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Background: Superficial skin abscesses account for a significant burden of emergency surgical admissions. The aim of this study was to evaluate the effectiveness of an ambulatory care pathway for emergently treating abscesses of the body requiring operative drainage. Method: A retrospective study of a prospective patient database was performed, using randomized patient selection. Patient demographics, length and cost of stay were compared between patients undergoing operative management for skin abscess before and after the implementation of the fast‐track ambulatory abscess pathway (FAAP). Results: In total, 100 patients were analysed with 50 in the pre‐ambulatory care pathway group and 50 in the FAAP group. The pre‐ambulatory care pathway group had a mean age of 37.7 ± 15.8 years versus FAAP group of 35.3 ± 14.5 years. Total length of stay for the group was 85 versus 17 days with a mean comparison of 1.7 days versus 0.34 days (P < 0.001). This translated into a total cost saving of $74 100 in the FAAP group, with a mean comparison cost between the groups of $2884 versus $1402 (P < 0.001). Both reductions in length of stay and cost of stay were statistically significant after implementation of the pathway. Conclusion: This is the first Australian study to report the findings from an ambulatory care pathway for an emergency surgical intervention. We have shown that skin abscesses presenting through emergency can be managed as a day‐case procedure, thereby decreasing these patients' overall length and cost of stay. [ABSTRACT FROM AUTHOR]

Port-site metastasis of pancreatic adenocarcinoma following "successful" completion of neoadjuvant chemoradiation using FOLFIRINOX Diagnostic laparoscopy is a well-established investigation as part of the initial staging for malignancy of the pancreatic head and tail. Interestingly, diagnostic laparoscopy is recommended in the initial staging of patients with left-sided pancreatic cancers in these trial protocols, but not following completion of systemic treatment. [Extracted from the article]

Background: In patients with primary hyperparathyroidism (PHPT) and preoperative imaging suggesting a solitary parathyroid adenoma (SPA), focused parathyroidectomy is most often curative. Even so, large studies show up to 3% of patients experience persistent or recurrent PHPT. Unilateral neck exploration (UNE) aiming to identify the SPA and the other ipsilateral parathyroid may reduce this failure rate. We hypothesized that: (i) minimally invasive video‐assisted (MIVA) approach would facilitate UNE and (ii) this would be a clinically relevant strategy. Methods: Prospective case series of a consecutive cohort of PHPT patients (with preoperative diagnosis of SPA), who underwent MIVA‐UNE. A 15 mm collar incision and endoscopic magnification were utilized to both excise the SPA and seek the ipsilateral parathyroid gland. Results: From 2009 to 2014, 132 patients were offered MIVA‐UNE (age: 63.0 (interquartile range: 11.2); females: 94 (71.2%); symptomatic: 89 (67.4%); mean serum corrected calcium: 2.7 (standard deviation: 0.9) mmol/L; mean serum parathyroid hormone: 16.8 (standard deviation: 11.8) pmol/L). Conversion from MIVA‐UNE to open UNE was required in 14 (10.6%) patients (excluded from subsequent analysis). MIVA‐UNE was concluded in 118 patients. The second ipsilateral parathyroid was identified in 62 (52.5%) patients and in 13 (11.0%) it appeared enlarged and was excised. Histopathology confirmed five (4.2%) of these glands to be hyperplastic. Conclusion: MIVA‐UNE allows identification of the second ipsilateral parathyroid in about half the patients. This approach helped to diagnose and treat unexpected multigland disease in almost 5% of patients. [ABSTRACT FROM AUTHOR]

Mirizzi syndrome (MS) is a rare but well-described complication of cholelithiasis where an impacted stone in the cystic duct or gallbladder neck causes extrinsic compression of the common hepatic duct (CHD) resulting in obstructive jaundice.[[1], [3]] We present the case of a woman with type III MS repaired with a novel method of choledochoplasty. A follow-up magnetic resonance cholangiopancreatography scan demonstrated a 20 mm solitary ovoid filling-defect in the gallbladder neck/cystic duct junction effacing the lower CHD. Given the anatomical disruption and long-term risks of a bilio-enteric anastomosis, we opted to perform a subtotal cholecystectomy and a novel method of choledochoplasty using a seromuscular flap lifted from the anterior wall of the remnant gallbladder (Fig.). [Extracted from the article]