scholarly journals Current practice in abdominoperineal resection: an email survey of the membership of the Association of Coloproctology

2012 ◽  
Vol 94 (3) ◽  
pp. 173-176 ◽  
Author(s):  
N Dabbas ◽  
K Adams ◽  
H Chave ◽  
G Branagan
Keyword(s):  
Significant Proportion ◽  
Patient Positioning ◽  
Perineal Wound ◽  
Wound Complication ◽  
Training Programme ◽  
Abdominoperineal Excision ◽  
Complication Rates ◽  
Oncological Outcomes ◽  
Perineal Wound Complication ◽  
National Training

INTRODUCTION This study aimed to gain insight into current preferences for type of surgical approach and patient positioning in abdominoperineal excision of the rectum (APER), to identify whether these factors affect self-reported oncological outcomes and complication rates, and to assess the opinions of members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) with regards to the benefit of a national training programme for APER surgery. METHODS Members of the ACPGBI were surveyed using a questionnaire designed to examine surgeon/departmental demographics, type of APER practised, audit of results and complications, opinions regarding extralevator APER (ELAPER) and opinions regarding the potential benefit of a national training programme. RESULTS According to the survey, 62% of surgeons perform perineal dissection in the supine position and 57% perform a standard APER technique. Surgeons who only practise colorectal surgery (p=0.002) and surgeons performing prone dissection (/xO.0001) are more likely to perform ELAPER. Three-quarters (76%) audit their results for perineal wound complication rates. Over 80% audit their oncological outcomes. The vast majority (94.6%) of those who perform ELAPER believe there is a benefit to this method while 59.6% of those who do not perform ELAPER still believe there is a benefit to ELAPER. Only 50% feel that there should be a national training programme. CONCLUSIONS There is a distinct discordance with regards to the APER technique. Among UK colorectal surgeons, although a significant proportion favours ELAPER, there remains a larger proportion still performing standard APER techniques.

scholarly journals Early Post-Operative Perineal Wound Complications in Patients Undergoing Extra Levator Abdominoperineal Excision, A Retrospective Study at Department of Surgical Oncology

2020 ◽  
pp. 1-6
Author(s):  
Aun Jamal ◽  
Aun Jamal ◽  
Sadaf Batool ◽  
Ihtisham Ul Haq ◽  
Faizan Ullah ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Wound Dehiscence ◽  
Perineal Wound ◽  
Wound Complication ◽  
Surgical Oncology ◽  
Abdominoperineal Excision ◽  
Current Evidence ◽  
Wound Complications ◽  
Perineal Wound Complication ◽  
Perineal Wound Complications

Objectives: Extra Levator Abdominoperineal Excision (ELAPE) is an emerging technique for the management of locally advanced distal rectal cancers. Current evidence suggests that this technique is associated with better oncological outcomes and hence survival. Extra levator abdominoperineal excision is associated with significant perineal complications both in short and long term. The objective of the current study is to emphasize on the early wound complications of the above-mentioned procedure. Study Design: It was a retrospective observational study with continent sampling. Place and Duration of Study: The study was conducted at department of Surgical Oncology Shaukat Khanum Memorial Cancer Hospital & Research Center Lahore, Pakistan. The study period was from 1st January 2014 to 31st December, 2019. Patients and Methods: A total of 84 patients were included in the study who underwent extra levator abdominoperineal excision (ELAPE). All patients undergoing extra levator abdominoperineal excision during the said period were included. Results: A total of 84 patients underwent Extra Levator Abdominoperineal Excision between January 2014 and December 2019. Wound infection was observed in 32 (38.09%) of the patients. Wound dehiscence was seen is five patients. Median day of detection of infection was day 10 (5-22). Median hospital stay was 7 (4-22) days. Conclusion: Extra Levator Abdominoperineal Excision is a procedure with significant perineal wound complication rate. The occurrence of perineal wound complications is multifactorial. Judicial use of the procedure is warranted

scholarly journals Benefits of EPAs at risk? The influence of the workplace environment on the uptake of EPAs in EPA-based curricula

2021 ◽  
Author(s):  
Karsten Arthur van Loon ◽  
Linda Helena Anna Bonnie ◽  
Nynke van Dijk ◽  
Fedde Scheele
Keyword(s):  
At Risk ◽  
Postgraduate Medical Education ◽  
Training Programme ◽  
Workplace Environment ◽  
Medical Specialists ◽  
Professional Activities ◽  
National Training ◽  
Local Medical Care

Abstract Introduction Entrustable Professional Activities (EPAs) have been applied differently in many postgraduate medical education (PGME) programmes, but the reasons for and the consequences of this variation are not well known. Our objective was to investigate how the uptake of EPAs is influenced by the workplace environment and to what extent the benefits of working with EPAs are at risk when the uptake of EPAs is influenced. This knowledge can be used by curriculum developers who intend to apply EPAs in their curricula. Method For this qualitative study, we selected four PGME programmes: General Practice, Clinical Geriatrics, Obstetrics & Gynaecology, and Radiology & Nuclear Medicine. A document analysis was performed on the national training plans, supported by the AMEE Guide for developing EPA-based curricula and relevant EPA-based literature. Interviews were undertaken with medical specialists who had specific involvement in the development of the curricula. Content analysis was employed and illuminated the possible reasons for variation in the uptake of EPAs. Results An important part of the variation in the uptake of EPAs can be explained by environmental factors, such as patient population, the role of the physician in the health-care system, and the setup of local medical care institutions where the training programme takes place. The variation in uptake of EPAs is specifically reflected in the number and breadth of the EPAs, and in the way the entrustment decision is executed within the PGME programme. Discussion Due to variation in uptake of EPAs, the opportunities for trainees to work independently during the training programme might be challenging. EPAs can be implemented in the curriculum of PGME programmes in a meaningful way, but only if the quality of an EPA is assessed, future users are involved in the development, and the key feature of EPAs (the entrustment decision) is retained.

scholarly journals Postless Hip Arthroscopy: A Safer Alternative for Treatment of Femoracetabular Impingement Syndrome

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110067
Author(s):  
Michael B. Held ◽  
Liana J. Tedesco ◽  
Mario H. Lobao ◽  
T. Sean Lynch
Keyword(s):  
Hip Joint ◽  
Hip Arthroscopy ◽  
Pudendal Nerve ◽  
Patient Positioning ◽  
Central Compartment ◽  
Operating Table ◽  
Complication Rates ◽  
Iatrogenic Complications ◽  
Diagnostic Arthroscopy ◽  
Hip Distraction

Background: Hip arthroscopy for femoroacetabular impingement (FAI) syndrome continues to gain popularity and indications for its use are expanding. Though low complication rates have previously been reported, there are iatrogenic complications specific to the use of the perineal post, such as pudendal nerve injuries, and possible pressure skin necrosis that warrant concern in the healthy young patient. The risk of these complications are increased during simultaneous bilateral hip arthroscopy. Indications: We describe a new technique, which will prevent such problems by using a postless pink pad technique in order to achieve adequate hip distraction. Technique Description: Arthroscopic investigation begins with proper, safe patient positioning in order to gain access to the hip joint with sufficient joint distraction. In the postless technique, a dense foam pad is utilized in lieu of a perineal post. The static friction between the pad, bed, and the patient counters the manual gross traction necessary to distract the hip joint while preventing the patient from sliding down or off of the operating table. The postless technique avoids pressure to the perineum and also allows for greater range of motion during dynamic intraoperative examination and femoroplasty. After hip distraction, standard portal placement allows for access to the central compartment in order to assess intraarticular pathology. Once identified on diagnostic arthroscopy, appropriate techniques are utilized to correct acetabular-sided pincer lesions, labral tears, and femoral-sided cam deformities. Results: When discussing this technique with patients, it is important to highlight that it diminishes the possibility of iatrogenic pressure injury to the pudendal nerve and skin of the perineum. The risk of these injuries typically occurs when the pudenal nerve is compressed against the post during traction and abduction. As such, postless technique prevents any compression and pressure to these regions. Discussion/Conclusion: Hip arthroscopy is a minimally invasive, low morbidity technique for treating a variety of chondral, ligamentous, and bony conditions of the hip. However, studies suggest that pudenal nerve injury is seen in up to 4.3% of patients following hip arthroscopy. Given avoidance of iatrogenic post complications, we describe a postless technique for achieving hip distraction during hip arthroscopy.

scholarly journals Lapco: national training programme for laparoscopic colorectal surgery

2009 ◽  
Vol 91 (8) ◽  
pp. 274-275 ◽  
Author(s):  
Mark Coleman
Keyword(s):  
Colorectal Surgery ◽  
Laparoscopic Resection ◽  
Laparoscopic Colorectal Surgery ◽  
Clinical Excellence ◽  
Training Programme ◽  
Open Resection ◽  
Department Of Health ◽  
Action Team ◽  
Colorectal Surgeons ◽  
National Training

In 2006 the National Institute for Health and Clinical Excellence issued guidance that laparoscopic resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable. Due to the lack of trained colorectal surgeons a waiver was issued, which is due to be reviewed in September 2009. In 2007 the Cancer Action Team (CAT) at the Department of Health (DH) instituted the national training programme (NTP) for laparoscopic colorectal surgery (LCS) for colorectal consultants in England. The intention is to provide all suitable patients with bowel cancer in need of resection, access to a trained surgeon for laparoscopic resection. The programme is funded by the CAT.

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