The influence of defaecating proctograms on clinical decision-making in pelvic floor disorders.

Aim: Defaecating proctogram (DP) studies have become an integral part of the evaluation of patients with pelvic floor disorders. However, their impact on treatment decision-making remains unclear. The aim of this study was to assess the concordance of decision-making by colorectal surgeons and the role of the DP in this process.

Complex anal fistulas: plug or flap?

Background: Rectal mucosal advancement flaps (RMAF) and fistula plugs (FP) are techniques used to manage complex anal fistulas. The purpose of this study was to review and compare the results of these methods of repair.

Methods: A retrospective review of all complex anal fistulas treated by either a RMAF or a FP at Auckland City Hospital from 2004 to 2008.

Stapled versus handsewn methods for ileocolic anastomoses.

Background: Ileocolic anastomoses are commonly performed for right-sided colon cancer and Crohn's disease. The anastomosis may be constructed using a linear cutter stapler or by suturing. Individual trials comparing stapled versus handsewn ileocolic anastomoses have found little difference in the complication rate but they have lacked adequate power to detect potential small difference.

Adult total parenteral nutrition at Auckland City Hospital: a 6-year review.

Aim: To summarise and evaluate data on the use of total parenteral nutrition (TPN) and associated septic complications at Auckland City Hospital (Auckland, New Zealand) over a 6-year period beginning with appointment of a specialist TPN nurse.

Methods: For each adult patient requiring TPN on an inpatient basis (excluding those in critical care) between January 1998 and December 2003 demographic data, reason for TPN requirement, number of days of TPN administration, type of central venous line used for administration, and frequency of infectious complications were collected prospectively.

Results: 498 episodes of TPN were recorded in 484 patients (202 male, median age 60, range 15-89 y).

Design and validation of a comprehensive fecal incontinence questionnaire.

Purpose: Fecal incontinence can have a profound effect on quality of life. Its prevalence remains uncertain because of stigma, lack of consistent definition, and dearth of validated measures. This study was designed to develop a valid clinical and epidemiologic questionnaire, building on current literature and expertise.

Experience with the use of vacuum dressings in the management of acute enterocutaneous fistulas.

High-output enterocutaneous fistulas involving an open abdominal wound are a difficult management problem. We report our experience on the use of vacuum dressings. The potential benefits, problems and new recommendations for the use of vacuum dressings in the management of enterocutaneous fistulas are discussed.

Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk.

Background: Anastomotic leakage is the most important complication specific to intestinal surgery. The aim of this study was to review the anastomotic leakage rates in a single Colorectal Unit and to evaluate the risk factors for anastomotic leakage after lower gastrointestinal anastomosis.

Methods: A total of 541 consecutive operations involving anastomoses of the colon and rectum that were carried out between 1999 and 2004 at a single colorectal unit were reviewed.

Judgment analysis of surgeons' prioritization of patients for elective general surgery.

Background: Access to elective general surgery in New Zealand is governed by clinicians' judgment of priority using a visual analog scale (VAS). This has been criticized as lacking reliability and transparency. Our objective was to describe this judgment in terms of previously elicited cues.

Clinical variables associated with positive angiographic localization of lower gastrointestinal bleeding.

Background: Localizing the source of severe lower gastrointestinal (GI) bleeding is often difficult but is important to plan the extent of colonic resection. The purpose of the present paper was to audit the Auckland Hospital experience of selective angiography, in localizing lower GI bleeding.

Methods: Patients admitted to Auckland Hospital with rectal bleeding and who subsequently had angiography were evaluated by reviewing their clinical notes and radiological results during a 7-year period (1997-2003).

Long-term outcome of postanal repair in the treatment of faecal incontinence.

Background: Idiopathic faecal incontinence is a common debilitating problem; the results of surgical treatment are variable with only a small proportion of patients achieving full continence.

Objectives: The aim of this study was to evaluate the long-term outcome of postanal repair in idiopathic faecal incontinence.

Patients And Methods: Patients who had postanal repair in Auckland between 1994 and 2001 were identified and mailed faecal incontinence severity index (FISI) and faecal incontinence quality of life (FIQOL) questionnaires.

The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature.

Purpose: Reported prevalence estimates for fecal incontinence among community-dwelling adults vary widely. A systematic review was undertaken to investigate the studied prevalence of fecal incontinence in the community and explore the heterogeneity of study designs and sources of bias that may explain variability in estimates.

Methods: A predetermined search strategy was used to locate all studies published that reported the prevalence of fecal incontinence in a community-based sample of adults.

Priority assessment of patients for elective general surgery: game on?

Background: Clinical priority assessment criteria (CPAC) are used to generate a score by which patients are prioritized and rationed for elective surgery. It is widely believed that surgeons elevate scores to ensure their patients' acceptance for elective surgery, colloquially called gaming. The purpose of the present paper was therefore to investigate whether there was a temporal trend to an increase in the assigned priority score from the inception of CPAC to the present.

Prioritizing patients for elective surgery: a systematic review.

Background: Priority scoring tools are moot as means for dealing with burgeoning elective surgical waiting lists. There is ongoing development work in New Zealand, Canada and the UK. This emerging international perspective is invaluable in determining the application of these tools and addressing any pitfalls.

Prioritizing patients for elective surgery: clinical judgement summarized by a Linear Analogue Scale.

Background: The New Zealand health reforms have resulted in the requirement that surgeons utilize Clinical Priority Access Criteria (CPAC) to ration patient access to elective surgery. The validity of the tools used as CPAC has been challenged. An alter-native tool, the Linear Analogue Scale (LAS), is therefore used in our institution.