AimThe aim was to compare postoperative quality of life (QOL) between patients undergoing pelvic exenteration (PE) and pelvic exenteration with sacrectomy (PES), and to investigate the influence of high (L5-S2) vs low (≤ S3) sacrectomy on QOL and functional outcomes.Method Patients undergoing en bloc sacrectomy as part of a PE and PE alone from 2008 to 2015 were identified from a prospectively maintained database. ResultsOf the 344 patients identified, data were available for 116 patients who underwent PE alone and 140 patients who underwent PES. PES patients had significantly poorer physical component scores (P < 0.001) but not mental component scores (P = 0.17). Of the 140 PES patients, 55 were eligible and were invited to participate in a second functional survey, with 30 patients returning the study questionnaire. High sacrectomy patients, compared with low sacrectomy, had significantly worse lower limb motor function (P = 0.03) and poorer physical (P = 0.001) and mental health component scores (P = 0.02). No differences were found in sexual, bladder and bowel function between high and low sacrectomy patients.Conclusions Patients undergoing PES had worse physical component scores compared with PE alone, whereas high sacrectomy patients had significantly worse lower limb motor function and physical and mental component scores but comparable bowel, bladder and sexual functional outcomes compared with low sacrectomy patients.

Background Inguinal hernias are a common pathology that often requires surgical management. The use of groin ultrasound (GU) to investigate inguinal hernias is a growing area of concern as an inefficient use of healthcare resources. Our aim was to assess changes in the rates of GU and the impact on surgical practice. Methods Medicare Item Reports and the Australian Institute of Health and Welfare Database were used to estimate annual GU and inguinal hernia repair (IHR) rates per 100 000 population for the period 2000/2001–2017/2018. Pearson's correlation coefficients and linear regression analyses were performed to assess associations between these variables. Results Over the 18‐year period, GU rates increased 13‐fold from 88 to 1174 per 100 000 population. Overall, total IHR rates decreased from 217 to 192 per 100 000. Overall, unilateral IHR rates have decreased (182–146 per 100 000), bilateral IHRs have increased (35–46 per 100 000), laparoscopic IHR has increased (30–86 per 100 000) and open surgery has declined (187–106 per 100 000). The increase in GU rates were strongly associated with the decrease in unilateral (r = −0.936, P = <0.001) and increase in bilateral IHR rates (r = 0.924, P = <0.001). Conclusion The use of GU has increased substantially, potentially representing an unnecessary cost to the healthcare system. Rising GU rates are not associated with an increase in IHR, however, may contribute to the increasing rates of bilateral IHRs. This study supports the opinion that more extensive clinical and health policy initiatives are needed in Australia to address this health issue.

Pelvic exenteration has evolved into an accepted treatment for advanced pelvic malignancies that were traditionally deemed incurable.However, in performing radical excision of soft tissue and bony compartments of the pelvis, the physical implications are immediately evident in the simultaneous creation of an empty space in the pelvis.This space has the potential to fill with fluid or bowel with subsequent development of complications including pelvic collections, bowel obstruction, fistula and perineal wound breakdown. This so-called "empty pelvis syndrome" presents a constant challenge for the exenteration surgeon; balancing the benefits of improved survival by obtaining a clear surgical margin while contending with the morbidity resulting from pelvic complications which can be acute to chronic and longstanding.In 2018, we originally described a novel technique using a synthetic biodegradable GORE BIO-A mesh (WL Gore & Assoc) addressing the empty pelvis syndrome through a case series of 10 patients at our institution over a 1-year period [1]. Since the routine implementation of this practice, we have had further patients