International journal of surgery
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Over the past decade there has been considerable change to surgical training such as modernising medical careers which have raised concerns over exposure to operative experience. With the National Health Service (NHS) plan aiming for the majority of elective surgical cases to be performed as day cases we sought to assess the level of exposure modern day surgical trainees obtain in day case surgery. ⋯ The survey reveals that the modern surgical trainee is gaining a low and inconsistent level of exposure to day case surgery despite being aware of the importance of this modality of training. An urgent review is required to ensure trainees become actively involved in day case surgery and are not missing on this vital training opportunity.
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Randomized Controlled Trial Comparative Study
Evaluation of recurrent laryngeal nerve monitoring in thyroid surgery.
Thyroidectomy creates a potential risk for all parathyroid glands and nerves. Nerve identification has decreased the rates of nerve injury during thyroidectomy. Intraoperative nerve monitoring (IONM) has been used as an adjunct to the visual identification of the nerve. The aim of this clinical trial is to evaluate the effect of the identification time of RLN during thyroidectomy using IONM. ⋯ Although the operating time was lower with IONM than with visualization alone, the shortened surgical time may not seem to have great clinical relevance. However, the shorter the nerve is identified the lower is the surgeon's level of stress. We think that it is important to use IONM to decrease the identification time of RLN in the course of thyroidectomy.
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Comparative Study
Peri-operative antibiotic prophylaxis: adherence to guidelines and effects of educational intervention.
This study was aimed to determine the propriety of perioperative antimicrobial prophylaxis, to evaluate the effects of a training intervention on correction. ⋯ Although this educational intervention study achieved improvements in indications, choice, and dosing of surgical antimicrobial prophylaxis, it failed to improve prolonged use and total compliance rate, and to lower the costs sufficiently. It will probably provide better results by means of compulsory measures for surgeons to comply with available protocols and guidelines, as well as education programs, in order to change the antibiotic utility habits on surgical prophylaxis and to achieve accurate prophylactic administrations.
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Comparative Study
Incisional hernia rates following laparoscopic colorectal resection.
In published series with satisfactory follow-up incisional hernia rates following laparotomy vary between 4 and 18%, with up to 75% developing within two years of operation. This therefore represents the commonest complication following open abdominal surgery and a substantial added workload for the colorectal/general surgeon. ⋯ The well-documented advantages of laparoscopic surgery include reduced hospital stay, early return to activity, decreased analgesic requirements and improved cosmesis. However, the results of this study suggest that incisional hernia rates are not decreased by laparoscopic surgery, although the hernias may be smaller and more amenable to repair by laparoscopic approaches.
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Neurocysticercosis (NCC) is caused by the larval form of the pork tapeworm Taenia solium and is the commonest parasitic infestation of the central nervous system. NCC is usually managed medically but in some instances surgery is required. Magnetic resonance imaging (MRI) and computed tomography (CT) are often able to provide the diagnosis of NCC in most patients with intraventricular and parenchymal cysts but in patients with hydrocephalus without any cysts, the diagnosis is confirmed by the presence of cysticercal antibodies in the serum. ⋯ For incompletely excised cysts and cysts or granulomas in locations such as the spinal cord, medical treatment with steroids and albendazole is recommended. Hydrocephalus is treated with a ventriculo-peritoneal shunt but shunts in these patients suffer from frequent obstructions and require multiple revisions. The outcome for patients with intraventricular and parenchymal cysts is usually good but for those with hydrocephalus associated with cisternal or racemose cysts and with cysticercotic meningitis, the mortality is high.