Rafael Gaszynski

Sydney Adventist Hospital, Hornsby Ku-ring-gai Hospital

We present the case of a 66-year-old male with spontaneous oesophageal perforation treated with oesophageal stenting. This patient reports sudden onset severe anterior chest pain after coughing and haematemesis with a background medical history of Type II DM, ESRF on Haemodialysis, Hypertension, OSA and takes prophylactic Aspirin. Endoscopy reveals...

Background: Laparoscopic fundoplication (LF) is well-established as the surgical intervention of choice for management of refactory gastro-esophageal reflux disease. Much of its success lies in the reported benefits in symptom control outlined by the postoperative patient. It is unclear whether patient-reported outcomes differ according to the ins...

Background: Optimal management of patients with gallstones and concomitant choledocholithiasis has been a longstanding dilemma. Advancements in laparoscopic and endoscopic techniques have enabled multiple options for management. This study aims to compare the effectiveness of different procedures for choledocholithiasis in patients requiring laparo...

Renal Cell Carcinoma (RCC) accounts for approximately 90% of primary renal malignancies, of which the clear cell subtype is most common. While metastatic disease is common at the time of diagnosis and generally confers a poor prognosis, metastatic RCC may demonstrate relatively indolent behaviour and present many years after resection of the primar...

Introduction: Hepatobiliary and pancreatic surgery is frequently complicated by surgical site infections (SSI) with significant postoperative morbidity and mortality rates contributing to the economic burden on healthcare. Advancements in operative techniques to prevent SSI are gaining traction in clinical practice. This study compares the effecti...

Introduction: Surgical site infections (SSI) are associated with significant morbidity and mortality rates and are a substantial economic burden on the healthcare system. This study compares the effectiveness of the ‘loop and drain technique (LDT)’, a novel method utilising a vesiloop and subcuticular suture for surgical wound closure in patients u...

Resection of pancreatic tumours involving proper, left or right hepatic arteries (PHA, LHA or RHA) may require vascular reconstruction to achieve R0 margins. Previously described reconstructions include anastomoses of combinations of (aberrant) LHA, RHA, PHA, common hepatic artery (CHA), gastroduodenal artery (GDA) and superior mesenteric artery, w...

Vessel loops have been commonly used for management of cutaneous abscesses by incision and loop drainage, primarily in children and in the emergency department.1,2 We describe the use of a vessel loop as a drain during repair of a large cutaneous flank laceration. An 82 year man presented to the emergency department following a fall off a 2 m ladd...

https://csurgeries.com/video/a-novel-technique-for-reconstruction-of-right-and-left-hepatic-arteries-in-pancreaticoduodenectomy/ Open pancreaticoduodenectomy was performed. During the procedure gross tumour involvement of the proper hepatic artery and its bifurcation was seen. Vascular surgery was involved and resection and reconstruction performe...

Hydatid disease (HD) remains endemic in Australia, with estimated incidence highest in rural and indigenous populations. Its recurrence is defined by new active cysts arising after appropriate therapy, and affects anywhere between 2-25% of total cases. Available treatment options include surgical resection, percutaneous drainage, and chemotherapy....

Management of a giant Oesophageal lipoma

Acute liver failure (ALF) is characterised by severe liver injury with the onset of coagulopathy (INR ≥1.5) and encephalopathy in the absence of pre-existing liver disease. It is associated with a high mortality rate of 10-57%, which is largely driven by multi-organ failure, sepsis and cardiac arrhythmia. Current management focuses on identifying a...

Management options for common bile duct stones found at laparoscopic cholecystectomy (LC) includes concurrent transcystic biliary stenting, effectively providing a conduit for common bile duct drainage and improving the success of subsequent endoscopic retrograde cholangiopancreatography. In the unprecedented COVID‐19 pandemic however, potential di...

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...

surgeon led management of choledocholithiasis

Candida peritonitis is associated with high mortality and multiple organ failure. With an evolving epidemiology of candidaemia indicating an increasing prevalence of rare Candida species worldwide, consideration of multidrug-resistant fungal pathogens as a cause of abdominal sepsis is paramount. We report three cases of Candida krusei as a cause of...

Background: Superficial skin abscesses account for a significant burden of emergency surgical admissions. The aim of this study was to evaluate the effectiveness of an ambulatory care pathway for emergently treating abscesses of the body requiring operative drainage. Method: A retrospective study of a prospective patient database was performed,...

Background: Australasian surgical training has traditionally occurredwithin the public hospital domain. Early studies suggest private sector train-ing appeared a feasible option. This study aims to examine the general sur-gical trainees’ experience in private hospital rotations, focusing on operativeexposure and predictors of an effective learning...

Background Symptomatic cholelithiasis accounts for a significant burden of emergency general surgical presentations in Australia and the Western population. Access to hepatobiliary ultrasonography to facilitate diagnosis can lead to delays in timely treatment. Surgical ultrasonography at the bedside (SUB) can mitigate this barrier to patient care....

Case report of a patient with diffuse aortic atherosclerosis who presented with multiple cholesterol emboli

Background: This study evaluated the safety, efficacy and compliance of an emerging technique for managing complex subcutaneous abscesses in an adult population (≥16 years). Methods: A retrospective review of prospectively collected data between April and October 2015 at a rural hospital comparing conventional incision drainage (CID) and repetit...

We describe the case of a 15 year old boy who presented with generalised abdominal pain following a seemingly minor collision at weekend soccer. Investigation revealed a grade IV pancreatic injury that was subsequently managed with pancreatic stent insertion by endoscopic retrograde cholangiopancreatography (ERCP) and total parenteral nutrition (TP...