Although there was consensus, supported by grade A-C evidence, on patient selection, the safety of short-term nonoperative management, and mesh reinforcement, among experts; there was limited evidence and broad variability in practice patterns in all other areas of practice. The lack of strong evidence and expert consensus on these topics has identified gaps in knowledge where there is need of further evidence.

Bridged repair was associated with more SSOs than was PFC, and PFC should be used whenever feasible. Endoscopic and perforator-sparing CS were associated with the fewest complications; however, these conclusions are limited by heterogeneity between studies and poor methodological quality. These results should be used to guide future trials, which should compare the risks and benefits of each CS method to determine in which setting each technique will give the best results.

Local excision alone for T1 rectal adenocarcinomas is associated with low recurrence and good survival rates that remain durable with long-term follow-up. T2 lesions treated via local excision and adjuvant therapy are associated with higher recurrence rates.

Background Hernia formation is common following abdominal operations and transplant patients are at increased risk due to their need for postoperative immunosuppression. The purpose of this study is to estimate the incidence of incisional hernia formation following primary abdominal solid organ transplantation and identify clinical risk factors for hernia formation. Methods We performed a single-institution retrospective review of a prospectively collected database to evaluate all patients who underwent primary liver, kidney, or pancreas transplantation between 2000 and 2011. The primary outcome measure was hernia formation at the transplant incision. Univariate and multivariate Cox proportional hazards models were used to identify risk factors for incisional hernia formation. Results 3460 transplants were performed during the study period: 2247 kidney only, 718 liver only, and 495 pancreas or simultaneous pancreas and kidney (pancreas group). The overall incisional hernia rate was 7.5%. The Kaplan-Meier rates of hernia formation at 1, 5, and 10 years were 2.5%, 4.9%, and 7.0% for kidney; 4.5%, 13.6%, and 19.0% for liver; and 2.5%, 12.7%, and 21.8% for the pancreas groups. On univariate analysis, surgical site infection (SSI), body mass index (BMI) >25, delayed graft function (DGF), and absence of a calcineurin inhibitor or mycophenolic acid (MMF) were associated with hernia formation in the kidney group. SSI and BMI>25 were associated with hernia formation in the liver group. In the pancreas group, SSI, the use of cyclosporine, and lack of MMF were all associated with hernia formation. On multivariate analysis, SSI was strongly associated with hernia formation in all groups (Hazard Ratio (HR): Kidney = 24.71, p<0.001; Liver = 12.0, p<0.001, Pancreas = 12.95, p=0.001). Conclusion Incisional hernias are common following abdominal organ transplant with nearly one in five patients developing an incisional hernia five years after liver of pancreas transplantation. Strategies focusing on prevention and early treatment of SSI may help to decrease the risk of incisional hernia formation following abdominal organ transplantation.

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he current health care environment is extremely complex. Systems span regional and state boundaries to provide state-of-the-art care to patients with a wide variety of medical needs. Coronavirus disease 2019 (COVID-19) is a rapidly spreading pandemic that is challenging health care systems across the globe. Systems have faced varying complexities adapting to the new reality, and patients may pay a grievous price when the demand for medical and critical care exceeds the supply. This pandemic continues to escalate rapidly in hot spots nationally and internationally, and the worst strain on our health care systems may be yet to come.The importance of preparation is highlighted when we consider the needs of our own family members, whether for COVID-19associated care or another urgent medical condition. The inability to access potentially life-saving care because of lost opportunities to prepare is heartbreaking. The purpose of this article is to provide a road map developed from lessons learned from our experience in the

IMPORTANCEMistreatment is a common experience among surgical residents and is associated with burnout. Women have been found to experience mistreatment at higher rates than men. Further characterization of surgical residents' experiences with gender discrimination and sexual harassment may inform solutions.OBJECTIVE To describe the types, sources, and factors associated with (1) discrimination based on gender, gender identity, or sexual orientation and (2) sexual harassment experienced by residents in general surgery programs across the US. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional national survey study was conducted after the 2019 American Board of Surgery In-Training Examination (ABSITE). The survey asked respondents about their experiences with gender discrimination and sexual harassment during the academic year starting July 1, 2018, through the testing date in January 2019. All clinical residents enrolled in general surgery programs accredited by the Accreditation Council for Graduate Medical Education were eligible. EXPOSURES Specific types, sources, and factors associated with gender-based discrimination and sexual harassment.MAIN OUTCOMES AND MEASURES Primary outcome was the prevalence of gender discrimination and sexual harassment. Secondary outcomes included sources of discrimination and harassment and associated individual-and program-level factors using gender-stratified multivariable logistic regression models. RESULTSThe survey was administered to 8129 eligible residents; 6956 responded (85.6% response rate)from 301 general surgery programs. Of those, 6764 residents had gender data available (3968 [58.7%] were male and 2796 [41.3%] were female individuals). In total, 1878 of 2352 female residents (79.8%) vs 562 of 3288 male residents (17.1%) reported experiencing gender discrimination (P < .001), and 1026 of 2415 female residents (42.5%) vs 721 of 3360 male residents (21.5%) reported experiencing sexual harassment (P < .001). The most common type of gender discrimination was being mistaken for a nonphysician (1943 of 5640 residents [34.5%] overall; 1813 of 2352 female residents [77.1%]; 130 of 3288 male residents [4.0%]), with patients and/or families as the most frequent source. The most common form of sexual harassment was crude, demeaning, or explicit comments (1557 of 5775 residents [27.0%] overall; 901 of 2415 female residents [37.3%]; 656 of 3360 male residents [19.5%]); among female residents, the most common source of this harassment was patients and/or families, and among male residents, the most common source was coresidents and/or fellows. Among female residents, gender discrimination was associated with pregnancy (odds ratio [OR], 1.93; 95% CI, 1.03-3.62) and higher ABSITE scores (highest vs lowest quartile: OR, 1.67; 95% CI, 1.14-2.43); among male residents, gender discrimination was associated with parenthood (OR, 1.72; 95% CI, 1.31-2.27) and lower ABSITE scores (highest vs lowest quartile: OR, 0.57; 95% CI, 0.43-0.76). Senior residents were more likely to report experien...

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