World Journal of Surgery

The widespread availability of newborn centers and competent management of respiratory problems in the newborn have allowed survival of many infants with patent ductus arteriosus (PDA) who previously would have died. Most deaths after surgical correction of PDA in the newborn have been due to problems in management of ventilation and nursing care. Since most patients are intubated and on respirators prior to election of operative closure, we decided to close the ductus in the newborn center, without moving the patient or disturbing the equipment. The same nurses and pediatric fellows would manage the infant after surgery. The first 9 consecutive premature infants with near-fatal respiratory problems associated with patent ductus arteriosus and operated upon in the newborn center all survived, improved, and were discharged home. There were no infections or other major surgical complications. We conclude that, in properly selected patients, surgical closure of the patent ductus arteriosus is best done in the newborn center under local anesthesia.

To investigate the safety of surgical performance by residents of different training level performing common general surgical procedures. Data were consecutively collected from all patients undergoing general surgical procedures such as laparoscopic cholecystectomy, laparoscopic appendectomy, inguinal, femoral and umbilical hernia repair from 2005 to 2011 at the Department of Surgery of the University Hospital of Zurich, Switzerland. The operating surgeons were grouped into junior residents, senior residents and consultants. The comprehensive complication index (CCI) representing the overall number and severity of all postoperative complications served as primary safety endpoint. A multivariable linear regression analysis was used to analyze differences between groups. Additionally, we focused on the impact of senior residents assisting junior residents on postoperative outcome comparing to consultants. During the observed time, 2715 patients underwent a general surgical procedure. In 1114 times, a senior resident operated and in 669 procedures junior residents performed the surgery. The overall postoperative morbidity quantified by the CCI was for consultants 5.0 (SD 10.7), for senior residents 3.5 (8.2) and for junior residents 3.6 (8.3). After adjusting for possible confounders, no difference between groups concerning the postoperative complications was detected. There is also no difference in postoperative complications detectable if junior residents were assisted by consultants then if assisted by senior residents. Patient safety is ensured in general surgery when performed by surgical junior residents. Senior residents are able to adopt the role of the teaching surgeon in charge without compromising patients’ safety.

The optimal surgical approach for patients with primary hyperparathyroidism (pHPT) and multiple endocrine neoplasia 1 (MEN1) is controversial. We sought to determine the optimal type of surgery for pHPT in MEN1. We collected data on clinical presentation, surgery, and follow-up for MEN1 patients with pHPT at the University Medical Center Utrecht and affiliated hospitals between 1967 and 2008. Furthermore, we performed a systematic review of the literature and meta-analysis. Surgical procedures were classified into less than subtotal (