Wherever there are people there will be a need for surgical care. Rural people have all kinds of problems and need all kinds of surgeons. The Royal Australasian College of Surgeons (RACS) Rural Health Equity Strategic Action Plan (RHESAP) was endorsed by Council in December 2020. The goal is to increase the rural surgical workforce and increase access to care, through providing motivated surgeons with the training they need to work where they are needed most.

Quality performance indicators for the surgical treatment of gastric adenocarcinoma: a systematic review.

Across a 12- year period, we observed a persistent upward trend in the number of surgical procedures (both elective and emergency) for our elderly patients (>= 65 years of age)

Bochdalek hernia is characterized by the protrusion of viscera into thorax through the posterolateral section of the diaphragm. It is an extremely rare type of congenital diaphragmatic hernia, it rarely concerns adults, and manifests with vague gastrointestinal or pulmonary symptoms. Surgical approach is the preferred method for their management with open procedures being preferable at emergency cases, while minimal invasive approach necessitates experienced centers.

Recurrent testicular torsion following previous surgical exploration and management of testicular torsion is a rarely reported event. Previous testicular surgery does not guarantee permanent fixation of the testis, even after bilateral orchidopexy. Failure to consider the rare possibility of RTT may delay diagnosis and result in testicular loss.

Proposed surgical classification system to provide a detailed and specific category for diphallia based on the soft tissue composition of the phallus, the urethra present in the most normal phallus and the bladder configuration.

A novel assessment instrument was designed around the JDocs framework using 48 behaviourally anchored questions. Trainees and supervisors participated in the study and we identified the factors that correlate with scoring higher or lower in each of the nine surgical competencies. This pilot study has provided an opportunity to explore a new assessment instrument for surgical trainees and will potentially be helpful in early identification of underperforming trainee, or its use as a selection tool for formal training programs.

This study describes the methodological approach of a design and developmental framework to create an online training module for micro suturing which has significant utility in hand surgery.

This article describes the development of learning from novice to expert in Stage 4 Clinical Decision making-postoperative reflection and review. It also outlines some or the teaching approaches suitable to facilitate that transition.

This is the first study to specifically describe the relative impacts of COVID-19 community prevalence, gender, race, surgical specialty and level of seniority on stress, happiness and depression of residents undergoing surgical training on an international scale.

COVID-19 pandemic has been affecting healthcare systems significantly on every aspect, and laparoendoscopic single-site surgery (LESS) on-site training is no exception. Thus, we have proposed a modified LESS surgical training course, enabling the trainees to keep on training and improve surgical practical skills during the pandemic.

This retrospective, population-based cohort study was conducted to determine the Australian national gastrectomy perioperative mortality rate (POMR). Logistic regression models were compared using de-identified procedural data between 1 July 2005 and 30 June 2017 from the Australian Institute of Health and Welfare. Australian gastrectomy POMRs are favourable when compared to international cohorts. Outcomes were consistent between states and territories, and metropolitan and regional centres. Progressive centralization of gastrectomy was demonstrated without evidence of improved outcomes.

Management of oesophageal impaction of button batteries in Queensland

This study reports our 10-year experience from a high volume public bariatric service which delivers multi-disciplinary care for primary and revisional procedures with mid- to long-term follow-up. This study confirms that bariatric surgery in Australia can be delivered effectively in resource constrained public health system with outcomes similar to private sector.

Adenocarcinoma of the distal oesophagus and gastro-oesophageal junction (GOJ) may represent differing disease processes. This study suggests that GOJ cancers have different clinicopathological characteristics and improved survival compared with distal oesophageal tumours.

Comparison of clinical outcomes for loop and drain (LDT) versus non-LDT.

This study evaluates the recurrence patterns after resection of CRLM and its association with survival. A retrospective review of prospectively collected data of patients with CRLM managed with curative-intent resection from January 2007 to December 2017 was performed. The timing and initial sites of recurrence are prognostic factors in determining survival after curative-intent resection of CRLM.

This study shows that laparoscopic caudate lobe resection can be done safely when performed by experienced surgeons and associated with decreased blood loss and shorter perioperative stay compared to open caudate lobe resection using a 1:2 propensity score-matched controlled study based on our single institution experience.

Diaphragmatic hernia after hepatectomy is a rare condition. It can cause fatal results and requires urgent intervention. Therefore, careful follow-up is required for early diagnosis. We also wanted to share our experiences on this subject.

Groove pancreatitis is an underrecognised subtype of chronic pancreatitis that most commonly presents as vomiting and abdominal pain in middle aged alcoholic men. This potentially debilitating condition can be successfully managed with surgery.

Ileal pouch-anal anastomosis (IPAA) can be safely performed in patients with ulcerative colitis (UC) over 50 years old, with good outcomes and quality of life (QOL). However, pouch retention rates decrease for patients over 70 years. Stapled anastomosis increases the chance of pouch retention and should be recommended as long as the distal rectum does not carry dysplasia.

Improved local recurrence rates have been identified in patients undergoing lateral pelvic lymph node dissections (LPND) in addition to total mesorectal excision for advanced lower rectal cancer. This series demonstrates the practicality and the safety of the robotic approach in the introduction of this technique for en-bloc resection or LPND.

The absolute numbers of elderly patients with colorectal peritoneal metastases is expected to increase. We retrospectively analysed CRS and HIPEC data from a single institution over a 10-year period, and compared outcomes between patients under and over 70 years of age. We concluded that in appropriately selected patients, CRS and HIPEC is safe, feasible and results in justifiable oncological outcomes for patients over the age of 70.

The influence of preoperative factors on PPOI has been well documented, but little is known about the impact of intraoperative conditions. This study collected intraoperative data during a one-off snapshot measure. We suggests that intraoperative conditions may contribute to the development of PPOI, but this could not be confirmed in the multivariate analysis.

Patients with a complication of the rectal anastomosis following rectal cancer resection can be difficult to manage. This paper proposes a pilot classification for chronic rectal anastomotic complications and correlates this classification with outcomes after ileostomy reversal.

Open abdomen is a complex management done in catastrophic abdominal situations. Having a dedicated emergency surgery team managing these patients creates improving results on the type of definitive fascial closure, length of the open abdomen treatment and possible complications.

Careful surgical strategy is paramount in balancing the prevention of fascial dehiscence, incisional hernia and fear of additional mesh-related wound complications post-laparotomy. This study aims to review early outcomes of patients undergoing an emergency laparotomy with prophylactic synthetic TIGR® mesh, used to reduce early fascial dehiscence and potential subsequent incisional hernia.

The aim of this study was to present a retrospective analysis of a cohort of Western Australian patients diagnosed with Splanchnic vein thrombosis (SVT) on imaging study, and a review of the literature surrounding the aetiology, location, anticoagulation treatment and outcomes of SVT.

This study evaluated the hospital- and surgeon-level variation in the severity of patient-reported symptoms prior to total hip and total knee replacement surgery and found only negligible between-surgeon variation in symptom severity, but significant differences between public and private hospital settings. These data indicate that surgeons are applying consistent surgical thresholds to hip and knee joint replacement patients. Threshold differences between public and private hospitals may reflect under- or over-treatment and differences in access to care in these settings.

Reducing in-hospital complications post TJA is both crucial and urgent in enhancing treatment efficacy and patient experience. Herein, under ERAS protocol, the number of POUR cases that required bladder catheterization was 3.4% for TKA and 10.1% for THA, which is in accordance with other reports. We also found that male gender, advanced age, THA, and SIP-IBC all significantly elevated POUR development risk.

Virtual Clinic follow-up of arthroplasty was introduced to our institution in 2014. It demonstrates a method of saving hospital resources, and is especially of utility during a period of pandemic when remote follow-up is desired.

A significant number of ACL injuries are associated with damage to the anterolateral complex (ALC) of the knee and this damage is responsible for failure of some ACL reconstructions. There are a number of surgical techniques available to correct this damage, but no research comparing their relative effectiveness. This study is the first randomized controlled trial (RCT) to compare 2 different techniques for reconstructing the ALC and demonstrates that the modified iliotibial band tenodesis is more effective than the lateral extracapsular tenodesis, when used to augment an ACL reconstruction, in terms of recurrence, meniscal tears and patient reported outcomes.

Tibial short stems combined with trabecular metal cones performed as well as long stems in revision total knee arthroplasty (rTKA) at minimum two years follow-up. A tibial short stem in combination with a trabecular metal cone is a reliable technique to achieve stable and durable fixation in rTKA.

In this Australian privately insured cohort opioid use was reported by 19% preoperatively and 7% at 6 months. Pre-operative opioid use was the strongest risk factor for opioid use at 6 months, increasing the odds 7–15 times. Preoperative opioid use was not associated with inferior outcomes or satisfaction.

Surgical site infections (SSIs) represent one of the most common and potentially preventable sources of morbidity and healthcare cost escalation associated with skin cancer surgery. To our knowledge this is the first comprehensive report of SSI microbiology following skin cancer surgery. The overwhelmingly predominant organisms were Staphylococcus sp. (76%), with the rate of MRSA approaching prevalence warranting empiric first-line treatment.

Characterization of costal cartilage allografts via assessment of histologic variability, using Masson's trichrome and tetrachrome staining.

• The keystone design perforator island flap (KDPIF) was applied in the reconstruction of soft-tissue defect in various regions of the body, clinical effectiveness of the KDPIF was described by use the acronym PACE (Pain free, Aesthetically acceptable, Lower complication and Economically effectiveness).
• As a local-regional flap, KDPIF is completely relied on the soft tissue around the defect as the donor site and corresponding characteristics of soft tissue condition should be cautiously considered while designing and applying the KDPIF at different locations. It is not recommended to larger defect with less movability of surrounding soft tissue which is not enough to cover the defect. Another contraindication should be mention based on our experience is Morel–Lavallee injury of the donor site which could compromise the subcutaneous perforators and result in flap failure. Relative contraindications include local situation compromise the vascularity and laxity of the flap such as wounds that have been irradiated, or undergone significant undermining, or currently in an inflammatory status.
• Preoperative design of KDPIF should be individualized regarding patient's general condition. Special positioning is required after operation to reduce position related wound tension and postoperative careful observation.

This case series describes five cases of COVID-19 vaccine associated cervical lympadenopathy. It highlights the importance of COVID-19 vaccination history taking and including vaccine associated lymphadenopathy in the differential diagnosis of a neck lump.

This cost-minimisation analysis examines costs associated with pre-operative overnight pulse oximetry and polysomnography in triaging paediatric patients undergoing AT for OSA to either a secondary or quaternary Australian hospital site. Within the scope of this partial economic evaluation, this study finds a small additional cost for a model of care involving overnight oximetry as a pre-operative triage tool, balanced by the reduced cost of care in a lower acuity centre for low-risk patients and potential high cost of complications if all children are treated in a low acuity centre. This supports oximetry in peri-operative risk stratification for paediatric AT from a financial perspective.

We performed a retrospective cohort study patients with perineural spread in head and neck cutaneous squamous cell carcinoma treated at a single Australian institution, and report their survival outcomes.

This multicentre cohort study demonstrated that pre-operative frailty was associated with adverse perioperative outcomes and increased major amputation but not mortality during the early COVID-19 pandemic. This outcome disparity highlights the importance of targeted interventions to optimise the care of older, frail patients, especially in times of healthcare stress.

Infective Endocarditis is a morbid condition with high mortality. We present a retrospective analysis of one hundred and seventy-two patients who presented to our institution with Infective Endocarditis. Multivariable analysis demonstrated that patients presenting with signs of embolic phenomena to the limbs was an independent predictor of mortality.

Superior rectal artery sparing oncological anterior resection in vasculopathic patients.