Routine cognitive screening for older people undergoing major elective surgery: Benefits, risks and costs.

Cognitive impairment and older age are major risk factors for postoperative delirium. Professional societies have advocated preoperative screening to identify at-risk individuals for implementation of interventions, which have moderate effectiveness in preventing delirium. However, it remains unclear from the guidelines whether screening should be completed routinely for all older individuals or targeted, and also which specific screening tool is preferred.

Peritoneal encapsulation - An unusual cause of acute bowel obstruction: A case report.

Introduction/importance: Peritoneal encapsulation (PE) is a rare congenital anomaly characterised by the presence of an accessory peritoneal membrane which encases part of the small bowel. Typically, this remains asymptomatic, however; in rare cases, a person may present with symptoms suggestive of a small bowel obstruction.

Case Presentation: Here we present a case of a 58 year old gentleman with congenital PE causing a bowel obstruction which was revealed on commuted tomography scan.

Restoration of intestinal continuity following emergency sigmoid colectomy for sigmoid volvulus: An American College of Surgeons National Surgical Quality Improvement Program analysis using coarsened exact matching.

Background: There is limited data to guide decision-making between performing a primary anastomosis and fashioning an end colostomy following emergency sigmoid colectomy for patients with sigmoid volvulus. The aim of this study was to compare the outcomes of these two approaches.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2006 to 2021 was retrospectively analyzed.

Impact of obesity on patients undergoing surgery for rectal cancer in Australia and New Zealand.

Purpose: Patients with obesity undergoing rectal cancer surgery may have an increased risk of developing complications, though evidence is inconclusive. The aim of this study was to determine the direct impact of obesity on postoperative outcomes using data from a large clinical registry.

Method: The Binational Colorectal Cancer Audit registry was used to identify patients who underwent rectal cancer surgery in Australia and New Zealand from 2007-2021.

Female with multiple groin pathologies: inguinal hernia containing fallopian tube, obturator hernia and subcutaneous endometrioma.

Groin lumps in females can be challenging due to unique anatomy and vast differential diagnostic pathologies. We report the case of a 39-year-old female presenting with a six-month history of painful left groin lump. Laparoscopic total extraperitoneal (TEP) hernia repair showed an incarcerated left indirect inguinal hernia sac containing part of the left fallopian tube and fimbrial cyst, a left fat-containing obturator hernia and associated with ectopic subcutaneous inguinal endometrioma.

Pelvic floor training improves faecal incontinence and obstructed defaecation despite the presence of rectal intussusception.

Background: Rectal intussusception is often observed in patients with faecal incontinence and obstructed defaecation. The aim of this study is to assess if pelvic floor training improves faecal incontinence and obstructed defaecation in patients with rectal intussusception.

Methods: Case notes of all patients referred to Bankstown Hospital Pelvic Floor Clinic between 2013 and 2018 for the management of faecal incontinence and obstructed defaecation and rectal intussusception were retrospectively reviewed using a prospectively maintained database.

Large hiatus hernia: time for a paradigm shift?

Background: Laparoscopic large hiatal hernia (LHH) repair remains a challenge despite three decades of ongoing attempts at improving surgical outcome. Its rarity and complexity, coupled with suboptimal initial approach that is usually best suited for small symptomatic herniae have contributed to unacceptable higher failure rates.

Results: We have therefore undertaken a systematic appraisal of LHH with a view to clear out our misunderstandings of this entity and to address dogmatic practices that may have contributed to poor outcomes.

Impact of preoperative smoking on patients undergoing right hemicolectomies for colon cancer.

Purpose: The tobacco epidemic is one of the biggest global public health issues impacting quality of life and surgical outcomes. Although 30% of colon cancers warrant a right hemicolectomy (RH), there is no specific data on the influence of smoking on postoperative complications following RH for cancer. The aim of this study was to determine its effect on post-surgical outcomes.

The impact of COVID-19 on delayed presentations of necrotising fasciitis.

The purpose of this study was to determine the impact of coronavirus disease 2019 (COVID-19) on the delayed presentation of necrotising fasciitis (NF). A retrospective study was conducted of adult patients (≥16 years old) diagnosed with NF at a hospital from 2017 to 2020. A quantitative comparative analysis for the COVID-19 group and control group between 2017 and 2019.

A diagnostic workup and laparoscopic approach for median arcuate ligament syndrome.

Background: Median arcuate ligament syndrome (MALS) is a rare disorder characterized by the compression of the coeliac trunk and plexus by fibrous arches of the median ligament. It commonly occurs in young women with postprandial epigastric pain, weight loss and nausea. We present a single surgeon experience on the diagnostic approach and management of MALS with a focus on laparoscopic surgery.

Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh.

Para-esophageal hernia repairs are challenging procedures and there is no consensus on the optimal approach to repair. Mesh reinforcement has been associated with lesser hernia recurrence when compared to the primary suture repair. The type of mesh that is most appropriate is still debatable.

Vesicocutaneous Fistula Following Radiation and Surgery for the Treatment of Rectal Cancer.

Vesicocutaneous fistulas (VCF) are abnormal tracts formed between the bladder and the cutaneous surfaces of the body. Although rare, it has been reported following radiotherapy to the pelvic region, surgery and trauma. We present a case of a 70-year-old male who underwent neoadjuvant chemoradiotherapy for the treatment of rectal cancer metastatic to the perineum prior to definitive abdominoperineal resection (APR).

Occult Para-Psoas Hernia during Routine Endoscopic Totally Extraperitoneal Inguinal Hernia Repair.

Background And Objectives: Advantage of the total extraperitoneal (TEP) technique over open inguinal hernia repair allows for exploration of other anatomical regions in search for occult hernias (OH).

Methods: Our institutional practice is to routinely explore the obturator and femoral regions for occult hernias. In addition to this technique, we routinely expose the psoas muscle extensively to perfect mesh placement followed by fibrin glue fixation on both 'triangles of doom and pain'.

Why Spermatic Cord Lipomas Must be Treated as "True" Inguinal Hernias.

Lipomas of the cord are common and generally associated with an indirect hernia sac, but not always, as the lipoma may be the only pathology identified during groin exploration. Missed lipoma of the spermatic cord is unfortunately not infrequent and may lead to persistence of post-operative groin pain, with confirmation of unresected cord lipoma on postoperative ultrasound, often necessitating reoperation. We present an interesting case of a 40-years-old male with symptomatic re-recurrent left inguinal hernia following previous open and subsequent endoscopic totally extraperitoneal (TEP) mesh repair.

A decade review of emergency obturator hernia repairs.

Background: Obturator hernia is a rare pelvic hernia associated with a high morbidity and mortality. It most commonly occurs in elderly, multiparous females with symptoms and signs of small bowel obstruction. We present an Australian hospital network experience on emergency presentations of obturator hernias highlighting differences between clinical profile and surgical management.

How to do a combined endoscopic and tailored open extraperitoneal approach for large congenital inguinoscrotal hernia.

Large inguinoscrotal hernias require experienced and skilful laparoscopic hernia surgeons to reap the benefits of laparoscopic versus open surgery. We advocate for an alternative hybrid TEP-open technique that allows tissue extraction away from the groin area, whenever necessary, thus avoiding more painful conventional open herniorrhaphy incision.

Diagnosis and Management of Adult Omental Infarction: 10-Year Case Series.

Background: Omental infarction is a rare cause of an acute abdomen with nonspecific signs that can be easily mistaken with other more common intra-abdominal pathologies. The increased use of radiological imaging has brought this diagnosis to attention with respect to management plan. We present the experience of an Australian hospital network with the diagnosis and management of omental infarction to raise awareness of this uncommon pathology.

A Fall Worth It: Cutaneous Metastatic Deposit of a Distant Colorectal Cancer With Fistula-in-Ano.

A seeded fistula-in-ano from a synchronous colon cancer is rare. We report an unconventional case of a 70-year old male who presented with an incidental post-traumatic perianal cutaneous lump following a fall. Lesion biopsy confirmed the presence of a cutaneous malignant deposit.