7 research outputs found
Factors influencing choice of inguinal hernia repair technique among surgeons and surgical trainees: a descriptive crosssectional Study in Kenyatta National Hospital, Nairobi-Kenya
No full textBackground: Inguinal hernia repair surgery is one of the most frequently performed
surgical procedures worldwide. Tension-free mesh repair has become a standard procedure
in the developed world due to the proven lower complication rates associated with this
technique. Clearly-defined structures for inguinal hernia repair training are present in the
West. However, in our setting, it is not known what factors influence surgeons and surgical
trainees’ choice with respect to operative technique, and whether this choice is influenced
by the evidence-base. This study sought to highlight factors that may influence decisions
concerning inguinal hernia repair techniques at Kenyatta National Hospital (KNH).
Objective: To establish the factors that influence the choice of inguinal hernia repair
technique among surgeons and surgical trainees at KNH.
Study design: This was a descriptive cross-sectional study
Study duration: One (1) month
Setting: Kenyatta National Hospital General Surgical Unit
Study Population: Surgeons and surgical trainees
Methodology: Data was collected through printed pre-tested questionnaires. Data
collected included: qualification of the operating doctor, level at which practical training on
inguinal hernia repair occurred, awareness of the surgeons and surgical trainees of the
various inguinal hernia repair methods, inguinal hernia repair method(s) used for the past
three (most recent) inguinal hernia operations and reasons for using that /those repair
method(s).
Data from all the doctors was entered into an MS access database, and exported to EpiData
and Stata software for analysis. Frequency tables and graphs have been used to present the
analyzed data.
Approval to carry out the study was sought from the KNH and University of Nairobi Ethics
and Research Committee Results: Fifteen (15) consultant surgeons and sixty (60) surgical trainees were recruited.
The modified Bassini is the repair method majority have been trained in (98.67% of the
respondents); followed by the Lichtenstein method. Training by an experienced peer (both
outside and during residency) is the most common way these two methods were learned by
the respondents. The most frequently used hernia repair method is the Lichtenstein method
(38.22%). The laparoscopic hernia repair methods (TAPP, TEP) – as opposed to the suture
and mesh repairs - are the least used (less than 3%). Some of the most frequently cited
reasons influencing choice of repair technique include: training on the technique, ease of
the technique, availability of repair material and equipment and decreased recurrent rate.
Conclusion: Training on the technique plays a big role in the choice of technique to use.
Residency is a critical time period for training in hernia surgery. Most trainees are trained
by their fellow peers. Limited resources act as a hindrance to the use of tension free hernia
repair methods (both open and especially laparoscopic).a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Keny
Inequalities in screening policies and perioperative protection for patients with acute appendicitis during the pandemic: Subanalysis of the ACIE Appy study
No full textDesign of a Novel Online, Modular, Flipped-classroom Surgical Curriculum for East, Central, and Southern Africa
No full textObjective: We describe a structured approach to developing a standardized curriculum for surgical trainees in East, Central, and Southern Africa (ECSA).
Summary background data: Surgical education is essential to closing the surgical access gap in ECSA. Given its importance for surgical education, the development of a standardized curriculum was deemed necessary.
Methods: We utilized Kern's 6-step approach to curriculum development to design an online, modular, flipped-classroom surgical curriculum. Steps included global and targeted needs assessments, determination of goals and objectives, the establishment of educational strategies, implementation, and evaluation.
Results: Global needs assessment identified the development of a standardized curriculum as an essential next step in the growth of surgical education programs in ECSA. Targeted needs assessment of stakeholders found medical knowledge challenges, regulatory requirements, language variance, content gaps, expense and availability of resources, faculty numbers, and content delivery method to be factors to inform curriculum design. Goals emerged to increase uniformity and consistency in training, create contextually relevant material, incorporate best educational practices, reduce faculty burden, and ease content delivery and updates. Educational strategies centered on developing an online, flipped-classroom, modular curriculum emphasizing textual simplicity, multimedia components, and incorporation of active learning strategies. The implementation process involved establishing thematic topics and subtopics, the content of which was authored by regional surgeon educators and edited by content experts. Evaluation was performed by recording participation, soliciting user feedback, and evaluating scores on a certification examination.
Conclusions: We present the systematic design of a large-scale, context-relevant, data-driven surgical curriculum for the ECSA region
Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study
No full textBackground: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P < 0·001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2
Inequalities in screening policies and perioperative protection for patients with acute appendicitis during the pandemic: subanalysis of the ACIE Appy study
No full textAcute appendicitis remains a common reason for hospital admission. Reports have suggested a reduction in patients attending emergency departments during the acute phase of the SARSCoV-2 pandemic. Moreover, a global surge in conservative management of acute appendicitis has recently been registered by the Appy Study of the Association of Italian Surgeons in Europe (ACIE)1. This is a treatment option that has been known for some years, although quite seldom used before the pandemic2–4. As most countries are experiencing new waves of the pandemic, the attitude of surgeons towards SARS-CoV-2 screening policies and personal protective equipment (PPE) used during the management of patients with acute appendicitis need to be established
PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK
No full textBackground
Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment.
Methods
All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals.
Results
A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death.
Conclusion
Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions
Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study
No full textBackground: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis.
Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic.
Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P < 0·001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe.
Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2
