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  1. Article ; Online: Systematic review of robotic ventral hernia repair with meta-analysis.

    Tran, Elisa / Sun, Jing / Gundara, Justin

    ANZ journal of surgery

    2023  Volume 94, Issue 1-2, Page(s) 37–46

    Abstract: Background: Despite being one of the most common operations performed by general surgeons, there is a lack of consensus regarding the recommended approach for ventral hernia repair (VHR). Recent times have seen the rapid development of new techniques, ... ...

    Abstract Background: Despite being one of the most common operations performed by general surgeons, there is a lack of consensus regarding the recommended approach for ventral hernia repair (VHR). Recent times have seen the rapid development of new techniques, such as robotic ventral hernia repair (RVHR). This systematic review and meta-analysis aims to evaluate the currently available evidence relating to RVHR, in comparison to open VHR (OVHR) and laparoscopic VHR (LVHR).
    Methods: A systematic search of the following databases was conducted: PubMed, Embase, Scopus and Web of Science. A meta-analysis was performed for the outcomes of length of stay (LOS), recurrence, operative time, intraoperative complications, wound complications, 30-day readmission, 30-day reoperation, mortality and costs.
    Results: A total of 39 studies met inclusion criteria. Overall, RVHR reduced LOS, intra-operative complications, wound complications and readmission compared to OVHR. Compared to LVHR, RVHR was associated with increased operative time and costs, with comparable clinical outcomes.
    Conclusion: There is currently a lack of robust evidence to support the robotic approach in VHR. It does not demonstrate major benefits in comparison to LVHR, which is more affordable and accessible. Strong quality, long-term data is required to help with establishing a gold standard approach in VHR.
    MeSH term(s) Humans ; Postoperative Complications/etiology ; Robotic Surgical Procedures/adverse effects ; Robotic Surgical Procedures/methods ; Laparoscopy/methods ; Hernia, Ventral/surgery ; Hernia, Ventral/complications ; Herniorrhaphy/adverse effects ; Herniorrhaphy/methods ; Intraoperative Complications/surgery ; Retrospective Studies
    Language English
    Publishing date 2023-12-13
    Publishing country Australia
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.18822
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  2. Article ; Online: Outcomes of a first point of contact speech language therapy clinic for patients requiring vocal cord check pre and post thyroid/parathyroid surgery.

    Davis, Jennifer / Ward, Elizabeth C / Seabrook, Marnie / Gundara, Justin / Whitfield, Bernard C S

    International journal of language & communication disorders

    2023  Volume 59, Issue 3, Page(s) 963–975

    Abstract: Introduction: Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with ... ...

    Abstract Introduction: Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions.
    Methods & procedures: The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey.
    Results: Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events.
    Conclusion & implications: The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services.
    What this paper adds: What is already known Assessment of laryngeal function via flexible nasoendoscopy is recommended best practice for patients pre and postthyroid/parathyroid surgery, as recurrent laryngeal nerve injury is a low incidence (<10%), yet well-recognised risk of these surgeries. Traditionally, general surgeons refer presurgical patients to ear, nose and throat (ENT) for vocal cord check (VCC) assessment. However, with access to specialist outpatient services under increasing pressure, there is growing support for utilisation of other health professionals, such as speech-language therapists working in first point of contact (FPOCC) models, to assist with the administration of pre- and postsurgical assessments of such low-risk populations. What this study adds This work expands on the emerging body of evidence for speech language therapy (SLT) led FPOCC models within ENT outpatient services, providing clinical and service outcomes to support the safety of a new model designed to administer VCCs for patients pre and post thyroid/parathyroid surgery. Adopting a similar model to a prior published SLT-led FPOCC model, the trained SLT completes the pre- and postsurgical VCC including flexible nasoendoscopy and videostroboscopy, with images and clinical information then presented to ENT for diagnosis and management planning. This study also provides the first data on consumer perceptions of this type of service model. Clinical implications of this study Data on 100 consecutive presurgical patients revealed positive service findings, supporting the safety of this model. Nature and incidence of clinical findings pre and post surgery were consistent with previously published studies using traditional models of care (i.e., ENT completing the flexible nasendoscopy). Consumer perception was positive. This model enables delivery of pre-and postsurgical assessments for patients receiving thyroid/parathyroid surgery, consistent with best practice care, and reduces burden on ENT services. In total 163 ENT appointments were avoided with this model, with positive implications for ENT waitlist management.
    MeSH term(s) Humans ; Female ; Male ; Middle Aged ; Adult ; Aged ; Speech Therapy/methods ; Vocal Cords ; Thyroidectomy/adverse effects ; Thyroidectomy/methods ; Dysphonia/diagnosis ; Dysphonia/etiology ; Postoperative Complications/diagnosis ; Patient Satisfaction ; Treatment Outcome ; Referral and Consultation ; Vocal Cord Paralysis/diagnosis ; Thyroid Diseases/surgery ; Preoperative Care/methods ; Young Adult ; Parathyroidectomy/methods
    Language English
    Publishing date 2023-11-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1415919-3
    ISSN 1460-6984 ; 1368-2822
    ISSN (online) 1460-6984
    ISSN 1368-2822
    DOI 10.1111/1460-6984.12976
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    Zs.A 587: Show issues Location:
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  3. Article ; Online: Value of thyroglobulin post hemithyroidectomy for cancer: a literature review.

    Tourani, Saam S / Fleming, Bill / Gundara, Justin

    ANZ journal of surgery

    2020  Volume 91, Issue 4, Page(s) 724–729

    Abstract: Background: An increasing number of patients with low and moderate risk differentiated thyroid cancer (DTC) are now managed with lobectomy alone. The value of serum thyroglobulin (Tg) in the follow up of these patients remains poorly defined.: Methods! ...

    Abstract Background: An increasing number of patients with low and moderate risk differentiated thyroid cancer (DTC) are now managed with lobectomy alone. The value of serum thyroglobulin (Tg) in the follow up of these patients remains poorly defined.
    Methods: A review of the MEDLINE and EMBASE databases was performed to assess the utility of Tg in the follow up of patients undergoing thyroid lobectomy for DTC.
    Results: A total of five retrospective reviews were identified including 1136 patients undergoing hemithyroidectomy with or without prophylactic central neck dissection. The overall locoregional recurrence rate was 3.7%. Changes in serum Tg following hemithyroidectomy for cancer were found to be clinically useful in one study only. The proposed cut-off value of 30 ng/mL following hemithyroidectomy as a predictor of recurrent disease was not validated by any study.
    Conclusion: Serum Tg values are not useful in the follow up of DTC patients managed with lobectomy alone. Good quality neck ultrasound appears to be an effective modality in the detection of locoregional recurrence in these patients while research efforts continue to identify and validate novel biomarkers.
    MeSH term(s) Humans ; Neoplasm Recurrence, Local/epidemiology ; Retrospective Studies ; Thyroglobulin ; Thyroid Neoplasms/surgery ; Thyroidectomy
    Chemical Substances Thyroglobulin (9010-34-8)
    Language English
    Publishing date 2020-11-26
    Publishing country Australia
    Document type Journal Article ; Review
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.16459
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  4. Book ; Online: The Case for Intercultural Education in a Multicultural World

    Gundara, Jagdish

    2014  

    Abstract: This volume brings together many of Professor Gundara's essays and contribution to the evolving international field of intercultural ... ...

    Abstract This volume brings together many of Professor Gundara's essays and contribution to the evolving international field of intercultural education
    Language English
    Size Online-Ressource (417 p)
    Publisher Mosaic Press
    Publishing place Ashland
    Document type Book ; Online
    Note Description based upon print version of record
    Database Library catalogue of the German National Library of Science and Technology (TIB), Hannover

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  5. Book ; Online: World Yearbook of Education 1997

    Gundara, Jagdish

    Intercultural Education

    (World Yearbook of Education)

    2012  

    Abstract: This volume in the yearbook series examines the variety of educational responses to differing forms of diversity within states. The growth of nationalism and regionalism in many parts of the world is considered alongside the emergence of such ... ...

    Series title World Yearbook of Education
    Abstract This volume in the yearbook series examines the variety of educational responses to differing forms of diversity within states. The growth of nationalism and regionalism in many parts of the world is considered alongside the emergence of such international structures as the European Community
    Language English
    Size Online-Ressource (225 p)
    Publisher Taylor and Francis
    Publishing place Hoboken
    Document type Book ; Online
    Note Description based upon print version of record
    ISBN 9780749421144 ; 0749421142
    Database Library catalogue of the German National Library of Science and Technology (TIB), Hannover

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  6. Article ; Online: Case report of hypereosinophilic syndrome presenting as severe ischaemic colitis.

    Eastment, Jacques / Burstow, Matthew / Bloomfield, Ian / Gundara, Justin

    ANZ journal of surgery

    2018  Volume 89, Issue 11, Page(s) E540–E541

    MeSH term(s) Abdominal Pain/diagnosis ; Abdominal Pain/etiology ; Biopsy, Needle ; Colectomy/methods ; Colitis, Ischemic/diagnosis ; Colitis, Ischemic/surgery ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Humans ; Hypereosinophilic Syndrome/diagnosis ; Hypereosinophilic Syndrome/therapy ; Immunohistochemistry ; Laparoscopy/methods ; Middle Aged ; Treatment Outcome
    Language English
    Publishing date 2018-10-02
    Publishing country Australia
    Document type Case Reports ; Journal Article
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.14894
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  7. Article ; Online: Operative Surgery Is Rarely Required in the Acute Management of Diverticulitis in the Modern Era.

    Dissanayake, Bhanuka / Burstow, Matthew J / Jeyakumar, Arunan / Yuide, Peter J / Gundara, Justin / Chua, Terence C

    The American surgeon

    2020  Volume 86, Issue 4, Page(s) 308–312

    Abstract: Acute diverticulitis is an emergency surgical condition that is commonly ... ...

    Abstract Acute diverticulitis is an emergency surgical condition that is commonly managed
    MeSH term(s) Abdominal Abscess/drug therapy ; Abdominal Abscess/etiology ; Abdominal Abscess/surgery ; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Australia ; Colostomy ; Diverticulitis, Colonic/complications ; Diverticulitis, Colonic/drug therapy ; Diverticulitis, Colonic/surgery ; Diverticulitis, Colonic/therapy ; Drainage ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Peritonitis/etiology ; Peritonitis/surgery ; Retrospective Studies
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2020-05-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
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  8. Article ; Online: Anti-lipid therapy and risk factor management for triglyceridaemia-induced acute pancreatitis.

    Tabone, Renee / Burstow, Matthew J / Vardesh, Deepak L / Yuide, Peter J / Gundara, Justin / Chua, Terence C

    ANZ journal of surgery

    2020  Volume 90, Issue 10, Page(s) 1997–2003

    Abstract: Background: Pancreatitis secondary to hypertriglyceridaemia is rare, accounting for less than 5% of pancreatitis presentations. We reviewed our institutional experience with triglyceridaemia induced acute pancreatitis to report the clinical presentation, ...

    Abstract Background: Pancreatitis secondary to hypertriglyceridaemia is rare, accounting for less than 5% of pancreatitis presentations. We reviewed our institutional experience with triglyceridaemia induced acute pancreatitis to report the clinical presentation, patient demographics and clinical management.
    Methods: The Acute Surgical Unit database at a high-volume general surgical referral centre was queried to identify cases of acute pancreatitis secondary to hypertriglyceridaemia between 2016 and 2019. Patient demographics, clinical manifestations, biochemical derangements and treatment regimens were analysed. Current related literature was reviewed.
    Results: There were 496 presentations for acute pancreatitis of which 14 presentations (2.8%), amongst 12 patients were due to hypertriglyceridaemia. The mean triglyceride level at presentation was 92.46 (standard deviation 46.9) mmol/L. Ten patients (83%) had poorly controlled type 2 diabetes. All patients were managed using conservative therapy combined with a restricted fat diet and commenced on long-term anti-lipid therapy to manage associated risk factors. In addition, 10 patients received an insulin infusion and one patient received insulin infusion, plasmapheresis and heparin infusion in combination. The median length of hospital stay was 5.5 (range 3-13) days. Two patients (16%) developed a recurrent episode related to non-compliance to medical therapy.
    Conclusion: Hypertriglyceridaemia is a rare cause of acute pancreatitis. Successful management involves the treatment of acute pancreatitis in conjunction with long-term anti-lipid therapy and optimisation of associated risk factors.
    MeSH term(s) Acute Disease ; Diabetes Mellitus, Type 2 ; Humans ; Hypertriglyceridemia/complications ; Hypertriglyceridemia/therapy ; Pancreatitis/chemically induced ; Pancreatitis/therapy ; Risk Factors
    Language English
    Publishing date 2020-03-19
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.15829
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  9. Article ; Online: Acute gastrointestinal manifestation of situs inversus abdominus.

    Brown, K M / Gundara, J S / Mittal, A

    Hernia : the journal of hernias and abdominal wall surgery

    2017  Volume 21, Issue 4, Page(s) 649–651

    Abstract: Purpose: Whilst situs inversus is associated with intestinal malrotation and volvulus particularly in infants, this is the first known report of acute intestinal obstruction in an adult patient with a situs anomaly specifically due to a congenital ... ...

    Abstract Purpose: Whilst situs inversus is associated with intestinal malrotation and volvulus particularly in infants, this is the first known report of acute intestinal obstruction in an adult patient with a situs anomaly specifically due to a congenital transmesenteric hernia.
    Case: A 54-year-old woman presented with a 12-h history of progressive abdominal pain. Contrast-enhanced computed tomography scan of the abdomen revealed an incidental finding of situs inversus abdominus, ischemic small bowel obstruction and a potential occlusive thrombus of the superior mesenteric artery. At operation, the cause of intestinal obstruction was found to be secondary to herniation of the intestine through a congenital mesenteric defect. The hernia was reduced and a strong pulse was subsequently felt in the distal superior mesenteric artery. The patient required resection of a segment of compromised small bowel, and was later anastomosed at a planned second laparotomy. Her laparostomy was closed using an absorbable BioA mesh.
    Conclusion: A high index of suspicion and low threshold for exploratory surgery should be maintained in patients with major congenital abdominal anomalies presenting with an acute abdomen.
    Language English
    Publishing date 2017-08
    Publishing country France
    Document type Journal Article
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-016-1519-1
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  10. Article ; Online: Unexpected deaths after endocrine surgery: learning from rare events using a national audit of surgical mortality.

    Chui, Juanita N / Papachristos, Alexander J / Mechera, Robert / Sidhu, Stan B / Sywak, Mark S / Lee, James C / Gundara, Justin / Lai, Christine / Glover, Anthony R

    The British journal of surgery

    2022  Volume 109, Issue 11, Page(s) 1164–1171

    Abstract: Background: The mortality rate is low in endocrine surgery, making it a difficult outcome to use for quality improvement in individual units. Lessons from population data sets are of value in improving outcomes. Data from the Australian and New Zealand ... ...

    Abstract Background: The mortality rate is low in endocrine surgery, making it a difficult outcome to use for quality improvement in individual units. Lessons from population data sets are of value in improving outcomes. Data from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) were used here to understand and elucidate potential systems issues that may contribute to preventable deaths.
    Methods: ANZASM data relating to 30-day mortality after thyroidectomy, parathyroidectomy, and adrenalectomy from 2009 to 2020 were reviewed. Mortality rates were calculated using billing data. Thematic analysis of independent assessor reports was conducted to produce a coding framework.
    Results: A total of 67 deaths were reported, with an estimated mortality rate of 0.03-0.07 per cent (38 for thyroidectomy (0.03-0.06 per cent), 16 for parathyroidectomy (0.03-0.06 per cent), 13 for adrenalectomy (0.15-0.33 per cent)). Twenty-seven deaths (40 per cent) were precipitated by clinically significant adverse events, and 18 (27 per cent) were judged to be preventable by independent ANZASM assessors. Recurrent themes included inadequate preoperative assessment, lack of anticipation of intraoperative pitfalls, and failure to recognize and effectively address postoperative complications. Several novel themes were reiterated, such as occult ischaemic heart disease associated with death after parathyroid surgery, unexpected intraoperative difficulties from adrenal metastasis, and complications due to anticoagulation therapy after thyroid surgery.
    Conclusion: This study represents a large-scale national report of deaths after endocrine surgery and provides insights into these rare events. Although the overall mortality rate is low, 27 per cent of deaths involved systems issues that were preventable following independent peer review.
    MeSH term(s) Adrenalectomy/adverse effects ; Anticoagulants ; Australia/epidemiology ; Humans ; New Zealand/epidemiology ; Postoperative Complications
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2022-08-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znac276
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