Papers by Michael Hollands
Australian and New Zealand Journal of Surgery, Sep 6, 2010
The treatment of chronic pancreatitis commonly yields disappointing results. Patients with chroni... more The treatment of chronic pancreatitis commonly yields disappointing results. Patients with chronic pancreatitis and a dilated pancreatic duct can be treated by longitudinal pancreaticojejunostomy. In order to evaluate the procedure, 20 patients undergoing pancreaticojejunostomy were followed for a median time of more than 5 years. Their clinical characteristics and outcomes have been compared with a group of 43 patients with chronic pancreatitis and small pancreatic ducts. There were no differences between the two groups in the major epidemiological parameters, except that calcification in the gland was more frequently noted in those with large ducts. The operation of longitudinal pancreaticojejunostomy could be accomplished with an acceptable morbidity. There was one death in the postoperative period. Seventy-six per cent of patients were found to have benefited clinically at five years, compared with 48% of those with small duct disease. This difference was statistically significant. Patients who benefited were defined by four factors; they were carrying out their usual occupation at the time of surgery, they were not narcotic dependent at the time of surgery, they had a pancreatic duct width greater than 7 mm and, they had totally abstained from alcohol from before the operation to the time of follow-up. Longitudinal pancreaticojejunostomy probably remains the best surgical treatment for suitable patients with chronic pancreatitis. The operation should only be performed when the pancreatic duct is greater than 7 mm in width. In such patients the operation produces considerable improvement of pain with minimal metabolic disturbance.
Anz Journal of Surgery, Dec 14, 2020
Boerhaave syndrome is a rare and life‐threatening condition characterized by a spontaneous transm... more Boerhaave syndrome is a rare and life‐threatening condition characterized by a spontaneous transmural tear of the oesophagus. There remains wide variation in the condition's management with non‐operative management (NOM) and surgery being the two main treatment strategies. The aim was to review the presentation, management and outcomes for patients treated for Boerhaave syndrome at our institution and to compare these data with that previously reported within the Australasian literature.
Journal of Gastrointestinal Surgery, Apr 17, 2014
World journal of surgery, Jan 16, 2015
Surgical resection of oesophageal cancer is a major procedure with potential for significant morb... more Surgical resection of oesophageal cancer is a major procedure with potential for significant morbidity and mortality. Patient selection can be challenging, as operative benefit must be balanced against risk and impact on quality of life. This study defines modern trends in patient selection, and evaluates the impact of age, stage, and comorbidities on complications and survival following oesophagectomy, in a tertiary Australian experience. Data were compiled across two 15-year operative eras ('Era 1': 1981-1995; and 'Era 2': 1996-2010), with patients followed minimum 3 years. A total of 180 unselected records were analysed (powered for a relative hazard ratio of 0.5). Analyses defined patient selection trends, and for Era 2, the impact of age, comorbidities (Charlson score), and disease (T/N stage) on complications (Clavien-Dindo grade) and survival (Kaplan-Meier). A further sub-analysis was conducted with data divided into three 10-year periods. The age of operated ...
British Journal of Surgery
Background Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has d... more Background Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has diverse clinical manifestations and the optimal treatment strategy is unknown. The aim of this study was to assess the efficacy of treatment strategies for different manifestations of anastomotic leak after oesophagectomy. Methods A retrospective cohort study was performed in 71 centres worldwide and included patients with anastomotic leak after oesophagectomy (2011–2019). Different primary treatment strategies were compared for three different anastomotic leak manifestations: interventional versus supportive-only treatment for local manifestations (that is no intrathoracic collections; well perfused conduit); drainage and defect closure versus drainage only for intrathoracic manifestations; and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis. The primary outcome was 90-day mortality. Propensity score matching was performed to adjust for confoun...
British Journal of Surgery, Apr 4, 2012
Anz Journal of Surgery, Dec 28, 2020
BackgroundDay‐only laparoscopic cholecystectomy (DOLC) has been shown to be safe and feasible yet... more BackgroundDay‐only laparoscopic cholecystectomy (DOLC) has been shown to be safe and feasible yet has not been widely implemented in Australia. This study explores the introduction of routine DOLC to Westmead Hospital, and highlights the barriers to its implementation.MethodsRoutine day‐only cholecystectomy protocol was introduced at Westmead Hospital in 2014. A retrospective review of patients who underwent elective laparoscopic cholecystectomy during a 12‐month period in 2014 was compared to a 12‐month period in 2018, to examine the changes in practice after implementation of a unit protocol. Data were collected on patient demographics, admission category, outcomes and re‐presentations.ResultsA total of 282 patients were included in the study, of these 169 were booked as day procedures, with 124 (73%) successfully discharged on the same day. There was a significant increase in the proportion of patients booked as day‐only from 2014 to 2018 (48% versus 73%, P < 0.001). Day‐only failure rates (unplanned overnight admissions), readmissions and complication rates were comparable between the two periods. The most common reason for unplanned overnight admissions were due to intraoperative findings (n = 28/45).ConclusionRoutine DOLC can be adopted in Australian hospitals without compromise to patient safety. Unplanned overnight admission is predominantly due to unexpected surgical pathology and can be reduced by protocols for the use of drains and planned outpatient endoscopic retrograde cholangiopancreatography. Unplanned outpatient review can be minimized by optimizing both intra‐ and post‐operative pain management. Individual surgeon and anaesthetist preferences remain an obstacle to a standardized protocol in the Australian setting.
Anz Journal of Surgery, Mar 1, 2020
Anz Journal of Surgery, Mar 1, 2009
It is now expected that medical practitioners around the world will engage in ongoing professiona... more It is now expected that medical practitioners around the world will engage in ongoing professional development. Many Colleges, medical associations and societies have made completion of appropriate continuing professional development (CPD) mandatory and medical registration in some jurisdictions is predicated on participation in a CPD programme. This commits doctors to a programme of lifelong learning.
Anz Journal of Surgery, Mar 6, 2020
Background: Laparoscopic pancreaticoduodenectomy (LPD) is gaining interest with several series re... more Background: Laparoscopic pancreaticoduodenectomy (LPD) is gaining interest with several series reporting favourable outcomes. However, there are significant limitations to the successful implementation of LPD programmes in Australian and New Zealand (ANZ) settings. This study presents a local series of consecutive hybrid LPD (HLPD) and a suggested protocol for implementation of an LPD programme in ANZ settings. Methods: A retrospective review of consecutive patients undergoing HLPD with a laparoscopic resection and open reconstruction performed by a single surgeon at two centres in Sydney, Australia, between February 2014 and October 2019 was undertaken. Data were collected from a prospectively maintained database and patient records. Results: Eighteen patients underwent HLPD. Median operative time was 370 min, with a median laparoscopic resection time of 253 min. Median length of stay was 11 days. There was no mortality within 90 days. Post-operative complications included two patients requiring a return to operating theatre for post-operative pancreatic fistula, and five patients with delayed gastric emptying. Median number of lymph nodes harvested was 13 (interquartile range 11-15.8). Resection margins were negative in 15 patients (83.3%). Conclusion: HLPD is associated with satisfactory perioperative outcomes and may be feasible as a first step towards eventual implementation of LPD in ANZ hospitals.
The Medical Journal of Australia, May 1, 2013
Anz Journal of Surgery, Aug 26, 2014
International Journal of Hepatobiliary and Pancreatic Diseases, Aug 8, 2016
Aims: Laparoscopic cholecystectomy (LC) is currently the standard treatment for symptomatic galls... more Aims: Laparoscopic cholecystectomy (LC) is currently the standard treatment for symptomatic gallstones. In the presence of moderate to severe inflammation when dissection of the cholecystohepatic triangle cannot be safely achieved, laparoscopic partial cholecystectomy (LPC) has been proposed as an alternative to open conversion to prevent bile duct injuries. The aim of this study is to review our experience of the technique. Materials and Methods: A retrospective review of all patients who underwent laparoscopic cholecystectomy under the upper gastrointestinal surgical unit at Westmead Hospital was undertaken. The study included all emergency and elective cases during a period from February 2012 to February 2014. Demographic, clinical, operative and postoperative characteristics including operative technique, placement of a drain, complications, length of hospital stay and histopathology
Journal of Medical Imaging and Radiation Oncology, May 1, 1993
This is a retrospective study to evaluate the ability of arterial chemo-embolization with Adriamy... more This is a retrospective study to evaluate the ability of arterial chemo-embolization with Adriamycin, Lipiodol and Gelfoam to relieve symptoms, primarily abdominal pain, and to prolong survival in patients with hepatocellular carcinoma. Twenty patients were referred from 1986 to 1991 and in 18 the chemo-embolization procedure was successful. In the follow-up period to March 1992, 17 patients had died. Their survival times were not found to be significantly different from the reported rates of survival in patients given no therapy. In only one of 10 patients followed with computed tomography was a reduction in tumour size seen. Nine of 11 patients with pain reported significant relief from pain following treatment. Six patients had repeat embolizations that successfully relieved recurrent pain. In the authors' experience chemo-embolization was helpful in relieving pain, but did not prolong life.
The Medical Journal of Australia, Aug 1, 2015
PubMed, Feb 1, 1990
Data on 306 liver injuries were collected prospectively during a 10-year period. Of the 306 injur... more Data on 306 liver injuries were collected prospectively during a 10-year period. Of the 306 injuries, 281 were the result of blunt trauma. Major hepatic venous injuries were encountered in 41 of 306 patients (13%). Blunt trauma was responsible for 39 of the 41 venous injuries. Twenty-five (61%) of these patients died compared with an overall mortality rate of 31% (chi 2; p less than 0.001). Twenty-two of the 25 deaths were caused by blood loss. Two patterns of hepatic venous injury appeared to predominate: avulsion of the trunk of the right hepatic vein from the inferior vena cava and avulsion of the upper branch of the right hepatic vein. The trunk injury was seen in 15 patients, 12 of whom died. The branch injury was seen in 13 patients, only 4 of whom died (Fisher's exact test; p = 0.006). In what appears to be the largest series of blunt hepatic venous injuries published, the injuries have been classified according to the anatomic site of the injury. Such a classification correlates with prognosis. Differences between blunt and penetrating hepatic venous trauma have been discussed.
British Journal of Surgery, Sep 16, 2011
When to avoid protective stoma in colorectal surgery Antonino Spinelli, Milano, IT ENDOMETRIOSIS ... more When to avoid protective stoma in colorectal surgery Antonino Spinelli, Milano, IT ENDOMETRIOSIS Endometriosiswhat is the role of the abdominal surgeon Tuynman Juriaan, Amsterdam, NL Challenges in Surgery of Endometriosisalways interdisciplinary?
Anz Journal of Surgery, May 13, 2019
Background: Laparoscopic cholecystectomy (LC) is the standard of treatment for symptomatic cholel... more Background: Laparoscopic cholecystectomy (LC) is the standard of treatment for symptomatic cholelithiasis. Although intraoperative cholangiography (IOC) is widely used as an adjunct to LC, there is still no worldwide consensus on the value of its routine use. Anatomical studies have shown that variations of the biliary tree are present in approximately 35% of patients with variations in right hepatic second-order ducts being especially common (15-20%). Approximately, 70-80% of all iatrogenic bile duct injuries are a consequence of misidentification of biliary anatomy. The purpose of this study was to assess the adequacy of and the reporting of IOCs during LC. Methods: IOCs obtained from 300 consecutive LCs between July 2014 and July 2016 were analysed retrospectively by two surgical trainees and confirmed by a radiologist. Biliary tree anatomy was classified from IOC films as described by Couinaud (1957) and correlated with documented findings. The accuracy of intraoperative reporting was assessed. Biliary anatomy was correlated to clinical outcome. Results: A total of 95% of IOCs adequately demonstrated biliary anatomy. Aberrant right sectoral ducts were identified in 15.2% of the complete IOCs, and 2.6% demonstrated left sectoral or confluence anomalies. Only 20.4% of these were reported intraoperatively. Bile leaks occurred in two patients who had IOCs (0.73%) and two who did not (7.4%). Conclusion: Surgeons generally demonstrate biliary anatomy well on IOC but reporting of sectoral duct variation can be improved. Further research is needed to determine whether anatomical variation is related to ductal injury.
British Journal of Surgery, Aug 1, 1991
Hpb, Feb 1, 2014
Background: Since the liver metastases rather than the colorectal cancer itself is the main deter... more Background: Since the liver metastases rather than the colorectal cancer itself is the main determinant of patient's survival, the 'Liver-First Approach (LFA)' with upfront chemotherapy followed by a hepatic resection of colorectal liver metastases (CLM) and finally a colorectal cancer resection was proposed. The aim of this review was to analyse the evidence for LFA in patients with colorectal cancer and synchronous CLM. Methods: A literature search of databases (MEDLINE and EMBASE) to identify published studies of LFA in patients with colorectal cancer and synchronous CLM was undertaken focussing on the peri-operative regimens of LFA and survival outcomes. Results: Three observational studies and one retrospective cohort study were included for review. A total of 121 patients with colorectal cancer and synchronous CLM were selected for LFA. Pre-operative chemotherapy was used in 99% of patients. One hundred and twelve of the initial 121 patients (93%) underwent a hepatic resection of CLM. In total, 60% had a major liver resection and the R0 resection rate was 93%. Post-operative morbidity and mortality after the hepatic resection were 20% and 1%, respectively. Ultimately, 89 of the initial 121 (74%) patients underwent a colorectal cancer resection. Postoperative morbidity and mortality after a colorectal resection were 50% and 6%, respectively. The median overall survival was 40 months (range 19-50) with a recurrence rate of 52%. Conclusions: Current evidence suggests that LFA is safe and feasible in selected patients with colorectal cancer and synchronous CLM. Future studies are required to further define patient selection criteria for LFA and the exact role of LFA in the management of synchronous CLM.
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Papers by Michael Hollands