Archives of Surgery最新文献

Objective: To evaluate factors associated with work-home conflicts (W-HCs) of US surgeons and their potential personal and professional consequences.

Design: Cross-sectional study.

Participants: Members of the American College of Surgeons.

Main outcome measures: Burnout, depression, quality of life, alcohol use, career satisfaction, and career decisions (ie, reduce work hours or leave current practice).

Results: Of 7197 participating surgeons, 3754 (52.5%) had experienced a W-HC in the previous 3 weeks. On multivariate analysis, hours worked per week, having children, sex, and work location (Veterans Administration or academic center) were independently associated with an increased risk for W-HC (all P < .01), while some factors (increased age and subspecialty field) reduced the risk. Surgeons with a recent W-HC were more likely to have symptoms of burnout (36.9% vs 17.1%; P < .001), depression (50.9% vs 28.1%; P < .001), alcohol abuse/dependency (17.2% vs 14.4%; P = .003), and were less likely to recommend surgery as a career option to their children (46.0% vs 54.4%; P < .001). Work-home conflicts were also independently associated with surgeons reporting a moderate or higher likelihood of planning to reduce clinical work hours (odds ratio, 1.769) and leave their current practice in the next 24 months for a reason other than retirement (odds ratio, 1.706) after controlling for other personal and professional factors.

Conclusions: Integrating personal and professional lives is a substantial challenge for US surgeons. Conflict in this balance appears to be a major factor in their decision to reduce work hours and/or move to a new practice, with potential substantive manpower implications for the surgical workforce.

Objective: To research the optimal surgical strategy for chronic pancreatitis.

Data sources: PubMed, EMBASE, Science Citation Index, SpringerLink, and secondary sources from inception through December 31, 2011, with no restrictions on languages or regions.

Study selection: All controlled experimental (randomized and nonrandomized) studies in which duodenum-preserving pancreatic head resection was compared with pancreaticoduodenectomy in chronic pancreatitis.

Data extraction: Data were extracted independently and in duplicate by 2 reviewers; discrepancies were resolved by discussion.

Data synthesis: A total of 1007 patients from 15 studies were included in the meta-analysis. The relative risks for postoperative pain relief and postoperative morbidity in the Beger procedure were 1.29 (95% CI, 1.03-1.61; P = .03) and 0.55 (0.21-1.39; P = .20), respectively, compared with pancreaticoduodenectomy. These results are just the opposite in the Frey procedure, in which a significantly better outcome was shown in postoperative morbidity compared with resection (relative risk, 0.60; 95% CI, 0.46-0.78; P < .01) but not in postoperative pain relief (1.03; 0.90-1.17; P = .67). In terms of quality of life, pancreatic exocrine function, and delayed gastric emptying, the results also favored duodenum-preserving strategies.

Conclusions: For the duodenum-preserving strategy of the Beger procedure, complete pain relief is achieved in most patients, but there is no evidence that it has a better result in postoperative morbidity. For the Frey procedure, a significantly lower postoperative morbidity is demonstrated, but complete pain relief is not provided in most cases. Thus, compared with conventional pancreaticoduodenectomy, both new strategies should be recommended on the basis of the patients' appropriate individual preferences.

For surgical trainees, perfecting a systematic approach to open inguinal herniorrhaphy can be complicated by the difficulty of conceptualizing hernias in relationship to the relatively complex anatomy of the inguinal canal. Open inguinal hernia repair is a common general surgery operation and a precise understanding of the operation is essential for residents. We present a systematic approach to this operation that uses the U and sushi roll technique as a conceptual aid to understand inguinal anatomy and a method of hernia repair.