Naevus sebaceous (NS) is a congenital cutaneous hamartoma characterised by epidermal, follicular, sebaceous and apocrine components, with a rare but significant potential for malignant transformation, most commonly into...Naevus sebaceous (NS) is a congenital cutaneous hamartoma characterised by epidermal, follicular, sebaceous and apocrine components, with a rare but significant potential for malignant transformation, most commonly into basal cell carcinoma (BCC). Syringocystoadenoma papilliferum (SCAP), a rare adnexal tumour, occasionally arises within NS lesions and may progress to malignancy. This study presents a comprehensive narrative review and a rare case of SCAP arising within NS and subsequently transforming into BCC, highlighting the interplay between these lesions. A systematic review adhering to PRISMA guidelines was conducted using databases including PubMed, OVID Medline and Cochrane, yielding 34 relevant articles after rigorous selection. While NS is present at birth, SCAP can emerge later in life, with hormonal and environmental factors contributing to its development. Both lesions exhibit overlapping genetic alterations, particularly involving PTCH and p16, which are also implicated in the pathogenesis of BCC. This genetic convergence suggests potential mechanisms linking NS and SCAP to malignant transformation, although further research is needed to appreciate their interrelationship fully. This review highlights the need for vigilant monitoring of NS lesions, particularly in the presence of multiple risk factors such as sun exposure and a family history of skin cancer. Early detection and management are critical to mitigate the risk of malignant progression.
BACKGROUND: Neoadjuvant systemic therapy (NAST) induces morphological changes within the axilla; however, its impact on lymph node yield (LNY) following axillary lymph node dissection (ALND) is less clear. METHODS: A ret...BACKGROUND: Neoadjuvant systemic therapy (NAST) induces morphological changes within the axilla; however, its impact on lymph node yield (LNY) following axillary lymph node dissection (ALND) is less clear. METHODS: A retrospective cohort study was performed including female patients who underwent ALND for biopsy-proven node-positive breast cancer within Western Sydney Local Health District hospitals between 2010 and 2022. Patients were grouped by receipt of NAST versus primary surgery (PS). LNY was compared between groups. Within the NAST group, univariate and multivariable logistic regression analyses identified variables associated with LNY ≥ 10. RESULTS: Among 768 patients, 217 (28.3%) received NAST and 551 (71.7%) underwent PS. Median LNY was lower following NAST compared to PS (17 [IQR: 10] vs. 21 [IQR: 10], p < 0.001), with fewer NAST patients achieving a LNY ≥ 10 compared to PS (90.8% vs. 97.5%, p < 0.001). On multivariable analysis, lymphovascular invasion (LVI) was associated with reduced odds of achieving a LNY ≥ 10 (OR: 0.26, 95% CI: 0.09-0.80, p = 0.019), whereas the HR+/HER2- subtype was associated with increased odds (OR: 3.89, 95% CI: 1.20-12.7, p = 0.024). Neither complete pathological response nor treatment effect was associated with reduced LNY. CONCLUSION: NAST was associated with a modest but statistically significantly lower LNY, although median yields exceeded traditional thresholds and lymph node ratio was preserved. Following NAST, LNY appears influenced by tumour biology rather than surgical adequacy. These findings reinforce the need to interpret historic numeric thresholds cautiously, with greater emphasis on residual disease and surgical intent in modern practice.
OBJECTIVES: To assess the effectiveness of a pre-operative triaging model for paediatric adenotonsillectomy in identifying risk of early post-operative respiratory complications, in order to propose an evidence-based tri...OBJECTIVES: To assess the effectiveness of a pre-operative triaging model for paediatric adenotonsillectomy in identifying risk of early post-operative respiratory complications, in order to propose an evidence-based triaging model for day-case paediatric adenotonsillectomy. STUDY DESIGN: A retrospective cohort study of 2953 children between 2- and 12-years-old undergoing adenotonsillectomy for obstructive sleep apnoea (OSA) between January 2011 and December 2019. Patients were triaged as either low-risk or high-risk for post-operative respiratory complications based on age, comorbidities and results of pre-operative investigation with either overnight oximetry or polysomnography. Pre-operative factors including respiratory investigations, intra-operative factors and post-operative course were analysed. RESULTS: Of the 2953 patients enrolled in this study, 1229 patients were deemed low-risk, and 1724 patients were deemed high-risk. Total respiratory complication rate in low-risk patients was 1.5% requiring either repositioning or prolonged oxygenation, with no major respiratory complications requiring admission to the intensive care unit (ICU) or non-invasive ventilation. Total respiratory complication rate in the high-risk cohort was 11.7%. In this cohort, five patients required non-invasive ventilation and seven had an unplanned admission to ICU for monitoring. Severity of OSA and the presence of recovery room complications were the most significant independent risk factors associated with post-operative respiratory compromise, with severe OSA conferring an odds ratio of 9.5 (95% CI 5.0-18.0) of respiratory compromise and 13.6 (95% CI 3.4-54.9) in the presence of any complications in the recovery room. CONCLUSIONS: Pre-operative oximetry and/or polysomnography are useful tools to aid triaging patients and stratifying risk when determining safety for day-case paediatric adenotonsillectomy.
Māori are significantly underrepresented within the surgical health workforce in Aotearoa, perpetuating longstanding inequities in access, experiences and outcomes. Little is known about the experiences of Māori across t...Māori are significantly underrepresented within the surgical health workforce in Aotearoa, perpetuating longstanding inequities in access, experiences and outcomes. Little is known about the experiences of Māori across the continuum from medical school to consultancy. This study aimed to explore the experiences of Māori doctors to identify barriers, enablers and opportunities for improving pathways into surgery. A qualitative study was undertaken using a Kaupapa Māori methodological approach, combining an online survey of Māori medical students, junior doctors, and registrars with semi-structured interviews with Māori surgical consultants. Key motivators for pursuing surgery were early surgical exposure, strong mentorship and commitment to improving Māori health. Culturally grounded initiatives such as the interview preparation wānanga and mentorship, particularly from Māori senior clinicians, were recognized as strong supportive factors. Key barriers included systemic and interpersonal racism, limited access to Māori mentors, and the cultural tensions experienced when navigating predominantly Pākehā surgical environments. This study provides one of the first continuum-wide insights into Māori doctors' experiences within surgical training. Addressing systemic barriers and strengthening culturally grounded support structures is essential to improving Māori representation and equity within the surgical workforce.
BACKGROUND: Laparoscopic cholecystectomy (LC) is the gold-standard treatment for benign gallbladder disease but carries a higher risk of bile duct injury than the open approach, largely due to misidentification of critic...BACKGROUND: Laparoscopic cholecystectomy (LC) is the gold-standard treatment for benign gallbladder disease but carries a higher risk of bile duct injury than the open approach, largely due to misidentification of critical hepatobiliary structures. This systematic review and meta-analysis synthesizes intraoperative evidence on the prevalence and surgical relevance of anatomical variations and evaluates their implications for safe LC. METHODS: Following Evidence-based Anatomy and PRISMA 2020 guidelines, four databases were investigated. Random-effects meta-analyses estimated pooled prevalences and small-study effects were assessed. RESULTS: Twenty-seven studies (n = 9618) were included. Conventional cystic artery and duct (CA and CD) anatomy was observed in 86.15% and 89.02% of cases, respectively. Among arterial variants, duplicate CA (7.18%) and caterpillar hump of the right hepatic artery (6.26%) were the most common "third elements" entering the hepatocystic triangle. CA positional deviations included courses posterior (14.95%), anterior (10.75%), and inferior (6.23%) to the CD. Aberrant right hepatic duct entering the hepatocystic triangle was recorded in 1.03%. CONCLUSIONS: Most CA and CD variations relevant to LC occur within the hepatocystic triangle, where they can interfere with identification of the vascular-biliary pedicle and increase the risk of vasculo-biliary injury. Integrating these findings into the cognitive framework of the Critical View of Safety (CVS) highlights the importance of anticipating "third elements" and heterotopic courses when dissecting.
Chronic pancreatitis and recurrent acute pancreatitis are progressive disorders associated with severe pain, functional limitation and major impairment in health-related quality of life. For selected patients with diseas...Chronic pancreatitis and recurrent acute pancreatitis are progressive disorders associated with severe pain, functional limitation and major impairment in health-related quality of life. For selected patients with disease refractory to medical, endoscopic or limited surgical therapy, total pancreatectomy with islet autotransplantation (TPIAT) offers definitive pain control whilst preserving endogenous insulin production. Whilst metabolic outcomes such as insulin independence have traditionally guided evaluation of this procedure, patient-reported outcomes provide a broader assessment of its clinical impact and are increasingly relevant to surgical decision-making. This narrative review synthesises the available evidence on health-related quality of life, psychological well-being and occupational outcomes following TPIAT in adult patients. Across published cohorts, TPIAT is consistently associated with clinically meaningful improvements in global quality of life, particularly in pain, physical functioning and emotional well-being, with benefits observed even amongst patients who remain insulin dependent. Psychological health generally improves following surgery, although detailed characterisation is limited by infrequent use of validated psychiatric instruments. In contrast, occupational recovery is more variable, often constrained by long-standing pre-operative disability, prolonged opioid exposure and socioeconomic factors rather than surgical outcomes alone. Interpretation of existing data is challenged by small sample sizes, heterogeneous outcome measures and limited long-term follow-up. Overall, current evidence supports TPIAT as a procedure that confers substantial patient-centred benefits for appropriately selected adults with refractory pancreatitis. These findings highlight the importance of timely referral, comprehensive pre-operative assessment, and structured multi-disciplinary post-operative support, and underscore the need for standardised, prospective evaluation of patient-reported outcomes to better inform surgical counselling and optimise long-term recovery.
BACKGROUND: Minimal-invasive surgery (MIS) was proven beneficial in Crohn's Disease (CD). Intracorporeal anastomosis (ICA) represents a further improvement as it is associated with decreased complications and shorter hos...BACKGROUND: Minimal-invasive surgery (MIS) was proven beneficial in Crohn's Disease (CD). Intracorporeal anastomosis (ICA) represents a further improvement as it is associated with decreased complications and shorter hospitalization. Extracorporeal anastomosis (ECA) is preferred to ICA as it allows haptic feedback of the bowel and mesentery, which is historically required for bowel resection in CD to minimize recurrences. We compared ICA and ECA in terms of recurrences and complications. METHODS: All patients between 2016 and 2022 with Crohn's disease who underwent a MIS ileocecectomy were identified and divided into ICA and ECA groups. Exclusion criteria were open surgery, end ileostomies, follow-up < 1 month, and ileocecectomy not due to CD. RESULTS: 107 patients were included in the ICA group (44.9% male, mean age of 40.2 [±16.6] years), while 270 patients were in the ECA group (46.7% male, mean age of 41.9 [±17.3] years). The rate of endoscopic recurrences with a Rutgeerts score > 2, clinical recurrence, and surgical recurrence were not statistically different between the two cohorts. On the multivariable analysis for endoscopic and clinical recurrences, the ICA/ECA approach was not significant. The ECA group revealed a higher overall complication rate (30.4% versus 15.9%, p = 0.004). The median length of stay was significantly reduced in the ICA group (p < 0.001). CONCLUSION: ICA seems to be safe in ileocecectomies for CD. The complication rate and length of stay were reduced while not affecting the endoscopic, clinical, and surgical recurrence rates. MIS technology provides enhanced visualization and haptic feedback, which could be used as surrogates for the tactile evaluation intra-operatively.
BACKGROUND: Reduced preoperative fasting times are beneficial for patients, have negligible aspiration risk and minimise intravenous fluid (IVF) use. For over 15 years the national anaesthetic guidelines in Australia hav...BACKGROUND: Reduced preoperative fasting times are beneficial for patients, have negligible aspiration risk and minimise intravenous fluid (IVF) use. For over 15 years the national anaesthetic guidelines in Australia have recommended solid food until 6 h prior to surgery and unlimited clear fluids until 2 h prior to surgery. In 2024 an additional recommendation was added: sips of clear fluids (typically water) up to 200 mL/h until sent to theatres. Nonetheless, 'fast from midnight' (FFM) and 'nil by mouth' (NBM) are commonly used. METHODS: This study was conducted on patients in a single, tertiary, metropolitan hospital. Baseline preoperative fasting data were retrospectively collected from 21/08/2024 to 18/09/2024. A staff education campaign and an EMR smart phrase (".FAST") were then introduced. Post implementation data were prospectively collected from 28/10/2025 to 20/01/2025. Data were analysed for fasting protocol type, total fasting time (TFT), and preoperative IVF use. Data modelling was used to calculate the projected impact of the .FAST protocol. RESULTS: Uptake of best practice fasting guidelines increased from 1% to 47% (p < 0.001). This was associated with a marked IVF use reduction-from 41% to 17% of patients (p < 0.001)-and a decrease in median fasting time from 9 to 2 h (p < 0.001). Median total time on IVF reduced from 8 to 0 h (p < 0.001). Projected annual savings in EGS with 100% uptake of the .FAST protocol were projected to be 23 doctor workdays and 46 nurse workdays (assuming an 8 h workday), and $2460 in IVF cost. CONCLUSIONS: Implementation of a simple to use, contemporary preoperative fasting protocol in EGS through staff education and an EMR smart phrase led to decreased time fasted for patients and IVF use. No patients fasted with .FAST had surgery cancelled due to inadequate fasting.
INTRODUCTION: On 1 July 2023, new advertising regulations were introduced in Australia to more closely regulate cosmetic surgery advertising. These guidelines apply to all practitioners of cosmetic surgery and were intro...INTRODUCTION: On 1 July 2023, new advertising regulations were introduced in Australia to more closely regulate cosmetic surgery advertising. These guidelines apply to all practitioners of cosmetic surgery and were introduced to protect patients. In Australia, three professional associations comprise most practitioners performing cosmetic surgery. These professional associations are the Australian Society of Plastic Surgery (ASPS), the Australian Society of Aesthetic Plastic Surgeons (ASAPS) and The Australian College of Cosmetic Surgery and Medicine (ACCSM). The aim of this study was to audit the compliance of practitioners performing cosmetic surgery to these new advertising guidelines. METHODS: This study involved the review of websites associated with all medical practitioners listed on the ASPS, ASAPS and ACCSM association websites in the state of Victoria, Australia. It was performed between the 1 and 30 September 2023 by three medical practitioners all working in plastic surgery. Guidelines from the Medical Board of Australia 'Guidelines for registered medical professionals who advertise cosmetic surgery' which came into effect on 1 July 2023 were used as the reference for this study. A retrospective review was then conducted on a cross section of results by an external reviewer who was a nurse not working in plastic surgery. RESULTS: A total of 158 practitioners were identified and 120 were eligible for audit. Eighteen percent of ASPS members, 33% of sole ASAPS members and 71% of ACCSM were found to breach a guideline. The external reviewer concurred with 95% of the global outcomes recorded by the primary reviewers. CONCLUSION: ASPS and ASAPS members in Victoria are more compliant with recently updated advertising regulations than ACCSM members. All cosmetic surgery practitioners should review their advertising practices and ensure compliance to updated regulations.
BACKGROUNDS: Previous studies have established an association between hepatitis B virus (HBV) infection and an elevated risk of intrahepatic cholangiocarcinoma (ICC); the prognostic implications of HBV infection in patie...BACKGROUNDS: Previous studies have established an association between hepatitis B virus (HBV) infection and an elevated risk of intrahepatic cholangiocarcinoma (ICC); the prognostic implications of HBV infection in patients with ICC remain inadequately characterized. METHODS: Between January 2003 and December 2013, consecutive patients with histologically confirmed ICC who underwent curative-intent liver resection were retrospectively enrolled. Patients were stratified into two cohorts based on HBV status: HBV-positive (defined as HBsAg and/or HBV DNA positivity) and HBV-negative (both HBsAg and HBV DNA negative). Clinical characteristics and survival outcomes were systematically compared between the groups. RESULTS: A total of 1842 patients were included in the analysis, comprising 839 (45.5%) in the HBV-positive group and 1003 (54.5%) in the HBV-negative group. Compared with HBV-negative patients, those with HBV infection were more likely to be male (76.4% vs. 58.4%), had a higher prevalence of underlying liver cirrhosis (39.4% vs. 6.0%) and macrovascular invasion (12.6% vs. 8.2%), and exhibited lower rates of lymph node metastasis (3.7% vs. 12.0%) and perineural invasion (1.9% vs. 7.1%). The HBV-positive group demonstrated superior median overall survival (41 months vs. 27 months) and significantly higher overall survival rates at 1, 3, and 5 years. However, no significant difference in disease-free survival was observed between the two groups. CONCLUSION: HBV-associated ICC exhibited distinct tumor biology more similar to hepatocellular carcinoma, and patients with HBV-associated ICC exhibited improved overall survival compared to their HBV-negative counterparts.
INTRODUCTION: The impact of time delays between multidisciplinary team (MDT) discussion and surgery for colorectal peritoneal metastases remains uncertain. This study evaluated whether the interval between MDT discussion...INTRODUCTION: The impact of time delays between multidisciplinary team (MDT) discussion and surgery for colorectal peritoneal metastases remains uncertain. This study evaluated whether the interval between MDT discussion and cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) affected surgical, patient-reported and survival outcomes. MATERIALS AND METHODS: This single centre retrospective study included patients with colorectal peritoneal metastases who underwent CRS and HIPEC between August 2017 and September 2024. Data on surgical outcomes including postoperative complications and survival were collected. Patient-reported outcomes were assessed using the Short Form 36 Survey (SF-36). Multivariate regression and Cox proportional hazards models assessed associations between MDT-to-surgery interval and outcomes. RESULTS: One hundred and eighty-five patients who underwent CC0 or CC1 cytoreduction were included. Median MDT-to-surgery time was 28 days (range 19-49). Time from MDT to surgery was not associated with postoperative complications (95% CI: 0.00-0.02, p = 0.13), physical and mental quality of life outcomes (for SF-36 scores at 12 months, 95% CI: -0.09 to 0.05, p = 0.56 and 95% CI: -0.05 to 0.12, p = 0.37 for physical and mental components, respectively) or survival (p = 0.20). Charlson Comorbidity Index (CCI) (95% CI: 0.82-3.90, p = 0.00) and Eastern Cooperative Oncology Group (ECOG) status (95% CI: 1.83-9.38, p = 0.00) were associated with increased postoperative stay. The SF-36 mental component at 6 months correlated with predischarge scores (95% CI: 0.18-0.49, p = 0.00). CONCLUSIONS: Moderate delays in MDT-to-surgery time did not influence outcomes. These findings help to reassure patients who face delays due to patient related or scheduling factors and might facilitate preoperative optimisation. Future research should explore integrated risk models using ECOG and CCI scores to identify patients requiring targeted support.
AIM: The Smart phone applications in the conservative management of shoulder dislocation (SPACS) study is a novel multi-centre, open label randomised controlled trial with a 24-month follow-up assessing the feasibility o...AIM: The Smart phone applications in the conservative management of shoulder dislocation (SPACS) study is a novel multi-centre, open label randomised controlled trial with a 24-month follow-up assessing the feasibility of a smart phone application as an adjunct to the conservative management of shoulder dislocation injuries. METHOD: Patients with simple shoulder dislocation injuries were recruited on presentation to the emergency department for treatment. Both the control and treatment arm were given the face-to-face physiotherapy intervention that is considered the standard of care. Those allocated to the treatment arm were given access to a smart phone application that provided instruction for an intensive rehabilitation exercise program. Outcomes for both arms were assessed using the Oxford Shoulder Instability Score (OSIS) at regular intervals up to 24 months. RESULTS: Patients randomised to the treatment cohort achieved a superior mean OSIS score at all data points collected past 24 weeks from the date of injury. DISCUSSION: The SPACS trial introduced a novel approach to conservative management of shoulder dislocations. An easily accessible adjunct to current rehabilitation regimes such as a smart phone application has the potential to offer a cost-effective, pragmatic solution to improve patient outcomes and reduce the strain on health resources. CONCLUSION: Utilisation of smart phone applications has the potential to improve clinical outcomes and compliance with rehabilitation exercises for patients undergoing conservative management of shoulder dislocations.
BACKGROUND: Same-day discharge (SDD) following laparoscopic appendicectomy (LA) is internationally recognised as safe and cost-efficient, but its routine implementation in Australia remains limited. This study aimed to e...BACKGROUND: Same-day discharge (SDD) following laparoscopic appendicectomy (LA) is internationally recognised as safe and cost-efficient, but its routine implementation in Australia remains limited. This study aimed to evaluate the safety, feasibility, and outcomes of an SDD protocol for LA within an Australian healthcare context. METHODS: A prospective quality control study was conducted at Campbelltown Hospital from 1 August 2024 to 1 September 2025, following the introduction of an SDD protocol. We aimed to assess the feasibility and safety of SDD, measured by the proportion of successful SDD LA and day-case appendicectomy (DCA), and 30-day re-presentation and readmission rates, respectively. RESULTS: Of 336 appendicectomies performed during the study period, 180 patients were considered for the SDD pathway and 82 met inclusion criteria. Successful SDD was achieved in 70.7% (n = 58), and DCA in 81.7% (n = 67). Multivariable analysis identified later operation start time (OR 1.93 per hour delay, p < 0.001) and postoperative Clavien-Dindo (CDC) Grade I (OR 32.9, p < 0.001) and Grade II complications (OR 26.5, p < 0.001) as independent predictors of SDD failure. 6.1% (n = 5) re-presented in 30 days, and one (1.2%) was readmitted. Patient experience was favourable: overall satisfaction was 83% among respondents (65%), and 70% preferred SDD. CONCLUSION: SDD following LA is safe and feasible in the Australian setting. Pathway failure was primarily driven by later operation timing and postoperative complications, highlighting the importance of careful patient selection and perioperative optimisation.