 42% of the cases. According to Nyhus, type III was found in 60% of the cases. Morbidity rate was 12%. They were 6 cases of scrotal and parietal hematoma and 2 cases of wound infections. The rate of recurrence and chronic pain were identical (0.9%). Conclusion: the morbidity of the Lichtenstein technique is low even under conditions of various grades of difficulty.
