Background: Routine histology for haemorrhoidectomy specimens remains commonplace in clinical practice, as a method of detecting incidental anal cancer. However, its utility and cost-effectiveness is unclear in the literature. This study aimed to determine the cost-effectiveness of routine histology for haemorrhoidectomy specimens in a regional Australian hospital. The secondary aim was to determine the proportion of specimens sent for histology, and whether individual surgeons had a statistically significant preference for whether to send for histology.Methods: This was a retrospective cohort study of patients who received haemorrhoidectomies at Hervey Bay Hospital between March 2012 and May 2020. Cost effectiveness of routine histology was investigated by weighing the number of incidental anal cancers detected against the cost of analysis. The proportion sent for histology was determined, both as a whole and by individual consultant surgeons.Results: Routine histology was ordered in 65% of patients who received haemorrhoidectomies over the study period (n=119), costing $13,623 AUD ($1,651 AUD per year). No cases of incidental anal dysplasia or neoplasia were found. Only 1 of the 8 most prolific surgeons over the study period demonstrated a statistically significant preference for whether to send for histology.Conclusions: Our study does not support routine histology for haemorrhoidectomy specimens as a cost-effective practice for detecting incidental anal cancer. Most individual surgeons did not display a clear preference for whether to send for histology.
Perforated diverticulitis is a rare cause of Fournier’s gangrene. Management for these conditions separately is well established, however no clear guidelines exist for operative management when they present in combination. This case provides a suggested management approach for managing the two conditions concurrently, in a peripheral hospital.
Choledocholithiasis is known to pass spontaneously in a large proportion of patients. This case report documents extensive choledocholithiasis and hepatolithiasis presenting as gallstone pancreatitis in a 37-year-old female. All ductal stones (>15 stones measuring up to 10 mm) had passed spontaneously at the time of endoscopic retrograde cholangiopancreatography, 10 days after presentation. No previous case reports document this number, size and location of ductal stones passing spontaneously.
Background: Australia has the highest incidence of non-melanoma skin cancers (NMSC) in the world estimated to be 2448/100,000 population with the state of Queensland carrying the highest burden of disease. Surgical excision is the primary treatment and makes up a large proportion of general surgical lists in regional Queensland where they are typically removed using either local anaesthetic (LA) alone, local anaesthetic and sedation (LAS), or general anaesthesia (GA). There is little in the literature to suggest if anaesthetic type effects the rate of incomplete excision. The purpose of this study is to establish if anaesthetic type impacts the rate of incomplete excision of NMSC.Methods: A retrospective audit was performed, incorporating a total of 194 squamous and basal cell carcinoma lesions excised between October 2019 and October 2020 at two hospitals in regional Queensland, Australia. Data was recorded for the type of anaesthetic used and the histopathology of the lesions including type of lesion and clearance of microscopic margins.Results: Of the 194 excised lesions 39 of them had involved margins (20.1%). The rate of involved margins under LA, GA and LAS were found to be 19.79, 18.52 and 22.73% respectively. When comparing these modalities with each other: LA vs. GA, LAS vs. GA and LA vs. LAS no significant difference was found in the rate of incomplete excision of NMSC with p values (<0.05) of 1, 0.62 and 0.82 respectively.Conclusions: Modality of anaesthetic used for excision of NMSC does not affect the outcome of incomplete excision of NMSC.
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