The World Health Organisation’s Surgical Safety Checklist in Belgian Operating Theatres: a Content-Driven Evaluation

Rationale, aims and objectives : It is unclear which items of the WHO surgical safety checklist are most crucial for producing its associated benefits. Thoughtless modification, especially removing items, can therefore potentially lead to reduced effectiveness of the instrument. This study describes the modifications made by Belgian hospitals. Method : An online survey was used to find out which checklists are used. An expert panel conducted a content-driven evaluation of the retrieved checklists by verifying the presence of the WHO items and evaluating any modifications made.

Results : All hospitals participating in the survey (n = 36) reported the use of a surgical safety checklist. Based on self-report, 69.4% (n = 25) of hospitals reported to use all WHO items. The expert panel determined that 17.1% (n = 6) of checklists included all WHO items. Inclusion ranged from 7 to 22 items (mean = 16.6, Std. Dev. = 4.48). Detailing on the functional parts of the checklist, 48.6% (n = 17) of checklists contained all sign-in items, 25.7% (n = 9) contained all time-out items and 37.1% (n = 13) enclosed all sign-out items. Sixty percent (n = 21) of checklists added items not mentioned in the original WHO checklist.

Conclusion : The modifications made to the WHO checklist vary between hospitals. Only a small number of hospitals included all 22 WHO items. It is unknown whether these modified checklists will be equally effective in decreasing the number of postoperative complications, including mortality. More detailed recommendations and guidance regarding the modification of the WHO surgical checklist is required.     

Morphodynamics and Surgical Correction of the Body’s Creases,Folds, and Wrinkles

The aesthetics of the human body are a balance of furrows and orifices, and artists of every period have studied the distance between ear and eye, eye and nostrils, nostrils and mouth, nipple and submammary crease, subgluteus folds and iliac crest and so on, to create a code for all body proportions. Currently, the ideal of female beauty prefers more elongated shapes than in the past, and surgical body modeling, performed in accordance with anthropometric rules, uses a combination of techniques to alter the orientation and depth of aesthetic reference points, such as body folds and curves. These must be integrated into the bodys biodynamics to both prevent and correct defects and irregularities of the body, which has an inherent disposition to change shape, both because of the physical forces acting on it and because of constant tissue replacement.     

Surgical management of a De Garengeot’s hernia using a biologic mesh: A case report and review of literature

IntroductionA De Garengeot hernia is a rare form of femoral hernia, where the appendix is found in the herniated sac. This feature is important to report, as both the diagnosis and the treatment are quite challenging in this particular condition.Presentation of caseWe report the case of a 77-year-old female presenting with a femoral hernia, containing an incarcerated necrotic vermiform appendix (De Garengeot hernia). A laparoscopic appendectomy was performed and the herniated defect was repaired according to Rives technique, using a biological mesh.DiscussionThe De Garengeot hernia is often unexpected and diagnosed intra-operatively. A pre-operative diagnosis is quite difficult, as it often presents clinically as a strangled femoral hernia. In patients without peritoneal signs, a contrast-enhanced Computed Tomography (CT) of the abdomen is useful for the diagnosis. Many surgical techniques have been discussed in literature, but there is no consensus. We show the feasibility and safety of the hernia repair according to Rives technique, through an inguinotomy with a biologic mesh. A laparoscopic approach was used to remove the necrotic appendix.ConclusionThe De Garengeot hernia is an uncommon differential diagnosis for patients presenting with clinical signs of strangled femoral hernia. Although hernia repairs with a synthetic mesh in the presence of appendicitis have been reported, we describe a case of femoral hernia repair using a biologic mesh, in a patient with a De Garengot hernia.     

Surgical resident’s training in colonoscopy: numbers, competency, and perceptions

Background  

There is currently great discrepancy in the training requirements between medical societies regarding the recommended threshold number of colonoscopies needed to assess for technical competence. Our goal was to determine the number of colonoscopies performed by surgical residents, rate of cecal intubation, as well as trainee perceptions of colonoscopy training after completion of their training period.     

Surgical treatment of multivessel lesions in Takayasu’s arteritis: Report of a case

Takayasu’s arteritis (TA) is a chronic vasculitis involving the aorta and its main branches, the pulmonary arteries, and the coronary tree. Here we report a case of TA complicated by severe stenosis of the left coronary ostium with multivessel brachiocephalic involvement. A combination of these abnormalities could complicate underlying illness in patients, posing an increased risk of surgical morbidity. Simultaneous surgical treatment of the ascending aorta to left carotid artery bypass and coronary artery bypass using the great saphenous vein were performed. We discuss the choice of simultaneous surgery and the options for surgical treatment of complicated lesions due to TA.     

Surgical treatment of cecal cancer in a patient with Glanzmann’s thrombasthenia: Report of a case

Glanzmann’s thrombasthenia (GT) is a rare inherited platelet disorder with no specific treatment. Prophylactic and therapeutic platelet transfusions work only as supportive treatments. To date, there has been no report of surgical treatment for malignant disease in GT patients. We herein report the case of a 43-year-old woman presenting with cecal cancer with accompanying GT. The patient underwent a laparotomic procedure under general anesthesia for resection of the tumor. A good perioperative course was achieved by the transfusion of ABO-identical and antihistocompatibility locus antigen-matched platelets, without causing any accidental bleeding.