Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Profile of Breast Diseases in Eastern Nepal

Background &amp; Objectives: Breast problems, benign or malignant are common in occurrence worldwide. Breast problems can present themselves in a number of ways like breast pain, nipple discharge, cystic lesions and more commonly a lump. Breast diseases are under reported and cancer is one of the leading causes of mortality in women. This prospective study was undertaken with an aim to study the profile of various breast diseases in eastern Nepal.Materials &amp; Methods:  This is a prospective study of women with breast diseases conducted from March 2011 to February 2012. Inclusion criteria were women irrespective of age with breast diseases with or without complaints. Exclusion criteria were women having breast abscess and mammary fistula.Results: Out of 125 breast diseases 39 cases (31%) had malignancy and 86 cases (69%) had BBD. The overall mean age for BBD was 25.9 years, with range of 10-60 years. The mean age for malignant breast diseases was 45.6 years, with range of 28-67 years. All of the cases had breast lump as their presenting complaints whether they came out benign or malignant. 52.8% had no significant pain associated with lump; in malignant cases 35.8% had pain associated with lump. In benign cases 68.7% had no perceptible change in lump size. On ultrasound scan, 69% of the lesions were designated benign compared to 31% malignant features. FNAC resulted in 68% lesions to be classified as of benign nature and 32% as malignant /suspicious malignancy.Conclusion: BBD constituted 69% of breast diseases, and mostly fibroadenoma and FCC/FCD and commonest malignant lesion was infiltrating ductal carcinoma. The BBD peaked at the age of 21-30 years.</p

e-TEP Retromuscular Repair for Recurrent Incisional Hernias: Report of Three Cases

Introduction. Recurrent incisional hernias are difficult to treat. There are many factors involved in the recurrence, and due to extensive dissections, the planes are fused with adhesions, and we may need a new plane for dissection and placement of meshes. Case Report. We report here three cases of recurrent incisional hernias which were dealt by a relatively new method to laparoscopy: the enhanced view totally extraperitoneal repair (e-TEP) retromuscular technique. There were three patients: one after an open onlay repair of lower midline incision, another after an onlay mesh repair of a subcostal incision for open cholecystectomy followed by an intraperitoneal onlay mesh hernioplasty (IPOM) repair, and another after IPOM repair of epigastric hernia. They were treated with the abovementioned technique with satisfying short-term results. Conclusion. The e-TEP technique is a relatively new method of providing minimal access surgery to these patients utilizing the previously unaccessed retromuscular (Rives and/or preperitoneal) space for the repair of these recurrent incisional hernias

Challenges and Results of Laparoscopic Splenectomy for Hematological Diseases in a Developing Country

Introduction. Though, in developed countries, laparoscopy is now a gold standard for splenectomy, we are lacking in this aspect in the eastern world. Splenectomy has mostly been performed by open surgery in our region. This is our effort to introduce laparoscopic splenectomy in our country. Methods. This is a retrospective cohort study done in patients presenting to hematology and surgery department of our hospital who underwent laparoscopic splenectomy for hematological diseases from January 2013 to December 2016. Results. There were 50 patients (38 females, 12 males). The diagnoses were idiopathic thrombocytopenic purpura in 31, (steroid/azathioprine-resistant, steroid dependent), hereditary spherocytosis in 9, alpha-thalassemia in 3, beta-thalassemia in 2, autoimmune hemolytic anemia in 4, and isolated splenic tuberculosis in 1. Average platelet counts preoperatively were 62000±11000/mm3 (range 52000-325000/mm3). The mean operative time was 130±49 minutes (range 108-224 min). The mean postoperative stay was 4±2.11 days (range 3-9 days). Laparoscopic splenectomy could be completed in 45 (90%) patients. Conclusion. Laparoscopic splenectomy could be successfully contemplated in patients with hematological diseases, especially if spleen is normal or only mildly enlarged, and is an advantageous alternative to open splenectomy. Absence of ideal resources has not limited our progress in minimal access approach