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Background Recently, the number of prehabilitation trials has increased significantly. The identification of key research priorities is vital in guiding future research directions. Thus, the aim of this collaborative study was to define key research priorities in prehabilitation for patients undergoing cancer surgery. Methods The Delphi methodology was implemented over three rounds of surveys distributed to prehabilitation experts from across multiple specialties, tumour streams and countries via a secure online platform. In the first round, participants were asked to provide baseline demographics and to identify five top prehabilitation research priorities. In successive rounds, participants were asked to rank research priorities on a 5-point Likert scale. Consensus was considered if > 70% of participants indicated agreement on each research priority. Results A total of 165 prehabilitation experts participated, including medical doctors, physiotherapists, dieticians, nurses, and academics across four continents. The first round identified 446 research priorities, collated within 75 unique research questions. Over two successive rounds, a list of 10 research priorities reached international consensus of importance. These included the efficacy of prehabilitation on varied postoperative outcomes, benefit to specific patient groups, ideal programme composition, cost efficacy, enhancing compliance and adherence, effect during neoadjuvant therapies, and modes of delivery. Conclusions This collaborative international study identified the top 10 research priorities in prehabilitation for patients undergoing cancer surgery. The identified priorities inform research strategies, provide future directions for prehabilitation research, support resource allocation and enhance the prehabilitation evidence base in cancer patients undergoing surgery.

Background There are no publications addressing the level of experience Australian surgical trainees achieve in inguinal hernia surgery. Internationally, some training boards have set minimum competency requirements, but this is not true in Australia. The longer learning curve for laparoscopic inguinal hernia repairs (LIHRs) compared to open inguinal hernia repairs (OIHRs) has placed greater demands on trainees. Methods Logbook data on OIHR and LIHR for Australian surgical trainees who graduated as fellows between 2013 and 2018 were obtained. A literature review was performed to analyse international published logbook numbers for surgical trainees from the past decade. International training board requirements, estimations of the learning curve and hernia society guidelines for each procedure were reviewed. Results In total, 7946 operations were recorded from 58 trainees. On average 49.2 OIHRs (range 13–101), 21.5 LIHRs (range 1–94) and 71.1 inguinal hernia repairs overall (range 25–129) were performed during training. The European Hernia Society recommends that at least 30–50 of each procedure be performed during training. The learning curves for LIHRs (50–100 procedures) have been shown to be longer than for OIHRs (40–64 procedures). Conclusion Australian general surgical trainees are achieving adequate primary operator logbook numbers for OIHRs but are not completing the required number of LIHRs. The tailored approach to inguinal hernia repair requires skill in both open and laparoscopic repairs. This may not be possible with the current training structure in Australia.

Primary tumors of the omentum, let alone omental lipomas, are rare causes of a large intra-abdominal mass. We report a case of an adult male presenting with an intra-abdominal mass, representative of a giant omental lipoma radiologically, confirmed on histopathology after complete resection at laparotomy. The case highlights the preoperative workup of a suspected omental lipoma, including the utility of various radiological modalities in differentiating from malignant pathologies, and anatomical characterization of the lesion for surgical planning.

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BackgroundIleal pouch‐anal anastomosis (IPAA) is considered the gold standard reconstructive option in ulcerative colitis (UC). Recent efforts to improve pouch outcomes have seen a push towards centralisation of surgery. This study aimed to document outcomes following pouch surgery at a population level within New South Wales (NSW), and identify factors associated with, and temporal trends of these outcomes.MethodsA retrospective data linkage study of the NSW population over a 19‐year period was performed. The primary outcome was pouch failure in patients with UC who underwent IPAA. The influence of hospital level factors (including annual volume) and patient demographic variables on this outcome were assessed using Cox proportional hazards modelling. Temporal trends in annual volume and evidence for centralisation over the studied period were assessed using Poisson regression analysis.ResultsThe annual volume of UC pouches reduced over the study period. The pouch failure rates were 8.6% (95% CI 6.3–10.8%) and 10.6% (95% CI 8.0–13.1%) at 5‐ and 10‐years, respectively. Increasing age and non‐elective admission were associated with higher failure rates. One‐third of UC pouches (31.6%) were performed in a single institution, which averaged 6.5 pouches/year throughout the study period. Three‐quarters (19/25) of NSW public hospitals who performed pouches performed less than one UC pouch annually.ConclusionsThe outcomes following UC pouch surgery in NSW are comparable with global standards. Concentrating IBD pouch surgery with the aim of producing specialist surgical teams may be a reasonable way forward in NSW and would ensure equity of access and facilitate research and training collaboration.

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