Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Rejection of goretex mesh used in prosthetic cruroplasty: A case series

AbstractIntroductionIn recent years prosthetic cruroplasty with PTFE has been advocated as the optimal way to reduce hernia recurrence when repairing large hiatal hernia. However, we have found in our series a significant incidence of rejection and mesh erosion.Materials and methodsStandard, tension-free ePTFE hiatal hernia repair was performed in 15 patients with large hiatal hernia. Three of these patients subsequently went on to develop complications with the mesh. Here we present these cases: 2 females and 1 male aged 84, 66 and 69 years, respectively. Each underwent prosthetic hiatal hernia repair using dual goretex mesh. After 7, 12, and 34 months each of the cases presented with dysphagia.ResultsIn all three of these cases initial endoscopy revealed narrowing at the lower end of the oesophagus, with inflammatory changes and erosion. In two of the cases, the mesh was noted to have eroded into the distal oesophagus, and in the third case relaparoscopy showed a peri-oesophageal collection including the mesh surrounded with fibrosis. Each of the complications was managed using minimally invasive techniques. In one instance the eroded mesh was removed by endoscopy without further complication. While in the second, due to the patient's age and comorbidities the eroded mesh was left in-situ and a covering stent was endoscopically sited. In the case of the peri-oesophageal collection, this was drained laparoscopically and the mesh was removed, with the patient making an excellent recovery. In each instance the patient's dysphagia was corrected and there was no recurrence of the hiatus hernia.ConclusionsWe conclude by acknowledging that in spite of the fact that Gore-Tex (ePTFE) is currently being recommended as one of the choice materials for the prosthetic reconstruction of the hiatus. Our experience suggests that it should be used with great caution in the peri-oesophageal region

A novel laparoscopic approach to lesions related to the posterior aspect of the pancreatic head

The posterior aspect of the pancreatic head has proven to be a technically demanding region to approach laparoscopically. Previously, this region was approached through the gastrocolic ligament with the patient in a left semilateral position. We believe that this makes the laparoscopic approach to the posterior pancreatic head extremely difficult. In the technique presented here, which has been successfully used in 4 patients, the patient was in full left lateral position, and Nathanson retractors were used to retract the liver and right kidney. This allowed full exposure of the second part of the duodenum before any major dissection. The duodenum was then Kocherized, and the posterior aspect of the pancreatic head, along with the inferior vena cava, left renal vein, and aorta, was exposed. We describe here a safe and feasible laparoscopic method for access to and management of lesions related to the posterior aspect of the pancreatic head