A retrospective cohort study of incidental abdominal aortic aneurysms on routine abdominal computed tomography scans in Te Tairawhiti (2018-2019).

AIM: Ruptured abdominal aortic aneurysm (rAAA) is associated with a high mortality rate which, is especially significant in rural and provincial regions. In Aotearoa New Zealand, Maori experience higher rates of AAA and worse overall medium-term survival following AAA repair. This study aimed to understand the prevalence of incidental AAA on routine abdominal computed tomography (CT) scans over 12 months. METHOD: A retrospective review of all abdominal CT scans performed on patients ≥50 years at Gisborne Hospital between 1 December 2018-1 December 2019 was performed. RESULTS: A total of 811 scans were reviewed, with 42 incidental AAA detected (5.2%). The majority of incidental AAA were in males aged ≥65 (65.8%), with a higher prevalence for Maori compared to New Zealand European (NZE) (16.2% vs 8.1%, p=0.052). This pattern was also seen in females, aged ≥65 (10.9% in Maori vs 3.8% in NZE, p=0.047). CONCLUSION: The detection of AAA on routine abdominal CT scans appears to be a useful adjunct in lieu of targeted AAA screening in our region. A high prevalence of incidental AAA (5.2%) over 12 months, with a significantly higher prevalence noted in Maori males and females ≥65 years (16.2% and 10.9%), was observed.

How to perform laparoscopic common bile duct exploration through a transverse choledochotomy.

This article reviews common bile duct stones and describes our technique of laparoscopic common bile duct exploration (LCBDE) through a transverse choledochotomy at Hawke's Bay Hospital, New Zealand.

Introducing SentiMag in a rural setting: a 5-year experience.

BACKGROUND: The Sentimag device is a probe that contains a sensitive magnetometer which detects either an implantable magnetic marker (MagSeed) or an infectable superparamagnetic ironoxide nanoparticle tracer (MagTrace). MagSeed is used to localise impalpable breast lesions; MagTrace is used to identify sentinel lymph nodes. In Australasia, Sentinel lymph node (SLN) biopsy, using radioactive colloid injection, is a mainstay of prognostication in breast surgery in patients with a clinically negative axilla. In addition, radioactive seeds or hookwires have been used to detect impalpable breast lesions. Gisborne Hospital has been using the SentiMag device since June 2016 to both identify sentinel lymph nodes (Magtrace) and impalpable tumours (Magseed). This study gives perspective over more than 5 years on how this new technology can benefit patients and clinicians in the rural setting. METHODS: Patient data had been collected by the operative surgeon prospectively and corroborated with the coding department. Consecutive cases performed by a single surgeon were included in this study. Inclusion criteria were: (1) any patient who needed localisation of an impalpable breast lesion; (2) any patient who needed a sentinel lymph node biopsy; (3) cases were collected from January 2013 with the large majority of cases were collected between January 2015 and Jan 2020. Comparisons were made between patients with different localisation methods. Basic demographics were collected at the time of the surgery and outcomes then recorded. Staging, lymph node status, lymph node detection rates and complications were collected. Mode of tumour and sentinel node location was recorded. Financial data was collected from administrative staff via receipts and invoices of purchases to the hospital. RESULTS: Of the 125 patients included in this study: 23 underwent magnetic seed insertion; 15 underwent a hookwire insertion; 45 cases used MagTrace injection; 71 cases used radioactive colloid injection. There was a significantly higher detection rate of two or more sentinel nodes in the SentiMag group. (91% vs. 71.8%, p = 0.01). Neither complication rates, nor cancer detection rates were significantly different. Eighty-four (67.2%) cases did not require tumour location. CONCLUSION: SentiMag is safe to use in a rural setting. Using the SentiMag system can simplify care for patients and surgeons and was shown to be cost effective in our hospital.

Index cholecystectomy in a rural hospital: it can be done.

BACKGROUND: Index cholecystectomy (IC) refers to an operation during a patient's first hospital admission with symptomatic gallstone (GS) disease. There are proven reductions in cost, hospital bed days and GS-related complications while awaiting elective surgery. IC has not been universally adopted, particularly in smaller centres where logistics can present a barrier. The aim of this paper is to describe the introduction of routine IC at Hastings Hospital and the effects in terms of waiting time until surgery; GS-related re-presentations and complications while awaiting surgery; operative complications and overall hospital stay. METHODS: Data were collected for all patients who underwent cholecystectomy in the year following the introduction of IC (2015/2016). The results were compared with data from the year 2009/2010. RESULTS: A total of 259 cholecystectomies were performed over the 2015/2016 study period compared with 186 in the 2009/2010 study period. The IC rate increased from 9.89% in 2009 to 75.4% in 2015 (P < 0.001). The incidence of GS pancreatitis whilst waiting for surgery reduced from six in 2009 compared with one in 2015 (P = 0.046). The operative complications were similar in both groups. Total hospital stay was also similar. CONCLUSION: The study shows that it is possible to perform IC in a rural setting reducing complications of waiting and in particular, rates of GS-related pancreatitis were significantly reduced. It can be done safely with an accommodating acute on-call system.

Laparoscopic Repair of Intrathoracic Stomach: Clinical and Health-related Quality of Life Outcomes.

BACKGROUND: This study aims to evaluate the clinical and quality of health outcomes in patients undergoing laparoscopic repair of intrathoracic stomach with or without gastric volvulus. MATERIALS AND METHODS: From January 2007 to December 2013, a prospectively maintained data, of patients undergoing surgical repair of intrathoracic stomach, with or without gastric volvulus, was reviewed. Patient demographics, ASA grade, diagnostic technique, semiurgent/emergency status, type of volvulus if present, details of surgery and perioperative complications were recorded. Validated SF-36 questionnaires were completed by patients to record preoperative and postoperative quality of life (QoL) status. Patients managed by nonoperative measures were excluded from the study. RESULTS: Thirty patients were identified with intrathoracic stomach. Fourteen patients had gastric volvulus. Twenty-seven patients (10 emergency, 17 semiurgent) underwent laparoscopic repair of intrathoracic stomach and were included in the study. Mean operating time was 156 (SD, 37.5; range, 105 to 230) minutes. All 27 operations were completed by laparoscopic approach. There was no conversion to open procedure or mortality at 30 days. Mean hospital stay was 5.2 (range, 1 to 15) days. There were 3 (11%) early postoperative complications. One (3.7%) patient developed recurrence at 2 years which required reoperation. Mean follow-up was 10.5 (range, 1 to 36) months. ASA grade and operative time determined the postoperative hospital stay (P=0.001, 0.001, respectively), whereas body mass index and age were shown to have no influence. Patient-reported QoL scores improved across all scales of the health questionnaire after surgery especially bodily pain, social functioning, and physical functioning. CONCLUSIONS: Laparoscopic surgery is a safe and effective treatment option for intrathoracic stomach, with or without gastric volvulus. It is associated with low rates of complications and recurrence. Self-reported patient data shows significant improvement to overall QoL after surgery for intrathoracic stomach.