Background:  Presently, several systems for the prognostication of pancreatic endocrine neoplasms (PENs) exist and the most appropriate classification system has not been clearly defined. This study aims to validate the performance of the 2004 World Health Organization (WHO), European Neuroendocrine Tumor Society (ENETS), Memorial Sloan-Kettering Cancer Center (MSKCC), American Joint Committee for Cancer (AJCC) TNM staging and Bilimoria criteria in a cohort of patients with PENs who underwent surgery at a single institution.Methods:  This study is a retrospective review of 61 consecutive patients who underwent surgical treatment for PEN. Actuarial disease-specific survival (DSS) of all 61 patients and recurrence-free survival (RFS) of 53 patients who had curative resection were analysed.Results:  On univariate analyses, tumour size ≥50 mm, non-curative resection, lymph node involvement, presence of distant metastases, presence of necrosis, mitotic count ≥2/10 hpf and poor differentiation were associated with decreased DSS. Tumour size ≥50 mm, lymph node involvement, lymphovascular invasion, presence of necrosis and mitotic count ≥2/10 hpf were associated with decreased actuarial RFS. All five staging systems were useful in stratifying the 61 patients according to actuarial DSS. However, the MSKCC grading and ENETS grading systems were not statistically significant in stratifying DSS in the 61 patients. In the 53 patients who underwent curative resection, the WHO, ENETS, MSKCC, AJCC staging and the MSKCC grading systems were successful in stratifying the patients according to actuarial RFS. However, the Bilimoria scoring and ENETS grading systems were not useful in prognosticating these 53 patients.Conclusion:  All five classification systems were useful for the prognostication of surgically treated PENs in our patient cohort.

Background:  Assessment of vocal cord mobility using Macintosh laryngoscope is frequently performed after extubation following thyroid surgery to rule out laryngeal nerve palsy. This study compared patient comfort and assessment accuracy of post-operative vocal fold mobility with Macintosh laryngoscope and fibreoptic endoscope.Methods:  One hundred four physically fit patients undergoing thyroid surgery were included for the study. Tele-laryngoscopy was done to rule out pre-existing vocal cord palsy. Direct laryngoscopy (DL) was performed to each patient after extubation, followed by nasal fibreoptic endoscopy (NFE) to assess the vocal cord mobility. Tele-laryngoscopic assessment was repeated after 1 week to compare the DL and NFE findings. Patient reactivity score (PRS) and haemodynamic parameters were recorded with each technique.Results:  Macintosh laryngoscope could pick up 4 (50% sensitivity and 88% specificity) and fibreoptic endoscope 7 (87.9% sensitivity and 98.9% specificity) out of the 8 vocal cord palsies identified by tele-laryngoscopy. Patients had significant discomfort during DL (PRS median 3) when compared with NFE and tele-laryngoscopy (PRS median 2), P < 0.05. Grade 1 view of larynx in 92.1% patients during intubation worsened to grade 2 (76.3%) and grade 3 (15.8%) during extubation with DL, and a significant rise in mean arterial pressure and heart rate was observed from the baseline value till 5 min and when compared with NFE (P < 0.05).Conclusion:  NFE provides accurate assessment of vocal fold mobility with reasonable patient comfort in the immediate post-operative period. Macintosh laryngoscope fails to give optimum visualization and predisposes the patient to significant discomfort and stress.

Background:  The variations in the anatomy of the external branch of the superior laryngeal nerve (EBSLN) are generally classified according to the relationship of the nerve to the superior thyroid artery, or the superior pole of the thyroid. Both artery and superior pole are themselves variable landmarks, and therefore are not consistent between subjects. We sought to examine EBSLN anatomy in relation to alternate, more consistent surgical landmarks.Methods:  Fifteen hemi-larynges from 20 embalmed human cadavers were dissected anatomically. Each nerve was categorized using established classification systems, and terminal branching patterns were also noted. Nerve location was recorded in relation to three different constant anatomical structures: the laryngeal prominence, midline junction of the cricothyroid muscles and ipsilateral cricothyroid joint.Results:  All cadavers were of European descent. The EBSLN had two branches to the cricothyroid muscle in 34% of cases. The EBSLN anatomical types found were mainly Cernea type 1 (80%), with 7% type 2a and 13% type Ni. An EBSLN was more likely to lie in an ‘at risk’ location if the subject was less than 160 cm tall. The EBSLN entered the crico-thyroid muscle at a median distance of 14 mm lateral from the laryngeal prominence and 8 mm inferiorly. The median distance from the medial-most point of the cricothyroid muscle junction was 14 mm laterally and 14 mm superiorly, and from the cricothyroid joint the entry lay a median distance of 10 mm superiorly and 11 mm medially.Conclusions:  The variability of EBSLN anatomy is again evident, as is the need for careful and knowledgeable surgical technique. New surgical landmarks for the relations of the insertion of the EBSLN reveal a deployment range for each, but one of more of these landmarks may prove useful in thyroid surgery.

Background:  The aim of this study was to analyse the effect of the right donor kidney and multiple arteries, on donor and recipient outcomes in the era of laparoscopic live donor nephrectomy (LLDN).Methods:  We retrospectively analysed the 200 donors and recipients who underwent a planned laparoscopic nephrectomy at two hospitals between September 1998 and December 2006. The impact of donor right kidney and multiple donor renal arteries on operative time, hospital stay, graft function, and donor and recipient complications were analysed.Results:  Of the total cohort (n = 200), 140 (70%) were classified as Simple LLDN (left live donor kidney with single renal artery). The Complex LLDN group (n = 60) contained all right-sided kidney (n = 28) and left-sided kidneys with multiple renal arteries (n = 32). Baseline characteristics, extraction time, conversion to open, length of admission, overall graft function and complication rates were similar between the simple and complex groups. The second warm ischaemic time in the Simple LLDN group was slightly shorter than the Complex LLDN group (32 versus 36 min P = 0.016). The 1-month post-operative recipient serum creatinine level was lower in the Simple LLDN group when compared with the Complex LLDN group (117 versus 125 µmol/L P = 0.025). There was no difference in post op dialysis, acute rejection within 3 months or graft survival between the Simple and Complex LLDN groups.Conclusion:  Laparoscopic procurements of right kidneys and kidneys with multiple arteries were safe and yielded kidneys with excellent function comparable with those of laparoscopic left donor nephrectomy with single artery.

Oesophageal cancer is an aggressive disease with a poor prognosis. Oesophagectomy is an established, potentially curative treatment, for patients with resectable oesophageal cancer. The anatomical location of the oesophagus explains why this type of operation is one of the most demanding and traumatic surgical procedures undertaken in general surgery. Unfortunately, the risk for severe post-operative complications is high and the chance for cure remains low. It is, however, encouraging that the post-operative morbidity has been decreasing and the survival has been improving during recent years. Several factors might have contributed to this improvement, including the centralization of oesophageal cancer surgery to high volume centres. This review focuses on the impact of hospital and surgeon volume on various outcomes after oesophagectomy for oesophageal cancer. Most available research indicates that, as far as post-operative complications, early post-operative mortality and health economics after oesophagectomy are concerned, high surgery volume is to be recommended, while the few studies evaluating long-term survival and health-related quality of life adjusted for tumour stage found no evidence of a role for volume. In conclusion, the available literature supports the centralization of oesophagectomy for cancer to dedicated centres with a multidisciplinary approach and a good track record of valid clinical research.

Background:  Chronic pain is a disturbing severe complication of mesh inguinal hernia repair. Its risk, incidence, severity and its aetiologies vary widely in the literatures. It is well established that laparoscopic repair has decreased the incidence of chronic pain, but only to a certain degree. The main source of pain with this approach is staple fixation. Different ways of fixation were sought to avoid this problem.Methods:  A review of the data collected prospectively, the cohort included 233 consecutive patients who underwent totally extraperitoneal (TEP) inguinal hernia repair by a single surgeon who used fibrin glue (Tisseel) to fix the mesh in all cases. Patients were reviewed by the original surgeon at 2 weeks and 6–12 weeks post-operatively, but also at 6 months in the first year of the study, and selectively then after if pain was reported by the patient. Data was reviewed and analysed by the researcher as part of quality assurance.Results:  During the period from February 2005 to September 2008, 233 consecutive patients underwent 309 TEP inguinal hernia repairs. The mean age was 44.9 years. There was no conversion to open surgery. There was no mortality and only one major morbidity. In total, eight patients were complaining of mild intermittent discomfort (2 in the groins and 6 in the testicles) on their second post-operative review, but had no complaint at 6 months following their surgery. Chronic groin pain occurred in only one patient (0.43%).Conclusions:  The use of fibrin glue is a safe and reliable way of mesh fixation in inguinal hernia repair, with very limited risk of developing chronic pain.

Background:  This audit was undertaken to review the outcomes achieved with the overlay graft technique of tympanic membrane repair in tympanoplasty surgery.Methods:  The charts of all patients who underwent tympanoplasty, in whom an overlay graft technique of temporalis fascia tympanic membrane repair was used, between 1994 and 2007 were reviewed. Information with respect to patient demographics, presence of cholesteatoma or active infection and perforation size was documented. Details of the surgical procedure and clinical outcomes and pre- and post-operative hearing thresholds were recorded in a computer database.Results:  A total of 147 overlay graft procedures were performed in 130 patients. Graft failure with reperforation occurred following five procedures, for an overall success rate of 96.6%. Eighty Type 1 tympanoplasty procedures were performed in which one failure occurred for a 98.75% success rate. Overlay grafting was combined with intact canal wall mastoidectomy (ICW) in 38 cases and with modified radical mastoidectomy (MRM) in 17 cases for a success rate of 93.8 and 95%, respectively. Delayed graft healing as a result of infection, problems such as epithelial pearl, blunting and myringitis occurred in 39 cases (26.5%). Thirty-one cases underwent procedures for ossicular chain reconstruction, 21 of which were 2nd stage procedures. Hearing outcomes were significantly better with Type 1 tympanoplasty compared with ICW or MRM procedures.Conclusion:  This review demonstrates the overlay graft technique of tympanoplasty to be highly successful for tympanic membrane repair, particularly for the more difficult cases such as revision surgery, subtotal perforations and mesotympanic cholesteatoma.

Background:  Solid pseudopapillary tumour (SPT) is a rare tumour of the pancreas with low malignant potential affecting mainly young women difficult to diagnose preoperatively. The aim of this study is to describe the endoscopic ultrasound (EUS) features and utility of EUS-guided fine needle aspiration (FNA) in diagnosing these tumours.Methods:  A retrospective analysis of SPTs identified in a tertiary institution EUS database between April 2002 and April 2009 was performed. Medical records, imaging, EUS features, cytology and histology specimens were reviewed. Patients were followed up until April 2009.Results:  Seven cases of SPTs were indentified out of 2400 EUS performed. All patients were females with a mean age of 41 years (range 22–69). The tumours were solitary with a mean diameter of 2.9 cm (range 2–4.3 cm). Five tumours were located in the body and tail of the pancreas and two in the neck. All lesions were hypoechoic, heterogenous and well circumscribed, with five having a cystic component and two having a calcified rim. FNA using a 22-gauge needle was performed in six cases with no complications. A preoperative diagnosis of SPT based on cytology was obtained in 5/6 cases (83%). Surgical resection was done in six cases with confirmation of SPT and no metastatic disease.Conclusion:  EUS-guided FNA is a minimally invasive, safe and reliable way of diagnosing SPT by providing characteristic cytological specimens. Definitive preoperative diagnosis leads to targeted and minimally invasive surgical resection.

Background:  A number of methods are available for the drainage of pancreatic pseudocysts, including percutaneous, endoscopic and open approaches. In Leicester, we developed a combined radiological and endoscopic technique (predating the use of endoscopic/ultrasound) to allow drainage of pancreatic pseudocysts into the stomach. The aim of the study was to evaluate the long-term results of this approach.Methods:  This is a retrospective study of patients undergoing combined endoscopic/ultrasound-guided percutaneous stenting between 1994 and 2007. Data were extracted from case records and our computerised radiology database.Results:  Thirty-seven combined endoscopic/ultrasound-guided procedures were undertaken. Median patient age was 52 years (range 26–84 years). Nineteen pseudocysts were secondary to acute pancreatitis and 18 were in patients with chronic pancreatitis. The diameter of pseudocysts on pre-procedure imaging ranged from 4 to 21 cm (median 11 cm). Median duration of hospital stay was 7 days (range 1–44 days) and 30-day mortality was 0%. Stents were inserted in 70.3% of patients (n= 26). Of those patients stented during the combined procedure, three developed infection of the pseudocyst, necessitating open cystgastrostomy within the first month. During a mean follow-up period of 41 months, two patients developed recurrent pseudocysts which were successfully drained with a further combined procedure (16 and 43 months). Repeat imaging in the remainder of patients failed to show any evidence of a persistent or recurrent pseudocyst beyond 2 months.Conclusion:  Combined radiological and endoscopic drainage is safe, cost-effective and highly efficient in preventing recurrent pseudocyst formation.

Background:  The ‘obesity epidemic’ is expected to result in an increased incidence of knee osteoarthritis and hence total knee replacements (TKRs). Reviews have demonstrated the conflicting results of TKR for all obese (body mass index (BMI) >30). The aim of this literature review was to specifically evaluate outcomes of TKR in patients with morbid obesity (MO; BMI >40).Methods:  A systematic review of medical databases (PubMed, Medline, Cochrane Library, ScienceDirect) by use of keywords from January 1990 to September 2009 was undertaken.Results:  Clinical and functional Knee Society Scores (KSS) improve after TKR for patients with MO. The post-operative functional KSS was, in general, less than in controls. Radiographic analysis was inconclusive because of small study populations and short duration of follow-up. All studies reporting complications noted a greater prevalence in MO patients (10–30%). Of concern was the significantly higher prevalence of deep prosthetic infection (3–9-times that of controls). The morbidly obese also had a significantly higher incidence of wound complications. TKR did not result in weight loss for MO patients, and therefore has no benefit on weight-related medical conditions. Bariatric surgery in MO under 65 years of age has been shown to be a cost-effective and clinically effective method of weight reduction. This surgery also results in significant improvement in weight-related medical conditions, the KSS and knee pain.Conclusions:  Given the increase in complications for MO patients after TKR, these patients should be advised to lose weight before surgery and, if suitable, would probably benefit from bariatric surgery.

In heart failure, post-myocardial infarction and some congenital cardiac anomalies, organ transplantation is the only effective cure. Shortage of organ donors and complications of orthotopic heart transplant remain major challenges to the modern field of transplantation. Tissue engineering using cell-based strategies presents itself as a new way of generating functional myocardium. Engineering functional myocardium de novo requires an abundant source of cells that can form cardiomyocytes. These cells may be used with biocompatible scaffold materials to generate a contractile myocardium. Lastly, to sustain the high metabolism of the construct, a functional vasculature needs to be developed with the forming cardiac tissue. This review provides an update on the progress of stem cell research in the context of cardiac tissue development, types of biomaterials used in cardiac tissue engineering (CTE) and currently employed strategies for vascularization in CTE. In addition, a brief overview of strategies utilized in CTE is provided.

Background:  The Harmonic Scalpel (HS) is widely used in thyroidectomy. Determining the safety margin of using the HS near the recurrent laryngeal nerve (RLN) is helpful in preventing the injury to this nerve during thyroidectomy.Methods:  The parameters of evoked electromyography (EEMG) of vocal muscles before and after using the HS at a power level of 3 were recorded in a rabbit model. Masson staining was used to determine lateral injury caused by incisions using the HS.Results:  After the activated tip of the HS made contact with the RLN for ≥1 s or was placed 1 mm from the nerve for 3 or 5 s or 2 mm from the nerve for 5 s, significant changes were observed in the minimal stimulus current intensity threshold, the optimal stimulus current intensity threshold, the onset latency and the wave amplitude of EEMG. After the activated HS tip touched the RLN or was placed 1 mm to the nerve for ≥1 s or 2 mm to the nerve for 5 s, significant changes were found in peak latency. The thickness of injured lateral tissue was <1, 1–2 and >2 mm when using HS for 1, 3 and 5 s, respectively.Conclusion:  When used near the RLN at a power level of 3, the activated HS tip should be ≥2 mm from the nerve and the duration of incision should be ≤3 s.

Background:  This paper describes the distinctions between major surgical and pharmaceutical trials and questions the application of a common ethical paradigm to guide their conduct and reporting.Methods:  Surgical trials differ from other trials in cumulative therapeutic effects, operator dependence, the clinical setting, interdependence of short- and long-term outcomes, and equipoise. A principal tenant of randomized controlled trial management is the maintenance of interim data confidentiality. Its application to complete surgical short-term data is examined across a variety of common clinical trial circumstances that influence data integrity and the reliability of conclusions regarding the benefit-to-risk profile of experimental interventions.Results:  Complete perioperative results describe important treatment ends that cannot influence primary outcomes. These short-term results may inform patient consent, teaching and provide valuable procedural insights to surgeons outside trial precincts.Conclusion:  Structured experimentation standards are necessary. But, the common paradigm applied across all clinical trials and the prohibition on short term data reporting may not serve the achievement of safe and effective advancements in surgery.

Background:  Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world especially in Asia. Radiofrequency ablation is now commonly use as either first line or in combination with other treatment modality for patients with HCC. It is the objective of this article to report our experience in a tertiary referral hospital.Methods:  Patients who diagnosed with HCC and underwent RFA in Queen Elizabeth Hospital during the period from May 2002 to February 2009 were included and analyzed.Results:  During this period, 138 sessions of RFA were performed in 117 consecutive patients with HCC. The calculated rate of primary (single attempt) successful ablation during this entire period was 89.2%. The in-hospital/30-day mortality rate was zero, and morbidity was 24.1%. Hospital stays were significantly longer in the open group (4.4 days versus 8.9 days, P = 0.000). Median follow-up in this study was 21 months. 11 (9.4%), 10 (8.5%) and 49 (41.0%) patients developed local tumor progression (LTP), systemic recurrence and Intrahepatic distant recurrence (IDR), respectively. The mean and median times to recurrence were 15.4 and 11 months, respectively. Most patients (91%) with LTP developed in the first 24 months. Disease-free survival was 65% at 1 year, 40% at 3 years and 25% at 5 years. Overall survival at 1, 3 and 5 years was 85, 66 and 40%, respectively. Alpha fetoprotein, aFP > 1,000 ng/ml and multiple tumor ablation predicted increased risk of recurrence.Conclusion:  Radiofrequecy ablation is useful tool in treating patients with HCC with high successful rate. However, intrahepatic recurrence is common and a well designed post ablation follow up protocol based on a sound knowledge of recurrence pattern is vital.

Background:  The International Classification of Diseases Injury Severity Score (ICISS) has been proposed as an International Classification of Diseases (ICD)-10-based alternative to mortality prediction tools that use Abbreviated Injury Scale (AIS) data, including the Trauma and Injury Severity Score (TRISS). To date, studies have not examined the performance of ICISS using Australian trauma registry data. This study aimed to compare the performance of ICISS with other mortality prediction tools in an Australian trauma registry.Methods:  This was a retrospective review of prospectively collected data from the Victorian State Trauma Registry. A training dataset was created for model development and a validation dataset for evaluation. The multiplicative ICISS model was compared with a worst injury ICISS approach, Victorian TRISS (V-TRISS, using local coefficients), maximum AIS severity and a multivariable model including ICD-10-AM codes as predictors. Models were investigated for discrimination (C-statistic) and calibration (Hosmer–Lemeshow statistic).Results:  The multivariable approach had the highest level of discrimination (C-statistic 0.90) and calibration (H–L 7.65, P= 0.468). Worst injury ICISS, V-TRISS and maximum AIS had similar performance. The multiplicative ICISS produced the lowest level of discrimination (C-statistic 0.80) and poorest calibration (H–L 50.23, P < 0.001).Conclusions:  The performance of ICISS may be affected by the data used to develop estimates, the ICD version employed, the methods for deriving estimates and the inclusion of covariates. In this analysis, a multivariable approach using ICD-10-AM codes was the best-performing method. A multivariable ICISS approach may therefore be a useful alternative to AIS-based methods and may have comparable predictive performance to locally derived TRISS models.

Background:  Previous studies demonstrated the feasibility of intraoperative radiotherapy (IORT) to the primary tumour bed using a miniature electron beam driven X-ray source for early breast cancer. This study aimed to evaluate the feasibility of IORT as a tumour bed boost after whole breast irradiation (WBI) in breast conserving therapy.Methods:  This was a single-arm prospective trial for women with breast cancer measuring <3 cm. After breast-conserving surgery, a single IORT dose of 5 Gray (Gy) prescribed to 10 mm from the applicator surface was delivered to the breast tissues using 50 kV X-ray followed by standard WBI. The feasibility rate of protocol therapy was defined as the percentage of all women who completed both IORT and WBI. A desirable completion rate was >90%. The protocol therapy would be considered unsuitable for further development if the completion rate was <75% or severe acute toxicity occurred in >15% of women who received IORT.Results:  Sixty patients were recruited for the study. IORT and WBI were delivered in 58 and 55 patients, respectively. Thus, the feasibility rates of IORT alone and both IORT and WBI were 97% (95% confidence interval (CI), 89–99%) and 92% (95% CI, 83–97%), respectively. A severe surgical complication or grade 3 or 4 acute radiation toxicity were identified in 10% (6/58) of women who had IORT.Conclusion:  Tumour bed boost using IORT in women with early breast cancer treated with conservative surgery and WBI was shown to be feasibly consistent with previous studies.

Background:  Surgical trainees' operating theatre (OT) experiences significantly influence their ability to attain key professional competencies. A measure of trainees' satisfaction with this learning environment would allow recognition of characteristics of highly successful teaching venues and threats to trainee development. Our study aimed to validate the Surgical Theatre Educational Environment Measure (STEEM) and use it to explore Australasian surgical trainees' satisfaction with OT learning.Methods:  In a cross-sectional study, the STEEM was distributed electronically to all 1500 Royal Australasian College of Surgeons trainees in Australia and New Zealand. Trainee satisfaction was gauged using Likert-type items, an overall satisfaction measure and content analysis of free-text comments. The STEEM's psychometric properties were evaluated using exploratory factor analysis.Results:  Three hundred fifty-six responses were received. The STEEM's original subscales were not supported by the data; empirically grounded subscales were identified for further analysis. Most trainees were satisfied with their OT environment and satisfaction was higher in senior than junior trainees. Trainees' relationship with their supervisor correlated most strongly with overall satisfaction. Less positively, only half of trainees report discussing their operative role with their supervisor prior to surgery.Conclusions:  The a priori STEEM subscales could not be replicated by factor analysis. We developed an empirically grounded instrument capable of identifying areas of trainee concern. The majority of trainees reported high levels of satisfaction. The revised instrument has potential to complement other sources of information to facilitate surgical supervisors' difficult task of optimizing trainees' compatibility with their OT learning environments.

Background:  Colonoscopy is considered the gold standard for investigation of large bowel pathology. Numerous factors influence the efficacy of bowel preparation for colonoscopy. Inadequate bowel preparation can lead to missed pathology. Timing of fasting and bowel preparation, timing of procedure and possibly patient bowel habit and presence of diverticula may have an influence on the quality of the preparation. The aim of this study was to investigate the quality of cleansing of sodium picosulfate (Picoprep-3™, Pharmatel Fresenius Kabi Pty Ltd, Pymble, NSW, Australia) with different administration schedules and to evaluate whether patient's bowel patterns influence the quality of cleansing.Methods:  Three hundred twenty-five patients (175 morning and 150 afternoon procedures) were interviewed prior to colonoscopy to evaluate bowel habit and timing of preparation administration. Quality of cleansing was then assessed during colonoscopy using a 5-point scale. Further factors analysed included the patient's prior bowel habit and the presence of diverticula at colonoscopy. Procedural end points evaluated included procedure total time, caecal intubation time and withdrawal times.Results:  The quality of cleansing for individual bowel segments was worse for afternoon procedures (P < 0.05 for some segments) and for patients with prior constipation (P < 0.05 for descending colon segments). Caecal intubation times were shorter for patients with diarrhoea and longer for female patients, who also had shorter withdrawal times. No correlation was found between the procedural end points (total duration, caecal intubation time and withdrawal times) and the timing of fasting.Conclusions:  Quality of cleansing is significantly improved when bowel preparation is taken entirely the day prior to colonoscopy. Patients with prior constipation demonstrated poorer cleansing.

Background:  Surgeons are noticing increasing numbers of cholecystectomy waiting list patients presenting with complications of their gallstones. In this study, we analysed the outcome of these to ascertain natural history and outcome.Methods:  Data for 5298 waiting list patients in Western Australia, from 1999 to 2006, were analysed. Negative binomial regression was used to analyse waiting times data with Waitlist Year, Urgency Category and Aboriginality, after adjusting for Gender, Location and Age at Cholecystectomy.Results:  The overall median waiting time for surgery was 40 days (interquartile range (IQR) = 15–103). The median waiting times for Urgent, Semi-Urgent, and Routine categories were 21 (IQR = 8–63), 44 (IQR = 20–97) and 50 (IQR = 17–131) days, respectively. While waiting for surgery, 240 (5%) patients had gallstone-related admissions. Eighty (33.3%) patients had previous gallstone-related admissions prior to their enrolment on the waiting list. Analysis of the crude odds ratio showed that the probability of readmission during wait for surgery was three times more, when the surgery was not performed within the recommended time. Aboriginal and Torres Strait Islanders wait 1.77 times longer than non aboriginals (P < 0.001) and waiting time decreased with more recent calendar years. (P= 0.001) Patients in the metropolitan hospitals waited twice as long compared with the regional hospitals (P < 0.001).Conclusion:  Approximately 5% of patients on the waiting list for an elective cholecystectomy were readmitted to the hospital for gallstone-related problems. Proper categorization of patients and definitive surgical treatment of acute gallbladder disease at index presentation might decrease this readmission rate. More effort needs to be made to ensure equity of access for gallstone patients.