ORCID Profile
0000-0001-9405-877X
Current Organisation
Sydney Adventist Hospital
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Publisher: Elsevier BV
Date: 2017
Publisher: Wiley
Date: 04-08-2020
DOI: 10.1111/ANS.16176
Publisher: Wiley
Date: 12-02-2014
DOI: 10.1111/CODI.12473
Abstract: Enterocutaneous fistula (ECF) presents a complex management problem with significant mortality and morbidity. The aim of this study was to assess the outcome of patients undergoing surgical cure for ECF and to predict factors that might relate to increased postoperative morbidity. Medical records of all patients who underwent definitive surgery for cure of an ECF within our colorectal surgery unit between 2000 and 2010 were reviewed. Forty-one patients (18 male) were identified, in whom 44 definitive procedures were performed. The median age was 54 (17-81) years. The median postoperative length of stay in hospital was 14 (2-213) days. Half (50%) of the ECFs occurred as a postoperative complication followed by spontaneous fistulation in Crohn's disease (36%). The interval to definitive surgery was influenced by the aetiology of the fistula. The median time to surgery after formation of postoperative fistula was 240 days (7.9 months). There was no 30-day postoperative mortality. There were two (4.5%) recurrences at 3 months. Thirty-eight (86%) patients suffered postoperative morbidity as defined by the Clavien-Dindo classification. High-grade morbidity occurred in 32% of patients. On univariate analysis, factors identified as being significantly associated with high-grade morbidity included a fistula output of > 500 ml/day (P = 0.004) in patients with postoperative ECF, malnutrition at presentation (P = 0.04) and a serum albumin value of < 30 g/l (P = 0.02) in patients with spontaneous ECF due to Crohn's disease. The majority of persistent complex ECFs can be cured surgically with low mortality and recurrence in a multidisciplinary setting. Postoperative morbidity, however, remains a significant burden.
Publisher: Elsevier BV
Date: 2017
Publisher: Wiley
Date: 24-06-2022
DOI: 10.1111/ANS.17862
Abstract: To achieve a competency‐based training paradigm, the ability to obtain reliable and valid quantitative assessments of intraoperative performance is required. Through this, weaknesses can be identified and practiced, and competency assessed. This study aimed to determine the validity and reliability an objective evaluation tool for assessment of performance in laparoscopic appendicectomy (LA). A prospective single‐blinded observational study design was used. Videos of inexperienced (performed LAs) and experienced (performed LAs) surgeons performing LA surgery were collected. Surgical performance during each recording was rated by two independent, blinded expert surgeons using the LA Rating Scale (LARS) and the modified Objective Structured Assessment of Technical Skill (OSATS) scale. The intraclass correlation coefficient (ICC) for LARS was 0.95 (95%CI 0.83–0.98). The ICC for each step ranged from 0.48 to 0.90, and the test–retest ICC for LARS was 0.91 (95%CI 0.69–0.98). S ignificant differences ( P 0.001) between median performance scores as rated by LARS were observed between the inexperienced and experienced surgeons. A Spearman's correlation coefficient of 0.87 ( P 0.001) was observed between LARS performance scores and modified OSATS scores. LARS demonstrated excellent inter‐rater and test–retest reliability, and construct and concurrent validity and can be used to quantitatively evaluate performance during LA. This can potentially allow specific weaknesses to be identified and improved upon through deliberate practice. Progress can be tracked through re‐evaluation and scores of expert surgeons can be used as performance goals for credentialing in LA.
Publisher: Wiley
Date: 09-2019
DOI: 10.1111/ANS.15365
Publisher: Springer Science and Business Media LLC
Date: 10-2017
DOI: 10.1007/S10151-017-1700-2
Abstract: There is no consensus on the optimal dosage of botulinum toxin (BT) as a sphincter sparing alternative to lateral internal sphincterotomy for chronic anal fissure. The aim of this study was to assess the long-term efficacy of high-dose BT as well as the presence of incontinence following the treatment of chronic anal fissure at a single institution. A retrospective case-control study was performed at a single institution over a 6-year period (2009-2014). Patients given high-dose (80-100 IU) BT were compared to low-dose (20-40 IU) case controls. Clinical notes were reviewed, and follow-up was carried out via a telephone questionnaire. One hundred and fifty-eight patients were treated with BT injections within the study period (103 high dose 55 low dose). The mean length of follow-up was 25 months (range 4-52 months). Classic posterior fissures with high anal tone were more prevalent in the low-dose group (40 vs 47%, p = 0.3). Patient satisfaction was higher in the high-dose group (90 vs 78%, p = 0.05). Long-term recurrence (6 months after the last treatment) was also lower (23 vs 53%, p = 0.0001) on multivariate analysis. No long-term incontinence was observed. In this series, the recurrence rate post-BT injection was significantly lower in the high-dose group. There was no long-term incontinence. Further studies are needed to confirm our results.
Publisher: Bond University
Date: 11-02-2021
DOI: 10.53300/001C.19465
Abstract: Background: Australasian vocational training traditionally occurs within the public hospital domain. Early studies and a Commonwealth funded program, suggested private sector training as a feasible option with implementation across multiple specialties. This is the first Australian study that examines the vocational trainees’ experience in private hospital rotations, focusing on procedural exposure and predictors of an effective learning experience. Methods: General surgical trainees were surveyed. Trainees that had completed at least six months were eligible. A 15 item questionnaire was used to assess five domains: operative, clinical teaching, trainees’ recommendations: clinic and on-call exposure. Results: Nine private hospitals with accredited rotations provided 95 eligible trainees, with 45 respondents (response rate 47%). 22% performed major procedures as the primary proceduralist and 13% performed any endoscopy. Over half of respondents rated the teaching in private hospitals as ‘average’ or below, whilst the majority (58%) were not satisfied with the overall training experience and would not recommend it to their peers. Conclusion: Whilst private sector training has been implemented by 13 specialist colleges, our survey suggests a gap remains between private and public vocational training. Limited trainee primary procedure exposure and difficulties with access to private outpatient clinics are major criteria that require review.
Publisher: Wiley
Date: 17-07-2014
DOI: 10.1111/CODI.12614
Abstract: Limited data are available on the relationship between the histological features of the resected specimens in patients with ulcerative colitis (UC) or indeterminate colitis (IC) and the outcome of restorative proctocolectomy. The aim of our study was to determine if the histological features of the resected specimen in patients with UC and IC can predict ileal-pouch-related outcome. A review of all patients who had a restorative proctocolectomy created following completion proctectomy or proctocolectomy for UC and IC was performed. Between 1992 and 2011, 142 patients (132 with UC and 10 with IC) were reviewed. After a median follow-up of 36 (3-149) months, 51 (35.9%) developed a pouch-related complication. Forty-two (29.7%) developed pouchitis while three (2.1%) developed a pouch-cutaneous fistula. Four (2.8%) had pouch failure, while stricture of the anastomosis was seen in three (2.1%) patients. The presence of extension of the inflammation into the muscularis propria of the resected specimen was associated with an increased risk of pouch-related complications (P = 0.01). The presence of submucosal oedema was also a significant risk factor (P = 0.03). The extension of inflammation into the muscularis propria appears to predict pouch-related complications following restorative proctocolectomy for UC or IC.
Publisher: Wiley
Date: 24-03-2020
DOI: 10.1111/ANS.15811
Publisher: Wiley
Date: 30-09-2020
DOI: 10.1111/ANS.15438
Abstract: Laparoscopic ventral repair is safe, with lower wound infection rates compared with open repair. 'Venetian blinds' technique of plication in combination with mesh reinforcement, is totally intra-corporeal, with hernia defect and sac plication to reduce seroma formation. While laparoscopic suturing of the abdominal wall can represent a technical challenge, pre-operative botulinum toxin A (BTA) injections as an adjunct can assist. This study aims to demonstrate feasibility and efficacy of this technique in abdominal wall hernia repair, with BTA adjunct in midline hernias. A single-centre case series was conducted using minimally invasive 'Venetian blinds' technique for repair of complex ventral abdominal hernias. Twelve patients (seven midline, five non-midline) underwent repair (11 laparoscopic one robotic). Midline hernias received BTA (200-300 units Botox) 4-6 weeks prior to surgery. Repairs were mesh-reinforced following fascial closure. Twelve (10 female, two male) patients, with a median age 72 years (range 31-83) and body mass index of 27.3 kg/m Minimally invasive 'Venetian blinds' technique has promising early results with both midline and non-midline ventral hernias. The addition of BTA is a novel and feasible combination for repair of midline ventral hernias.
Publisher: Wiley
Date: 04-2018
DOI: 10.1111/ANS.14409
Publisher: Springer Science and Business Media LLC
Date: 21-05-2018
DOI: 10.1007/S00384-018-3086-7
Abstract: Diverticula of the appendix (DA) have a reported incidence of up to 2.1%. They are primarily detected incidentally, through imaging and intraoperative or histologic diagnosis. This study's objective was to examine the prevalence of DA, and its relationship with inflammation and neoplasia, as well as review the literature with respect to clinical outcomes and ability to identify DA preoperatively. A retrospective search of all patients undergoing an appendicectomy for right lower quadrant pain at a single institution between 2004 and 2017 was conducted. Histopathology reports for evidence of DA, location of the DA, presence of inflammation, and any relationship between DA and neoplasms (adenoma, carcinoma, carcinoid, lymphoma, and mucinous neoplasm) within the appendix were reviewed. Clinical notes, operative records, and preoperative imaging were also reviewed. Two thousand seven hundred eleven patient were included in the study, with a mean age of 34 years, with acute appendicitis found in 82.5%. 31.6% of patients with DA had associated inflammation of the DA. DA was present in 57 patients (2.1%), with 55 patients in the total cohort having neoplasia (2.0%). Patients with DAs were ten times more likely to have appendicular neoplasm than patients without a DA (17.5 vs 1.8% p < 0.0001, OR 11.8 95%, CI 5.6-24.8). This is the first Australian study demonstrating DAs are a significant marker of appendiceal neoplasm. Appendicectomy in all incidentally discovered erticulum should be considered. Due to a paucity of data, research is required into this area to assess for the need for endoscopy following diagnosis.
Publisher: Wiley
Date: 13-06-2017
DOI: 10.1111/ANS.14066
Publisher: Wiley
Date: 20-04-2023
DOI: 10.1111/ANS.18370
Abstract: Diverticular disease of the colon occurs commonly in developed countries. Immunosuppressed patients are thought to be more at risk of developing acute erticulitis, worse disease, and higher complications secondary to therapy. This study aimed to assess outcomes for immunosuppressed patients with acute erticulitis. A retrospective single‐centre review was conducted of all patients presenting with acute erticulitis at a major tertiary Australian hospital from 2006 to 2018. A total of 751 patients, comprising of 46 immunosuppressed patients, were included. Immunosuppressed patients were found to be older (62.25 versus 55.96, p = 0.016), have more comorbidities (median Charlson Index 3 versus 1, P 0.001), and undergo more operative management (13.3% versus 5.1%, P = 0.020). Immunosuppressed patients with paracolic elvic abscesses (Modified Hinchey 1b/2) were more likely to undergo surgery (56% versus 24%, P = 0.046), while in patients with uncomplicated erticulitis, there was no difference in immunosuppressed patients undergoing surgery (6.1% versus 5.1% P = 0.815). Immunosuppressed patients were more likely to have Grade III‐IV Clavien‐Dindo complication ( P 0.001). Immunosuppressed patients with uncomplicated erticulitis can be treated safely with non‐operative management. Immunosuppressed patients were more likely to have operative management for Hinchey 1b/II and more likely to have grade III/IV complications.
Publisher: Wiley
Date: 21-02-2019
DOI: 10.1111/ANS.15042
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.PATHOL.2018.07.004
Abstract: Vitamin C is an essential micronutrient in the human diet. While large population studies measuring vitamin C have been performed in other countries, there are few studies of deficiency in the Australian population. This study aimed to quantify vitamin C deficiency, identify scorbutic symptoms and examine dietary associations in a cohort of preoperative general surgical patients. Vitamin C levels were determined in a cohort of patients referred to a single surgeon between January 2011 and December 2013. Baseline data were collected along with data on fruit consumption, weekly citrus fruit intake and presence of scorbutic symptoms. A total of 309 patients were included in the study and 21.4% of our cohort showed a vitamin C level ≤11.4 μmol/L (deficient). Mean citrus fruit intake was significantly higher in the normal vitamin C groups (>28.4 μmol/L) and patients with vitamin C levels ≤28.4 were more likely to consume no fruit (p=0.0004) which was also significant on multivariate analysis. Neither age nor gender appeared predictive of suboptimal vitamin C levels. No symptoms were significantly related to vitamin C levels on multivariate analysis. Vitamin C deficiency was common in Australian adults attending a surgical practice within south western Sydney. Review of the Australian recommended daily allowance for vitamin C is suggested, not only in clinically well patients but particularly in ICU and hospital inpatients. Larger studies examining the prevalence and impact of vitamin C deficiency in the Australian population are required to further investigate these findings.
Publisher: Elsevier BV
Date: 2018
No related grants have been discovered for Praveen Ravindran.