Vijayaragavan Muralidharan

Vijayaragavan Muralidharan
University of Melbourne | MSD · Department of Surgery (Austin)

PhD; FRACS; MSurgicalEd; MBBS(Hons); B Med Sci;

About

197
Publications
21,864
Reads
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3,268
Citations
Introduction
Circulating Biomarkers in liver, pancreas and biliary disorders and Liver Transplantation. Individualizing therapy in HPB diseases and Liver Transplantation .Surgical educational research.
Additional affiliations
May 2014 - present
Royal Australasian College of Surgeons
Position
  • Chair, Vic/Tas Training Committe, Board in General Surgery,
May 2014 - present
Austin Health
Position
  • Supervisor of Surgical Training
May 2004 - present
University of Melbourne
Position
  • Professor (Associate)
Education
February 2012 - December 2014
University of Melbourne
Field of study
  • Surgical Education
February 1999 - January 2001
Monash University (Australia)
Field of study
  • Medicine
February 1996 - January 2000
Royal Australasian College of Surgeons
Field of study
  • General Surgery

Publications

Publications (197)
Article
BACKGROUND Liver transplantation (LT) is a potentially curative therapy for patients with hepatocellular carcinoma (HCC). HCC-recurrence following LT is associated with reduced survival. There is increasing interest in chemoprophylaxis to improve HCC-related outcomes post-LT. AIM To investigate whether there is any benefit for the use of drugs with...
Article
Full-text available
The presence of precursor to exhausted (Tpex) CD8⁺ T cells is important to maintain robust immunity following treatment with immune checkpoint inhibition (ICI). Impressive responses to ICI are emerging in patients with stage II-III mismatch repair (MMR)-deficient (dMMR) colorectal cancer (CRC). We found 64% of dMMR and 15% of mismatch repair-profic...
Article
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BACKGROUND Cost analyses of patients undergoing esophagectomy is valuable for identifying modifiable expenditure drivers to target and curtail costs while improving the quality of care. We aimed to define the cost-complication relationship after esophagectomy and delineate the incremental contributions to costs. AIM To assess the relationship betwe...
Article
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Background The concept of a “textbook outcome” is emerging as a metric for ideal surgical outcomes. We aimed to evaluate the impact of an advanced haemodynamic monitoring (AHDM) algorithm on achieving a textbook outcome in patients undergoing hepatobiliary–pancreatic surgery. Methods This retrospective, multicentre observational study was conducte...
Article
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The recurrence of colorectal liver metastasis (CRLM) following liver resection is common; approximately 40% of patients will experience tumor recurrence post-surgery. Renin–angiotensin inhibitors (RASis) have been shown to attenuate the growth and progression of CRLM in pre-clinical models following liver resection. This study examined the efficacy...
Article
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Objective Postoperative complications following major abdominal surgeries is a pressing concern for hospital care and health economics. Given the paucity of available cost data for patients undergoing major abdominal surgery, we evaluated the number and the severity of postoperative complications following major abdominal surgeries and calculated t...
Article
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Background Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures. Methods This international, multicentre, prospective cohort study collected data fr...
Article
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Background. Ex vivo normothermic machine perfusion (NMP) is an organ preservation technique that enables an extended assessment of graft suitability before liver transplantation (LT). Established monitoring protocols used during NMP vary significantly in their assessment of transplant suitability when applied to the same grafts. Graft-derived cell...
Article
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Introduction The optimal analgesic modality for patients undergoing hepato-pancreato-biliary (HPB) surgery remains unknown. The analgesic effects of a multimodal intrathecal analgesia (MITA) technique of intrathecal morphine (ITM) in combination with clonidine and bupivacaine compared to ITM alone have not been investigated in these patients. Meth...
Article
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Background: Graft-derived cell-free DNA (gdcfDNA) analysis has shown promise as a non-invasive tool for monitoring organ health following solid organ transplantation. A number of gdcfDNA analysis techniques have been described; however, the majority rely on sequencing or prior genotyping to detect donor-recipient mis-matched genetic polymorphisms....
Article
Background: Revisional antireflux surgery, including hiatus hernia repair, is increasingly common. Mesh-augmented hiatal closure at the time of index operation is controversial but commonly performed. Although a meta-analysis of randomized data has demonstrated no additional benefit of routine mesh placement, it is unclear whether this practice re...
Article
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Background Although guidelines recommend the use of perioperative chemical thromboprophylaxis for antireflux surgery, the optimal timing for its initiation is unknown. The aim of this study was to investigate whether perioperative timing of chemical thromboprophylaxis affects bleeding, symptomatic venous thromboembolism, and complication rates in p...
Article
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Background and AimThe C-reactive protein to albumin ratio, albumin-bilirubin index and platelet-albumin-bilirubin index have emerged as prognostic scores in hepatocellular carcinoma, although their clinical utility remains unclear, with ongoing investigation in multiple patient populations. This study aims to report survival outcomes and evaluate t...
Article
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Abstract Hepatocellular carcinoma (HCC) is an aggressive primary malignancy of the liver and is the third most common cause of cancer‐related global mortality. There has been a steady increase in treatment options for HCC in recent years, including innovations in both curative and non‐curative therapies. These advances have brought new challenges a...
Article
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Background and aim: During COVID-19, restrictions to elective endoscopy were introduced worldwide. A reduction in procedures may impact trainees' endoscopy learning. This study aims to assess Australian advanced gastroenterology and general surgery trainees' self-perceived efficacy and knowledge in endoscopy during the pandemic. Methods: All Aus...
Article
Objective: To determine whether early (before skin closure) versus postoperative chemoprophylaxis affects the incidence of venous thromboembolism (VTE) and bleeding following major abdominal surgery, in a high thromboembolic risk population. Background: Major abdominal surgery incurs both VTE and bleeding risks. Patients with high preoperative V...
Article
The detection of methylated templates in cell-free DNA (cfDNA) is increasingly recognized as a valuable, non-invasive tool for diagnosis, monitoring and prognostication in a range of medical contexts. The importance of controlling pre-analytical conditions in laboratory workflows prior to cfDNA quantification is well-established. Significant variat...
Article
Full-text available
(1) Liver regeneration following partial hepatectomy for colorectal liver metastasis (CRLM) has been linked to tumour recurrence. Inhibition of the renin–angiotensin system (RASi) attenuates CRLM growth in the non-regenerating liver. This study investigates whether RASi exerts an antitumour effect within the regenerating liver following partial hep...
Article
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Background: Pancreatic cancer is a malignancy with one of the poorest prognoses amongst all cancers. Patients with unresectable tumours either receive palliative care or undergo various chemoradiotherapy regimens. Conventional techniques are often associated with acute gastrointestinal toxicities, as adjacent critical structures such as the duoden...
Article
Background & Aims Malnutrition and sarcopenia are associated with increased morbidity and mortality in cirrhosis but conflicting data are reported after liver transplantation (LT), with little known about the economic burden of malnutrition at LT. This study aims to investigate the impact of pre-transplant malnutrition and muscle strength on post-t...
Article
Graft‐derived cell‐free DNA (gdcfDNA) quantification is a promising, minimally‐invasive tool for detecting acute T‐cell mediated rejection (ATCMR) following liver transplantation. We investigated the utility of measuring hepatocyte‐specific methylation in cfDNA (HS‐cfDNA) to quantify gdcfDNA, examining its accuracy in detecting ATCMR in a prospecti...
Article
Background: Liver transplantation is an established treatment for liver failure, and its success relies on the quality of the donated organ amongst other factors. Studies on procurement-related liver injury (PRLI) are few and some may not apply to modern-day practice. This is the first Australian study examining risk factors and consequences of PR...
Article
Background Bile duct injury (BDI) after cholecystectomy can lead to recurrent cholangitis, even after biliary reconstruction. This necessitates hepatectomy in a minority of patients. A systematic review was conducted, summarizing the pattern of biliary injury sustained in this group and their outcomes after hepatectomy. Methods A literature search...
Article
Background Postoperative pancreatic fistula (POPF) remains a significant cause of morbidity in patients undergoing distal pancreatectomy (DP). The use of polyethylene glycol (PEG) and recombinant human albumin sealant gel applied to the transected pancreatic margin in DP may reduce POPF rates and was assessed. Methods A retrospective single centre...
Article
Background and aim: The role of circulating mitochondrial DNA (cmtDNA) in transplantation remains to be elucidated. cmtDNA may be released into the circulation as a consequence of liver injury; yet recent work also suggests a causative role for cmtDNA leading to hepatocellular injury. We hypothesized that elevated cmtDNA would be associated with a...
Article
Background Despite improvements in the genetic and epigenetic analysis of cell-free DNA (cfDNA), there has been limited focus on assessing the preanalytical variables of recovery efficiency following cfDNA extraction and bisulfite modification. Quantification of recovery efficiency after these steps can facilitate quality assurance and improve reli...
Article
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(1) Background: Recent clinical and experimental data suggests that the liver’s regenerative response following partial hepatectomy can stimulate tumor recurrence in the liver remnant. The Wnt/β-catenin pathway plays important roles in both colorectal cancer carcinogenesis and liver regeneration. Studies have shown that the Wnt/β-catenin pathway re...
Article
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Purpose Hypoxia is associated with aggressive tumour behaviour and can influence response to systemic therapy and radiotherapy. The prevalence of hypoxia in metastatic colorectal cancer is poorly understood, and the relationship of hypoxia to patient outcomes has not been clearly established. The aims of the study were to evaluate hypoxia in metast...
Article
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Introduction Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) is a rare multisystem neurodegenerative disorder. We describe our perioperative evaluation and care of a patient with CANVAS undergoing a pancreaticoduodenectomy for an ampullary adenocarcinoma, with a focus on perioperative risk stratification and optimisation, i...
Article
Background In Australia, ethics committees across different states vary in application, requirement and process for the ethical review and approval for clinical research. This may lead to confusion and delays in the enablement of multicentre research projects. This study explores the effect of differing processes for Ethics and Governance in the es...
Preprint
Full-text available
Colorectal cancer liver metastasis (CLM) is the most of common cause of death in patients with colorectal cancer (CRC) worldwide. There are various immune-suppressive and tumor-promoting mechanisms, which contribute to the unresponsiveness associated with current check point immunotherapy in CRC. Techniques such as Multiplex immunohistochemistry (m...
Article
Background Surgical site infection (SSI) is a common complication following emergency laparotomy occurring in around 25% of patients in UK practice. The use of single use negative pressure dressings (SUNPDs) for these wounds has been proposed as a prophylactic method of reducing the rate of SSI. Method The Single Use Negative pRessure dressing for...
Article
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Due to advances in modern medicine, liver transplantation has revolutionised the prognosis of many previously incurable liver diseases. This progress has largely been due to advances in immunosuppressant therapy. However, despite the judicious use of immunosuppression, many liver transplant recipients still experience complications such as rejectio...
Article
Background Despite guidelines recommending perioperative thromboprophylaxis for patients undergoing general surgery, we have observed significant variations in its practice. This may compromise patient safety. Here, we quantify the heterogeneity of perioperative thromboprophylaxis across all major general surgical operations, and place them in rela...
Article
Background: Cholecystectomy is commonly performed in general surgery. Despite guidelines recommending chemical thromboprophylaxis in the perioperative period, the most appropriate time for its initiation is unknown. Here, we investigated whether timing of chemoprophylaxis affected venous thromboembolism (VTE) and bleeding rates post-cholecystectom...
Article
Purpose: Inappropriate prioritization of colonoscopy requests increases service demand, waiting time and healthcare costs. This study reviews the referral patterns and indications for elective colonoscopies at a tertiary hospital. Methods: Retrospective single centre data was collected from July 2014 - July 2016 from ProVation database, Scanned Me...
Conference Paper
Introduction: At most accredited training sites in Victoria, general surgical trainees attend surgical outpatient clinics. While this act of service provision is essential to the delivery of surgical care, benefit to the trainee is unexplored in the literature. The educational value of trainees attending surgical outpatient clinics is of particular...
Chapter
Surgical infections refer to those infections requiring surgical intervention or those occurring as a complication of surgical procedures. The principles of source control, systemic control and local control may be applied to all such infections. Perioperative infections increase morbidity and mortality and significantly contribute to the healthcar...
Chapter
Diffuse liver infections may be caused by liver‐specific hepatitis viral infections or as part of systemic viral infections. The role of surgery in liver infections was previously related to local infections such as bacterial or amoebic abscesses and complicated hydatid diseases. Improvements in antibiotic therapy and interventional radiology have...
Article
Cell‐free DNA (cfDNA) is emerging as an immuno‐modulator in numerous medical conditions including in malignancy, chronic inflammatory diseases, trauma, sepsis, and organ transplantation. Significant evidence exists supporting a link between cfDNA and the presence of neutrophil extracellular traps (NETs). NETs, comprising an extra‐cellular mesh of c...
Article
Full-text available
Background: Major hepatectomy (MH) and particular types of liver transplantation (LT) (reduced size graft, living-donor and split-liver transplantation) lead to a reduction in liver mass. As the portal venous return remains the same it results in a reciprocal and proportionate rise in portal venous pressure potentially resulting in small for size...
Article
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Background: Assessment of donor-specific cell-free DNA (dscfDNA) in the recipient is emerging as a noninvasive biomarker of organ rejection after transplantation. We previously developed a digital polymerase chain reaction (PCR)-based approach that readily measures dscfDNA within clinically relevant turnaround times. Using this approach, we charac...
Article
Despite excellent treatment of primary colorectal cancer (CRC) the majority of deaths occur as a result of metastasis to the liver. Recent population studies have estimated that one quarter of patients with CRC will incur synchronous or metachronous colorectal liver metastasis (CRLM). However, only one quarter of these patients will be eligible for...
Article
Background: Central hepatectomy (CH) is more difficult than extended hepatectomy (EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent post-hepatectomy liver failure (PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors. Methods:...
Article
Background Acute biliary pain is the most common presentation of gallstone disease. Untreated patients risk recurrent pain, cholecystitis, obstructive jaundice, pancreatitis and multiple hospital presentations. We examine the outcome of implementing a policy to offer laparoscopic cholecystectomy on index presentation to patients with biliary colic...
Article
Full-text available
Introduction: Serum carbohydrate antigen 19-9 (CA19-9) is routinely used in the management of pancreatic cancer for diagnosis, prognostication and surveillance purposes despite its low specificity. Case presentation: This case report demonstrates the challenges of interpreting elevated serum CA19.9 levels in a patient with pancreatic cancer. We per...