Background: An inguinal hernia is one of the most common surgical pathologies, and therefore the repair of an inguinal hernia is one of the most common general surgical procedures. The aim of this study was to assess the trend in inguinal hernia repair (IHR) rates in Australia between 2000/2001 and 2014/2015 using population data from public and private hospitals. Methods: ICD-10 data cubes from the Australian Institute of Health and Welfare were analysed to determine the number of inguinal hernia repairs performed, open or laparoscopically, between 2000/2001 and 2014/2015 financial years. These data were combined with the Australian Bureau of Statistics population data estimates for the corresponding years, to give a procedure per 100 000 estimates. Results: Incidence of IHRs within Australia decreased from 217 to 194 per 100 000 population over the 15-year study period. There was a clear shift towards increased uptake of laparoscopic surgery with a subsequent fall in rates of open IHRs. Males accounted for the majority of IHR procedures. Unilateral repair was more common; however, the incidence of unilateral repair rates decreased while bilateral IHR rates increased over the study period. Conclusion: Laparoscopic techniques are increasingly being used within public and private institutions across the country for inguinal hernia repair. There has also been a decrease in the incidence of IHR procedures performed per year over the 15-year period studied, consistent with published literature from Europe and the USA. Methods Data extraction Data regarding surgical procedures performed in Australia, in both public and private hospitals, are recorded by the AIHW. Data regarding IHRs were located within each financial year's
Background
Obstetric anal sphincter injuries (OASIs) are a significant complication of vaginal delivery, and a leading cause of anal incontinence in women.
Aims
The aims were to explore the management of OASIs in Australia and New Zealand (ANZ) by colorectal surgeons and how this compares with current recommendations and international experience, and to identify the deterrents to the provision of best‐practice care among colorectal surgeons.
Materials and Methods
Three hundred colorectal surgeons of the Colorectal Surgical Society of ANZ were mailed questionnaires. Areas of interest included: surgeon demographics; exposure to OASIs; understanding of current recommendations; and opinions regarding the importance of symptoms and assessment tools in OASIs.
Results
There were 94 completed questionnaires (response rate 31.3%). Fifty‐seven surgeons (60.6%) reported low exposure to OASIs during their fellowship training. Greater than 90% believed patients with grade three tears and above should have anal sphincter assessment. Sixty‐six (70.2%) reported that they routinely review women who have had OASIs. However, 56.4% were unaware if their obstetrics department followed a standard protocol for OASIs. Surgeons practising in metropolitan centres reported higher rates of their obstetrics department following a protocol (P = 0.013), and greater access to investigative tools (P < 0.001), when compared to rural‐based surgeons.
Conclusions
Most ANZ colorectal surgeons have had minimal training in OASI management. Colorectal surgeons are more commonly involved with OASI patients in the non‐acute setting. Management protocols involving a multidisciplinary team of both colorectal surgeons and obstetricians should be clearly defined, and the gap between metropolitan and rural centres needs to be reviewed.
BackgroundAdequate training and assessment of competency in surgical trainees are important in minimizing adverse events and achieving good patient outcomes. The purpose was to investigate the current literature on digitally supported methods of facilitating work‐based competency assessment of surgical trainees.MethodsTwo concurrent literature searches were performed by two independent researchers using three databases: MEDLINE, Embase and Education Resources Information Center. Eligible studies reported on digitally supported tools for assessing surgical competency in a work‐based setting for interns, residents or trainees of a post‐graduate surgical programme. Studies focusing primarily on training courses, simulations or other tools for assessing surgical skills in a setting outside of work were excluded. Articles published as abstracts only, articles not published in English and review articles that did not contain original data were excluded.ResultsA total of 11 eligible studies were included, with six of these implementing smartphone application‐based programmes, and five utilizing web‐based programmes. Five studies implemented the ‘System for Improving and Measuring Procedural Learning’ smartphone application. Studies were based predominantly on general surgery residents, and were limited to the North American context. There was significant variability between studies regarding methodology, including the scoring system used to assess competency.ConclusionThis review confirms that digitally supported competency assessment of surgical trainees in a work‐based setting is both feasible and effective. Digital platforms allow evaluations to be performed in a timely fashion without significant disturbance to workflow.
Percutaneous endoscopic gastrostomy (PEG) tube is a common procedure.
This discusses the rare complication of acute pancreatitis, due to tube
migration, causing obstruction of the ampulla of Vater. Radiological
confirmation of tubes prior to usage may aid in preventing this
reversible complication.
Percutaneous endoscopic gastrostomy (PEG) tube is a common procedure. This discusses the rare complication of acute pancreatitis, due to tube migration, causing obstruction of the ampulla of Vater. Radiological confirmation of tubes prior to the usage may aid in preventing this reversible complication.
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