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| 1 | Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand显示文摘BACKGROUND Hemorrhoidal disease is the most common anorectal disorder.Hemorrhoids can be classified as external or internal,according to their relation to the dentate line.External hemorrhoids originate below the dentate line and are managed conservatively unless the patient cannot keep the perianal region clean,or they cause significant discomfort.Internal hemorrhoids originate above the dentate line and can be managed according to the graded degree of prolapse,as described by Goligher.Generally,low-grade internal hemorrhoids are effectively treated conservatively,by non-operative measures,while high-grade internal hemorrhoids warrant procedural intervention.AIM To determine the application of clinical practice guidelines for the current management of hemorrhoids and colorectal surgeon consensus in Australia and New Zealand.METHODS An online survey was distributed to 206 colorectal surgeons in Australia and New Zealand using 17 guideline-based hypothetical clinical scenarios.RESULTS There were 82 respondents(40%)to 17 guideline-based scenarios.Nine(53%)reached consensus,of which only 1(6%)disagreed with the guidelines.This was based on low quality evidence for the management of acutely thrombosed external hemorrhoids.There were 8 scenarios which showed community equipoise(47%)and they were equally divided for agreeing or disagreeing with the guidelines.These topics were based on low and moderate levels of evidence.They included the initial management of grade I internal hemorrhoids,grade III internal hemorrhoids when initial management had failed and the patient had recognised risks factors for septic complications;and finally,the decision-making when considering patient preferences,including a prompt return to work,or minimal post-operative pain.CONCLUSION Although there are areas of consensus in the management of hemorrhoids,there are many areas of community equipoise which would benefit from further research. | George E Fowler Javariah Siddiqui Assad Zahid Christopher John Young | 2019 | World Journal of Clinical Cases2019，7，22： | 8 |
| 2 | Necrotizing fasciitis after placement of intraperitoneal catheter显示文摘 | Jori S. Carter Sarah L. Hutto Javariah I. Asghar Deanna G.K. Teoh | 2013 | Gynecologic Oncology Case Reports2013，，： | 1 |
| 3 | Colorectal surgeon consensus with diverticulitis clinical practice guidelines显示文摘AIM To determine the application of clinical practice guidelines for the current management of diverticulitis and colorectal surgeon specialist consensus in Australia and New Zealand.METHODS A survey was distributed to 205 colorectal surgeons in Australia and New Zealand, using 22 hypothetical clinical scenarios.RESULTS The response rate was 102(50%). For 19 guidelinebased scenarios, only 11(58%) reached consensus(defined as > 70% majority opinion) and agreed with guidelines; while 3(16%) reached consensus and did not agree with guidelines. The remaining 5(26%) scenarios showed community equipoise(defined as less than/equal to 70% majority opinion). These included diagnostic imaging where CT scan was contraindicated, management options in the failureof conservative therapy for complicated diverticulitis, surgical management of Hinchey grade 3, proximal extent of resection in sigmoid diverticulitis and use of oral mechanical bowel preparation and antibiotics for an elective colectomy. The consensus areas not agreeing with guidelines were management of simple diverticulitis, management following the failure of conservative therapy in uncomplicated diverticulitis and follow-up after an episode of complicated diverticulitis. Fifty-percent of rural/regional based surgeons would perform an urgent sigmoid colectomy in failed conservative therapy of diverticulitis compared to only 8% of surgeons city-based(Fisher's exact test P = 0.016). In right-sided complicated diverticulitis, a greater number of those in practice for more than ten years would perform an ileocecal resection and ileocolic anastomosis(79% vs 41%, P < 0.0001).CONCLUSION While there are areas of consensus in diverticulitis management, there are areas of community equipoise for future research, potentially in the form of RCTs. | Javariah Siddiqui Assad Zahid Jonathan Hong Christopher John Young | 2017 | World Journal of Gastrointestinal Surgery2017，9，11： | 0 |
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