Expectativas y realización profesional en Cirugía General y subespecialidades quirúrgicas: situación actual de los cirujanos jóvenes en Córdoba / Expectations and professional fulfillment in general surgery and surgical sub-specialties: current situation of young surgeons in Cordoba

RESUMEN Antecedentes: en la Argentina, la especialidad Cirugía General se encuentra en crisis y esta situación alarmante se halla vinculada a las malas condiciones laborales del cirujano general. Objetivo: describir la percepción que el cirujano joven tiene al terminar su programa de formación, en relación con su perspectiva laboral, actividad quirúrgica y académica. Material y métodos: estudio transversal basado en una encuesta dirigida a cirujanos jóvenes en Córdoba, Argentina. Resultados: participaron 53 encuestados. El 58% eran hombres y la mediana de edad fue 32 años. El 72% ejercía Cirugía General y el 55% trabajaba en el sector privado. El 34% pertenecía a la Asociación de Cirugía de Córdoba y el 23% a la Asociación Argentina de Cirugía. En cuanto a la experiencia profesional, el 53,1% eran cirujanos junior y el 64% eran competentes para realizar procedimientos de baja o mediana complejidad. En relación con la perspectiva laboral, el 89% consideró que el cirujano joven no consigue salida laboral rápida y el 96,2% refirió que sus prácticas no eran bien remuneradas. Respecto de la calidad de vida personal y laboral, el 57% manifestó frustración e incertidumbre económica. En cuanto a las cirujanas, la tasa de inequidades de género y hostigamiento sexual en el ámbito laboral fue del 73% y 50%, respectivamente. Conclusión: encontramos la percepción de un bajo nivel de competencia para las cirugías de mayor complejidad y una baja tasa de adherencia a sociedades quirúrgicas. Debido a la escasa oferta laboral existe gran frustración e incertidumbre económica. Actualmente, predomina y persiste el maltrato y hostigamiento hacia las cirujanas.

ABSTRACT Background: In Argentina, the specialty of general surgery is in crisis, and this alarming situation is associated with the poor working conditions of general surgeons. Objective: The aim of this study is to describe the perception of young surgeons at the end of their training program, in relation to their job prospects, surgical and academic activity. Material and methods: We conducted a cross-sectional study based on a survey responded by young surgeons in Cordoba, Argentina. Results: The survey was responded by 53 young surgeons; 58% were men and median age was 32 years. Seventy-two percent practiced general surgery and 55% worked in the private setting. Thirtyfour percent were members of Asociación de Cirugía de Córdoba and 23% belonged to Asociación Argentina de Cirugía. As for professional experience, 53.1% were junior surgeons and 64% were capable of performing low or medium complexity procedures. Eighty-nine percent considered that young surgeons do not get a job quickly and 96.2% reported that they were not well paid for their practice. When asked about their personal and professional quality of life, 57% expressed frustration and economic uncertainty. Among women surgeons, 73% reported gender inequities and 50% reported sexual harassment in the workplace. Conclusion: Young surgeons perceived they had low level of competencies for high complexity surgical procedures and reported low rate of membership in surgical societies. Most of them feel frustrated due to scarce job opportunities and expressed economic uncertainty. Nowadays, abuse and harassment of women surgeons still prevails and persists.

Obstrucción intestinal debido a hernia interna transmesentérica congénita en adulto / Bowel obstruction due to congenital transmesenteric internal hernia in adults

RESUMEN Las hernias internas constituyen una causa rara de obstrucción de intestino delgado. Entre estas se encuentra la hernia transmesentérica congénita, que es muy infrecuente en adultos. Presentamos el caso de un paciente de sexo masculino de 20 años, sin antecedentes quirúrgicos ni traumáticos, que acudió al Servicio de Urgencias con sintomatología de obstrucción intestinal. Se realizó laparotomía de emergencia, encontrándose intestino delgado encarcelado a través de un defecto localizado en mesenterio yeyunal distal. No había necrosis intestinal por lo que no fue necesaria la resección intestinal. El paciente evolucionó favorablemente y fue dado de alta al tercer día posoperatorio.

ABSTRACT Internal hernias are a rare cause of bowel obstruction. Congenital transmesenteric hernias, a type of internal hernias, are uncommon in adults. We report the case of a 20-year-old male patient with no history of surgeries or trauma who presented to the emergency department with symptoms of bowel obstruction. Emergency laparotomy revealed small bowel incarceration through a defect in the distal jejunal mesentery. As the bowel was viable there was no need to perform bowel resection. The patient evolved with favorable outcome and was discharged on postoperative day 3.

Work-Related Burn Injuries in a Tertiary Care Burn Center, 2013 to 2018.

The features of work-related burn (WRB) injuries are not well defined in the literature and they vary depending on geographical location. We wanted to describe these characteristics among patients treated in the UNC Burn Center to evaluate the potential impact of commonly accepted prevention efforts. Adults of working age, admitted between January 1, 2013, and December 31, 2018, were identified using our Burn Center Registry. Demographic data, characteristics of injury, course of treatment, and patients' outcomes were described. Differences between work-related and non-work-related injuries were evaluated using the Chi-square test and Student t-test where appropriate. Three thousand five hundred and forty-five patients were included. WRB cases constituted 18% of the study population, and this proportion remained relatively stable during the study timeframe. Young white males were the majority of this group. When compared with non-WRB patients, they were characterized by fewer co-morbidities, decreased TBSA burns, decreased risk of inhalation injury, shorter time of intensive care treatment, shorter lengths of hospital stay, and lower treatment cost. In contrast to non-WRB, among which flame injuries were the main reason for admission, work-related patients most often suffered scald burns. They also had a dramatically increased proportion of chemical and electrical burns, making the latter the most common cause of death in that group. WRB are characterized by a characteristic patient profile, burn etiologies, and outcomes. Learning specific patterns at this group may contribute to optimize work safety regulations and medical interventions.

Treatment Modalities for Esophageal Adenocarcinoma in the United States: Trends and Survival Outcomes.

Background: Owing to the rising incidence of esophageal adenocarcinoma (EAC), we sought to assess the national trends in the use of different treatment modalities and compare survival outcomes among them. Methods: Using Surveillance, Epidemiology, and End Results (SEER) Program registry (2004-2014), we identified adult patients diagnosed with EAC undergoing definitive chemoradiotherapy (dCRT), esophagectomy, or neoadjuvant chemoradiotherapy plus esophagectomy (nCRT/S). Linear trends in the yearly incidence of each treatment were assessed using Poisson regression. An inverse probability of treatment weighted (IPTW) Cox regression was used to estimate the effect of each treatment on mortality. IPTW was used to account for potential confounding by year of diagnosis, patient demographics, and cancer characteristics. Results: A total of 10,755 patients were included in the study. From 2004 to 2014, the use of esophagectomy alone decreased from 15% to 5% (P < .0001), whereas nCRT/S increased from 14% to 20% (P < .0001); dCRT remained relatively stable (26% to 29%, P = .08). The 60-month survival rate was 13.0% for dCRT, 33.0% for esophagectomy only, and 36.3% for nCRT/S. After accounting for patient and cancer characteristics, both esophagectomy (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.55-0.70, P < .0001) and nCRT/S (HR 0.45, 95% CI 0.41-0.48, P < .0001) had significantly the highest survival rates. Conclusion: The use of esophagectomy alone has decreased, whereas nCRT/S has increased among EAC patients. Considering the better outcomes achieved with surgical resection, the use of dCRT should be discouraged in surgically fit patients.

Laparoscopic Heller Myotomy: A Fundoplication Is Necessary to Control Gastroesophageal Reflux.

Background: Achalasia is a rare esophageal motility disorder that causes progressive dysphagia and regurgitation. The aim of treatment for achalasia is to provide symptom relief by reducing esophageal outflow resistance by disrupting the muscles at the level of the esophagogastric junction to allow esophageal emptying by gravity. Methods: A review of the literature concerning laparoscopic treatment of esophageal achalasia. Results: Surgical myotomy with partial fundoplication is very effective in relieving symptoms, and is able to strike a balance between relief of symptoms and control of abnormal reflux. Conclusions: Since reflux of gastric contents into the aperistaltic esophagus can cause esophagitis, peptic strictures, Barrett's esophagus, and even esophageal carcinoma, the addition of a partial fundoplication is very important. The choice of partial fundoplication is based on surgeons' preference and expertise.

Racial and Socioeconomic Disparities in the Surgical Management and Outcomes of Patients with Colorectal Carcinoma.

INTRODUCTION: Colorectal cancer (CRC) is the second leading cause of cancer mortality in the USA. We aimed to determine racial and socioeconomic disparities in the surgical management and outcomes of patients with CRC in a contemporary, national cohort. METHODS: We performed a retrospective analysis of the National Inpatient Sample for the period 2009-2015. Adult patients diagnosed with CRC and who underwent colorectal resection were included. Multivariable linear and logistic regressions were used to assess the effect of race, insurance type, and household income on patient outcomes. RESULTS: A total of 100,515 patients were included: 72,552 (72%) had elective admissions and 27,963 (28%) underwent laparoscopic surgery. Patients with private insurance and higher household income were consistently more likely to have laparoscopic procedures, compared to other insurance types and income levels, p < 0.0001. Black patients, compared to white patients, were more likely to have postoperative complications (OR 1.23, 95% CI, 1.17, 1.29). Patients with Medicare and Medicaid, compared to private insurance, were also more likely to have postoperative complications (OR 1.30, 95% CI, 1.24, 1.37 and OR 1.40, 95% CI, 1.31, 1.50). Patients in low-household-income areas had higher rates of any complication (OR 1.11, 95% CI 1.06, 1.16). CONCLUSIONS: The use of laparoscopic surgery in patients with CRC is strongly influenced by insurance type and household income, with Medicare, Medicaid and low-income patients being less likely to undergo laparoscopic surgery. In addition, black patients, patients with public insurance, and patients with low household income have significant worse surgical outcomes.