Hookwire localization using ultrasound guidance is an invaluable tool in directing the surgeon intraoperatively when excising deep intramuscular haemangiomas.

Our medium-term experience has demonstrated the efficacy of SMART in the reduction of parastomal hernia occurrence. With appropriate learning curve, parastomal hernia can be prevented.

titles marked with an asterisk were judged for the RACS Prize for the best paper from a Trainee. Titles marked with a double asterisk were judged for the Bard Australia Prize for the best paper from a Trainee in hernia management. GS01HERNIA REPAIR: ARE WE THERE YET? M. Mccallum Newcastle, New South WalesHerniae have been documented since ancient times, but the era of modern hernia treatment is accepted as starting with the surgery of Bassini. Suture repairs of various types then dominated the treatment of hernia until the era of mesh repair championed by Stoppa and Lichtenstein.Surgeons feel that mesh repairs have revolutionized hernia surgery. Have the mesh repairs really made such a difference? There is evidence that all is not as it seems! Published recurrence figures don't seem to withstand close scrutiny.One of the trendy terms in herniology is the "myo-pectineal orifice", while many hernia specialists pay lip service to this concept, very few available hernia operations address this problem.The latest area of interest in the world of hernia surgery is the area of posthernia groin pain, either neuralgic or non-neuralgic. There are studies showing an incidence of chronic groin pain following anterior repairs of 30% or more, and yet these operations are the most common hernia operations in the world! Keith in 1924 first postulated the concept of herniosis and was criticized. However there is a large volume of convincing evidence that herniae are manifestations of a metabolic disorder. They are associated with abdominal aortic aneurysm and possibly with such diverse conditions as diverticular disease, cholelithiasis, and perhaps haemorrhoidal disease.Are we there yet? The answer is certainly no. However research into the metabolic problem of hernia development means that we are surely closer than we have ever been before.Purpose: Inguinal hernia repair is a common operation with much focus in recent times on improving morbidity. The use of mesh repair has greatly decreased reoccurrence rates and focus turns towards improving postoperative groin pain. This review examines the use of UHS in inguinal hernia repair and relation with postoperative groin pain. Methods: A retrospective audit of consecutive cases over one year (telephone and mailed questionnaires) was conducted. The recently validated IPQ (inguinal pain score) was used. A review of files and operative reports was also undertaken. Cases undergoing bilateral repair, or other operations simultaneously were excluded. Results: 59 patients (61%) participated in the audit, with a mean follow up of 11 months (range 5-16). 4 minor wound complications occurred. Higher pain scores appeared to correlate preoperatively with age and workers compensation status. Postoperative pain scores and limitation to functional status were low, and trended towards lower values in the UHS (ultrapro hernia system) repair group compared to the group who underwent repair with PHS (preceding week pain scores respectively -UHS repair, mean 1.22, (95%CI 1.07-1.38); PHS 1.76, (95%CI 1....

Background Colorectal surgery in patients with liver cirrhosis poses a significant challenge due to the associated peri-operative morbidity and mortality risks. The aim of this systematic review was to evaluate the outcomes in this cohort of patients following colorectal surgery. Methods The PubMed, Embase and Cochrane databases and references were searched up to October 2022 using the PRISMA guidelines. The data collated included: patient demographics, pathology or type of colorectal operation performed, severity of liver cirrhosis, post-operative complication rates, mortality rates and prognostic factors. A quality assessment of included studies was performed with the Newcastle-Ottawa scale.Results Sixteen studies reporting the outcomes of colorectal surgery in patients with liver cirrhosis were identified, including the results of 8646 patients. The indications, pathologies and/or type of operations varied. The overall complication rate ranged from 29 to 75%, minor complication ranged 14.5-37% and major complication ranged 6.7-59.3%. The mortality rates ranged from 0 to 37%. Conclusion Colorectal surgery in patients with liver cirrhosis still carries considerable morbidity and mortality rates. This group of patients needs to be managed in a multidisciplinary setting to achieve excellent outcomes. Future research should focus on uniform definitions to enable interpretable outcomes.

titles marked with an asterisk were judged for the RACS Prize for the best paper from a Trainee. Titles marked with a double asterisk were judged for the Bard Australia Prize for the best paper from a Trainee in hernia management. GS01HERNIA REPAIR: ARE WE THERE YET? M. Mccallum Newcastle, New South WalesHerniae have been documented since ancient times, but the era of modern hernia treatment is accepted as starting with the surgery of Bassini. Suture repairs of various types then dominated the treatment of hernia until the era of mesh repair championed by Stoppa and Lichtenstein.Surgeons feel that mesh repairs have revolutionized hernia surgery. Have the mesh repairs really made such a difference? There is evidence that all is not as it seems! Published recurrence figures don't seem to withstand close scrutiny.One of the trendy terms in herniology is the "myo-pectineal orifice", while many hernia specialists pay lip service to this concept, very few available hernia operations address this problem.The latest area of interest in the world of hernia surgery is the area of posthernia groin pain, either neuralgic or non-neuralgic. There are studies showing an incidence of chronic groin pain following anterior repairs of 30% or more, and yet these operations are the most common hernia operations in the world! Keith in 1924 first postulated the concept of herniosis and was criticized. However there is a large volume of convincing evidence that herniae are manifestations of a metabolic disorder. They are associated with abdominal aortic aneurysm and possibly with such diverse conditions as diverticular disease, cholelithiasis, and perhaps haemorrhoidal disease.Are we there yet? The answer is certainly no. However research into the metabolic problem of hernia development means that we are surely closer than we have ever been before.Purpose: Inguinal hernia repair is a common operation with much focus in recent times on improving morbidity. The use of mesh repair has greatly decreased reoccurrence rates and focus turns towards improving postoperative groin pain. This review examines the use of UHS in inguinal hernia repair and relation with postoperative groin pain. Methods: A retrospective audit of consecutive cases over one year (telephone and mailed questionnaires) was conducted. The recently validated IPQ (inguinal pain score) was used. A review of files and operative reports was also undertaken. Cases undergoing bilateral repair, or other operations simultaneously were excluded. Results: 59 patients (61%) participated in the audit, with a mean follow up of 11 months (range 5-16). 4 minor wound complications occurred. Higher pain scores appeared to correlate preoperatively with age and workers compensation status. Postoperative pain scores and limitation to functional status were low, and trended towards lower values in the UHS (ultrapro hernia system) repair group compared to the group who underwent repair with PHS (preceding week pain scores respectively -UHS repair, mean 1.22, (95%CI 1.07-1.38); PHS 1.76, (95%CI 1....

No abstract

PurposeInguinal hernia repair is one of the most frequently performed operations in general surgical practice. A variety of techniques have been used in the past with different results. The aim of the present study is to report our experience of inguinal hernia repair using the Kugel patch and to measure the frequency of postoperative recurrence and chronic groin pain. MethodologyData were recorded prospectively from a series of 333 inguinal hernia repairs performed between January 2004 to December 2006 using the Kugel patch technique. Wound infection, seroma, haematoma urinary retention, 6-month recurrence and chronic groin pain were the outcome measures. ResultsThe Kugel patch hernia repairs were performed in 284 patients during the 3-year period. There were no recurrences or chronic groin pain within 6 months of the 333 repairs. There was only one reported wound infection. The average operating time for bilateral hernia repair was 40.5 minutes (SD 8.8). Recurrent hernias took an average of 26 minutes (SD6.2) to repair whilst unilateral hernias took an average of 23 minutes (SD 6.8). 5 (1.8%) of the 284 patients had urinary retention. The average operating time for 136 direct procedures was 27 minutes compared with 25 minutes for the 148 indirect procedures (p = 0.096, t-test). ConclusionIn this prospective series the Kugel hernia repair is associated with no post hernia repair groin pain and no recurrence within 6 months of the procedure. It is inexpensive compared with laparoscopic repair, and allows the surgeon to cover all potential defects with one piece of mesh. PurposeTo review the experience with laparoscopic splenectomy, to determine it's efficacy for treating immune thrombocytopaenic purpura (ITP) and to highlight key technical issues with the operation. MethodologyAll splenectomies performed between 1992 and 2005 were identified from the Otago Surgical Audit and the clinical notes reviewed, including the laboratory records for follow-up data related to the haematologic cases. ResultsThere were 289 splenectomies performed over the 13 year period. The indications were trauma (111, 38%), haematologic disease (93, 32%), incidental (40, 14%) splenic malignancy (39, 13%), and other (8, 3%). Of the 68 patients with ITP, 49 (72%) had a lateral laparoscopic splenectomy (LLS) with no conversions, a 5% complication rate and one mortality. Based on platelet counts and the requirement for maintenance steroids there was a complete response in 44 (68%) patients at >6 months, a partial response in 16 (24%) and no response in 5 (8%) patients. A short video presentation will highlight the key steps for the safe and efficient performance of the LLS, including patient and port positioning, the use of ultrasonic dissection, splenic pedicle stapling, and morcellation. The indications for hand-port assisted laparoscopic and open splenectomy will be discussed. ConclusionsThe LLS is the preferred approach to splenectomy for all but massive splenomegaly and can be performed safely with careful attention to key technical issue...