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At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

1990-2001 US general surgery chief resident gastric surgery operative experience: analysis of paradigm shift.

The almost complete disappearance of benign gastric ulcer disease has led to the perception that there may be an insufficient gastric surgery experience for surgery residents. This study analyzed resident-reported gastric procedure experience by chief residents from U.S. programs. The Resident Statistic Summaries (Report C) for 1990-2001 were compiled and analyzed. Results are expressed as the average number of operations performed per resident, standard deviation (SD), and the percentage (%) of total gastric operative cases. For all gastric-related surgery, the average reported cases per chief resident ranged from 9.8-12.4 with a peak in 1990 and a nadir in 1999; in 2001 the reported case average was 11.3 (SD ranged from 6-8). Over the same interval, vagotomy decreased from 24% in 1990 to 7% in 2001, whereas gastric-reduction operations increased from 5%-34%. Total gastrectomy remained a constant less than 1.0 per chief resident (range 0.6-0.8), whereas partial gastric resection (PGR) was unchanged. The percentage of all types of gastric resections slightly diminished from 34% in 1990 to 29% in 2001. U.S. surgical chief residents report a widely variable experience in gastric surgery over the period analyzed. However, their overall experience has not significantly diminished since 1990 although specific procedural volume has varied.

Digestive System Surgical Procedures↗
PubMed1996

Teaching the craft of operative surgery.

(a) Recent changes in practice and organisation of surgery make it even more important than formerly to focus attention on the acquisition of operative skills. Once the elements of good operative technique are inculcated, the trainees need practice to establish and refine the natural skill patterns that convert competence into mastery. As opportunities to acquire practical operative experience diminish in Britain, we should encourage our future surgeons to spend a period in less affluent countries where there is a heavy workload of predominantly open surgery. At present such periods are too often dismissed as 'experience, not training'. (b) Apprenticeship remains the essential element for acquiring the craft skills. Apprenticeship does not imply merely allowing trainees to watch and assist. They must also perform under supervision while being assisted by the master. (c) Craft workshops are valuable adjuncts for formal instruction and 'hands on' experience as a preliminary to continued practice of the skills. They allow the principles of good surgery to be formally stated and reinforced. (d) We do not yet have objective tests of operative skill and should not judge trainees at an early stage, except in their adherence to accepted precepts and by their results. (e) Those of us who are privileged to train the next generation of surgeons should critically assess the standards of our own technique, not just in relation to our surgical success but also to the standards we are passing on to our successors.

Education, Medical, Graduate↗
PubMed2003

Re-operative surgery in pediatric patients.

In spite of recent emphasis on primary repair for congenital heart defects, multiple operations are often required for staged repairs of complex lesions or replacement of outgrown or degenerated prosthetic material. The vast majority of re-do operations proceed without incident; however, re-operation entails greater risk of inadvertent injury to the phrenic nerve and other heart and vascular structures, postoperative bleeding, and may require alternative cannulation sites. Recommendations to address these hazards are reviewed, as are areas of research that may impact future approaches to the patient who requires re-operation. Pericardial closure and pericardial substitutes, bovine and synthetic, are briefly discussed, as is the use of aprotinin for its hemostatic and anti-inflammatory effects.

Aprotinin↗
PubMedDate not supplied

[Hormonal regulation during cardiac surgery operations on the "dry" heart].

Central and peripheral compartments of hypophyseo-adrenal regulation, the state of renin-angiotensin-aldosterone system (RAAS) and thyroid-stimulating functions of hypophysis have been assessed in 72 patients with heart valve defects operated under profound hypothermal perfusion. It has been established that cardiopulmonary bypass surgery with profound hypothermia is accompanied by moderate and reversible changes in the above parameters. The activity of hypophyseo-adrenal system and RAAS reaches the maximum during a warming-up period and then gradually decreases. TSH content considerably decreases in the early postoperative period. Cardiopulmonary bypass surgery with profound hypothermia causes more pronounced changes in neurohormonal regulation than heart valve correction under hypothermal perfusion, which might be associated with blood flow arrest in major vessels causing changes in peripheral metabolic processes.

Adolescent↗
PubMedDate not supplied

[Complicated colon cancer: the experience at an Operative Surgery Unit].

INTRODUCTION: Prognosis of colon cancer is worse if complications are present at the moment of diagnosis. The high mortality rate with surgery in emergency in such cases needs a careful reflection about the best suitable operation to perform. MATERIALS AND METHODS: 107 consecutive patients observed along a 9 year-period for colon-rectal cancer are retrospectively analysed. 27 of them were complicated at the presentation for obstruction (19 patients), colon perforation (6 patients) or rectal hemorrhage (2 patients). In the whole experience 5 patients underwent primary resection of the tumour and direct anastomosis; 5 only a decompressive colostomy; 6 were primarily resected and anastomized under the protection of a cecostomy; 6 other patients underwent a Hartmann procedure; 2 were treated with only an intestinal by-pass; 1 was treated with Miles procedure; 1 with an anterior rectal section and the last one was resected-anastomosed in two steps, after a temporary decompressive colostomy. RESULTS: Intraoperative mortality was of 11.1% (3 patients) and morbidity 18.5% (5 patients). General 5 years survival was 62.1% among the cases complicated at presentation. The recurrence rate was 8.45%. Both these figures are below a statistical significance (p = 0.57). CONCLUSIONS: The necessity to treat in emergency the colon cancers reduces the possibility to adopt the best rules of modern programmed oncologic surgery giving up the chemotherapy w/o neoadjuvant radiotherapy with which a preoperative down-staging of the tumour were possible. For these reasons in emergency not only mortality and morbidity are higher than in case of elective surgery, but also metastasization and recurrence are worse because of a more difficult radicality in surgery.

Adenocarcinoma↗
PubMed2000

Coding plastic surgery operations: an audit of performance using OPCS-4.

Accurate coding is essential for local and national data reporting and for contracting. It is also integral to clinical governance. This study aimed to assess the accuracy of coding in Morriston Hospital plastic surgery theatres and coding office, to reaudit and address poor practice. A third coding system, a computerised logbook developed by the senior author, was not analysed in this study. Fifty operations coded using OPCS-4 were compared with a gold standard for overall accuracy, primary and procedural codes. Results were discussed with all relevant staff and reaudit took place 3 months later. The data were analysed using the paired Student's t -test for intergroup comparisons and the unpaired test for intragroup assessment. At initial audit, the coding office was significantly better than theatre staff in overall accuracy (78% vs 43% respectively P<< 0.01) and in procedural codes (98% vs 42%, P<< 0.01) but there was no difference in primary codes (62% vs 74%). At reaudit the only significant improvement was in overall accuracy of coding office records, although the clinical coders were now significantly better at recording primary codes than theatre staff (76% vs 56%, P< 0.05). The conclusions were that the quality of coding in theatre was poor and should stop. Clinical coders performed better but 1/3-1/4 of essential codes were inaccurate. This may have been due to limited understanding of terminology and techniques, difficulty reading operation notes and complexity of OPCS-4. Recommendations included closer cooperation between surgeons and coders to support and improve clinical coding performance.

Forms and Records Control↗
PubMed1995

An overview of consumer-driven ambulatory surgery: operative laparoscopy.

Laparoscopy is considered one of the first truly consumer-driven medical advances. It is estimated that 30% to 70% of all gynecologic surgery currently performed via laparotomy incision could be completed by using the laparoscope. The emerging trend in recent years is the change from using the laparoscope in gynecology for diagnosis and tubal sterilization to treating ectopic pregnancy and ovarian neoplasm. The 1991 and 1992 Gynecologic and Obstetrical Society's review and recommendations of this surgical specialty reflect a 1.5-fold increase in the number of laparoscopic procedures reported in 1988. Pelvic pain is the most frequent indication for operative laparoscopy. There is a need for further evaluation of laparoscopy, including an evaluation of cost-savings claims and an evaluation of necessary recovery time in comparison with laparotomy. Primary care providers can effectively monitor patients' potential surgical needs and appropriately counsel patients when armed with knowledge of the benefits and risks of operative laparoscopy. This article provides a review of the history, purpose, benefits, risks, and patient surgical outcomes of operative laparoscopy.

Ambulatory Surgical Procedures↗