There is a lack of cohesive reports on the systemic levels of local anaesthetic after intraperito... more There is a lack of cohesive reports on the systemic levels of local anaesthetic after intraperitoneal application. A comprehensive systematic review with no language restriction was conducted. Eighteen suitable articles were identified. Data were compiled and presented according to local anaesthetic agent. Intraperitoneal local anaesthetic has been studied in many different procedures, including open and laparoscopic surgery. A total of 415 patients were included for analysis. There were no cases of clinical toxicity. There were 11 (2.7%) cases with a systemic level above or close to a safe threshold (as determined by the report authors) in three trials utilising intraperitoneal local anaesthetic after laparoscopic cholecystectomy. Intraperitoneal lignocaine doses varied from 100 to 1000 mg, mean Cmax ranged from 1.01 to 4.32 microg/ml and mean Tmax ranged from 15 to 40 minutes. Intraperitoneal bupivacaine doses varied from 50 to 150 mg (weight based doses also reported), mean Cmax ...
Expert review of gastroenterology & hepatology, Jan 16, 2015
Familial colorectal cancer syndromes pose a complex challenge to the treating clinician. Once a s... more Familial colorectal cancer syndromes pose a complex challenge to the treating clinician. Once a syndrome is recognized, genetic testing is often required to confirm the clinical suspicion. Management from that point is usually based on disease-specific guideline recommendations targeting risk reduction for the patient and their relatives through surgery, surveillance and chemoprophylaxis. The aim of this paper is to provide an up-to-date summary of the most common familial syndromes and their medical and surgical management, with specific emphasis on evidence-based interventions that improve patient outcome, and to present the information in a manner that is easily readable and clinically relevant to the treating clinician.
Oesophagectomy is a complex procedure associated with a significant morbidity and mortality rate.... more Oesophagectomy is a complex procedure associated with a significant morbidity and mortality rate. There is very little published data from New Zealand, with no published data from a non-Tertiary New Zealand hospital. We aimed to evaluate the outcomes of oesophagectomy at a single provincial hospital in New Zealand. Retrospective review of clinical records of all patients who underwent oesophagectomy at Palmerston North Hospital (a level II provincial New Zealand public hospital) between 1993 and 2010 was performed. Demographic data, operative details, postoperative recovery parameters, survival data, pathological data, and details of adjuvant treatment were collected. Data from all 68 patients who underwent oesophagectomy were included. Mean age was 63.6 plus or minus 10.9 years, and 69% of patients were male. Mean operating time was 438.37 plus or minus 101.8 min, and mean intraoperative blood loss was 934.5 plus or minus 790.2 ml. Median intensive care unit stay was 7 (1-29) days,...
There are few published ERAS cost-analyses in colorectal surgery. The aim of this paper is to eva... more There are few published ERAS cost-analyses in colorectal surgery. The aim of this paper is to evaluate whether costs saved by reduced postoperative resource utilisation would offset the financial burden of setting up and maintaining such an ERAS programme. A cost-effectiveness analysis from a healthcare provider perspective using a case-control model. The study group consisted of patients enrolled in the ERAS program for elective colonic surgery at Manukau Surgical Centre between December 2005 and March 2007. The control group consisted of consecutive patients from September 2004 to September 2005 (before the start of ERAS). Groups were matched with respect to operation, BMI, ASA, and Cr-POSSUM score. Data were available for 50 patients in each group. There was a significant reduction in total hospital stay, intravenous fluid use, and duration of epidural use in the ERAS group. There were significantly fewer complications in the ERAS group. Implementation of ERAS cost approximately ...
To investigate the therapeutic value of Gastrografin in shortening duration of prolonged postoper... more To investigate the therapeutic value of Gastrografin in shortening duration of prolonged postoperative ileus (PPOI) after elective colorectal surgery. Gut wall edema is central to the pathogenesis of PPOI. Hyperosmotic, orally administered, water-soluble contrast media such as Gastrografin are theoretically capable of mitigating this edema. A double-blinded, placebo-controlled, randomized trial was conducted. Participants were allocated to receive 100 mL of Gastrografin (Exposure Group) or flavored distilled water (Control Group) administered enterally. Other aspects of management were standardized. Resolution of PPOI was assessed 12-hourly. Eighty patients were randomized equally, with 5 in the Exposure Group and 4 in the Control Group excluded from analysis. Participants were evenly matched at baseline. Mean duration of PPOI did not differ between Exposure and Control Groups (83.7 vs 101.3 hours; P = 0.191). When considering individual markers of PPOI resolution, Gastrografin did not affect time to resolution of nausea and vomiting (64.5 vs 74.3 hours; P = 0.404) or consumption of oral diet (75.8 vs 90.0 hours; P = 0.297). However, it accelerated time to flatus or stool (18.9 vs 32.7 hours; P = 0.047) and time to resolution of abdominal distension (52.8 vs 77.7 hours; P = 0.013). There were no significant differences between groups in nasogastric output; analgesia, antiemetic, or fluid requirement; complications; or length of stay. Gastrografin is not clinically useful in shortening an episode of PPOI characterized by upper and lower gastrointestinal symptoms. It may however be of therapeutic benefit in the subset of PPOI patients who display lower gastrointestinal symptoms exclusively after surgery.
Computed tomographic colonography (CTC) has been advocated for use after incomplete colonoscopy. ... more Computed tomographic colonography (CTC) has been advocated for use after incomplete colonoscopy. Most of the literature is based on data from urban centres. The purpose of this study is to evaluate the use of CTC in a rural New Zealand hospital. Patient files, electronic endoscopy and radiology records of patients from Timaru Hospital between who had a CTC between 1 April 2004 and 1 December 2006 were retrospectively reviewed. 196 CTCs were performed after incomplete colonoscopy. The diagnostic yield of CTC for lesions > or = 10 mm was 8.7%; and for lesions less < 10 mm was 5.6%. CTC was performed as the primary investigative modality in 568 patients. The sensitivity and specificity of CTC for detecting colonic lesions were 90.7% and 50.4% respectively. The positive and negative predictive values of CTC were 71.9% and 79.5%. The sensitivity and specificity for lesions that were 10 mm or more were 100% and 92.1%. CTC may be an effective tool for the detection of clinically impo...
There is a lack of cohesive reports on the systemic levels of local anaesthetic after intraperito... more There is a lack of cohesive reports on the systemic levels of local anaesthetic after intraperitoneal application. A comprehensive systematic review with no language restriction was conducted. Eighteen suitable articles were identified. Data were compiled and presented according to local anaesthetic agent. Intraperitoneal local anaesthetic has been studied in many different procedures, including open and laparoscopic surgery. A total of 415 patients were included for analysis. There were no cases of clinical toxicity. There were 11 (2.7%) cases with a systemic level above or close to a safe threshold (as determined by the report authors) in three trials utilising intraperitoneal local anaesthetic after laparoscopic cholecystectomy. Intraperitoneal lignocaine doses varied from 100 to 1000 mg, mean Cmax ranged from 1.01 to 4.32 microg/ml and mean Tmax ranged from 15 to 40 minutes. Intraperitoneal bupivacaine doses varied from 50 to 150 mg (weight based doses also reported), mean Cmax ...
Expert review of gastroenterology & hepatology, Jan 16, 2015
Familial colorectal cancer syndromes pose a complex challenge to the treating clinician. Once a s... more Familial colorectal cancer syndromes pose a complex challenge to the treating clinician. Once a syndrome is recognized, genetic testing is often required to confirm the clinical suspicion. Management from that point is usually based on disease-specific guideline recommendations targeting risk reduction for the patient and their relatives through surgery, surveillance and chemoprophylaxis. The aim of this paper is to provide an up-to-date summary of the most common familial syndromes and their medical and surgical management, with specific emphasis on evidence-based interventions that improve patient outcome, and to present the information in a manner that is easily readable and clinically relevant to the treating clinician.
Oesophagectomy is a complex procedure associated with a significant morbidity and mortality rate.... more Oesophagectomy is a complex procedure associated with a significant morbidity and mortality rate. There is very little published data from New Zealand, with no published data from a non-Tertiary New Zealand hospital. We aimed to evaluate the outcomes of oesophagectomy at a single provincial hospital in New Zealand. Retrospective review of clinical records of all patients who underwent oesophagectomy at Palmerston North Hospital (a level II provincial New Zealand public hospital) between 1993 and 2010 was performed. Demographic data, operative details, postoperative recovery parameters, survival data, pathological data, and details of adjuvant treatment were collected. Data from all 68 patients who underwent oesophagectomy were included. Mean age was 63.6 plus or minus 10.9 years, and 69% of patients were male. Mean operating time was 438.37 plus or minus 101.8 min, and mean intraoperative blood loss was 934.5 plus or minus 790.2 ml. Median intensive care unit stay was 7 (1-29) days,...
There are few published ERAS cost-analyses in colorectal surgery. The aim of this paper is to eva... more There are few published ERAS cost-analyses in colorectal surgery. The aim of this paper is to evaluate whether costs saved by reduced postoperative resource utilisation would offset the financial burden of setting up and maintaining such an ERAS programme. A cost-effectiveness analysis from a healthcare provider perspective using a case-control model. The study group consisted of patients enrolled in the ERAS program for elective colonic surgery at Manukau Surgical Centre between December 2005 and March 2007. The control group consisted of consecutive patients from September 2004 to September 2005 (before the start of ERAS). Groups were matched with respect to operation, BMI, ASA, and Cr-POSSUM score. Data were available for 50 patients in each group. There was a significant reduction in total hospital stay, intravenous fluid use, and duration of epidural use in the ERAS group. There were significantly fewer complications in the ERAS group. Implementation of ERAS cost approximately ...
To investigate the therapeutic value of Gastrografin in shortening duration of prolonged postoper... more To investigate the therapeutic value of Gastrografin in shortening duration of prolonged postoperative ileus (PPOI) after elective colorectal surgery. Gut wall edema is central to the pathogenesis of PPOI. Hyperosmotic, orally administered, water-soluble contrast media such as Gastrografin are theoretically capable of mitigating this edema. A double-blinded, placebo-controlled, randomized trial was conducted. Participants were allocated to receive 100 mL of Gastrografin (Exposure Group) or flavored distilled water (Control Group) administered enterally. Other aspects of management were standardized. Resolution of PPOI was assessed 12-hourly. Eighty patients were randomized equally, with 5 in the Exposure Group and 4 in the Control Group excluded from analysis. Participants were evenly matched at baseline. Mean duration of PPOI did not differ between Exposure and Control Groups (83.7 vs 101.3 hours; P = 0.191). When considering individual markers of PPOI resolution, Gastrografin did not affect time to resolution of nausea and vomiting (64.5 vs 74.3 hours; P = 0.404) or consumption of oral diet (75.8 vs 90.0 hours; P = 0.297). However, it accelerated time to flatus or stool (18.9 vs 32.7 hours; P = 0.047) and time to resolution of abdominal distension (52.8 vs 77.7 hours; P = 0.013). There were no significant differences between groups in nasogastric output; analgesia, antiemetic, or fluid requirement; complications; or length of stay. Gastrografin is not clinically useful in shortening an episode of PPOI characterized by upper and lower gastrointestinal symptoms. It may however be of therapeutic benefit in the subset of PPOI patients who display lower gastrointestinal symptoms exclusively after surgery.
Computed tomographic colonography (CTC) has been advocated for use after incomplete colonoscopy. ... more Computed tomographic colonography (CTC) has been advocated for use after incomplete colonoscopy. Most of the literature is based on data from urban centres. The purpose of this study is to evaluate the use of CTC in a rural New Zealand hospital. Patient files, electronic endoscopy and radiology records of patients from Timaru Hospital between who had a CTC between 1 April 2004 and 1 December 2006 were retrospectively reviewed. 196 CTCs were performed after incomplete colonoscopy. The diagnostic yield of CTC for lesions > or = 10 mm was 8.7%; and for lesions less < 10 mm was 5.6%. CTC was performed as the primary investigative modality in 568 patients. The sensitivity and specificity of CTC for detecting colonic lesions were 90.7% and 50.4% respectively. The positive and negative predictive values of CTC were 71.9% and 79.5%. The sensitivity and specificity for lesions that were 10 mm or more were 100% and 92.1%. CTC may be an effective tool for the detection of clinically impo...
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