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Introduction
Peter Wysocki is a general surgeon with an interest in benign pancreatobiliary disease, hernia surgery and pilonidal sinus disease.
He is a Visiting Surgeon at Sunnybank Private Hospital. He is also the Deputy Director of Surgery at Logan Hospital on Brisbane's south side and a senior lecturer at the Griffith University Medical School. He provides an outreach service (clinic and surgery) at Beaudesert Hospital.
Publications
Publications (67)
Aim
Pilonidal sinus disease is a common condition treated by colorectal surgeons. There is a lack of literature in the field to guide optimal management of this condition. As part of the PITSTOP study, we aimed to identify policy and research priorities to provide direction to the field.
Method
Patients and surgeons were invited to participate. A...
Aim
Research in pilonidal disease faces several challenges, one of which is consistent and useful disease classification. The International Pilonidal Society (IPS) proposed a four‐part classification in 2017. The aim of this work was to assess the validity and reliability of this tool using data from the PITSTOP cohort study.
Method
Face validity...
Objective:
Pilonidal sinus disease (PSD) is a chronic inflammatory condition of skin that is thought to be related to implanted loose hair. Although PSD is most frequently seen in the sacrococcygeal region, it can also occur at the axilla, perineum, suprapubic regions, hands, and umbilicus. The aim of this project was to find factors influencing t...
Introduction
Pilonidal sinus disease is a chronic inflammatory condition typically found in the sacrococcygeal region. It is caused by loose hair penetrating natal cleft skin. Treatment of symptomatic disease is surgical. There is a lack of consensus on the ideal surgical technique.
Methods
The Karydakis flap involves asymmetric excision of the di...
Background: Bile duct injury rates for laparoscopic cholecystectomy (LC) remain higher than during open cholecystectomy. The “culture of safety” concept is based on demonstrating the critical view of safety (CVS) and/or correctly interpreting
intraoperative cholangiography (IOC). However, the CVS may not always be achievable due to difficult anatom...
AimsThe rate of acute laparoscopic cholecystectomy remains low due to operational constraints. The purpose of this study is to evaluate a service model of index admission cholecystectomy with referral protocols, refined logistics and targeted job planning.MethodsA prospectively maintained dataset was evaluated to determine the processes of care and...
Background:
The cystic lymph node (CLN) represents an anatomic safety marker and a surrogate marker of technique during laparoscopic cholecystectomy (LC). We aim to demonstrate the value of CLN in comparison to the critical view of safety (CVS) and study the effects of increasing difficulty on the 2 approaches.
Methods:
A prospective study of co...
Background
General surgeons frequently see patients with groin lumps and pain. However, in the absence of a lump, an ultrasound scan identified groin hernia is a diagnostic and management challenge. Some surgeons recommend inguinal hernia surgery while others do not. The outcome of non-operative management is uncertain.
Methods
This study represen...
Inguinal hernia repair with mesh is one of the most common operations performed by general surgeons. Mesh infection is a rare complication that has detrimental effects on the patient and the healthcare system. The purpose of this systematic review was to determine an evidence-based management approach for patients with infected mesh following an op...
Background
Pilonidal sinus disease (PSD) is a simple chronic inflammatory condition resulting from loose hairs forcibly inserted into vulnerable tissue in the natal cleft. It is an acquired disease with a slight familial tendency. There is no agreement on optimum treatment and the multitude of therapeutic options cannot be compared due to the lack...
Erratum to: coloproctology 2019 10.1007/s00053-019-0346-0 In Fig. 2 the color correlation was not clearly given. You can see the corrected figure …
This review article summarizes the approach to patients with pilonidal sinus disease based on morphologically different stages. Pilonidal sinus disease is a very common condition especially among young people. The proposed classifications for pilonidal disease and commonly used procedures are summarized here. There is currently limited literature t...
Background
Surgical management of sacrococcygeal pilonidal disease ranges from pit/sinus procedures through excision with healing by secondary intent to various flap techniques. Short- and long-term outcomes differ between surgeons and techniques.
Objective
An overview of primary open treatment of sacrococcygeal pilonidal disease, including techni...
Introduction: Sacrococcygeal Pilonidal Disease (SPD) presents in a variety of patterns. Multiple classifications have been proposed but none are in everyday use. In order to compare treatment outcomes, a method of categorizing is required.
Methods: Discussion over e-mail between several surgeons was performed over a period of 10 months.
Results: Su...
Background
Surgical deaths in Australia require the treating surgeon to document the event via a standard report. A section of this report invites surgeons to reflect on changes to management they would initiate in retrospect. This study analyses these reflective statements and categorizes them in an effort to gain insight into reflective learning....
PLEASE NOTE THE JOURNAL EDITOR REVISED THE ABSTRACT. THE STATEMENT ABOUT THE PATHOLOGISTS IS NOT ENTIRELY ACCURATE.
THE ARTICLE ITSELF IS ACCURATE.
Introduction: Expert opinion recommends that surgeons perform a laparoscopic cholecystectomy (LC) in a standardized manner by dissecting the hepatobiliary triangle lateral to the cystic artery lymph...
Background:
Trauma remains the most frequent cause of death for patients under 35 years of age. Head injury and catastrophic haemorrhage account for the majority of early deaths. A trauma laparotomy is often necessary to arrest haemorrhage.
Methods:
All patients who died in Queensland hospitals between 2011 and 2016 having had a trauma laparotom...
Introduction
Acute appendicitis is one of the most common causes of abdominal pain. Post-operative Intra-abdominal Abscess (PIA) frequently complicates appendicectomy and increases morbidity and cost (1). Its incidence is increased in perforated or gangrenous appendicitis (2). Risk factors for the development of PIA within this high-risk group have...
Introduction: Hartmann’s procedure is typically performed for sigmoid colon obstruction or perforation. The primary aim of this study was to compare patients who died after a Hartmann’s procedure for obstruction and perforation. The secondary aim was to collate opinions of surgeon reviewers of any clinical events.
Methods: Patients who died in Qu...
Background:
Infection may complicate surgical patients' hospital admission. The effect of hospital-acquired infections (HAIs) on processes of care among surgical patients who died is unknown.
Aim:
We investigated the effect of HAIs on processes of care in surgical patients who died in-hospital.
Methods:
Surgeon-recorded infection data extracte...
Background:
The Royal College of Anaesthetists published the National Emergency Laparotomy Audit (NELA) to describe and compare inpatient care and outcomes of major emergency abdominal surgery in England and Wales in 2015 and 2016. The purpose of this article is to compare emergency abdominal surgical care and mortality in a regional hospital (Log...
Background:
In order to minimize bile duct injury, experts suggest that dissection during laparoscopic cholecystectomy (LC) should be performed lateral to the lymph node (LN). This study aims to determine whether the frequency of excision of the LN is related to patient factors, disease severity or surgical difficulty.
Methods:
All LCs performed...
Background
Surgical mortality audit is an important tool for quality assurance and professional development but little is known about the impact of such activity on professional practice at the individual surgeon level. This paper reports the findings of a survey conducted with a self-selected cohort of surgeons in Queensland, Australia, on their e...
Introduction: A number of international guidelines have recently been developed to minimize variability in the treatment of pilonidal sinus disease (PSD). The aim of this study was to identify surgeon opinions and current practice in relation to technical aspects of elective surgery for PSD.
Methods: A nine-question survey, focusing on clinical dec...
Aim: Day case laparoscopic cholecystectomy is achievable but in most hospitals it is not routine. We describe our experience with day case laparoscopic cholecystectomy in a rural Queensland hospital. Methods: Retrospective analysis of consecutive adult patients with uncomplicated cholelithiasis who underwent day case laparoscopic cholecystectomy by...
Iatrogenic bile duct injury at time of cholecystectomy is a rare but devastating event. A twofold higher frequency of bile duct injury during cholecystectomy without cholangiography is reported in population-based studies. Some interpret this as a cause-and-effect relationship and thus mandate routine cholangiography. A critical appraisal of popula...
Background:
All surgical deaths in Queensland, Australia are reviewed by external surgeon peers, and clinical events are recorded. The study objective was to classify clinical events in surgical patients who died.
Methods:
Deaths notified to the Queensland Audit of Surgical Mortality between 2007 and 2013 were assessed by surgeons' peers who dec...
Basal Cell Carcinoma typically occurs on the head and neck. Excision with clear margins is the primary goal of treatment. Involved surgical margins occur more frequently on the head and neck and may be related to surgical volume. All histology reports generated by the Toowoomba Base Hospital Department of Pathology in Queensland, Australia over an...
Mesh repair is indicated for medium sized umbilical hernias (larger than 2 – 4 cm). Preperitoneal placement of self gripping mesh would be expected to be difficult due to its self gripping property and the small working space. The author evaluated the time taken to place Covidien Parietex Pro Grip mesh in the preperitoneal plane during adult medium...
Background:
Surgical audits provide constructive feedback to individual surgeons, hospitals and other healthcare sector professionals. Audits identify deficiencies in treatment processes, evaluate practice trends and detect practice gaps. The credibility and validity of the Queensland Audit of Surgical Mortality (QASM) relies on the accuracy of it...
Historical journey through pilonidal sinus treatment.
Introduction: Right hemicolectomy is frequently performed for malignancy but emergency surgery is associated with double the mortality rate of elective colonic resection. The study was designed to compare perioperative clinical incidents patients who died following elective and emergency right hemicolectomy. Methods: Adult patients who died under t...
Failure To Rescue was first defined in patients who died due to a complication following (open) cholecystectomy but research into the relevant factors has been scarce. This study was designed to determine a chronological sequence of deficiencies in care.
Adult patients who died under the care of a surgeon following cholecystectomy in Queensland wer...
L’échec de secours ou de prise en charge a été initialement décrit chez les patients décédés des suites d’une complication après cholécystectomie (par laparotomie), mais les recherches dans ce domaine sont relativement rares. Cette étude a été conçue pour analyser la séquence chronologique des carences de soins dans ce cadre.
It is assumed that increased age signifies increased surgical care. Few surgical studies describe the differences in care provided to older patients compared with younger patients. We aimed to examine the relationships between increasing age, preoperative factors and markers of postoperative care in adults who died in-hospital after surgery in Aust...
Background:
Studies evaluating mortality in patients with acute appendicitis focus on the outcomes of appendicectomy alone. We hypothesize this may not be representative of what happens in clinical practice as a small proportion of patients with acute appendicitis undergo procedures other than appendicectomy, for example, caecectomy or right hemic...
Introduction: Acute Pancreatitis has been referred to as the most terrible of abdominal
conditions, yet guidelines on the provision of analgesia are limited. We hypothesized this
lack of clear guidelines results in a clinician specific approach to the administration of
analgesia. This study was carried out to test this hypothesis, document the anal...
Objective:
To develop a new classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of the published evidence, and worldwide consultation.
Backgrounds:
The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of specialist in pancreatic diseases, but are suboptim...
Background and Objectives: The mortality rate of patients with acute cholecystitis is low with either medical or surgical management. It is unclear how surgeons decide which patients will not undergo cholecystectomy. We postulated those who died following medical management would have a greater burden of comorbidities than those who died following...
Deficiencies in daily ward rounds are increasingly identified. A ward safety checklist has recently been devised to improve the fast-paced surgical ward round.
Over 2 weeks the morning post-take surgical ward round was evaluated using the ward safety checklist. In order to avoid the Hawthorne effect, doctors involved were not aware their performanc...
Tracheostomies are commonly performed on critically ill patients requiring prolonged mechanical ventilation. The purpose of this study was to review our experience with surgical and percutaneous tracheostomies and identify factors affecting outcome.
Patients who underwent tracheostomy between January 1999 and June 2008 were identified on the basis...
No clinical trials have been done to guide the surgeon in the optimal technique of draining a pilonidal abscess. The aim of our study was to investigate whether the location of the incision influences wound healing.
Electronic records from the surgical database at our 200-bed district general hospital were reviewed for operative technique (midline...
The ultimate reason why pancreatologists have strived to establish definitions for inflammatory pathologies of the pancreas is to improve patient care. Although the Atlanta Classification has been used for around for 17 years, considerable misunderstanding of the key elements of the nomenclature still persists. While a recent article by Stamatakos...
The work hours of junior doctors have been in the spotlight since the mid-1980s. Rostering and the structure of surgical units aim to balance quality and continuity of patient care with reasonable working hours.
Actual hours worked during two 12-week surgical registrar rosters were compared. Compliance of each roster with fatigue recommendations wa...
The challenge for the pancreatologist managing patients with infected pancreatic necrosis is to devise a treatment algorithm that enables recovery but at the same time limits the morbidity and mortality. The current gold standard remains open necrosectomy. Recent literature contains scattered reports of endoscopic, radiologic, laparoscopic, percuta...
Purpose:
Sliding inguinal hernias represent a small proportion of inguinal hernias but become more common with advancing age. The most recent review is based on a series published over 50 years ago. There are, however, many case reports of unusual presentations in girls.
Methods:
We performed a review of a prospectively kept electronic record of...
Indications for and goals of surgical treatmentSurgical proceduresReferencesPancreatic duct drainage proceduresConclusions
ReferencesDuodenum-preserving pancreatic head resection in inflammatory and cystic neoplastic lesions of the pancreasDiagnostic work-upReferencesMajor pancreatic resectionsReferencesNerve ablation techniques in chronic pancreat...
The evolution of the local manifestations of severe acute pancreatitis has been described previously, whereby extension of pancreatic and peripancreatic necrosis occurs within the first 4-5 days in association with peripancreatic edema [1, 2]. The edema within this initially essentially solid inflammatory mass subsequently coalesces into acute flui...
Acute pancreatitis is one of the more common reasons for surgical admission. Most patients have mild disease and settle quickly with intravenous fluids and analgesia; the major consideration is prevention of further attacks. In 20% of patients, local inflammation initiates a systemic inflammatory response that results in a variable degree of respir...
An inflammatory fibroid polyp (IFP) is a rare benign submucosal gastro-intestinal lesion with an uncertain origin and natural history. An IFP was first described in the stomach and is rare in the duodenum. Presenting signs and symptoms vary according to anatomical site. This systematic literature review was prompted by the recent presentation of a...
Treatment of bulky retroperitoneal malignancy may require en bloc resection of the infrarenal inferior vena cava. A number of reconstructive options are available to the surgeon but objective haemodynamic assessment of the peripheral venous system following resection without replacement is lacking. The aim of the present paper was thus to determine...