Patterns for nonoperative management of pediatric blunt splenic injuries (BSIs) vary significantly within and between institutions. The indications for repeated imaging, duration of activity ...restrictions, as well as the impact of volume and type of trauma center (pediatric vs. adult) on outcomes remain unclear.
A retrospective review of all patients younger than 16 years with BSI managed at a rural American College of Surgeons-verified adult Level II trauma center from January 1995 to December 2008 was completed. Patients were identified from the trauma registry by DRG International Classification of Diseases-9th Rev. (865.00-865.09) and management codes (41.5, 41.43, and 41.95). Variables reviewed included demographics, mechanism of injury, Injury Severity Score, grade of splenic injury, degree of hemoperitoneum, presence of arterial phase contrast blush on computed tomography at admission, admission and nadir hemoglobin level, blood transfused, length of stay, disposition, outpatient clinical and radiographic follow-up, interval of return to unrestricted activity, and clinical outcomes.
During the 13-year study period, 38 children with BSI were identified. Thirty-seven (97%) were successfully managed nonoperatively. Median grade of splenic injury was 3 (range, 1-5); 73% had moderate-to-large hemoperitoneum. Median Injury Severity Score was 10 (range, 4-34). Three patients with isolated contrast blush on initial computed tomography were successfully managed nonoperatively with no angiographic intervention. One patient failed nonoperative management and underwent successful splenorrhaphy. All patients were discharged home. Thirty-day mortality was zero. Median follow-up duration was 5.5 years, with no late complications identified. Of the patients successfully managed nonoperatively, 92% had their follow-up at our institution; 74% underwent subsequent imaging, and none resulted in intervention or alteration of management plan.
Pediatric BSI can be managed in adult trauma centers with success rates of nonoperative management comparable to dedicated children's hospitals. Routine follow-up imaging is not necessary. Overall splenic injury salvage rate in our experience was 100%.
Therapeutic/epidemiologic study, level IV.
Robotic-assisted surgical procedures are being increasingly used in general surgery, including in the rural and community setting. Although there is no requirement, general surgery residency programs ...have begun to incorporate curriculums to train residents in this discipline. As a small rural community program, we recently instituted a voluntary and structured curriculum, and our initial experience is shared here. Our curriculum was voluntary for all general surgical residents for the academic years 2016–2017. The curriculum consisted of online training, bedside training, console simulation, bedside assisting, and operating at the console. During the fiscal year of 2016, 193 robot-assisted surgeries performed within the General Surgery Department. Fourteen of fifteen residents participated in the curriculum, with the exception being a resident new to our program. A survey was sent to the residents to evaluate their opinions towards robotic surgery and the curriculum, with 12/15 residents responding. Overall, residents’ impressions were very favorable, with all reporting being either very or mostly satisfied with the curriculum and most, 58.4%, reporting there participating level on the robot to be appropriate. Importantly most, 91.7% did not think that the curriculum put an undue stress on their time or that it was detrimental to other aspects of their training. This study shows that a community rural general surgery program can incorporate a voluntary robotic curriculum effectively with high resident participation and satisfaction.
Surgery is an ever evolving discipline, and robotic-assisted procedures are the next generation of surgical techniques. There is currently no requirement for robotic training in surgical residency ...programs; thus, general surgery programs have incorporated it into their curriculums to varying degrees, including our recently adopted curriculum. As programs adopt new curriculum, it is unknown how applicants in community general surgery view the importance of robotic surgery for future procedures and its overall value in their training. To answer these questions, a voluntary and anonymous survey was given to all applicants of our community general surgery program and the responses assessed with descriptive statistics. The majority (76.92%) of our applicants believed robotic surgery would be very important in the future; however, less respondents (63.46%) believed that robotics would be very important to their particular career. While most (57.69%) reported being very interested in a program that offers robotic surgery, other respondents (53.85%) were indifferent toward a program that did not offer a robotics curriculum. Therefore, most applicants to our community program believe that robotic surgery will be an important part of surgery in upcoming years and most are very interested in a residency program that includes robotic surgery in the curriculum.
Amyloidosis is a group of diverse disorders that fall into several major categories: primary, secondary, dialysis-associated, and hereditary forms. Clinically, amyloidosis may be categorized as ...localized or systemic. The gastrointestinal tract is among the most common places for deposition of amyloid, but large, localized amyloid deposits are an uncommon occurrence and rarely cause extraluminal bowel compression resulting in obstruction as was seen in the case presented in this clinical scenario.
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