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

Ultrasound-guided ilioinguinal/iliohypogastric nerve block compared to posterior quadratus lumborum block in patients undergoing inguinal hernia repair

ABSTRACTBackground “Ilioinguinal/iliohypogastric nerve block” (IINB) has been described as effective regional anesthetic method for providing analgesia after inguinal hernia operations. Other studies have also reported that the “posterior quadratus lumborum block” (PQLB) is an effective analgesic option for lower abdominal surgeries. Herein, we compared the previous two block techniques for postoperative pain management in adults undergoing unilateral inguinal hernia repair.Methods According to the block technique, 76 adult patients scheduled for inguinal hernioplasty under general anesthesia were randomly enrolled into two groups; the PQLB and IINB groups. The block was performed after skin closure and before patient extubation. Postoperative analgesic profiles were recorded in both groups.Results The PQLB had lower heart rate and mean arterial pressure readings during postoperative assessment compared to the other group. Pain scores showed a significant decline in association with the PQLB during the first postoperative day, which resulted in a significant decline in pethidine consumption (49.17 vs. 70 mg in the IINB group) and better patient satisfaction. The duration to the first analgesic request significantly increased in association with the PQLB (13.25 vs. 8.42 hours in the IINB group). The incidence of nausea and vomiting increased significantly in the IINB group secondary to increased pethidine requirements.Conclusion PQLB is superior to IINB in providing analgesia for patients undergoing inguinal hernia repair

Multi center experience of interrupted versus continuous parachuting suturing technique of hepatico-jejunostomy posterior layer anastomosis

Background: In Biliary enteric anastomosis procedures, hepatico-jejunostomies are a crucial step. Depending on the situation, the hepatico-jejunostomy operation procedure varies depending on the surgical school, and can be continuous or interrupted. Patients and Methods: A prospective comparative randomized study included 100 Patients  complaining of malignant pancreatic tumour (65%), iatrogenic bile duct injury (20%), multiple common bile duct stones (10%) and liver transplantation of cirrhotic patients (5%) underwent hepatico-jejunostomy anastomosis to review a multi-center experience of hepatico-jejunostomy anastomosis in Theodor Bilharz Research Institute and Faculty of Medicine of Cairo University with regard to the types of anastomosis performed, early and late complications, and long-term patency and outcomes. Results: According to the type of suturing technique, hepatico-jejunostomy anastomosis patients are sub grouped into posterior interrupted sutures group A and posterior parachuting sutures group B. A significant direct correlation of leakage in group A  with obstructive jaundice (r = 0.327 and p value = 0.02), CBD diameter (r = 0.408 and p value = 0.001), and Duct wall thickness (r = 0.408 and p value = 0.001) While there were inverse correlations with pre-operative stent (r = -0.375 and p value = 0.01)

Multi CENTER Experience of Interrupted Versus Continuous Parachuting Suturing Technique of Hepatico-jejunostomy Posterior Layer Anastomosis

Background: In Biliary enteric anastomosis procedures, hepatico-jejunostomies are a crucial step. Depending on the situation, the hepatico-jejunostomy operation procedure varies depending on the surgical school, and can be continuous or interrupted. Patients and Methods: A prospective comparative randomized study included 100 Patients  complaining of Malignant pancreatic tumour (65%), iatrogenic bile duct injury (20%), multiple common bile duct stones (10%) and liver transplantation of cirrhotic patients (5%) underwent hepatico-jejunostomy anastomosis to review a multi-center experience of hepatico-jejunostomy anastomosis in Theodor Bilharz Research Institute and Faculty of Medicine of Cairo University with regard to the types of anastomosis performed, early and late complications, and long-term patency and outcomes. Results: According to the type of suturing technique, hepatico-jejunostomy anastomosis patients are sub grouped into posterior interrupted sutures group A and posterior parachuting sutures group B. A significant direct correlation of leakage in group A  with obstructive jaundice (r = 0.327 and p value = 0.02), CBD diameter (r = 0.408 and p value = 0.001), and Duct wall thickness (r = 0.408 and p value = 0.001) While there were inverse correlations with pre-operative stent (r = -0.375 and p value = 0.01)