The case of Canadian general surgeons.
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Canada↗
Biomedical subjects
R H Railton
Publications and source records attributed to R H Railton.
The case of Canadian general surgeons: getting the message heard.
The problem of physician resources is at the top of the health care policy agenda, and physicians are faced with the challenge of change. General surgeons, like others, must address the changes in health care needs and demands, technology, information and funding. This paper begins with a demographic and workload profile of general surgery based on data provided by the Canadian Medical Association's Physician Resource Questionnaire (PRQ). The findings indicate the following: the supply of general surgical procedures has been declining; general surgeons are older than other specialists; and the proportion of women in general surgery is lower than that of the profession as a whole. The practice profile of general surgery is also changing because of advances in technology and information and the changing practice of subspecialists. Changes affecting general surgery raise important questions regarding future physician resource policies. The medical profession's involvement in the area of physician resources at the national level is outlined, with a particular focus on the role of the Canadian Medical Association. It is important that general surgeons become involved in the discussion, since the policy decisions made today will affect the future practice of general surgery.
Canada↗
The double stapling technique for low anterior resection of rectal carcinoma.
The double stapling technique (TA-55 and EEA staplers) was used to perform low anterior resections for rectal carcinomas in 79 patients (49 men, 30 women). The mean age was 66 years (range, 38 to 85 years). Curative resections were performed in 68 patients, and palliative resections in 11 patients. The mean level of the cancer from the dentate line was 9 cm (range, 5 to 16 cm). The mean follow-up has been 29 months (range, four to 58 months). Perioperative mortality was 2.5 percent (two patients). Technical problems related to the stapling technique occurred in 6 percent (five patients). The clinical anastomotic leak rate was 8 percent (six patients). There were 11 local recurrences among 68 curative resections (16 percent). Local recurrence according to individual surgeon showed marked variability (range, 0-43 percent, P greater than 0.05). There were no differences in location, differentiation, or stage in those that recurred. The mean distal resection margin for the recurrent cancer group was 3.0 cm and for the nonrecurrent group, 2.9 cm. Disturbances of continence were seen commonly (56 percent) in the first three months after surgery, but 85 percent of patients became fully continent with an acceptable bowel habit at later follow-up. The double stapling technique is useful for the restorative resection of suitable mid and low rectal cancers. The anastomotic leak rate, local recurrence rate, and functional results are acceptable.
Adult↗
Symposium on surgical manpower in the smaller community. The Canadian Association of General Surgeons and the community surgeon.
The relationship between the Canadian Association of General Surgeons and the community surgeon is a symbiotic one. Despite the controversy about medical costs and the oversupply of physicians, there is and will continue to be an increased need for general surgeons in Canada. Highly trained general surgeons are needed in medium-sized and smaller communities where the bulk of general surgery is done. The Canadian Association of General Surgeons sponsors research in education that will affect surgical knowledge and the training and future of community surgeons.
Canada↗
Double stapling technique for low anterior resection.
A report is given on 26 patients (18 men and 8 women) undergoing low anterior resection for carcinoma of the rectum, using both the TA 55 and EEA staplers. The average age was 65 years (range, 45 to 92 years). The preoperative level of the lesion from the anal verge averaged 9.8 cm (range, 4 to 17 cm). All had well-differentiated or moderately well-differentiated lesions. All lesions were removed using the following technique. The TA 55 stapler was placed across the lower rectum at the distal resection margin. The EEA stapler was introduced into the rectum with the anvil removed. The shaft was then passed through the rectum stump either through or immediately adjacent to the staple line. The anvil was refitted and the anastomosis completed between the more proximal colon and the rectal stump. A defunctioning colostomy was employed in only one patient. There has been no mortality. Follow-up has been 2 to 16 months, and there has been no early recurrence. The postoperative level of the anastomosis averaged 5.5 cm (range, 2 to 11 cm). Stapler-related complications occurred in three patients. One of these patients developed a postoperative anastomotic leak, which necessitated a defunctioning colostomy. Two anastomotic strictures occurred following either an anastomotic leak or postoperative radiation therapy. Early incontinence to gas, night-time anal soilage, and urgency occurred in eight patients (30 per cent). These symptoms improved or disappeared within three months following operation. The authors' preliminary experience has shown the double stapling technique to have definite advantages. It obviates the use of lower purse-string suture and permits a lower and easier anastomosis. It avoids the problem of disparity of sizes of the two ends of the bowel. The rectum is not opened and fecal spillage is minimized. To date, results have been good without excessive complications.
Adenocarcinoma↗