Patient Experiences and Expectations Regarding Erectile Dysfunction Education Prior to Rectal Cancer Surgery: A Qualitative Study

Erectile dysfunction is common after surgery for rectal cancer with a prevalence of moderate to severe erectile dysfunction up to 35%. Preservation of sexual function is regarded as a core outcome in colorectal surgery. We wanted to investigate male patients' perspectives on preoperative education about the risk of erectile dysfunction after surgery for rectal cancer. Using an interview guide, we performed individual semi-structured interviews with male patients who had surgery for rectal cancer within the past 3-12 months. The interviews were transcribed, condensed, coded, and analyzed with inductive qualitative content analysis. We interviewed 13 male patients. Their perspectives were condensed in four main themes: importance of a partner to be present at the preoperative counseling; information as crucial; wishful thinking as a coping strategy; and the need for direct information to avoid unrealistic expectations. Patients described general gratitude across the entire process but a lack of follow-up regarding erectile function. Surgeons should actively engage in a discussion with patients regarding the risk of developing erectile dysfunction. Importance might differ since patients have different preoperative erectile functions and different postoperative needs. A partner or close relative should participate in the preoperative counseling.

Quality of Life and Working Conditions of Plastic Surgeons and Trainees: A National Survey

BACKGROUND

While the well-being and working conditions of healthcare professionals are increasingly scrutinized, there remains a critical research gap regarding the quality of life and job satisfaction of plastic surgeons in Switzerland. No prior national study has systematically examined these aspects within this specialty.

OBJECTIVE

This study aims to address this gap by evaluating workload, career satisfaction, and quality of life among Swiss plastic surgeons and trainees, thereby providing evidence to inform systemic improvements in the profession.

METHODS

A national, multilingual online survey was distributed to all members of the Swiss Society for Plastic Surgery and the Association of Young Plastic Surgeons. A total of 102 plastic surgeons responded (response rate: 22.7%). The survey assessed contractual versus actual working hours, work performed during personal time, mental health indicators (e.g., burnout), and career satisfaction. Descriptive and correlational analyses were conducted.

RESULTS

The respondents reported an average of 58 actual versus 49 contractual working hours per week, with an additional 8.1 h spent working during leisure time. Burnout symptoms were present in 29%, and 63% experienced work-related stress during their free time. While 42% wished to reduce their workload, 88.7% would still choose the profession again. Career satisfaction averaged 3.66/5, although 35% rated their salary as inadequate. Notably, 79.8% reported work negatively affecting private relationships, despite 82.65% feeling supported by their environment.

CONCLUSION

This first nationwide assessment highlights the high workload and psychological strain faced by Swiss plastic surgeons. Key priorities include targeted burnout prevention, structural workload reduction, enhanced support for work-life integration (especially among women and younger surgeons), and improved compensation. These measures are essential to sustain the well-being of practitioners and ensure long-term quality in surgical care.

Effects of low anterior resection syndrome after colorectal cancer resections on health-related quality of life: a systematic review and meta-analysis

BACKGROUND

Low anterior resection syndrome (LARS) is a term that encompasses multidimensional bowel dysfunction that typically occurs following resections of rectum and distal parts of the colon. We aimed to systematically assess the available literature on the effects of bowel dysfunction after colorectal cancer (CRC) surgeries on health-related quality of life (HRQOL) and conduct a meta-analysis.

METHODS

Studies were included if they assessed patients who had undergone sphincter-preservation surgeries for CRC. Studies were eligible if they assessed bowel dysfunction using the LARS score and HRQOL using the European Organization for Research and Treatment Core Quality-of-Life Questionnaire (EORTC QLQ-C30).

RESULTS

Of 1410 reports, 28 studies were included. According to the analyses, patients with major LARS had lower global health status [weighted mean differences (WMD) = - 10.98; 95% confidence interval (CI) - 13.18, - 8.79], physical functioning (WMD = - 5.96; 95% CI - 7.40, - 4.52), role functioning (WMD = - 10.59; 95% CI - 12.54, - 8.63), emotional functioning (WMD = - 11.09; 95% CI - 14.34, 7.84), cognitive functioning (WMD = - 9.27; 95% CI - 12.22, - 6.32), and social functioning (WMD = - 15.73; 95% CI - 18.82, - 12.63) and higher scores of symptoms compared to patients with minor/no LARS.

CONCLUSIONS

The study findings suggest that patients with major LARS experience worse HRQOL compared to those with minor/no LARS.

REGISTRATION

PROSPERO, CRD42023479657.

Congenital absence of omentum with short bowel syndrome: a case report

INTRODUCTION

Short bowel syndrome can manifest as either an inherited or acquired condition, with the inherited form occurring sporadically. Furthermore, the complete absence of the omentum at birth (congenital absence) is a highly uncommon event.

CASE REPORT

This case report presents a unique confluence of these rare conditions in a 38-year-old Iranian male with a prior history of intestinal obstruction requiring right hemicolectomy and ileostomy. He subsequently presented to the emergency department experiencing intense abdominal pain and swelling in his lower extremities. Laboratory investigations revealed an elevated white blood cell count and metabolic alkalosis. During the surgical exploration prompted by his acute presentation, both congenital absence of the omentum and short bowel syndrome were confirmed. A jejunostomy was performed, but unfortunately, this intervention resulted in severe malabsorption and subsequent cachexia. This case sheds light on the rare occurrence of anastomotic leakage and subsequent peritonitis following right hemicolectomy and ileostomy in a patient with the combined conditions of congenital short bowel and congenital absence of the omentum.

CONCLUSION

This unique presentation highlights the potential complexities that can arise due to the convergence of these rare medical conditions.

Comparing the impact of foot and hand reflexology on anxiety and physiological indices in colonoscopy candidates: A randomized clinical trial

Introduction and objective

Colonoscopy is a standard diagnostic procedure, yet pre-procedural anxiety remains a prevalent concern. While pharmacological interventions are available, non-pharmacological approaches such as reflexology offer a promising alternative. Despite its therapeutic potential, comparative evidence on foot and hand reflexology in this setting is limited. This study aimed to evaluate their effects on pre-colonoscopy anxiety and physiological parameters.

Methods

This randomized clinical study was conducted from November 2022 to August 2023 at the Amir al-Momenin Educational and Therapeutic Center in Arak, Iran. A total of 105 patients were randomly assigned to three equal-sized groups (n = 35) using block randomization: foot reflexology, hand reflexology, and a control group. Patients in the intervention groups received a 30-min reflexology session. Anxiety levels were assessed using the Spielberger State-Trait Anxiety Inventory (STAI-Y1), a validated tool for measuring situational anxiety. Physiological indices, including systolic and diastolic blood pressure, heart rate, and arterial oxygen saturation (SpO2), were measured immediately before and after the intervention.

Results

There were no significant differences in clinical outcomes among the groups at baseline (p > 0.05). However, following the intervention, the mean anxiety scores in both reflexology groups (foot reflexology: 44.39 ± 5.21; hand reflexology: 45.6 ± 4.49) were significantly lower than that of the control group (48.05 ± 4.81) (p = 0.008), as determined by one-way analysis of variance (ANOVA). The anxiety reduction was more pronounced in the foot reflexology group than the hand reflexology group, although this difference did not reach statistical significance (p > 0.05). Additionally, post-intervention assessments revealed significant differences in systolic blood pressure (foot reflexology: 123.48 ± 16.40 mmHg; hand reflexology: 122.65 ± 14.97 mmHg; control group: 132.14 ± 18.48 mmHg) and heart rate (foot reflexology: 78.60 ± 9.54 bpm; hand reflexology: 78.25 ± 11.41 bpm; control group: 85.05 ± 10.82 bpm) across the groups (p < 0.05). However, no significant differences were observed for diastolic blood pressure or arterial oxygen saturation (SPO2) between groups (p > 0.05).

Conclusion

The findings of this study indicate that reflexology, particularly foot reflexology, can significantly reduce anxiety and lead to improvements in physiological parameters, such as systolic blood pressure and heart rate, in patients undergoing colonoscopy. These results highlight the potential of reflexology as an effective complementary method for managing anxiety and enhancing patient comfort during medical procedures.

Minimally Invasive Surgical Technique for the Extraperitoneal Fixation of Acetabulum Fracture: Technical Feasibility Study in Cadaver

Background and Objectives: When operating on acetabular fractures in conventional open surgery, visualization of crucial structures can be challenging. In recent years there have been several case reports on laparoscopy-assisted acetabulum surgery in the literature. Therefore, we have developed this method further using extraperitoneal endoscopy to manage acetabulum fractures. Methods: Operative technique: An experienced hernia surgeon familiar with the totally extraperitoneal laparoscopic technique facilitates access to the acetabulum area so that orthopaedic surgeons can focus on fixing the area with a plate and screws through laparoscopy ports. Results: We developed this operative technique in a cadaver laboratory where we could easily fix and plate the acetabulum area with extraperitoneal endoscopy visualization in seven cadavers both on the left and right sides. Conclusions: A minimally invasive full endoscopic procedure for acetabular fractures offers significant benefits over traditional open surgery due to faster rehabilitation, potentially less blood loss, and fewer wound complications. According to our initial experiences with cadavers, this minimally invasive method appears promising in terms of superior visibility and easier access to the otherwise narrow and difficult fracture site in the pelvic region compared to open surgery. Furthermore, this minimally invasive method seems feasible for exact plate placement under combined endoscopic and fluoroscopic visual control. The usefulness of this novel method in the minimally invasive treatment of acetabular fractures in real life, especially considering the practicality of proper fracture reduction, should be confirmed in future clinical trials.

The impact of death and caring for the dying and their families on surgeons - an AI assisted systematic scoping review

CONTEXT

Surgeons are taking central roles in caring for patients leaving them prone to the emotional turmoil and grief of patients and families and the moral, psychological and existential distress of members of the interprofessional team and trainees. This has implications on patient safety and surgeon welfare.

OBJECTIVES

A systematic scoping review was carried out to address the primary research question "what is known of the effects of caring for the dying and the impact of patient's death on surgeons?". It is hoped that the insights gained will better guide support and assessment of surgeons in their evolving roles.

METHODS

Guided by the Systematic Evidence-based Approach (SEBA), we conducted a systematic scoping review (SSR). This review included articles published between 1st January 2000 and 2nd September 2024 on Pubmed, Embase, Scopus, Google Scholar, ERIC databases. To enhance trustworthiness and enhance the comprehensiveness of our review the articles identified were also evaluated using ChatGPT 4o and Notebook LM. The findings of these assistive processes were compared with the independent thematic and content analysis carried out by the two research teams.

RESULTS

In total, 4966 titles and abstracts were identified, 174 full-text articles were reviewed, and 26 full-text articles analysed. With the findings of the assistive analysis by the AI tools echoing the findings of the research teams- two key domains were identified: (1) the impact on personhood, (2) predisposing factors.

CONCLUSION

This AI assisted SSR in SEBA confirms that surgeons do suffer from the cumulative effects of caring for dying patients and their families and from the death of the patient and supporting the family and members of the interprofessional team and trainees. Without timely and personalized support surgeons are prone to depression, burnout, and substance abuse, and compromises to patient and family experiences, outcomes, safety and satisfaction. The need for effective longitudinal and personalized assessment tools is clear.

Effects of a couple-based self-efficacy intervention on health outcomes among colorectal cancer patients and spousal caregivers: A randomized controlled trial

PURPOSE

This study aimed to assess the feasibility and acceptability of a couple-based self-efficacy (SE) intervention, and to examine the effects of the intervention on health outcomes for CRC couples.

METHODS

An assessor-blinded, two-armed, randomized controlled design was used. The study randomly assigned 144 patients hospitalized for colorectal cancer to receive either the SE intervention or the usual care. SE was the primary outcome. The secondary outcomes included quality of life and mental health (positive emotions and negative emotions). Repeated measures analysis of variance was used to examine the data.

RESULTS

The recruitment and retention rates were 80% and 87.5%, respectively. First, we found that patients scored significantly higher on anxiety (p = 0.001), depression (p = 0.001) and benefit findings (p = 0.009) than did spousal caregivers, whereas spousal caregivers scored significantly higher than patients on the quality of life (p < 0.001 for both physical scores and mental scores) in the SE group. Second, immediately after the intervention, the SE group showed statistically significant improvements were found in SE (p < 0.001 for both couples), quality of life (mental scores) (p = 0.002 for spousal caregivers), negative emotion (anxiety, p < 0.05 for both couples; depression, p = 0.03 for patients), and positive emotion (benefit findings) (p < 0.001 for both couple) when compared to the control group.

CONCLUSION

A couple-based SE intervention significantly improved SE, quality of life (mental scores), and psychological well-being, suggesting a short-term intervention effect.

Management and outcome of mesh infection after abdominal wall reconstruction in a tertiary care center

PURPOSE

Abdominal wall reconstruction is a common surgical procedure, with a post-operative risk of mesh-associated infection of which management is poorly known. This study aims to comprehensively analyze clinical and microbiological aspects of mesh infection, treatment modalities, and associated outcomes.

METHODS

Patients with abdominal mesh infection were included in a retrospective observational cohort (2010-2023). Patients characteristics and management were described, and determinants for failure were assessed by logistic regression and treatment failure-free survival curve analysis (Kaplan-Meier).

RESULTS

Two hundred and nine patients (median age, 62 [IQR, 55-71] years) presented a mesh infection occurring within 15 (IQR, 7-31) days after surgery, mainly as an abdominal wall or deep abscess (n=189, 90.4%). Infection was polymicrobial in 89/166 (79.4%) cases, S. aureus (n=60, 36.1%), Enterobacteriaceae (n=60, 36.1%) and anaerobes (n=40, 24.1%) being the most prevalent pathogens. Surgery was performed in 130 (62.2%) patients, associated with a 13.5 (IQR, 8-21) day course of antimicrobial therapy in 172/207 (83.1%) cases. Sixty-three (30.1%) treatment failures occurred, associated with previous multiple abdominal surgeries (OR, 3.305; 95%CI, 1.297-8.425), complete mesh removal (OR, 0.145; 95%CI, 0.063-0.335) and antimicrobial therapy (OR, 0.328; 95%CI, 0.136-0.787). The higher failure rate of conservative strategies was associated with symptom duration >1 month (OR, 3.378; 95%CI, 1.089-4.005) and retromuscular mesh position (OR, 0.444; 95%CI, 0.199-0.992).

CONCLUSION

Mesh infection is associated with high treatment failure rates. Complete mesh removal coupled with targeted antibiotic therapy is associated with better outcomes. Conservative treatment strategies must rely on careful patient selection based on symptom duration and mesh placement.

Platelet-rich Plasma as an Adjuvant Therapy to Crystallized Phenol in the Treatment of Pediatric Pilonidal Sinus Disease: A Prospective Randomized Controlled Trial

OBJECTIVE

This study aims to evaluate the safety and efficacy of platelet-rich plasma (PRP) as an adjuvant to crystallized phenol (CP) in treating pediatric pilonidal sinus disease (PSD).

METHODS

A single-center randomized controlled trial was conducted at Istanbul Esenyurt Hospital. Eighty-seven patients aged 0-18 were randomly assigned to two groups: the CP group (n = 42) and the CP + PRP group (n = 45). Upon arrival at the clinic, patients began a regimen of manual shaving and, if necessary, laser epilation every 6-8 weeks. For those with pilonidal abscesses, incision, drainage, and antibiotics were given. The treatment area was sterilized and numbed with local anesthesia. Hair removal and curettage were performed, followed by the application of crystallized phenol. In CP + PRP group, PRP injections were also administered. The procedure concluded with wound dressing and thorough disinfection. The study was registered https://clinicaltrials.gov/ (NCT06324656).

RESULTS

The CP + PRP group demonstrated significantly shorter healing times (19.4 ± 7.88 days) compared to the CP group (30.7 ± 12.9 days) (p < 0.001). The cosmetic score was higher in the CP + PRP group (7.42 ± 1.61) than in the CP group (6.11 ± 1.88, p = 0.001). CP + PRP group had lower VAS scores at measured all-time points after applications (p < 0.05 for each). Complications were comparable between the groups, with no significant differences in bleeding, infections, or skin burns (p > 0.05 for each comparison). No difference was found between groups in terms of total complication rate (p = 0.398). The success rate was higher in CP + PRP group (98%; n = 44) compared to CP group (86%; n = 36) (p = 0.039). Recurrence rates were lower in CP + PRP group (2%; n = 1) than CP group (14%; n = 6) (p = 0.039).

CONCLUSION

The autologous PRP injection in pediatric PSD is safe. The addition of PRP to CP treatment for pediatric PSD significantly improves healing time, cosmetic outcomes, and overall success rates without increasing complication rates. This combined approach offers a promising alternative for effective and efficient treatment of PSD in children.

TYPE OF THE STUDY

Randomized controlled trial.

LEVEL OF EVIDENCE

Level I.

Clitoral reconstruction and psychosexual care after female genital mutilation/cutting: Assessment of multidisciplinary care

BACKGROUND

Multidisciplinary care following female genital mutilation/cutting (FGM/C) can consist of surgical interventions such as clitoral reconstruction (CR) in combination with individualized psychosexual care (PC). Evidence on both treatments, alone or in association, is limited.

OBJECTIVES

To investigate the overall satisfaction with PC only or PC in combination with CR.

DESIGN

Cross-sectional study of women who attended the FGM/C outpatient clinic under study and asked for CR between January 2013 and November 2021.

METHODS

Data were collected through questionnaire-based interviews on motivations for asking for CR, psychological well-being (World Health Organization-Five Well-Being Index), sexual response (Female Sexual Function Index), vulvar pain, genital self-image (Female Genital Self-Image Scale), overall satisfaction with the care received, and, in the case of CR, postoperative complications.

RESULTS

The 20 women included underwent therapy primarily to feel repaired or reconstructed and to improve their sexual function. Mean overall satisfaction with the care was rated 8.95/10 ± 1.39. Twelve (60%) received CR in combination with PC. Eight (40%) received PC only. Women who received combined therapy reported higher overall satisfaction (9.17 versus 8.57), psychological well-being (17.8 versus 9.25), sexual response (31.22 versus 21.56), and genital self-image (25.60 versus 17.60) in comparison with those who only received PC. The main surgical complications were minor postoperative bleeding and one painful wound infection triggering a relapse of posttraumatic stress disorder.

CONCLUSION

Tailored PC and CR after FGM/C seem to improve psychosexual health, well-being, body image, and pain.Registration: ClinicalTrials.gov (NCT05026814).

Streamline Flow of the Portal Vein Affects the Distribution of Colorectal Cancer Metastases: Clinical Reality or Just a Belief? A Systematic Review and Meta-Analysis

Background: The "streamline flow" of the portal vein (PV) is a controversial yet well-known theory presented almost 125 years ago. It states that blood from the superior mesenteric vein (SMV) goes preferentially to the right liver lobe, while splenic and inferior mesenteric veins divert blood predominantly to the left lobe, affecting this way the metastatic distribution of colorectal cancer (CRC). The aim of this systematic review is to assess its validity by examining and combining all the relevant literature with a critical eye. Materials and methods: This study constitutes a systematic review of the literature and adheres to all PRISMA system criteria. Three search engines (PubMed, Google Scholar, and the Cochrane Library) were used, and 11 out of 435 studies between 1984 and 2024 were finally included in this meta-analysis. All statistical analysis was conducted using RevMan Web, Version: 7.12.0, and Jamovi v 2.3.260 software. Results: The meta-analysis revealed that regardless of the primary location of the tumor, the metastases preferentially migrate to the right lobe due to various possible reasons. The prevalence of metastases from right colon cancer to the right liver lobe was 75%, while the prevalence of left colon cancer metastases to the right lobe was 68%. This difference was not found statistically significant. Conclusions: The theory has been proven inaccurate, at least from the perspective of the origin-associated distribution of CRC metastases in the liver lobes, and therefore bears no clear predictive value. Further research under different perspectives is essential for determining more definite conclusions.

The impact of patient death on the risk of developing occupational burnout in midwives a preliminary cross-sectional study

The study aimed to assess the impact of experienced emotional states on the risk of the development of occupational burnout in midwives who experienced the death of a patient while on duty. The study was conducted on 54 midwives in Warsaw, Poland. We used the Oldenburg Burnout Inventory (OLBI) and the author's questionnaire. The average professional burnout level of midwives participating in the study was determined as 5.08 ± 0.67. Helplessness (57.4%) and depression (48.1%) were the most frequently experienced emotions. The number of deaths of patients experienced by the respondents did not affect the severity of burnout (Z = - 0.753; p > 0.05). However, midwives who declared that they had experienced the death of a patient more than 10 times while on duty were more likely to experience a feeling of relief (2.83 vs. 2.00; Z = - 2.30; p < 0.05) and calmness (2.97 vs. 2.24; Z = - 1.95; p < 0.05). The experienced depression positively correlated with the level of exhaustion (rho = 0.465; p < 0.001) and the overall level of occupational burnout (rho = 0.291; p < 0.05). However, it was not correlated with the level of disengagement (p > 0.05). Depression has a significant impact on the risk of developing occupational burnout, which highlights the need to develop and implement effective support methods for midwives experiencing difficult emotions related to the death of patients while on duty.

NAMAH-An Innovative Tele-ECHO Mentoring Program to Foster Well-being Among Physicians

Background

The current study aimed to develop and implement the National Assistance in Mental Health for Health Care Providers (NAMAH) module, which focused on wellness and building resilience for a cohort of physicians.

Methods

The NAMAH module is a 12-week tele-mentoring program leveraging videoconference technology that uses the ECHO (Extension of Community Healthcare Outcome) HUB and SPOKE and consists of real-life case discussions and a brief didactic. The module's content was developed after iterative feedback from experts and incorporated suggestions from healthcare providers (HCPs) following a needs assessment. A pre and post-design was used to assess the impact of the module on psychological distress using the self-reported Kessler Psychological Distress Scale (K10) and burnout using the Maslach Burnout-Inventory-Human Services Survey (MBI-HSS) among the 32 physicians who participated.

Results

There was a significant decrease in the mean scores before (19.5 ± 6.27) and after (17.38 ± 6.23) the NAMAH module (p < .05) in the psychological distress as measured by K 10 with a Cohen's d of 0.41 (95% CI: 0.05-0.77). There was also a significant decrease in the mean scores after the intervention in the emotional exhaustion and depersonalization domain of the MBI-HSS with a medium effect size (Cohen's d of 0.65) and large effect size (Cohen's d of 0.94), respectively.

Conclusion

The findings from this pilot study lay a foundational framework, encouraging further exploration, research, and scaling-up of such interventions to enhance mental health among physicians and HCPs.

Beyond the operating room: addressing the "second-victim" phenomenon in surgical practice

Complications are plausible events during surgical operations. Surgical complications profoundly impact surgeons, often called "second victims" of adverse events. These complications trigger a range of emotional and psychological responses, including guilt, anxiety, heightened empathy, and the looming threat of burnout. Moreover, the toll extends to physical health, with chronic stress and sleep disturbances taking their toll. Surgeons' social lives are not immune to the fallout, and their career satisfaction may wane, pushing some towards defensive medicine practices. While mentorship, counselling, and peer support are crucial support mechanisms, they encounter barriers such as time constraints and the fear of negative perceptions. This paper suggests practical recommendations, including comprehensive wellness programmes, a streamlined badge card system for easy access to resources, and mindfulness training to mitigate stress and burnout. Recognising and proactively addressing these multifaceted impacts is imperative for cultivating a resilient medical community capable of providing optimal patient care.

Does portal vein anatomy influence intrahepatic distribution of metastases from colorectal cancer?

BACKGROUND

Other than location of the primary colorectal cancer (CRC), a few factors are known to influence the intrahepatic distribution of colorectal cancer liver metastases (CRLM). We aimed to assess whether the anatomy of the portal vein (PV) could influence the intrahepatic distribution of CRLM.

PATIENTS AND METHODS

Patients with CRLM diagnosed between January 2018 and December 2022 at two tertiary centers were included and imaging was reviewed by two radiologists independently. Intra-operator concordance was assessed according to the intraclass correlation coefficient (ICC). The influence of the diameter, angulation of the PV branches and their variations on the number and distribution of CRLM were compared using Mann-Whitney, Kruskal-Wallis, Pearson's Chi-square and Spearman's correlation tests.

RESULTS

Two hundred patients were included. ICC was high (> 0.90, P < 0.001). Intrahepatic CRLM distribution was right-liver, left-liver unilateral and bilateral in 66 (33%), 24 (12%) and 110 patients (55%), respectively. Median number of CRLM was 3 (1-7). Type 1, 2 and 3 portal vein variations were observed in 156 (78%), 19 (9.5%) and 25 (12%) patients, respectively. CRLM unilateral or bilateral distribution was not influenced by PV anatomical variations (P = 0.13), diameter of the right (P = 0.90) or left (P = 0.50) PV branches, angulation of the right (P = 0.20) or left (P = 0.80) PV branches and was independent from primary tumor localisation (P = 0.60). No correlations were found between CRLM number and diameter (R: 0.093, P = 0.10) or angulation of the PV branches (R: 0.012, P = 0.83).

CONCLUSIONS

PV anatomy does not seem to influence the distribution and number of CRLM.

Platelet-Rich Plasma in Pediatric Surgery: A Comprehensive Review

Platelet-Rich Plasma (PRP) therapy has become a promising treatment option in pediatric surgery, offering a novel approach to tissue repair and regeneration. Obtained from the patient's own blood or umbilical cord blood (CB), PRP is a concentrated form of plasma enriched with platelets, growth factors, and cytokines essential for stimulating tissue healing. This systematic review explores the applications of PRP therapy in pediatric surgical procedures, focusing on its role in promoting wound healing, reducing postoperative complications, and enhancing patient outcomes. A systematic literature overview was conducted in accordance with PRISMA guidelines, encompassing studies published between 2004 and 2024. The research has identified different fields of application for PRP therapy in pediatric surgery, including treatment of pilonidal sinus and hypospadias repair. Key findings from clinical studies and randomized controlled trials are summarized, highlighting the efficacy of PRP therapy in accelerating wound healing, reducing pain, and improving patient recovery. Despite promising results, challenges and controversies surrounding PRP therapy persist, including variability in preparation protocols and optimal dosing regimens. The safety of PRP therapy in pediatric patients is also discussed, emphasizing its autologous nature and minimal risk of adverse reactions. In summary, this review highlights the role of PRP therapy as a safe and effective therapeutic approach in pediatric surgery, while further research to standardize protocols and elucidate optimal treatment strategies are still necessary.

Systematic Review of Platelet-Rich Plasma in Medical and Surgical Specialties: Quality, Evaluation, Evidence, and Enforcement

Background: Platelet-rich plasma (PRP) is widely used in various medical and surgical specialties for its regenerative properties, including aesthetics (facial rejuvenation, hair restoration, and skin tightening) and orthopedics (treatment of tendinitis and osteoarthritis). However, the inconsistent literature on PRP's efficacy and safety leads to critical knowledge gaps. This systematic review evaluates quality control measures in PRP preparation and application and explores the regulatory environment governing its clinical use. Methods: Following PRISMA guidelines, a comprehensive search was conducted across multiple databases, including PubMed, EMBASE, and Web of Science, for studies published from January 2020 to April 2024. The review included randomized controlled trials (RCTs) involving human participants undergoing PRP treatment for aesthetic or regenerative purposes. Key parameters such as the PRP preparation methods, platelet concentration, and quality control measures were analyzed. The study protocol was registered with PROSPERO (ID: CRD42024557669). Results: Out of 75 RCTs involving 5726 patients, the review identified significant variability in PRP preparation methods and application techniques, including differences in centrifugation protocols and platelet concentration levels. A new evidence-based scoring system, the William-Eqram Scoring System for PRP Quality Reporting (WESS-PQR), was proposed to address these inconsistencies. Correlation analysis revealed a strong positive correlation (r = 0.79) between proper temperature control during preparation and PRP efficacy. Initial platelet count assessment showed a moderate positive correlation (r = 0.57) with efficacy. Conclusions: Standardized PRP preparation protocols and robust regulatory frameworks are urgently needed to ensure the safety and efficacy of PRP treatments. The proposed WESS-PQR scoring system can serve as a valuable tool for clinicians and researchers, promoting consistency and reliability in PRP applications.

The Effect of Platelet-Rich Plasma on the Healing of Nasal Mucosa After Surgery of the Nose: A Randomized Clinical Trial

Purpose

To investigate the effect of platelet-rich plasma (PRP) on the healing of nasal mucosa after surgery of the nose.

Methods

This prospective, randomized, Comparative Analytic study was conducted on 40 patients. Patients were randomly allocated into two groups: Group A, subjected to PRP, and Group B, who were not subjected to PRP after nasal surgery. The outcome of both Techniques was analyzed and compared.

Results

Significant differences were found in dryness, encrustations, and postoperative healing days in the PRP group. However, no significant differences between the two groups were observed in primary bleeding, secondary bleeding, nasal synechiae, pain, healing time, return to physical activity, and patient satisfaction.

Conclusion

Our study detects the potential hopeful effect of PRP on postoperative wound healing of nasal mucosa, dryness, and nasal crustations. According to these results, the application of PRP post-nasal surgery can be considered an effective method for maintaining post-nasal surgery Mucosa.

Late-Onset Mesh Infection Manifesting as Preperitoneal Abscess and Cutaneous Fistula Post-TEP Inguinal Hernia Repair: A Case Report

BACKGROUND Endoscopic inguinal hernia repair has become the preferred technique currently. The use of mesh to facilitate a tension-free reinforcement has become the standard of care during endoscopic totally extraperitoneal (TEP), laparoscopic transabdominal pre-peritoneal, and open inguinal hernia repair. Although uncommon, late-developing mesh infections, defined as those occurring in the surgical site months or years after the procedure, can lead to severe complications. To achieve the best possible outcome for the patient, prompt imaging and a multidisciplinary approach to management, including complete surgical removal of the contaminated mesh and proper antibiotic therapy, are crucial. CASE REPORT A 39-year-old woman presented with a 1-month history of intermittent fever, progressive lower abdominal pain and fullness, and purulent discharge from the abdominal wall. Her medical history was significant for an endoscopic right TEP inguinal hernia repair performed 3 years earlier, which involved the use of an anatomic mesh and titanium screws. Physical examination and ultrasound findings revealed a large preperitoneal abscess with cutaneous fistulization, secondary to a deep-seated mesh infection. Pseudomonas aeruginosa was identified as the causative pathogen. She underwent a 2-step surgical procedure, including an initial fistulectomy followed by endoscopic abscess drainage and surgical excision of the infected mesh, combined with antimicrobial therapy, resulting in an excellent clinical response and complete resolution. This strategy also allowed for an effective assessment of the abdominal wall integrity. CONCLUSIONS This case underscores the importance of considering late-developing mesh infections in patients presenting with abdominal symptoms who have previously undergone TEP hernia repair, even years after the initial surgery.

Evaluating frailty using the modified frailty index for colonic diverticular disease surgery: analysis of the national inpatient sample 2015-2019

BACKGROUND

Frailty has been associated with increased postoperative mortality and morbidity; however, the use of the modified frailty index (mFI-11) to assess patients undergoing surgery for diverticular disease has not been widely assessed. This paper aims to examine frailty, evaluated by mFI-11, to assess postoperative morbidity and mortality among patients undergoing operative intervention for colonic diverticular disease.

METHODS

We used data from the Healthcare Cost and Utilization Project National Inpatient Sample (October 1, 2015-December 31, 2019). ICD-10-CM codes were utilized to identify a cohort of adult patients with a primary admission diagnosis of diverticulitis. mFI-11 items were adapted to correspond with ICD-10-CM codes. Patients were stratified into robust (mFI < 0.27) and frail (mFI ≥ 0.27) groups. Primary outcomes were in-hospital postoperative morbidity and mortality. Secondary outcomes included system-specific postoperative complications, length of stay (LOS), total admission cost, and discharge disposition. Multivariable regression models were fit.

RESULTS

Of the 26,826 patients, there were 24,194 patients with mFI-11 < 0.27 (i.e., robust) and 2,632 patients with mFI-11 ≥ 0.27 (i.e., frail). Adjusted analysis showed significant increases in postoperative mortality (aOR 2.16, 95% CI 1.38-3.38, p = 0.001) and overall postoperative morbidity (aOR 1.84, 95% CI 1.65-2.06, p < 0.001). LOS was higher in the frail group (MD 1.78 days, 95% CI 1.46-2.11, p < 0.001) as well as total cost (MD $25,495.19, 95% CI $19,851.63-$31,138.75, p < 0.001).

CONCLUSION

In the elective setting, a high mFI-11 (i.e., presence of the variables comprising the index) could alert clinicians to the possibility of implementing preoperative optimization strategies. In the emergent setting, a high mFI-11 may help guide prognostication for these vulnerable patients.

Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation

Background

There is no consensus on optimal management of pilonidal disease. Surgical practice is varied, and existing literature is mainly single-centre cohort studies of varied disease severity, interventions and outcome assessments.

Objectives

A prospective cohort study to determine: • disease severity and intervention relationship • most valued outcomes and treatment preference by patients • recommendations for policy and future research.

Design

Observational cohort study with nested mixed-methods case study. Discrete choice experiment. Clinician survey. Three-stage Delphi survey for patients and clinicians. Inter-rater reliability of classification system.

Setting

Thirty-one National Health Service trusts.

Participants

Patients aged > 16 years referred for elective surgical treatment of pilonidal disease.

Interventions

Surgery.

Main outcome measures

Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence. Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features.

Results

Clinician survey: There was significant heterogeneity in surgeon practice preference. Limited training opportunities may impede efforts to improve practice. Cohort study: Over half of patients (60%; N = 667) had a major procedure. For these procedures, pain was greater on day 1 and day 7 (mean difference day 1 pain 1.58 points, 95% confidence interval 1.14 to 2.01 points, n = 536; mean difference day 7 pain 1.53 points, 95% confidence interval 1.12 to 1.95 points, n = 512). There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference -10.1%, 95% confidence interval -18.1 to -2.1%, n = 575), and longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days). Mixed-methods analysis: Patient decision-making was influenced by prior experience of disease and anticipated recovery time. The burden involved in wound care and the gap between expected and actual time for recovery were the principal reasons given for decision regret. Discrete choice experiment: The strongest predictors of patient treatment choice were risk of infection/persistence (attribute importance 70%), and shorter recovery time (attribute importance 30%). Patients were willing to trade off these attributes. Those aged over 30 years had a higher risk tolerance (22.35-34.67%) for treatment failure if they could experience rapid recovery. There was no strong evidence that younger patients were willing to accept higher risk of treatment failure in exchange for a faster recovery. Patients were uniform in rejecting excision-and-leave-open because of the protracted nursing care it entailed. Wysocki classification analysis: There was acceptable inter-rater agreement (κ = 0.52, 95% confidence interval 0.42 to 0.61). Consensus exercise: Five research and practice priorities were identified. The top research priority was that a comparative trial should broadly group interventions. The top practice priority was that any interventions should be less disruptive than the disease itself.

Limitations

Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment.

Conclusions and future work

Results suggest the burden of pilonidal surgery is greater than reported previously. This can be mitigated with better selection of intervention according to disease type and patient desired goals. Results indicate a framework for future higher-quality trials that stratify disease and utilise broad groupings of common interventions with development of a patient-centred core outcome set.

Trial registration

This trial is registered as ISRCTN95551898.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/17/02) and is published in full in Health Technology Assessment; Vol. 28, No. 33. See the NIHR Funding and Awards website for further award information.

VacStent as an Innovative Approach in the Treatment of Anastomotic Insufficiencies and Leakages in the Gastrointestinal Tract-Review and Outlook

Anastomotic insufficiencies are severe complications of abdominal surgery, often leading to prolonged hospitalization, serious tissue inflammation, and even sepsis, along with the need for recurrent surgery. Current non-surgical treatments such as self-expanding metal stents (SEMSs) and endoscopic vacuum therapy (EVT) have limitations, including stent migration or perforation. This review evaluates the effectiveness of the VacStent GITM (Möller Medical GmbH, Fulda, Germany), a novel medical device combining SEMS and negative-pressure wound therapy in treating gastrointestinal leaks. Data were gathered from four prospective studies and compared with existing treatments. Studies on the VacStent GITM application demonstrate technical success and competitive closure rates in upper gastrointestinal leaks, with minimal complications reported. Comparative analyses with SEMS and EVT reveal promising and most importantly equally good outcomes while maintaining the possibility for sustained enteral nutrition and reducing the risk of stent migration. The VacStent GITM presents a promising alternative to current non-surgical treatments. Ongoing research aims to validate its efficacy in lower gastrointestinal leaks and comprehensively establish its role in leak management. Further investigation is necessary to confirm these findings and optimize treatment protocols. Future usages of the VacStent GITM in colonic anastomotic insufficiencies promise an effective approach and might be able to lower the rates of necessary implementations of a stoma.

The joint impact of burnout and neurotic personality on career satisfaction and intention to leave among health workers during the first 2 years of COVID-19

PURPOSE

The purpose of the study is to examine the psychological impact of COVID-19 on health workers' career satisfaction and intention to leave the health profession, with neurotic personality type as a moderator.

DESIGN/METHODOLOGY/APPROACH

A total of 277 health workers in two public hospitals in Ghana were included in this study. Purposive and convenience sampling techniques were adopted for the study, focusing on eight departments that were involved in the management of COVID-19 cases. Validated instruments were used to measure burnout, intention to leave, neurotic personality and career satisfaction. Using AMOS and partial least squares structural equation modeling (PLS-SEM), various techniques were employed to analyze mediating and moderating mechanisms.

FINDINGS

The departments had staff sizes ranging from 19 to 40, with 67% female and 33% male, with an average age of 31. Nurses accounted for the majority of responses (67.8%), followed by physicians (13.9%), sonographers (0.9%), lab technicians (0.9%) and other respondents (16.5%). The study found that health workers' level of burnout during COVID-19 had a positive effect on their intention to leave the health profession. Career satisfaction does not mediate this relationship; however, career satisfaction negatively influences the intention to leave the health profession. A neurotic personality does not moderate this relationship.

ORIGINALITY/VALUE

This study provides validation of burnout and intention to leave among health workers in Ghana during COVID-19 and supports the proposition that threats to resources (burnout) and having a resource (career satisfaction) have effects on the intention to leave one's profession.

Patient Anxiety in Endoscopy: A Comparative Analysis of Single vs. Dual Procedure Effects

AIM

This study aimed to investigate the difference in anxiety levels between patients undergoing gastroscopy only and those subjected to both gastroscopy and colonoscopy. Despite known preoperative anxiety impacts, no prior research has compared these specific patient groups.

MATERIALS AND METHODS

A total of 150 patients were divided equally into two groups: Group I, undergoing gastroscopy only, and Group II, undergoing gastroscopy and colonoscopy. Inclusion criteria were patients in the age range 18-70 years and having an ASA (American Society of Anesthesiologists) physical status classification of I-III. Exclusion criteria were patients outside the age range, and patients with hearing disorders, psychiatric disorders, dementia, or recent anxiolytic drug use. Anxiety was analysed using the Beck Anxiety Inventory Scale before procedures, without any premedication.

RESULTS

Patients in Group II had significantly higher anxiety levels, with particular increases noted in symptoms such as leg weakness and tremors, inability to relax, and fears of adverse events and death. These results highlighted a considerable elevation in anxiety among patients anticipating or undergoing combined endoscopic procedures.

DISCUSSION

The findings revealed that undergoing combined gastroscopy and colonoscopy procedures significantly elevated patient anxiety levels compared to gastroscopy alone. This suggests a critical need for healthcare providers to implement more strong preoperative counselling and anxiety reduction strategies for patients facing multiple procedures. Addressing this increased anxiety could lead to better patient experiences, reduced procedural complications, and improved satisfaction and outcomes.

Reliability and validity of the Turkish version of the New Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire

PURPOSE

This study aims to adapt and validate the Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire (CCF-CaQL) in Turkish, addressing the significant need for reliable, language-specific QoL measures for colorectal cancer (CRC) in Turkiye. This effort fills a critical gap in CRC patient care, enhancing both patient-provider communication and disease-specific QoL assessment.

METHODS

The CCF-CaQL was translated into Turkish, verified for accuracy, and reviewed for clarity and relevance. Eligible patients who underwent colorectal surgery for cancer between July 2021 and July 2022 from six hospitals completed the CCF-CaQL and SF-36 questionnaires. For analysis, confirmatory factor analysis using Smart PLS 4 and descriptive statistics were employed. The questionnaire's reliability and validity were assessed using Cronbach alpha, composite reliability, and the heterotrait-monotrait (HTMT) ratio, along with multicollinearity checks and factor loadings. Nonparametric resampling was used for precise error and confidence interval calculations, and the Spearman coefficient and split-half method were applied for reliability testing.

RESULTS

In the study involving 244 colorectal cancer patients, confirmatory factor analysis of the CCF-CaQL indicated effective item performance, with one item removed due to lower factor loading. The questionnaire exhibited high internal consistency, evidenced by a Cronbach alpha value of 0.909. Convergent validity was strong, with all average variance extracted (AVE) values exceeding 0.4. Discriminant validity was confirmed with HTMT coefficients below 0.9, and no significant multicollinearity issues were observed (VIF values < 10). Parallel testing with the SF-36 scale demonstrated moderate to very strong correlations, affirming the CCF-CaQL's comparability in measuring quality of life.

CONCLUSION

The Turkish version of the CCF-CaQL was validated for assessing quality of life in colorectal cancer patients. This validation confirms its reliability and cultural appropriateness for use in Turkiye. The disease-specific nature of the CCF-CaQL makes it a useful tool in clinical and research settings, enhancing patient care by accurately monitoring treatment effects and interventions in the Turkish colorectal cancer patient population.

A comprehensive review of platelet-rich plasma for the treatment of dermatologic disorders

Platelet-rich plasma (PRP) offers anti-inflammatory and regenerative properties through angiogenesis, cell differentiation, and proliferation. Although studied in many dermatologic conditions, its efficacy is not well-understood. Our objective is to review the use and effectiveness of PRP for dermatologic conditions. A literature search was performed through PubMed and yielded 54 articles published between January 2000 and November 2021; articles written in English were reviewed. Intradermal injections were associated with increased hair density in androgenic alopecia. Successful treatment of inflammatory nail diseases with PRP has been reported. Improvement in psoriasis was described, but only two studies were available. PRP was associated with higher patient self-assessment scores of photoaging and fine lines. Treatment with PRP in melasma has been associated with improved subjective satisfaction, but not with objective measures of disease improvement. PRP can serve as a safe and potentially effective adjunct for hair loss, vitiligo, nonhealing wounds, photoaging, and acne scars. An important barrier to interpreting PRP research is lack of standardization of PRP preparation protocols, inconsistent clinical endpoints, and frequent combination treatments. However, PRP is relatively noninvasive, has a well-established safety profile, and patient satisfaction is often high as patients perceive great benefit from treatment with PRP.

Quality of life assessment of patients after removal of late-onset infected mesh following open tension-free inguinal hernioplasty: 3-year follow-up

PURPOSE

Open tension-free inguinal hernioplasty is one of the common surgical methods used today to treat inguinal hernias due to its simplicity and low recurrence rate. With the widespread use of tension-free inguinal hernia repair, the number of patients with mesh infections is gradually increasing. However, there is a lack of studies assessing the quality of life of patients after the removal of late-onset infected meshes in open inguinal hernias. The aim of this study was to analyse and assess the quality of life, pain severity and anxiety of patients after late-onset infection mesh removal following open inguinal hernioplasty.

METHODS

Data from 105 patients admitted to our hospital from January 2014 to January 2019 who developed delayed mesh infection after open tension-free inguinal hernia repair were retrospectively analysed. 507 patients without mesh infection after open inguinal hernioplasty were included as cross-sectional controls. The baseline data of the two groups were matched for propensity score matching (PSM) with a caliper value of 0.05 and a matching ratio of 1:1. Patients are followed up by telephone or outpatient consultations for 3 years to assess quality of life, pain and anxiety after removal of the infected mesh.

RESULTS

The 105 patients who developed late-onset mesh infection after inguinal hernia repair had a mean age of 64.07 ± 12.90 years and a mean body mass index (BMI) of 24.64 ± 2.67 (kg/m2). The mean follow-up time was 58 months and 10.5% (10/105) of the patients were lost to follow-up. At the 3-year follow-up there was one case of hernia recurrence and five cases of mesh reinfection. The patients' quality of life scores, pain scores and anxiety scores improved after surgery compared to the preoperative scores (all p < 0.01).

CONCLUSION

Patients with late-onset mesh infection after inguinal hernioplasty showed an improvement in quality of life, pain and anxiety compared to preoperative after removal of the infected mesh. Mesh-plug have a higher risk of mesh infection due to their poor histocompatibility and tendency to crumple and shift.

Platelet-rich plasma for pilonidal disease: a systematic review

OBJECTIVE

To examine the use of platelet-rich plasma (PRP) for treatment of pilonidal disease (PD) and thus provide a reference for clinical application.

METHODS

A systematic review of PubMed and the Cochrane Library was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We considered all studies that reported the use of PRP for treatment of PD. Extracted data included the first author's name, year of publication, study type, number of included patients, inclusion and exclusion criteria, interventions, anesthesia, application of PRP (source, preparation, dose, and operation), antibiotics, follow-up time, therapeutic outcomes, and adverse events.

RESULTS

In total, eight randomized controlled trials and one prospective cohort study involving 809 patients were included. PRP reduced pain, accelerated healing, and reduced adverse events. The application of combined minimally invasive surgery achieved better results. However, overfilling of the wound with PRP in minimally invasive surgeries was shown to potentially increase the risk of adverse events.

CONCLUSION

PRP can be used as an adjuvant treatment in PD surgery to improve the therapeutic effect and reduce adverse events. The optimal combination of PRP and various factors is an important direction of future research.INPLASY registration number: INPLASY2023100070.

Burnout and Intention to Change Profession among Romanian Dentists during COVID-19: A Cross Sectional Study Using the Maslach Burnout Inventory

This study aims to examine the relationship between burnout and dentists' intentions to change careers during the COVID-19 pandemic. The MBI-Human Services Survey for Medical Personnel-MBI-HSS (MP) was used to measure burnout levels and investigate how they relate to dentists' intentions to change their profession. The sample included 69 Romanian dentists, 56 of whom were women and 13 of whom were men. Self-reported questionnaires provided to the participants were used to collect the data. Female participants reported higher levels of emotional Exhaustion and Depersonalisation than males. However, there were no substantial differences in Personal Accomplishment levels between genders. As for the intentions to change careers, 41 expressed a clear intention to change their profession, 15 were still determining if they would choose the same speciality, and 28 indicated they would not choose the medical field. The study's findings provide insight into how dentists' thoughts about perceived burnout during the COVID-19 pandemic significantly influenced their attitudes regarding their career paths. The results suggest concerns regarding burnout in the dental field and emphasise the necessity for burnout interventions and support services, particularly during healthcare crises. Further research and interventions to mitigate burnout and promote well-being among dentists are needed to ensure the sustainability and quality of dental healthcare services in Romania.

The tendency of segmental distribution of hepatic metastasis according to couinaud classification: a comparison of portal versus systemic route of metastatis due to primary colorectal and breast tumors

Objective

The liver is the commonest site of metastatic disease for patients with colorectal cancer (CRC), with at least 25% of patients developing liver metastasis (LM) during their illness. About 50% of patients diagnosed with metastatic breast cancer develop LM, and 5-12% of these patients develop LM as the main site of breast cancer recurrence. This study aims to determine the frequency of segmental distribution of LM seeding from portal versus systemic routes of dissemination due to primary CRC and breast carcinoma, respectively.

Material and methods

This retrospective study was conducted in a tertiary care teaching hospital in Pakistan. Ethical approval was taken from the institutional review board. A total of 587 patients were included in the study with 297 CRC patients with LM and 300 breast carcinoma patients with LM. Segment I involvement was excluded from the calculation because of the dual blood supply. Patients' detailed demographics and other information were collected on a predesigned proforma. The authors evaluated axial and multiplanar reformatted computed tomography images for LM and CRC metastasis. Data analysis was done using SPSS version 25. P value less than or equal to 0.05 was considered statistically significant.

Results

A study population of 587 patients was employed that comprised 287 CRC and 300 breast carcinoma patients. There were 179 (30.5%) male and 408 (69.5%) female patients. The mean age of patients was 54.9±13.3. The study revealed that 204 (34.8%) CRC patients showed right lobe (V, VI, VII, VIII) and 83 (14.1%) CRC patients showed left lobe involvement of metastasis while 192 (32.7%) breast carcinoma patients showed right lobe involvement and 108 (18.4%) breast carcinoma patients showed left lobe involvement in metastasis (P=0.02). We also found 40 (6.8%) colorectal and 55 (9.4%) breast carcinoma patients showed left lateral segment (II, III) involvement. Medial segment involvement (IV) was seen in 43 (7.3%) CRC patients and 53 (9%) breast carcinoma patients (P=0.03).

Conclusion

The right hepatic lobe is the predominant site of metastasis independent of the portal or systemic route of dissemination in primary carcinoma. Moreover, in left lobe metastasis medial segment (IV) is more affected in CRC while the lateral segment (II, III) is more affected in breast carcinoma.

Gender Differences in Psychosocial Outcomes and Coping Strategies of Patients with Colorectal Cancer: A Systematic Review

(1) Background: Gender is an important factor impacting cancer experience. This review mainly aimed to summarize colorectal cancer (CRC) patients' gender differences in psychosocial outcomes and coping strategies. (2) Methods: Relevant studies were searched for in four electronic databases from 2007 to July 2023. And manual searching was performed on the included studies' reference lists to identify additional eligible studies. (3) Results: A total of 37 eligible articles were included in this review. These studies were conducted in 19 countries, and they targeted CRC patients at various treatment stages. Significant results showed that female patients tended to have more psychological distress, complex social functioning, and less sexual distress and to choose more positive coping strategies than male patients. But there was no gender difference in psychosocial outcomes and/or coping strategies in some studies, which implied that gender similarity also existed. (4) Conclusions: The findings support the fact that there are both gender differences and similarities in CRC patients' psychosocial outcomes and coping strategies. A perspective beyond the simple masculine-feminine binary improved our in-depth understanding of gender tendency. Importantly, taking gender tendency into account is critical for medical staff to provide more personalized support and communication interventions.

Quality of Life and Working Conditions of Hand Surgeons-A National Survey

Background and Objectives: Providing high-quality care for patients in hand surgery is an everyday endeavor. However, the quality of life (QoL) and working conditions of hand surgeons ensuring these high-quality services need to be investigated. The aim of this study was to evaluate the QoL and working conditions of Swiss hand surgeons. Materials and Methods: A national survey with Swiss hand surgeons was conducted. Standardized questionnaires were completed anonymously online. Core topics included working conditions, QoL, satisfaction with the profession, and aspects of private life. Results: A total of 250 hand surgeons were invited to participate, of which 110 (44.0%) completed the questionnaire. Among all participants, 43.6% stated that they are on call 4-7 days per month, versus 8.2% never being on call. Overall, 84.0% of the residents, 50.0% of the senior physicians, 27.6% of the physicians in leading positions, and 40.6% of the senior consultants/practice owners, as well as 55.1% of the female and 44.3% of the male respondents, felt stressed by their job, even during holidays and leisure time. Out of all participants, 85.4% felt that work affects private relationships negatively. Despite the reported stress, 89.1% would choose hand surgery as a profession again. Less on-call duty (29.1%) and better pay (26.4%) are the most prioritized factors for attractiveness of a position at a hospital. Conclusions: The QoL of Swiss hand surgeons is negatively affected by their workload and working hours. Residents, senior physicians and female surgeons suffer significantly more often from depression, burnout or chronic fatigue in comparison to leading positions, senior consultants/practice owners and male surgeons. Better pay or less on-call duty would make the work more attractive in acute care hospitals.

Implementation, Feasibility, and Perception of Facilitated Process Groups in Surgical Residency

OBJECTIVE

Recent studies have demonstrated burnout in surgeons, with trainees affected at alarming levels. However, few studies have focused on specific wellbeing initiatives in surgical residency. We implemented facilitated process groups at our residency program and aimed to understand the feasibility and perception of this program.

DESIGN

We recruited a psychologist to conduct weekly process groups. Each postgraduate year (PGY) class was scheduled for a rotating 1-hour session every 6 weeks during protected didactic time. A presurvey was conducted shortly following program commencement for PGY1-5 residents (11/2020-1/2021) and a postsurvey conducted after 9 to 10 months of implementation for PGY2-5 residents. Surveys included demographics, a 2-item Maslach Burnout Inventory, and questions about stress, lifestyle, and perception of the process groups, including qualitative feedback.

SETTING

The study took place at within the General Surgery Residency at Massachusetts General Hospital, a tertiary-care institution in Boston, Massachusetts.

PARTICIPANTS

Participants in process groups were all General Surgery residents during the timeframe of the study. Participation in the presurvey and postsurvey was voluntary for residents.

RESULTS

A total of 32 and 35 residents completed the presurveys and postsurveys, respectively. Groups were similar with regards to gender and race. A total of 97% and 57% of postsurvey respondents attended ≥1 and ≥3 process groups, respectively, with 95% citing clinical/other obligations as the cause of missing sessions. Perception of process groups was highly positive and persisted across both surveys. There were no significant differences in perception or burnout questions, except for a slight decrease in "I think process groups might help me process personal challenges" on postsurvey. Of 15 qualitative postsurvey responses, 73% were positive and the remainder were neutral.

CONCLUSIONS

Based on current measures, it is feasible to implement facilitated process groups for surgical residents. Resident perception of these groups was persistently positive.

Duty Hours on Surgery Clerkship: From Compliance Nightmare to Leadership and Professional Development Opportunity

OBJECTIVE

To evaluate the impact of an innovative leadership development initiative in the core surgery clerkship that addressed duty hours compliance and time-off requests.

DESIGN

A combination of deductive and inductive analysis of medical student reflections written after rotating on Acute Care Surgery over 2 academic years (2019-2020 and 2020-2021) was performed. Reflections were part of criteria to receive honors and a prompt was given to discuss their experience in creating their own call schedules. We utilized a combined deductive and inductive process to identify predominant themes within the reflections. Once established, we quantitatively identified frequency and density of themes cited, along with qualitative analysis to determine barriers and lessons learned.

SETTING

Dell Seton Medical Center, Dell Medical School at The University of Texas at Austin, a tertiary academic facility.

PARTICIPANTS

There were 96 students who rotated on Acute Care Surgery during the study period, 64 (66.7%) of whom completed the reflection piece.

RESULTS

We identified 10 predominant themes through the combined deductive and inductive processes. Barriers were cited by most students (n = 58, 91%), with communication being the most commonly discussed theme when cited with a mean 1.96 references per student. Learned leadership skills included: communication, independence, teamwork, negotiating skills, reflection of best practices by residents, and realizing the importance of duty hours.

CONCLUSIONS

Transferring duty hour scheduling responsibilities to medical students resulted in multiple professional development opportunities while decreasing administrative burden and improving adherence to duty hour requirements. This approach requires further validation, but may be considered at other institutions seeking to improve the leadership and communication skills of its students, while improving adherence to duty hour restrictions.

Testicular necrosis and subsequent orchiectomy as a complication of inguinal mesh infection surgery: a case report

The management of inguinal hernias has been revolutionised with mesh-based techniques, which are now the gold standard. In rare cases, complications can occur, the most common being prosthesis infection. The course is unpredictable, causing considerable morbidity and multiple interventions in the case of chronicity. We treated a 38-year-old patient for an inguinal mesh infection that evolved for 8 years before definitive management. The peculiarity of this finding is the occurrence of testicular necrosis following complete removal of the prosthesis, which is likely to be related to spermatic vessel injuries. This observation shows that although healing is achieved, there may be significant sequelae, and infection prevention must be a constant concern while inserting a mesh.

Robot-assisted versus laparoscopic short- and long-term outcomes in complete mesocolic excision for right-sided colonic cancer: a systematic review and meta-analysis

BACKGROUND

Complete mesocolic excision (CME) surgery is increasingly implemented for the resection of right-sided colonic cancer, possibly resulting in improved 5-year overall and disease-free survival compared to non-CME surgery. However, it is not clear what surgical platform should be used. The aim of this study was to compare the following outcomes between robot-assisted and laparoscopic CME-surgery for right-sided colonic cancer: (i) short-term clinical outcomes, (ii) pathological specimen quality, and (iii) long-term oncological outcomes.

METHODS

Medline, Embase, and Cochrane Database of Systematic Reviews were searched from inception until August 2021. Pooled proportions were calculated by applying the inverse variance method. Heterogeneity was explored by I-square and supplemented by sensitivity- and meta-regression analyses. The risk of bias was evaluated by either MINORS or Cochrane's risk-of-bias tool (RoB 2).

RESULTS

Fifty-five studies with 5.357 patients (740 robot-assisted and 4617 laparoscopic) were included in the meta-analysis. Overall postoperative morbidity was 17% [95% CI (14-20%)] in the robot-assisted group and 13% [95%CI (12-13%)] in the laparoscopic group. Robot-assisted CME was associated with a shorter hospital stay, lower intraoperative blood loss, a higher amount of harvested lymph nodes, and better 3-year oerall and disease-free survival. MINORS and RoB2 indicated a serious risk of bias across studies included.

CONCLUSIONS

This review which includes predominantly non-randomized studies suggests a possible advantage of the robot-assisted CME compared with a laparoscopic technique for several short-term outcomes.

Ways of preventing surgeon burnout

In surgical practice, numerous sources of stress (stressors) are unpredictable, two examples being daily workload and postoperative complications. They may help to explain surgeon burnout, of which the prevalence (34 to 53%) has been the subject of many studies. That said, even though assessments are legion, recommended solutions have been few and far between, especially insofar as by nature and training, surgeons are disinclined to interest themselves in burnout, which they are prone to consider as something experienced by "others". The objective of this attempt at clarification is to identify in the literature the strategies put forward in view of avoiding surgeon burnout, and to assess the impact of this phenomenon not only on the surgeon's professional and personal entourage, but also on patient safety. Prevention-based strategies, many of them focused on modifiable stressors, will be detailed.

Definition and reporting of lymphadenectomy and complete mesocolic excision for radical right colectomy: a systematic review

BACKGROUND

Several procedures have been proposed to reduce the rates of recurrence in patients with right-sided colon cancer. Different procedures for a radical right colectomy (RRC), including extended D3 lymphadenectomy, complete mesocolic excision and central vascular ligation have been associated with survival benefits by some authors, but results are inconsistent. The aim of this study was to assess the variability in definition and reporting of RRC, which might be responsible for significant differences in outcome evaluation.

METHODS

PRISMA-compliant systematic literature review to identify the definitions of RRC. Primary aims were to identify surgical steps and different nomenclature for RRC. Secondary aims were description of heterogeneity and overlap among different RRC techniques.

RESULTS

Ninety-nine articles satisfied inclusion criteria. Eight surgical steps were identified and recorded as specific to RRC: Central arterial ligation was described in 100% of the included studies; preservation of mesocolic integrity in 73% and dissection along the SMV plane in 67%. Other surgical steps were inconstantly reported. Six differently named techniques for RRC have been identified. There were 35 definitions for the 6 techniques and 40% of these were used to identify more than one technique.

CONCLUSIONS

The only universally adopted surgical step for RRC is central arterial ligation. There is great heterogeneity and consistent overlap among definitions of all RRC techniques. This is likely to jeopardise the interpretation of the outcomes of studies on the topic. Consistent use of definitions and reporting of procedures are needed to obtain reliable conclusions in future trials. PROSPERO CRD42021241650.

Treatment of mesh infection after inguinal hernia repair: 3-year experience with 120 patients

PURPOSE

Mesh infection is a devastating complication of sterile hernia repair surgery. This study was performed to assess the short- and long-term outcomes following treatment for mesh infection after inguinal hernia repair.

METHODS

This single-center retrospective study included all patients who developed mesh infection after inguinal hernia repair from January 2018 to December 2020. Patient demographics, mesh infection characteristics, microbiology, features of surgery, short- and long-term outcomes, and follow-up data were analyzed.

RESULTS

In total, 120 patients (8 women, 112 men; mean age, 54.4 years; mean body mass index, 24.8 kg/m²) were treated for mesh infection. The cultures were positive in 88 patients; 62.5% of these were positive for Staphylococcus aureus. Laparoscopic exploration was performed in 108 patients. Seventy patients underwent complete removal of infected mesh, and 50 underwent partial removal. During the short-term follow-up, 11 patients developed a minor wound infection and were treated with dressings and antibiotics, 1 developed a wound infection requiring debridement, 30 developed seromas, and 3 developed hematomas that did not require surgical intervention. During the mean follow-up of 39.1 months, 4 patients developed hernia recurrence, 2 experienced chronic pain, and 23 developed recurrent infection requiring reoperation in the partial mesh removal group (in contrast, only 4 patients in the complete mesh removal group developed recurrent infection, with a statistically significant difference).

CONCLUSION

The outcome of mesh infection after inguinal hernia repair treated by mesh removal is satisfactory. Systematic individualized treatment by experienced experts based on the patient's previous repair technique, implanted mesh, and physical condition is recommended.

Platelet-Rich Plasma (PRP) for Sacrococcygeal Pilonidal Disease: An Updated Systematic Review and Meta-Analysis

BACKGROUND

Pilonidal disease can be a debilitating condition which carries a significant physical and economic burden. This systematic review and updated meta-analysis presents the evidence for the use of platelet-rich plasma (PRP) for wound healing following open and minimally-invasive sacrococcygeal pilonidal surgery.

METHODS

A literature search was performed during December 2021 for studies relating to platelet-rich plasma and pilonidal wound healing following surgery.

RESULTS

Nine studies remained after applying the exclusion criteria, incorporating a total of 621 (open surgery group) and 309 (minimally-invasive group) patients, respectively. Pooled analysis of the six open surgery group studies demonstrated a significant reduction in wound healing time (mean difference [MD] = - 13.98 days, 95% CI - 18.41 to - 9.55, p < 0.001, I² = 98%). Three open surgery group studies compared post-operative time off work, while three recorded mean pain duration; pooled analysis also revealed a significant reduction in both outcomes, respectively (MD = - 8.7 days, 95% CI - 9.4 to - 8.0, p < 0.001, I² = 57%; MD = - 9.5 days, 95% CI - 15.6 to - 3.3, p = 0.002, I² = 98%). Methodological heterogeneity among the minimally-invasive studies precluded formal meta-analysis; however, two studies demonstrated a modest improvement in wound healing when treated with PRP.

CONCLUSIONS

This systematic review and updated meta-analysis provide further evidence supporting the use of PRP for wound healing in sacrococcygeal pilonidal disease. PRP application was demonstrated to significantly reduce healing time, postoperative pain and time off work in the open surgery group. Nevertheless, there is still considerable heterogeneity among PRP manufacture and administration techniques, and further high-powered RCTs with consistent methodology are required to substantiate these findings.

The Impact of Depression on Quality of Life in Caregivers of Cancer Patients: A Moderated Mediation Model of Spousal Relationship and Caring Burden

Family caregivers play an important role in managing and supporting cancer patients. Although depression in family caregivers is known to negatively affect caregiver health, the mechanism by which it affects caregivers is not clear. The purpose of this study was to explore the influence of depression on quality of life (QoL) in family caregivers of patients with cancer. Specifically, this study examined (1) whether caring burden mediates the relationship between depression and QoL, and (2) how this mediating effect varies depending on the caregiver's relationship with the patient. This study performed a secondary analysis on cross-sectional survey data. Ninety-three family caregivers of cancer patients were included in the study. Moderated mediation analyses were conducted using PROCESS macro with the regression bootstrapping method. The moderated mediation models and the indirect effect of caregiver depression on QoL through caring burden were significantly different depending on caregivers' relationships with patients (i.e., spousal or non-spousal). Specifically, the indirect effect of caregiver depression on QoL was greater for the patient's spouse than for other family caregivers. Healthcare providers should focus on identifying caregivers' depression and relationship with the patient and offer tailored support and intervention to mitigate the caring burden and improve the caregivers' QoL.

What is the outcome of late-onset infected mesh removal after open tension-free inguinal hernioplasty: 3-year follow-up

PURPOSE

Reports of mesh infections following open tension-free inguinal hernioplasty are gradually increasing. Recent research has focused on identifying and managing mesh infections. However, studies examining the long-term outcomes and quality of life following mesh removal for late-onset infections are few. This study aimed to analyze the short and long-term outcomes after maximal removal of the implanted mesh in patients with late-onset mesh infection after open tension-free inguinal hernioplasty.

METHODS

Data of 105 patients who developed late-onset mesh infection after open tension-free inguinal hernioplasty and were admitted to our hospital from January 2014 to January 2019 were retrospectively analyzed. Patients were followed up by telephone or outpatient consultation for 3 years, focusing on hernia recurrence and mesh infection recurrence. Quality of life was assessed preoperatively and postoperatively using our developed scale; postoperative inguinal area pain was assessed using the visual analog score, and postoperative anxiety was assessed using the anxiety self-assessment scale.

RESULTS

Of the 105 patients who experienced late-onset mesh infection following open inguinal hernioplasty, 100 underwent mesh plug repair. The mean follow-up time was 58 months, and 10.5% (95/105) of the patients were lost to follow-up. Recurrence of infection was observed in 28.6% of patients (2/7) who underwent partial mesh removal and in 3.4% of patients (3/88) who underwent complete mesh removal. One inguinal hernia recurred 12 months after mesh removal (1.0% recurrence rate). In the third year following surgery as compared to the preoperative period, there were significant improvements in quality of life.

CONCLUSIONS

Hernia plugs may not be a good choice in tension-free inguinal hernia repair in view of the risk of late infections and fistulas. Remove all mesh at the time of the first operation for mesh infection. Hernia recurrence after late-onset infected mesh removal following open inguinal tension-free hernioplasty is rare. The post-operative quality of life, pain, and anxiety are gradually steadily improving.

Burnout among surgeons and surgical trainees: A systematic review and meta-analysis of the prevalence and associated factors

Introduction

The more effort is put into work, the greater the chances of burnout. This is common among surgical personnel. We carried out this review study to determine the overall and per-specialty prevalence of burnout, and to identify the factors that affect burnout positively and negatively.

Methods

All full-text articles reporting data related to burnout in surgery and surgical subspecialties using the Maslach Burnout Inventory (MBI) were included. The following bibliographic databases were searched PubMed, Embase and Google Scholar (First 500 pages). We extracted data on the characteristics of the articles including the burnout prevalence and factors.

Results

27 articles met the criteria. The studies involved 8617 surgeons cutting acrossvarious surgical specialties. The overall prevalence was 47%. The rate per specialty ranged between 15% and 77% with Ear, Nose and Throat (ENT) surgeons having the highest rates. Associated factors included work-related issues and poor work/life balance while protective factors included career advancement, increase in postgraduate years, and having good relationships with co-residents. Our findings are similar to findings from other studies; ENT is seen to have the highest burnout rate while pediatric surgery the lowest.

Conclusion

The high prevalence of burnout among surgeons is concerning and the identified factors responsible should be explored by surgeons, hospital management boards, training colleges, and all bodies concerned to see how it can be reduced.

Borrowing the Features of Biopolymers for Emerging Wound Healing Dressings: A Review

Wound dressing design is a dynamic and rapidly growing field of the medical wound-care market worldwide. Advances in technology have resulted in the development of a wide range of wound dressings that treat different types of wounds by targeting the four phases of healing. The ideal wound dressing should perform rapid healing; preserve the body’s water content; be oxygen permeable, non-adherent on the wound and hypoallergenic; and provide a barrier against external contaminants—at a reasonable cost and with minimal inconvenience to the patient. Therefore, choosing the best dressing should be based on what the wound needs and what the dressing does to achieve complete regeneration and restoration of the skin’s structure and function. Biopolymers, such as alginate (ALG), chitosan (Cs), collagen (Col), hyaluronic acid (HA) and silk fibroin (SF), are extensively used in wound management due to their biocompatibility, biodegradability and similarity to macromolecules recognized by the human body. However, most of the formulations based on biopolymers still show various issues; thus, strategies to combine them with molecular biology approaches represent the future of wound healing. Therefore, this article provides an overview of biopolymers’ roles in wound physiology as a perspective on the development of a new generation of enhanced, naturally inspired, smart wound dressings based on blood products, stem cells and growth factors.