Background In 2006, we reported results of a randomized trial of laparoscopic paraesophageal hernia repair (LPEHR), comparing primary diaphragm repair (PR) with primary repair buttressed with a ...biologic prosthesis (small intestinal submucosa SIS). The primary endpoint, radiologic hiatal hernia (HH) recurrence, was higher with PR (24%) than with SIS buttressed repair (9%) after 6 months. The second phase of this trial was designed to determine the long-term durability of biologic mesh-buttressed repair. Methods We systematically searched for the 108 patients in phase I of this study to assess current clinical symptoms, quality of life (QOL) and determine ongoing durability of the repair by obtaining a follow-up upper gastrointestinal series (UGI) read by 2 radiologists blinded to treatment received. HH recurrence was defined as the greatest measured vertical height of stomach being at least 2 cm above the diaphragm. Results At median follow-up of 58 months (range 42 to 78 mo), 10 patients had died, 26 patients were not found, 72 completed clinical follow-up (PR, n = 39; SIS, n = 33), and 60 repeated a UGI (PR, n = 34; SIS, n = 26). There were 20 patients (59%) with recurrent HH in the PR group and 14 patients (54%) with recurrent HH in the SIS group (p = 0.7). There was no statistically significant difference in relevant symptoms or QOL between patients undergoing PR and SIS buttressed repair. There were no strictures, erosions, dysphagia, or other complications related to the use of SIS mesh. Conclusions LPEHR results in long and durable relief of symptoms and improvement in QOL with PR or SIS. There does not appear to be a higher rate of complications or side effects with biologic mesh, but its benefit in reducing HH recurrence diminishes at long-term follow-up (more than 5 years postoperatively) or earlier.
Abstract Background The Early Specialization Program (ESP) surgery was designed by the American Board of Surgery (ABS), the American Board of Thoracic Surgery (ABTS) and the Residency Review ...Committees for Surgery and Thoracic Surgery to allow surgical trainees dual certification in general surgery (GS) and either vascular surgery (VS) or cardiothoracic surgery (CT) after 6-7 years of training. After > 10 years’ experience, this analysis was undertaken to evaluate efficacy. Study Design ABS and ABTS records of VS and CT ESP trainees were queried to evaluate Qualifying exam (QE) and Certifying exam (CE) performance. Case logs were examined and compared to contemporaneous non-ESP trainees. Opinions of Programs Directors (PD) of GS, VS and CT and ESP participants were solicited via survey. Results 26 CT ESP residents have completed training at 10 programs; 16 VS ESP at 6 programs. First time pass rates on ABS QE and CE exams were superior to time-matched peers; greater success in specialty specific examinations was also found. Trainees met required case minimums for GS despite shortened time in GS. By survey, 85% of PD endorsed satisfaction with ESP with 90% endorsing graduate readiness for independent practice. ESP participants report increased mentorship and independence, greater competence for practice, and overall satisfaction with ESP. Conclusions Individuals in ESP programs in VS and CT were successful in passing GS and specialty exams and achieving required operative cases despite an accelerated training track. PDs and participants report satisfaction with the training and confidence that ESP graduates are prepared for independent practice. This documented success supports ESP training in any surgical subspecialty, including comprehensive GS.
Background The majority of general surgery residents pursue fellowships. However, the relative demand for general surgical skills vs more specialization is not understood. Our objective was to ...describe the current job market for general surgeons and compare the skills required by the market with those of graduating trainees. Study Design Positions for board eligible/certified general surgeons in Oregon and Wisconsin from 2011 to 2012 were identified by review of job postings and telephone calls to hospitals, private practice groups, and physician recruiters. Data were gathered on each job to determine if fellowship training or specialized skills were required, preferred, or not requested. Information on resident pursuit of fellowship training was obtained from all residency programs within the represented states. Results Of 71 general surgery positions available, 34% of positions required fellowship training. Rural positions made up 46% of available jobs. Thirty-five percent of positions were in nonacademic metropolitan settings and 17% were in academic metropolitan settings. Fellowship training was required or preferred for 18%, 28%, and 92% of rural, nonacademic, and academic metropolitan positions, respectively. From 2008 to 2012, 67% of general surgery residents pursued fellowship training. Conclusions Most general surgery residents pursue fellowship despite the fact that the majority of available jobs do not require fellowship training. The motivation for fellowship training is unclear, but residency programs should tailor training to the skills needed by the market with the goal of improving access to general surgical services.
Reply Oelschlager, Brant K., MD, FACS; Pellegrini, Carlos A., MD, FACS; Mitsumori, Lee M., MD ...
Journal of the American College of Surgeons,
2012, Letnik:
215, Številka:
1
Journal Article
PDF