Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia.

BACKGROUND: The prevalence of terminal parastomal hernia (PH) after colostomy placement may be as high as 50%. The effect of the PH may range from discomfort to life-threatening complications. Surgical procedures for repairing PH are difficult to perform and present a high-failure rate. OBJECTIVE: To reduce the incidence of PH by implanting a lightweight mesh in the sublay position. MATERIAL AND METHODS: Randomized, controlled, prospective study. Patients were scheduled for permanent end colostomy surgery to treat cancer of the lower third of the rectum, performed by the same colorectal surgery team. An Ultrapro lightweight mesh was inserted in the sublay position in the study group. Using simple randomization, the sample size required was estimated to be 27 per group. Patients were followed-up clinically and radiologically with abdominal computed tomography by an independent clinician and a radiologist who were all blind to the aims of the study, 1 month and every 6 months after surgery. RESULTS: : The groups were homogeneous in terms of their clinical and demographic characteristics. Surgical time and postoperative morbidity were similar in the 2 groups. Mortality was 0. No mesh intolerance was reported. In the clinical follow-up (median: 29 months, range: 13-49), 11/27 (40.7%) hernias were recorded in the control group compared with 4/27 (14.8%) in the study group (P = 0.03). Abdominal computed tomography identified 14/27 (44.4%) hernias in the control group compared with 6/27 (22.2%) in the study group (P = 0.08). CONCLUSIONS: Parastomal placement of a mesh reduces the appearance of PH. The technique is safe, well-tolerated, and does not increase morbidity rates.

[How are resident physicians evaluated? The residents' computerized activity record]. / 'Cómo evaluamos la actividad de los médicos internos residentes? El libro informático del residente.

INTRODUCTION: Because of the developments that have occurred in surgery in the last few years, updates are required not only in the content of resident physicians' training but also in evaluation of the knowledge acquired. The present article aims to present our experience of an integral evaluation model. This model is based on evaluation of theoretical knowledge and surgical skills. MATERIAL AND METHOD: The training program for resident physicians (medico interno residente [MIR]) has four main branches: clinical work, continuing training, research (doctorate) and evaluation of the activity performed (computerized activity record). This record allows the theoretical knowledge and skills acquired to be evaluated at the end of each rotation. Through 6-monthly evaluations, each resident's activity can be quantified over time and compared with that of other residents. RESULTS: The system was introduced in July 2004. Each resident was given his or her own database. All the activities performed were then introduced into the database. The results of overall activity and that of each resident are presented. CONCLUSIONS: The method used allows residents' integral progress to be followed-up and a completely objective evaluation to be made at the end of each year and at the end of the residency period. Widespread use of this system, or a similar system, would enable comparisons with other centers to be made under similar premises. This system could also help to unify criteria and identify deviations in training.

¿Cómo evaluamos la actividad de los médicos internos residentes? El libro informático del residente / How are resident physicians evaluated? The residents’ computerized activity record

Introducción. La evolución de nuestra especialidad en los últimos años obliga a realizar actualizaciones no sólo en contenidos, sino en una evaluación de los conocimientos aprendidos. El objetivo de este artículo es presentar nuestra experiencia en un modelo de evaluación integral. Se basa en una valoración de los conocimientos teóricos y las habilidades quirúrgicas. Material y método. El programa de formación para los MIR que hemos aplicado está fundamentado en 4 apartados: asistencial, formación continuada, investigación (doctorado) y control de la actividad realizada (libro informático del residente). Permite una evaluación de los conocimientos teóricos y las habilidades aprendidas al final de cada rotación. Mediante la creación del libro informático del residente que presentamos, se practica cada 6 meses una cuantificación de la actividad de forma continua y comparada. Resultados. En julio de 2004, iniciamos la puesta en marcha de este sistema de evaluación de la actividad de los residentes. Se entregó a cada uno de ellos su propia base de datos para que iniciara su desarrollo mediante la introducción de todas las actividades realizadas. Se presentan los resultados de la actividad global y particular de cada residente. Conclusiones. El método que utilizamos permite seguir la evolución integral del residente y realizar, al final de cada año y de la residencia, una valoración totalmente objetiva. La generalización de este método o uno similar facilitará la realización de comparaciones con otros centros y bajo premisas similares. Por otra parte, podría unificar criterios y determinar desviaciones de formación (AU)

Introduction. Because of the developments that have occurred in surgery in the last few years, updates are required not only in the content of resident physicians' training but also in evaluation of the knowledge acquired. The present article aims to present our experience of an integral evaluation model. This model is based on evaluation of theoretical knowledge and surgical skills. Material and method. The training program for resident physicians (medico interno residente [MIR]) has four main branches: clinical work, continuing training, research (doctorate) and evaluation of the activity performed (computerized activity record). This record allows the theoretical knowledge and skills acquired to be evaluated at the end of each rotation. Through 6-monthly evaluations, each resident's activity can be quantified over time and compared with that of other residents. Results. The system was introduced in July 2004. Each resident was given his or her own database. All the activities performed were then introduced into the database. The results of overall activity and that of each resident are presented. Conclusions. The method used allows residents' integral progress to be followed-up and a completely objective evaluation to be made at the end of each year and at the end of the residency period. Widespread use of this system, or a similar system, would enable comparisons with other centers to be made under similar premises. This system could also help to unify criteria and identify deviations in training (AU)