Surgeons from the Dutch St. Radboud University Medical Centre recently presented the results of a prospective study on adhesiolysis in abdominal surgery. In this methodologically sound study, the ...authors provided substantial data on the consequences of adhesiolysis. Most patients who have undergone an abdominal operation in the past appear to have adhesions. During an adhesiolysis procedure, 10% of patients suffer intestinal damage, the operating time is prolonged and blood loss is more severe. Results of this prospective study revealed twice as many surgical complications; mortality was also much higher, the duration of hospitalisation was prolonged and the costs were higher. Adhesiolysis can have serious consequences for the patient, and this should be taken into account during shared decision-making on which patients should be eligible for re-laparotomy.
Feedback during laparoscopic training Spruit, Edward N; Band, Guido P H; Hamming, Jaap F
Nederlands tijdschrift voor geneeskunde,
2013, Letnik:
157, Številka:
23
Journal Article
A recent Danish study showed that instructor feedback significantly reduced the duration of training time needed for acquiring laparoscopic skills. While there is a clear advantage to trainees ...reaching a predetermined expert level of performance more rapidly, this does not necessarily imply that the skills were also acquired more efficiently. Experiencing continual feedback while undergoing a training task could reduce the level of difficulty in performing it; the presence of an instructor can also heighten emotional tension. Both of these factors can impair the learning process. For this reason, we recommend self-directed feedback during training on complex laparoscopic skills.
Giant true hepatic aneurysm mimicking Mirizzi syndrome Corion, Christine L S; Vriens, Patrick W H E; Alwayn, Ian P J ...
Journal of vascular surgery cases and innovative techniques,
12/2020, Letnik:
6, Številka:
4
Report
Giant true aneurysms of the hepatic arteries are rare. Pseudoaneurysms of the hepatic arteries are more common and are mostly caused by intra-abdominal infection, iatrogenic injury, or trauma. ...Hepatic or cystic pseudoaneurysms are often successfully treated by embolization owing to their saccular nature as opposed to true aneurysms. We present a case of a patient with a giant true aneurysm of the proper hepatic artery, mimicking Mirizzi syndrome. Open reconstruction was successfully preformed, and the patient made a full recovery.
Trainee feedback: trainer assessment Hamming, Jaap F; de Leede, Beatrijs J A
Nederlands tijdschrift voor geneeskunde,
2010, Letnik:
154
Journal Article
The quality of medical specialty education depends highly on the trainers, i.e. the specialists. Trainees are very important in the assessment of their trainers because they continuously undergo all ...the important aspects of the training. Currently, periodical announced visits take place, creating a formal atmosphere. A regular, semi-structured questionnaire for the trainees would be a better way of evaluating the program. Additionally there should be a thorough follow-up leading to a system with a process of continuous quality improvement.
To gauge the opinion of Dutch surgeons concerning the use of ultrasound and CT in the case of a suspected acute appendicitis.
Written survey.
All 1020 members of the Association of the Surgeons of ...the Netherlands received a questionnaire with 8 statements concerning the diagnosis of acute appendicitis. The statements could be answered with 'agree', 'disagree', or 'no opinion'.
The questionnaire was returned by 439 members (43%). A majority (64%) of these respondents established the diagnosis acute appendicitis on the basis of clinical symptoms, whereas a minority (22%) routinely performed ultrasound. For a classical presentation, 45% of the respondents thought ultrasound was indicated; for less than 3 classical symptoms, 70% of the respondents thought ultrasound was indicated. For women of fertile age, 74% of the respondents thought ultrasound was indicated. Approximately half (46%) of the surgeons always had access to a radiologist who could reliably perform ultrasound imaging, whereas 34% did not. The combination of ultrasound and CT was considered to be a reliable diagnostic procedure by 74% of the surgeons.
The majority of the surgeons considered acute appendicitis to be mainly a clinical diagnosis.
Background
From August 2006–August 2010, as part of the ISAF mission, the Armed Forces of the Netherlands deployed a role 2 enhanced Medical Treatment Facility (R2E-MTF) to Uruzgan province, ...Afghanistan. Although from the principle doctrine not considered a primary task, care was delivered to civilians, including many children. Humanitarian aid accounted for a substantial part of the workload, necessitating medical, infrastructural, and logistical adaptations. Particularly pediatric care demanded specific expertise and equipment. In our pre-deployment preparations this aspect had been undervalued. Because these experiences could be influential in future mission planning, we analyzed our data and compared them with international reports.
Methods
This is a retrospective, descriptive study. Using the hospital’s electronic database, all pediatric cases, defined as patients <17 years of age, who were admitted between August 2006 and August 2010 to the Dutch R2E-MTF at Multinational Base Tarin Kowt (MBTK), Urzugan, Afghanistan were analyzed.
Results
Of the 2736 admissions, 415 (15.2 %) were pediatric. The majority (80.9 %, 336/415) of these admissions were for surgical, often trauma-related, pathology and required 610 surgical procedures, being 26 % of all procedures. Mean length of stay was 3.1 days. The male to female ratio was 70:30. Girls were significantly younger of age than boys. In-hospital mortality was 5.3 %.
Conclusion
Pediatric patients made up a considerable part of the workload at the Dutch R2E-MTF in Uruzgan, Afghanistan. This is in line with other reports from the recent conflicts in Iraq and Afghanistan, but used definitions in reported series are inconsistent, making comparisons difficult. Our findings stress the need for a comprehensive, prospective, and coalition-wide patient registry with uniformly applied criteria. Civilian disaster and military operational planners should incorporate reported patient statistics in manning documents, future courses, training manuals, logistic planning, and doctrines, because pediatric care is a reality that cannot be ignored.
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