BACKGROUNDS: To evaluate the safety and efficacy of Holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia when performed within 2 weeks after a transrectal prostate biopsy (PB). METHODS: A re...BACKGROUNDS: To evaluate the safety and efficacy of Holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia when performed within 2 weeks after a transrectal prostate biopsy (PB). METHODS: A retrospective study was conducted on 153 patients undergoing HoLEP between March 2020 and April 2023. The cohort was divided into two groups based on the interval between PB and HoLEP: 67 patients underwent HoLEP within 2 weeks post-PB, and 86 patients underwent HoLEP more than 2 weeks post-PB. Baseline characteristics and perioperative parameters were documented, including enucleation efficiency (EE), catheter time, hospital stay, and hemoglobin reduction. All patients were followed up at 1, 6, and 12 months postoperatively, with assessments of maximum urinary flow rate (Q), postvoid residual volume (PVR), International Prostate Symptom Score (IPSS), and quality of life (QoL) score. Perioperative and postoperative complication rates were recorded. Spearman's correlation analysis was applied to explore the relationship between the PB-to-HoLEP interval and both perioperative parameters and functional outcomes. RESULTS: Baseline parameters were comparable between groups. No significant differences were observed in perioperative parameters or complication rates between groups. Postoperative outcomes (Q, PVR, IPSS, QoL score) in both groups showed significant improvements compared to baseline values; however, these improvements did not differ significantly between groups. Spearman's correlation analysis revealed no significant association between the PB-to-HoLEP interval and perioperative parameters, nor with postoperative changes in functional outcomes (delta IPSS, delta Q, delta PVR). CONCLUSION: HoLEP within 2 weeks of transrectal PB does not adversely affect surgical safety or outcomes.
BACKGROUND: Proximal humerus fractures are becoming more prevalent with associated increases in operative management. This study aimed to compare costs between operative and non-operative management of these fractures in...BACKGROUND: Proximal humerus fractures are becoming more prevalent with associated increases in operative management. This study aimed to compare costs between operative and non-operative management of these fractures in an Australian population. METHODS: A cost-analysis was performed in a cohort of patients initially managed at a Level 1 Trauma Centre between January 2010 and December 2018, who sustained a proximal humerus fracture following a road traffic injury. Patients were identified using ICD-10-AM coding and matched to the Victorian Orthopaedic Trauma Outcome Registry. This cohort was linked with data from the state's no-fault third-party insurer for transport injuries to obtain total claims cost data for the acute admission, subsequent admissions, and rehabilitation costs in Australian dollars. RESULTS: A total of 113 patients met the inclusion criteria; 31 non-operative and 81 operative. The mean (SD) age was 50.1 (20.3) years in the non-operative group and 44.0 (15.8) in the operative group (p = 0.10). In the non-operative group, 87% of patients sustained other injuries compared with 76% of patients in the operative group (p = 0.30). The median total treatment cost in the non-operative group was A$48 982 compared to A$36 457 in the operative group (p = 0.99). Median subsequent admission costs for the respective groups were A$9 643 and A$8 378 (p = 0.77) and median rehabilitation costs were A$6 016 and A$4 754 respectively (p = 0.95). CONCLUSION: Healthcare associated costs did not differ significantly in trauma patients with proximal humerus fractures regardless of management undertaken. Concerns regarding healthcare costs should not impact on surgical decision-making when managing these fractures.
UNLABELLED: Abdominoplasty is one of the most popular body contouring procedures. However, complications are common, particularly in post-bariatric patients, and surgical safety is a topic of growing interest. Among the...UNLABELLED: Abdominoplasty is one of the most popular body contouring procedures. However, complications are common, particularly in post-bariatric patients, and surgical safety is a topic of growing interest. Among the significant steps, Osvaldo Saldanha first introduced the concept of lipo-abdominoplasty in 2001. Following an aggressive liposuction, the extensive dissections of traditional techniques are avoided, reducing complications. Furthermore, in 2014, Francisco Villegas advanced the TULUA technique. The latter introduces a transverse plication of rectus muscles, avoiding supraumbilical undermining, further improving safety. With the present study, we aim to introduce the TULUANHA: the modified TULUA and Saldanha lipo-abdominoplasty, a new technique electively designed for post-bariatric patients. METHODS: A retrospective study was conducted on post-bariatric patients who underwent TULUANHA between January 2019 and January 2021. The TULUANHA involved a bipolar radiofrequency scalpel assisted abdominoplasty with transverse plication of rectus muscles, umbilical preservation, and extensive liposuction. RESULTS: Twelve post-bariatric patients matched the selection criteria and were included in the study. Minor complications occurred in 1 of 12 patients (8.3%), consisting of a seroma. No major complications were reported. According to the Salles score, all included patients revealed satisfactory aesthetic outcomes. CONCLUSIONS: The TULUANHA, by combining the principles of the TULUA and the lipo-abdominoplasty, a minimal supraumbilical undermining, and innovative technologies for surgical dissections, represents an innovative abdominoplasty technique. Potential benefits include enhanced vascular safety and reduced complications. Moreover, the TULUANHA allows for umbilical preservation, which is instead removed and reconstructed in the original technique. By avoiding any extensive supraumbilical dissection and related devascularization risks, the TULUANHA seems a promising technique for post-bariatric patients, and future research is expected. LEVEL OF EVIDENCE: Level V, retrospective study.
This paper describes the surgical technique for a laparoscopic caudate lobectomy, offering a detailed educational demonstration of this complex procedure. Our contribution focuses on the clear visualisation of the intric...This paper describes the surgical technique for a laparoscopic caudate lobectomy, offering a detailed educational demonstration of this complex procedure. Our contribution focuses on the clear visualisation of the intricate anatomical relationships with major vascular structures and outlines the key steps to approach this technically challenging operation safely.
OBJECTIVES: To review the waiting list data and outcomes after liver transplantation (LT) in patients with cystic fibrosis (CF) in Australia and New Zealand. METHODS: The Australia and New Zealand Liver and Intestinal Tr...OBJECTIVES: To review the waiting list data and outcomes after liver transplantation (LT) in patients with cystic fibrosis (CF) in Australia and New Zealand. METHODS: The Australia and New Zealand Liver and Intestinal Transplant Registry was utilised to identify patients with CF listed for LT, including as a component of multi-organ transplantation. Outcomes were compared to non-CF patients. RESULTS: Between January 1989 and July 2022, 55 patients with CF underwent LT at a median age of 18.9 (13.5-30.0) years. Twenty-five (45%) were less than 18 years of age at the time of LT. Thirty-seven (67%) underwent isolated LT, and 18 (33%) underwent LT as a component of multi-organ transplantation. In paediatric CF isolated LT recipients, 15-year survival was similar to non-CF recipients (90.9% vs. 83.4%, p = 0.71); however, waiting list mortality was higher (3/21 [14.3%] vs. 33/779 [4.2%], p = 0.03). In adult CF recipients, there was no significant difference in 5- and 10-year survival after isolated LT (CF: 72.7% and 60.6% vs. non-CF: 83.0% and 73.0%, respectively, p = 0.07), and no significant difference in 5- and 10-year survival after multi-organ transplantation (excluding liver-kidney) compared to non-CF recipients (CF: 60.7% and 45.5% vs. non-CF: 66.7% and 66.7%, p = 0.27). In adult CF recipients, waiting time was longer (293 days [IQR 69-534] vs. 82 days [IQR 19-203], p = 0.004), and time to waiting list mortality in those listed for multi-organ transplantation was shorter (129 days [IQR 47-161] vs. 351 days [IQR 166-691], p = 0.049) than non-CF recipients. CONCLUSIONS: Survival after isolated LT in children with CF is equivalent to non-CF patients; however, waiting list mortality is higher. Adults with CF experience longer waiting times and shorter time to waiting list mortality.
BACKGROUND: The global incidence of rectal cancer is rising, accompanied by the increasing use of neoadjuvant chemoradiotherapy. Although this approach improves oncological outcomes, it frequently increases operative dif...BACKGROUND: The global incidence of rectal cancer is rising, accompanied by the increasing use of neoadjuvant chemoradiotherapy. Although this approach improves oncological outcomes, it frequently increases operative difficulty during rectal resection. Achieving a negative circumferential resection margin (CRM) remains critical to reducing local recurrence. While clear margins are often attainable utilising the standard total mesorectal excision (TME) plane, dissection beyond TME is increasingly required following neoadjuvant radiation or for locally advanced or recurrent disease. Such surgery demands detailed knowledge of complex pelvic anatomy and sound operative strategies to achieve optimal outcomes. METHODS: This publication presents a novel 'onion peel' approach to pelvic anatomy comprising five sequential layers. Layer 1-the TME plane; Layer 2-the ureterohypogastric fascia and anterior viscera; Layer 3-lymphovascular structures; Layer 4-neural structures and Layer 5-musculoskeletal anatomy. Within each layer, key anatomical features are outlined alongside practical operative strategies to facilitate safe dissection and recognition of vital structures. CONCLUSION: This paper provides colorectal surgeons with a novel overview of the anatomy surrounding the mesorectal envelope along with simple operative strategies to enter and safely dissect planes beyond TME.
BACKGROUND: Skin cancer is one of the most common comorbidities for liver transplant recipients (LTRs). Carcinogenesis is a multifaceted process: immunosuppression and personal risk factors such as smoking status, UV exp...BACKGROUND: Skin cancer is one of the most common comorbidities for liver transplant recipients (LTRs). Carcinogenesis is a multifaceted process: immunosuppression and personal risk factors such as smoking status, UV exposure, past history of skin cancer and family history of skin cancer can all play a significant role in determining the extent of skin cancer development. OBJECTIVE: To undertake a large-scale retrospective case matched cohort study examining the effect of personal and transplant related risk factors in cutaneous carcinogenesis. METHODS: A case-control study was performed of 114 LTRs who developed skin cancer who were compared to 288 age, sex, time since transplant and aetiology matched controls (1:2 ratio). Data, including histology, were collected via chart review and phone interviews and analysed using logistic regression to determine odds ratios. RESULTS: A total sample size of 342 was attained. Harmful risk factors that achieved statistical significance were being of Fitzpatrick skin type 1 or 2 (OR = 6.98, p < 0.01), incurring greater than five blistering sun burns (OR = 3.71, p < 0.01), pre-transplant history of skin cancer (OR = 3.36, p < 0.01), smoking status (OR = 3.30, p < 0.01). Immunosuppression protocols that included mTOR inhibitors (OR = 0.30, p < 0.01) were shown to be protective. Most skin cancers were high risk SCCs (63.11%). CONCLUSIONS: Personal and transplant related risk factors significantly modify the risk of cutaneous carcinogenesis in LTRs. Risk stratification of the likelihood of skin cancer development post liver transplant can help to structure an individualised surveillance scheme to facilitate early detection and treatment of skin cancers in LTRs.
BACKGROUND: Sacral nerve stimulation (SNS) is an accepted first-line surgical treatment for faecal incontinence (FI) with variable success. This study aims to analyse the parameters that may predict initial and sustained...BACKGROUND: Sacral nerve stimulation (SNS) is an accepted first-line surgical treatment for faecal incontinence (FI) with variable success. This study aims to analyse the parameters that may predict initial and sustained success with SNS in patients with FI. METHODS: A retrospective audit was conducted on 56 patients with FI managed with SNS implantation by a single Australian colorectal surgeon. A successful outcome was defined as a 50% or greater reduction in the number of FI episodes per week at the end of the two-week trial period (temporary stimulation) or at their last follow-up visit (permanent implantation). Patient characteristics, pre-implantation anal manometry, endoanal ultrasound and electrophysiological testing were compared on univariate analysis between success and failure groups. RESULTS: Temporary stimulation was successful in 53.6% of patients. Thirty patients proceeded to permanent SNS with 21 (70%) patients having ongoing success over a median follow-up of 50.2 months. BMI > 25 and reduced maximal tolerable volume on pre-implantation anal manometry studies predicted success of temporary SNS (p = 0.013 and p = 0.02, respectively). Whereas a history of vaginal or bladder prolapse surgery predicted failure of temporary SNS (p = 0.012). CONCLUSION: This study identified baseline BMI > 25 and relative hypersensitivity of rectal distension predicted success of temporary SNS. A history of previous surgery for vaginal or bladder prolapse was associated with failure. We failed to identify any clinical or pre-assessment parameter that predicted long-term success with permanent stimulation.
BACKGROUND: The management of patients with colorectal liver metastases (CRLM) is complex and requires a tailored approach based on disease extent, patient age, and comorbidities. Given the heterogeneity in presentation...BACKGROUND: The management of patients with colorectal liver metastases (CRLM) is complex and requires a tailored approach based on disease extent, patient age, and comorbidities. Given the heterogeneity in presentation and evolving treatment algorithms, prognostic factors for long-term survival following liver resection are contested. This study aimed to evaluate "real-world" outcomes in patients with long-term follow-up after potentially curative liver resection at a tertiary Australian center. METHODS: A retrospective analysis was conducted on prospectively collected data from patients who underwent first-time liver resection for CRLM between 1998 and 2018. Standardized clinical, biochemical, and radiological follow-up was undertaken. Multivariable Cox regression analysis was used to identify independent predictors of overall survival (OS), measured from the diagnosis of liver metastases to death or last contact. RESULTS: Of 396 patients who underwent resection, 320 met the inclusion criteria. The median follow-up was 123.3 months (95% CI: 110.5-131.0), median OS was 69.6 months (95% CI: 57.2-84.5), and the 10-year OS rate was 33%; 5-year and 10-year disease-free survival rates were 29% and 25%, respectively. Neoadjuvant chemotherapy was administered in 72% of patients, with 25% receiving targeted therapy in this setting. Postoperative (adjuvant or recurrence-related) chemotherapy was given to 50% of patients, with 17% also receiving targeted therapy. Independent predictors of poor OS included older age, right-sided primary tumours, large liver tumours, administration of locoregional liver therapy, and the use of chemotherapy ± targeted therapy in both the neoadjuvant and adjuvant settings. CONCLUSION: One-third of patients who undergo liver resection for CRLM achieve long-term survival. While multi-modal therapy was commonly used, determining the specific contribution of non-surgical treatments is challenging in a real-world cohort where treatment paradigms evolved over time. This study provides rare 10-year follow-up data and reinforces the need for ongoing refinement of personalised management strategies for CRLM.
BACKGROUND: Despite the advantages of lower healthcare costs and decreased elective surgery wait times without compromise to patient outcome, rates of day-case hernia repairs remain much lower than the RACS target of 70%...BACKGROUND: Despite the advantages of lower healthcare costs and decreased elective surgery wait times without compromise to patient outcome, rates of day-case hernia repairs remain much lower than the RACS target of 70%-80%. Certain patient cohorts are often unnecessarily excluded due to perceived risks. OBJECTIVES: To review literature on patient and procedural factors influencing same-day discharge after inguinal, femoral, and umbilical hernia repairs, and to outline an evidence-based selection criteria and perioperative protocol to improve day-case rates. METHODS: A systematic review of peer-reviewed English-language studies involving inguinal, umbilical, and femoral hernia repairs in patients over 18 years, in day and overnight case settings. RESULTS: Patient factors facilitating same-day discharge are age under 65 years, ASA grades I-II, and uncomplicated hernia types. Selected patients aged over 65 or with ASA grades III-IV may be appropriate candidates and should not be excluded by default. Procedural factors facilitating same-day discharge include unilateral surgery, use of adjunctive local anaesthesia, and protocols to reduce risk of common postoperative complications. Logistical factors such as comprehensive discharge planning and strategic theatre scheduling can further increase the success of day-cases. CONCLUSIONS: For appropriately selected patients, aged up to 80 years and ASA up to IV, day-case hernia repair can be a safe and effective alternative, offering comparable clinical outcomes and greater socioeconomic benefits. Comprehensive and holistic perioperative planning plays a crucial role to successfully expand day-case hernia repairs. Based on the results of this study, a patient selection criteria and perioperative protocol for day-case hernia repair are proposed.
BACKGROUND: Minimally invasive techniques, including laparoscopic and robotic-assisted surgeries, have revolutionized hernia repair by reducing recovery times and postoperative pain (1). Existing studies have explored ge...BACKGROUND: Minimally invasive techniques, including laparoscopic and robotic-assisted surgeries, have revolutionized hernia repair by reducing recovery times and postoperative pain (1). Existing studies have explored general outcomes of robotic surgery, including shorter hospital stays and fewer complications (2). However, assessing and comparing postoperative pain in this context remains challenging due to inconsistencies in measurement methods, timing, and reporting practices across studies. METHODS: A scoping review was conducted on studies published from January 2014 to August 2024. Studies included were those comparing pain outcomes in laparoscopic and robotic-assisted hernia repair. Two independent reviewers performed data extraction, capturing study design, population characteristics, surgical technique, and details on pain assessment methods and timing. RESULTS: Fifteen of the 403 studies screened were included, comprising 2 randomised controlled trials and 13 cohort studies covering a total of 21 500 patients who underwent either robotic or laparoscopic abdominal wall hernia repairs. Pain assessment methods varied across the studies; the most employed being visual analogue scales (VAS), numerical rating scale (NRS), and opioid analgesic equivalence requirements. Timing of assessments ranged from immediate postoperative periods to 1-year post-surgery. Robotic-assisted surgery was associated with reduced pain scores and analgesic requirements in close to 50% of studies compared to laparoscopic approaches. However, methodological inconsistencies in pain assessment and timing limit the reliability of these findings. CONCLUSION: This review highlights substantial variability in pain assessment practices in minimally invasive hernia surgery. Robotic-assisted surgery shows promise in reducing postoperative pain, but standardised guidelines for pain measurement are needed to enable more robust comparisons.
BACKGROUND: Advances in imaging, non-operative management, and endovascular techniques have reshaped abdominal trauma care, but their impact on operative trends in blunt-dominant Australian trauma systems is incompletely...BACKGROUND: Advances in imaging, non-operative management, and endovascular techniques have reshaped abdominal trauma care, but their impact on operative trends in blunt-dominant Australian trauma systems is incompletely described. AIMS: To describe temporal trends in operative and minimally invasive management of abdominal trauma at an Australian Level 1 trauma centre, and to discuss their implications. METHODS: A retrospective study of the Alfred Health Trauma Registry (2001-2024) identified adult major trauma (MT) patients (ISS > 12) undergoing emergency laparotomy, laparoscopy, or solid-organ embolisation within 24 h of admission. Temporal trends were assessed using linear regression and offset Poisson models. Sensitivity analyses used abdominal AIS ≥ 2 as the denominator. RESULTS: Among 25 497 major trauma patients, 1330 (5.2%) underwent laparotomy, 107 (0.4%) laparoscopy, and 417 (1.6%) embolisation. Annual major trauma presentations increased from 643 to 1498, while the number of patients with abdominal AIS ≥ 2 also rose. Laparotomy rates declined significantly over time, from 10.7% to 2.7% of major trauma admissions (R = 0.80; p < 0.01), with the decline persisting when abdominal AIS ≥ 2 was used as the denominator. Embolisation increased significantly, whereas laparoscopy volumes rose numerically but did not demonstrate a consistent statistically significant temporal increase. CONCLUSION: Emergency trauma laparotomies have declined despite increasing trauma volume and abdominal injury burden, consistent with greater use of selective non-operative and endovascular strategies. These changes have implications for maintaining operative readiness within contemporary multidisciplinary trauma systems.
BACKGROUND: En bloc transurethral resection of bladder tumour (ERBT) has been increasingly adopted to improve pathological accuracy and reduce recurrence rates compared with conventional TURBT. However, the influence of...BACKGROUND: En bloc transurethral resection of bladder tumour (ERBT) has been increasingly adopted to improve pathological accuracy and reduce recurrence rates compared with conventional TURBT. However, the influence of surgeon experience on procedural quality, oncologic outcomes, and learning curve dynamics remains underexplored. METHODS: A retrospective cohort study was performed on 80 consecutive patients undergoing ERBT between 2018 and 2024 at Palmerston North Hospital. Surgeons were stratified by experience (< 100 vs. ≥ 100 prior ERBTs). Primary outcomes included detrusor muscle presence, margin positivity, recurrence, and progression rates. Secondary analysis employed cumulative sum (CUSUM) and rolling mean analyses to evaluate the procedural volume required for competency. RESULTS: Detrusor muscle was present in 82% of specimens, with no significant difference between high- and low-experience surgeons (79% vs. 84%, p = 0.77). Recurrence (27% vs. 37%, p = 0.14), progression (11% vs. 3%, p = 0.26), and complication rates (8% vs. 6%, p = 1.00) were comparable. CUSUM analysis indicated consistent detrusor muscle sampling after 14 cases, while operative efficiency improved and stabilized after 17 cases. Mean operative efficiency was 2.07 ± 1.13 min/mm overall, and high experienced surgeons demonstrated greater efficiency (1.71 ± 0.89 vs. 2.64 ± 1.24 min/mm). CONCLUSION: ERBT is a safe and reproducible procedure that can be effectively performed by supervised trainees with outcomes equivalent to those of senior surgeons. Competency appears to be achieved after approximately 14-17 cases. These findings support the integration of ERBT into structured urological training programmes as a model for competency-based education.
OBJECTIVE: Nephrectomy remains the cornerstone treatment for localised renal cancer (RC). The objective of this study was to assess outcomes of nephrectomy in a single regional centre. METHODS: We conducted a retrospecti...OBJECTIVE: Nephrectomy remains the cornerstone treatment for localised renal cancer (RC). The objective of this study was to assess outcomes of nephrectomy in a single regional centre. METHODS: We conducted a retrospective cohort study of 114 patients undergoing nephrectomy with three surgeons at a regional referral centre between January 2019 and April 2024. Primary outcomes included operative time, ICU admission, and in-hospital mortality. Secondary outcomes included blood loss, post-operative complications, and preservation of renal function. Rurality was stratified according to the Modified Monash Model (MMM) rurality classification. Statistical analyses included chi-square, t-tests, Spearman correlation, and multivariate regression. RESULTS: Of the cohort, 71.9% underwent laparoscopic and 28.1% underwent open nephrectomy. The open group had significantly longer operative time (217.5 vs. 180.0 min; p < 0.0001), higher blood loss (535.0 vs. 50.0 mL; p < 0.0002), and lower Day 1 post-op Hb (109.0 vs. 119.0 g/L; p = 0.03). On multivariate regression, blood loss (p = 0.03) and male gender (p = 0.03) independently predicted ICU admission. Age was the only significant predictor of post-op complications (p = 0.041). Pre-op eGFR predicted post-op renal function (p < 0.001), and open surgery was associated with lower Day 1 eGFR (p = 0.002). Rurality was not associated with worse outcomes. CONCLUSION: Nephrectomy can be safely and effectively performed in regional centres, with outcomes comparable to metropolitan benchmarks. These findings support the provision of localised care for members of regional and rural communities.
Mariem H, Rakia S, Mohamed Ali M
… +15 more, Chaima Y, Hajer H, Nesrine K, Fatma T, Radhia B, Abdelwaheb M, Amal B, Yahia Y, Souhir M, Rami G, Brahim G, Karim S, Hamida M, Hela K, Mohamed BS
BACKGROUND: Managing patients with adhesive small bowel obstruction (ASBO) requiring surgery is challenging, particularly in performing adhesiolysis safely while minimizing iatrogenic complications. Identifying at-risk p...BACKGROUND: Managing patients with adhesive small bowel obstruction (ASBO) requiring surgery is challenging, particularly in performing adhesiolysis safely while minimizing iatrogenic complications. Identifying at-risk patients is important, as it may facilitate earlier diagnosis and strengthen prophylactic measures. We conducted this study to report factors associated with ASBO. METHODS: A case-control study was conducted in the general surgery "B" department of Rabta Hospital, including patients operated on for ASBO between 2004 and 2020. Patients were asked to report ASBO occurrence following index surgery. Logistic regression analysis was used to determine associated factors. RESULTS: Two hundred patients were included, with 100 patients in each group. Radiological ischemic features were observed in 14.5% of cases. Surgery was performed in 35 patients, with laparoscopy attempted in 8.6% but converted in two cases. Postoperative complications occurred in 31.4% (n = 11), with two deaths (5.7%). Logistic regression revealed three independent factors associated with ASBO: male sex (adjusted OR = 7.489, 95% CI: 2.726-20.578; p < 0.0001), diabetes (adjusted OR = 15.465, 95% CI: 3.698-64.683; p = 0.0002), and Pfannenstiel incision (adjusted OR = 5.704, 95% CI: 1.456-22.351; p = 0.0125). CONCLUSION: This study highlights male sex, diabetes, and Pfannenstiel incision as associated factors for ASBO. Recognizing these risks may improve postoperative management and outcomes. Larger prospective multicenter studies are needed to validate these findings.
BACKGROUND: Acute pancreatitis is a common acute surgical condition worldwide as well as in Fiji. The incidence, epidemiology, management, and outcomes have not been previously documented. The aims of this study were to...BACKGROUND: Acute pancreatitis is a common acute surgical condition worldwide as well as in Fiji. The incidence, epidemiology, management, and outcomes have not been previously documented. The aims of this study were to determine the causes, treatment and outcomes of acute pancreatitis at Colonial War Memorial Hospital (CWMH) in Fiji. METHOD: This was a retrospective, single center, descriptive study conducted over a 5-year period for all adult patients diagnosed with acute pancreatitis at CWMH, a tertiary hospital and regional referral center. RESULTS: There were 156 patients; 50% were female; 53% were of I-Taukei origin; and a median age of 44.5 years. The most common cause identified was idiopathic/unknown (38%) followed by gallstones (36%), alcohol (13%), hyperlipidaemia (7%) and others (6%). The incidence was 49 per 100 000 with majority mild (89%) in severity, 10% moderately severe and 1% severe. Inappropriate prophylactic antibiotics were given to 30% of the patients. For gallstone pancreatitis, only 17% had cholecystectomy on index admission while 20% underwent cholecystectomy within 6 weeks. Major morbidity occurred in 8%. There were no inpatient mortality recorded. No patients received minimally invasive treatment for complicated pancreatitis. CONCLUSION: The management of acute pancreatitis in Fiji is largely in line with international standards, but in some aspects severely limited by lack of resources, a common issue in developing countries. Establishment of pathways for antibiotic use and index admission cholecystectomy is recommended. Further resourcing for infrastructure and training is needed to improve diagnosis for etiology, as well as radiological and endoscopic treatment of complications.