{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T07:13:52Z","timestamp":1761808432551,"version":"3.40.5"},"reference-count":9,"publisher":"Wiley","issue":"1-2","license":[{"start":{"date-parts":[[2020,11,26]],"date-time":"2020-11-26T00:00:00Z","timestamp":1606348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Post\u2010operative nausea and vomiting (PONV) is often encountered following corrective scoliosis surgery in children, frequently attributed to high\u2010dose opiate administration. PONV is a frequent cause of prolonged hospital stay. Mechanisms related to transient partial duodenal compression by narrow angulation of the superior mesenteric artery (SMA) and aorta following scoliosis surgery are poorly understood and might be implicated in PONV. This study investigates relationships between biomechanical anatomic variations of the SMA and aorta, and its relationship with clinically significant PONV following scoliosis surgery in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Children undergoing elective spinal arthrodesis for adolescent idiopathic scoliosis were assessed by preoperative abdominal ultrasound and spinal X\u2010ray prior to surgery. Post\u2010operative assessment of clinically significant PONV is compared to preoperative imaging and clinical variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirteen patients (11 female and two male), with a mean age of 14\u2009years and 1 month were included. Five patients (38.5%) developed clinically significant PONV. A significant association was observed between the coronal aorto\u2010mesenteric orientation and PONV (<jats:italic>P<\/jats:italic> =\u20090.035). Of the five patients who developed PONV, two had direct coronal angulation of the SMA, one had left angulation and two had right angulation. Patients with significant PONV had narrower aorto\u2010mesenteric distances which approached significance (<jats:italic>P<\/jats:italic> =\u20090.06). No other preoperative variable reached significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with coronal aorto\u2010mesenteric orientation preoperatively appear at greater risk of developing significant PONV following scoliosis surgery, independent of opiate requirements, prompting consideration of transient partial duodenal obstruction as an important factor in the mechanisms of PONV. A coronal aorto\u2010mesenteric orientation theory (CAMOT) is proposed to explain this biomechanical vascular \u2018scissor\u2019.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.16438","type":"journal-article","created":{"date-parts":[[2020,11,27]],"date-time":"2020-11-27T04:36:45Z","timestamp":1606451805000},"page":"174-178","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The coronal aorto\u2010mesenteric orientation theory for post\u2010operative nausea and vomiting following scoliosis surgery in children: a pilot study"],"prefix":"10.1111","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9593-7837","authenticated-orcid":false,"given":"George D.","family":"Dounas","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Women's and Children's Hospital  Adelaide South Australia Australia"},{"name":"Discipline of Orthopaedic Surgery and Trauma The University of Adelaide  Adelaide South Australia Australia"},{"name":"Centre for Orthopaedic and Trauma Research The University of Adelaide  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas P.","family":"Cundy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Women's and Children's Hospital  Adelaide South Australia Australia"},{"name":"Discipline of Orthopaedic Surgery and Trauma The University of Adelaide  Adelaide South Australia Australia"},{"name":"Centre for Orthopaedic and Trauma Research The University of Adelaide  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Women's and Children's Hospital  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"Gent","sequence":"additional","affiliation":[{"name":"Medical Imaging Women's and Children's Hospital  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgia","family":"Antoniou","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Women's and Children's Hospital  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leanne M.","family":"Sutherland","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Women's and Children's Hospital  Adelaide South Australia Australia"},{"name":"Discipline of Orthopaedic Surgery and Trauma The University of Adelaide  Adelaide South Australia Australia"},{"name":"Department of Orthopaedic Surgery South Australian Health and Medical Research Institute  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8050-6153","authenticated-orcid":false,"given":"Peter J.","family":"Cundy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Women's and Children's Hospital  Adelaide South Australia Australia"},{"name":"Discipline of Orthopaedic Surgery and Trauma The University of Adelaide  Adelaide South Australia Australia"},{"name":"Centre for Orthopaedic and Trauma Research The University of Adelaide  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,11,26]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/aas.12571"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032196"},{"key":"e_1_2_8_4_1","first-page":"901","article-title":"Scoliosis and acute vascular compression of the duodenum","volume":"67","author":"Bunch W","year":"1970","journal-title":"Surgery"},{"key":"e_1_2_8_5_1","first-page":"129","article-title":"A study of growth in girls with adolescent idiopathic structural scoliosis","volume":"101","author":"Willner S","year":"1974","journal-title":"Clin. 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