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Fulltext Post-Operative Outcome of Traumatic Extradural Haematoma in HOSHAS

Lim CY, Baharuddin OB, Xavier RG

IIUM Medical Journal Malaysia, 2019;18(101):26-27.
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Traumatic extradural haematoma (EDH) is a common surgical emergency with huge socio-economic impact. Prompt diagnosis and management are key for patient survival and good outcome. Considering that neurosurgical units are mostly only available in tertiary centres, it is a challenge for non-neurosurgical centres to transport patient to the nearest neurosurgical unit for emergency surgery, which may be of significant distance away, hence, a delay in surgery. General surgery units are more widely available and general surgeons are trained to competently manage patients with EDH. Referring to the nearest general surgery unit for emergency surgery for EDH can be life-saving and avoid delay in surgery. There is a lack of study regarding outcome of patients with EDHoperated by general surgeons, hence the aim of this study to investigate in this regard. To determine the post-operative functional outcome of patients with extradural haematoma in a non-neurosurgical centre, and compare the outcome with other centres. Materials andMethods: This study was a retrospective review of records of all post-operative patients operated in HOSHAS for traumatic EDH in year 2017. Sample were obtained from 2017 General Surgery Department operative census in HOSHAS. Data were obtained from patient admission records using a proforma. Documented patient post-operative functional status was classified as per Glasgow Outcome Scale (GOS). Data were analysed using SPSS version 22. Results: A total of 11 patient data were collected. Mean age of the study population is 27. All samples were male patients. Road traffic accident was the main mode of injury (82%). Seven patients had GCS on arrival of 9 to 12 (64%), while 4 patients had severe brain injury on arrival (36%). All except 1 patient with moderate brain injury (GCS on arrival 9-12) recovered well post-operatively. As for patients with severe brain injury on arrival (GCS 3-8), only half of the patients had complete recovery post operatively. Most of the patients (73%) had good post-operative recovery (GOS 4-5). One patient died (GOS 1) and another ended up in vegetative state (GOS 2). The post-operative outcome in this study is comparable to other studies done in neurosurgical unit. Conclusion: The functional outcomes of traumatic EDH patients operated by general surgeons in HOSHAS are similar to those in neurosurgical centre.
Fulltext Pathological Complete Response After Neoadjuvant Therapy in Rectal Adenocarcinoma: a 5-Year Follow-up

Leow YC, Roslani AC, Xavier RG, Lee FY

Indian J Surg, 2021 May 27.
PMID: 34075282 DOI: 10.1007/s12262-021-02945-5

Neoadjuvant therapy is the gold standard treatment of locally advanced rectal cancer. It may induce complete sterilization of tumor cell and decreases its local recurrence rate. While 15-20% of patients were found to have pathological complete response (pCR) with combined multimodal therapy, Asian data were generally scarce. pCR rate can indicate the suitability of applying the "watch-and-wait" strategy, which advocates deferment of surgery that can alleviate surgery-associated morbidity.To determine the percentage of pCR of rectal cancer after neoadjuvant therapy. Patients diagnosed with rectal cancer underwent treatment from 2013 to 2017 were retrieved retrospectively. Demographic data, tumor localization, pre- and post-operative pathological reports, neoadjuvant therapy, and pCR status were collected from patients' records. A total of 242 out of 259 patients were treated with definitive rectal surgery. Mean age was 67.1 years old. Chinese ethnicity and male gender were predominant (n = 131, 54.1% and n = 146, 64.3% respectively). More than half (n = 124, 51.2%) had tumor located at mid or low rectum. Histologically, moderate differentiated adenocarcinoma was predominant (n = 227, 93.8%). Merely half (n = 123, 50.8%) of the patients received neoadjuvant chemoradiation therapy, but only 12 (9.8%) had a pCR. From follow-up on these 12 pCR patients, most had 2-year disease-free survival but 1 (8.3%) of the pCR had distant metastasis within 1-year post-surgery. The pathological complete response rate in our center was lower than reported. Stringent patient selection with close follow-up for patients should be carried out if the "watch-and-wait" strategy is implemented in our population.
Fulltext Transvaginal natural orifice specimen extraction surgery for left-sided colorectal resection: A single-centre cohort study

Xavier RG, Ke TW, Chen WT

J Minim Access Surg, 2025 Jan 01;21(1):51-59.
PMID: 39718944 DOI: 10.4103/jmas.jmas_108_24

INTRODUCTION: Transvaginal natural orifice specimen extraction surgery (NOSES) is an innovative and feasible approach for left-sided colorectal resections in females. This study aimed to report our experience with transvaginal NOSES for left-sided laparoscopic colorectal resections.
PATIENTS AND METHODS: We analysed data for all patients with transvaginal extraction performed for left-sided laparoscopic colorectal resections between 2011 and 2021 at a tertiary teaching hospital in Taiwan.
RESULTS: The 18 post-menopausal patients were of a mean age of 69.2 ± 10.14 years. The lesions were located at the descending ( n = 5), sigmoid colon ( n = 12) and rectum ( n = 1). The operative time was 262.5 ± 83.91 min, and the blood loss was 34 ± 35.98 mL. All patients had an end-to-end anastomosis, and the anastomotic height was 15.06 ± 8.57 cm. Two patients received diversion stoma. The mean length of hospital stay was 5.1 days (standard deviation ± 2.42; range: 3-12 days). There were no cases of clinical infection. The pathology was malignancy ( n = 14, 77.8%), diverticulitis ( n = 2, 11.2%) and benign ( n = 2, 11.2%). In cancers, they were Stage I ( n = 1, 7.1%), IIa ( n = 1, 7.1%), IIIb ( n = 15, 78.7%) and IV ( n = 1, 7.1%). Malignant specimens ( n = 14) were mostly moderately differentiated ( n = 11, 78.6%), with two poorly differentiated (14.3%) and one well-differentiated (7.1%). The lymph nodes harvested were 16.1 ± 8.11. The widest dimension of the lesion was 3.43 cm ± 1.28 (range: 1.5-6) and the length of the specimen was 14.69 cm ± 5.01 (range: 8-27).
CONCLUSION: Transvaginal NOSES is safe and feasible for left-sided colorectal resection. Factors to consider are the characteristics of the specimen, anal canal and vagina.
Fulltext Pre-surgical COVID-19 swabs in surgical patients: An institutional experience in a middle income country

Xavier RG, Roslani AC, Draman Yusof MR, Ng DS, Govindaraju R, Singh S, et al.

Asian J Surg, 2021 03;44(3):560-561.
PMID: 33627224 DOI: 10.1016/j.asjsur.2020.11.028
Fulltext Focused surgical pandemic response in a Malaysian hybrid COVID-19 hospital

Roslani AC, Vythilingam G, Seevalingam KK, Xavier RG, Idris MS, Karuppiah R

Asian J Surg, 2021 Jan;44(1):404-406.
PMID: 33317901 DOI: 10.1016/j.asjsur.2020.10.012