We add our experience of 30 cases of SCF repair to the international literature. We experienced a complication rate lower than the reported average, and maintain that the SCF is an excellent reconstructive option in patients with previously irradiated necks or comorbidities that affect microvasculature and anaesthetic resilience.

Objectives To detail how human anatomy is currently being taught and assessed in Australian and New Zealand medical schools. Methods Medical schools in Australia and New Zealand were invited to respond to an online survey of their teaching and assessment of human anatomy in the 2018 academic year. The results are compared with 2008 data. Changes in curricula and teaching methods are reported. Results Despite robust media and academic discussion over the last decade, very little has changed in the amount of anatomy teaching or assessment of anatomy in Australasian medical schools. One exception is that most universities have invested in new technology for teaching; however, the use of new technologies is irregular. Conclusions Australian and New Zealand medical schools should actively and cohesively respond to the changing requirements for anatomy education, or risk being left behind our international counterparts in the provision of anatomy education, to the detriment of doctors’ training and the healthcare system.

Acalculous cholecystitis caused by gallbladder torsion is a rare condition. Only 500 cases have been reported since the first diagnosed case in 1898. We present the case of a 89-year-old woman with sudden onset of severe epigastric pain, radiating across her right costal margin, associated with nausea. Her abdomen was soft, mildly distended, Murphy’s negative but with epigastric tenderness and palpable mass. Computed tomography and ultrasound demonstrated significant acute cholecystitis, with the common bile duct measuring 7 mm. Due to the patients’ comorbidities, conservative treatment was initiated, until she was becoming increasing worse, so a laparoscopic cholecystectomy was performed. The operation revealed gallbladder torsion causing complete gallbladder necrosis and perforation with intraperitoneal biliary spillage. Gallbladder torsion should be a high differential if an elderly female patient presenting with sudden onset of abdominal pain, tender epigastric/right upper quadrant mass and a distended gallbladder on imaging. A laparoscopic cholecystectomy must be performed promptly to reduce the likelihood of gallbladder rupture and reduce the mortality and morbidity associated with this condition.

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Introduction:Carcinosarcoma of the gallbladder (CSGB) is a rare clinical condition. To date, only 107 cases of CSGB have been reported worldwide. We present our experience of a late presentation of disseminated CSGB. To this we add a discussion of prognostic factors and treatment options for this rare gallbladder malignancy drawn from CSGB cases reported in the literature. Case report: A 73-year-old female presented to our facility with a poorly differentiated CSGB with widespread liver and peritoneal metastases. Fifteen days from the time of hospital admission, the patient suffered an acute episode of massive haematemesis with clinical signs of perforated viscous. Her cause of death was thought to be a tumour-related duodenal erosion. Discussion: Given the poor prognosis of CSGB, particularly when diagnosed at locally advanced or disseminated stages, we suggest a greater role for laparoscopic tissue diagnosis before considering radical surgical intervention.

Background The purpose of this study was to review the current management of gastro-oesophageal reflux disease (GORD), including treatment costs, safety profile and effectiveness. Methods A literature review was performed of randomized-controlled trials, systematic reviews, Cochrane reports and National/Societal guidelines of the medical, endoscopic and surgical management of GORD. Proton pump inhibitor (PPI) prescribing patterns and expenditure were reviewed in different countries, including Australia, Canada, New Zealand, UK and USA. Results Proton pump inhibitors (PPIs) are primarily indicated for control of GORD, Helicobacter pylori eradication (combined with antibiotics), preventing NSAID-induced gastrointestinal bleeding and treating peptic ulcer disease. There is widespread overprescribing of PPIs in Western and Eastern nations in terms of indication and duration, with substantial expense for national health providers. Despite a favourable short-term safety profile, there are observational associations of adverse effects with long-term PPIs. These include nutrient malabsorption, enteric infections and cardiovascular events. The prevalence of PPI use makes their long-term safety profile clinically relevant. Cost-benefit, symptom control and quality-of-life outcomes favour laparoscopic fundoplication rather than chronic PPI treatment. Laparoscopic fundoplication in long-term management of PPI-responsive GORD is supported by SAGES, NICE and ACG, and PPI-refractory GORD by AGA and SAGES guidelines. The importance of establishing a definitive diagnosis prior to invasive management is emphasized, especially in PPI-refractory heartburn. Conclusions We examined evidence-based guidelines for PPI prescribing and deprescribing in primary care and hospital settings and the need for PPI stewardship and education of health professionals. This narrative review presents the advantages and disadvantages of surgical, endoscopic and medical management of GORD, which may assist in shared decision making and treatment choice in individual patients. This paper was presented (GS020) at the 88th RACS Annual Scientific Conference, 6-10 May, 2019.

A 19-year-old female has multiple presentations to emergency department with recurrent abdominal pain. During her third presentation, the radiological features were suggestive of high-grade small bowel obstruction in a virgin abdomen. A diagnostic laparoscopy has been performed. The intraoperative findings include a band adhesion between omentum and small bowel mesentery, and perihepatic adhesions consistent with Fitz-Hugh-Curtis syndrome. The histopathology from a biopsy of the macular lesions of the abdominal wall showed endosalpingiosis. The postoperative high vaginal swab was positive for Chlamydia trachomatis. The underlying cause of her small bowel obstruction could be due to pelvic inflammatory disease, Fitz-Hugh-Curtis syndrome, or endosalpingiosis. We aimed to create awareness amongst readers that small bowel obstruction in young female patients with no prior abdominal surgery is possible and often difficult to diagnose immediately.

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