ASERNIP-S: unusual acronym, outstanding results.

In the late 1990s, concerns regarding the introduction of new surgical procedures arose following the rapid uptake of some minimally invasive procedures. At that time, the evidence was not clear on the safety and effectiveness of these new procedures, and it was recommended that data be collected to look at both short- and long-term outcomes. Based on a UK group, 'the Safety and Efficacy Register of New Interventional Procedures (SERNIP)', the Australian SERNIP was born under the auspices of the Royal Australasian College of Surgeons, with '-S' added to the acronym to highlight the focus on surgery. ASERNIP-S was established to review the evidence on new interventional procedures before their introduction into the Australian healthcare system. The programme operated with initial national government funding for 7 years. Following establishment of the Medical Services Advisory Committee, ASERNIP-S became a contractor and remains so today. ASERNIP-S was an also an early adopter of Horizon Scanning, a key activity informing of new procedures/technologies on the verge of introduction into our healthcare system. A strong international reputation of ASERNIP-S is recognised, both by lead roles of international networks and in working relationships with overseas agencies. In recent years the remit of ASERNIP-S has expanded to include research and evaluation services across the Royal Australasian College of Surgeons (including committees) and for Specialty Surgical Societies. Externally funded work is growing, including for the Federal Office of Public Health in Switzerland and the Ludwig Boltzmann Institute in Austria. It is unknown what the future will be for this unusually titled programme, but its long history in promoting and supporting surgical evidence and innovation is clear.

Splenic artery aneurysm rupture in pregnancy.

Splenic artery aneurysm (SAA) is the commonest visceral artery aneurysm. It is diagnosed more frequently in younger women, with up to 95% presenting during pregnancy. Rupture is associated with a disproportionately high maternal and fetal mortality. We performed a literature search on the patient and SAA characteristics, clinical presentations, management and outcome of this serious complication. There were 32 patients in total with a mean age of 27.9 years (range 20-38). The mean SAA size was 2.25 cm (range 0.5-4 cm) and from the available data half of the ruptured SAA were 2 cm or less. Only one case (3.1%) was discovered incidentally, whilst the rest (96.9%) were found following rupture. The majority ruptured spontaneously. Most (62%) of the patients underwent SAA ligation and splenectomy. The maternal death rate was 21.9% (n=7), and fetal death rate was 15.6% (n=5). Most cases are not diagnosed until surgery following rupture. Ruptured SAA should be considered in the differential diagnosis of a pregnant patient with severe and unexplained abdominal pain.