Surgeons' learning style in comparison to their medical colleagues

Objectives: To present the learning style of surgeons and compare it to their medical colleagues

Methods: This study was conducted at King Hussein Medical Center between 1-15/July 2014. An equal number of randomly selected surgeons and physicians received Honey and Mumford learning style questionnaire. The participants were asked to fill the questionnaire with their name initials, age, gender, specialty [surgeon or physician] and scientific medical level [specialist or consultant]. The results between these two groups were compared using statistical methods

Results: A total number of 40 participants filled the questionnaire, 20 in each group. Thirty six [90%] were males, with a mean age of 37.6 years [SD +/- 6.32]. There were 7 consultants and 33 specialists. The majority [80-90%] of surgeons and physicians showed reflector and theorist learning styles. When grouping them into activist/ pragmatist, reflector/ theorist or mixed learning styles; 80% of surgeons and 90% of physicians demonstrated mixed learning style

Conclusion: Both surgeons and physicians demonstrated a mixed learning style. This means that doctors in both specialties use all four learning styles which inevitably will bring the best learning results. We suggest the application and appreciation of all learning styles in the surgical curriculum as the most educational and practical approach

Management of fistula-in-ano at King Hussein medical center

To describe the treatment of fistula-in-ano in the newly formed colorectal unit at King Hussein Medical Center. This is a descriptive, retrospective review of case medical records of 91 patients with different types of fistula-in-ano treated surgically between March 2009 and May 2011. Anatomic classification and operative procedure of all fistulae were recorded. Eighty-five patients underwent surgery for fistula-in-ano. There were 93 fistulae in our study group; with eight patients having two fistulae tracts. There were 76 [89%] males, with a mean age of 39.1 years [range 19-76]. Eleven patients had superficial, 5 patients had inter-sphincteric, 68 patients had trans-sphincteric, 3 patients had supra-sphincteric and 5 patients had extra-sphincteric fistulae. Thirty-eight patients [45%] had complex fistulae. The radial site of fistulae was detected, with 44 [47%] presenting with an internal opening in the posterior anal canal, 19 [21%] opening into the anterior canal and 30 [32%] opening laterally. Fistulotomy was the commonest procedure [n=40] with marsupialization in 20 patients, followed by loose Seton [n=33], endorectal advancement flap [n=5], tight Seton [n=4] and ligation of the intersphincteric fistula tract [LIFT] procedure [n=2]. Careful selection of the treatment method that takes into account the anatomy of the fistula, state of the anal sphincters and patient's preference is central in the successful management of fistula-in-ano

Vulvar lipoma: a case report

Lipomas are multilobular benign tumours of fat usually arising in the superficial subcutaneous tissues of the trunk and limbs but may also be found in the peritoneal cavity and within muscles. Lipomas are usually soft, fluctuant, painless, subcutaneous lumps measuring from two to 20 cm in diameter. Most lipomas are excised for cosmetic reasons. Lipomas of the vulva are rare and not so many cases were reported in the literature. We present a case of a large vulvar lipoma in a 30-year old woman

Fistula-in-ano: a prospective audit

Fistula-in-ano is a common condition that is characterized by intermittent pain and discharge. We present an audit of all patients seen with anal fistula at Prince Hashem Hosptial during an eighteen month period. This audit includes all patients that underwent examination under anesthetic for fistula-in-ano from September 2006 to May 2008. Anatomic classification and operative procedures of all fistulae were recorded. Patients were followed-up for a mean period of 13 months and details of wound healing, fistula recurrence and function were gathered. Forty three consecutive patients underwent examination under anesthesia for fistula. There were 36 males with a mean age of 32.2 years [range 17-65]. Eight [18.6%] patients had superficial, 15 [34.9%] intersphincteric, 17 [39.5%] transphincteric, 3 [7%] suprasphincteric and none had extrasphincteric fistulae. Forty [93%] patients had fistulae of cryptoglandular [idiopathic] origin. Two [74.4%] patients underwent fistulotomy. One disease and one [2.3%] had low rectal malignancy. Thirty two [74.4%] patients underwent fistulotomy. One [2.3%] patient had advancement flap. Nine [21%] patients had loose seton in situ and one patient underwent abdominoperineal resection. Four [9.5%] patients had some degree of flatus incontinence, two [4.8%] had incontinence to liquid stool. Soiling was present in one patient. Fistula-in-ano is relatively a common condition in Jordan. Its variation in anatomical distribution should alert the surgeons for the variety of surgical options available for its treatment, especially the difficult and complex ones, that should be managed by a colorectal surgeon of general surgeon that has adequate experience in this field. Unusual causes like Crohn's disease and malignancy should be kept in mind in complex, unhealed fistulae

Dufourmentel flap for the treatment of pilonidal sinus disease

Pilonidal sinus is a common disease in young adults that carries high postoperative morbidity and patients' discomfort. The aim of our study was to present our experience with the Dufourmentel flap technique in the management of pilonidal sinus disease and to evaluate the morbidity and recurrence. This study was conducted in the surgical department of Prince Hashem Bin Al-Hussein Hospital in Zarqa between October 2006 and July 2008. Eleven patients were included, eight had previous surgical drainage of multiple natal cleft abscesses, and three had acute disease at the time of surgery. Nine patients had complex, recurrent pilonidal sinus. By using the Dufourmentel transposition flap, we were able to excise the diseased area and close the defect. Operative time, hospital stay, healing time, wound infection, wound breakdown, return to normal activity and recurrence were assessed. There were 10 males and one female with a median age of 23 years [range 17-32 years]. Mean follow-up was 13.5 months [range 1-21 months]. Mean operative time was 63.2 minutes [range 55-75 minutes]. Hospital stay was 3.4 days [range 2-5]. Postoperative morbidity involved superficial wound infection in two patients, superficial gangrene of wound edges in one patient and partial wound breakdown in one patient that settled with dressing in the out-patient clinic. All wounds healed and the median healing time was 15 days. There was no recurrence in our series. Median time to return to normal activity was 17.8 [range 10-27] days. Dufourmentel flap is a useful technique in the treatment of advanced, difficult cases of pilonidal sinus disease. It has relatively low morbidity, allows early return to full activity and does not necessitate prolonged postoperative care. A larger series and longer follow up time is needed to assess the recurrence rate more adequately