ABSTRACT
Background: As the classical surgical training (mentor–trainee) model is not feasible in the current era of surgical training and simulation model for training young residents is proven, the advanced surgical residents may benefit from cadaver based surgical teaching.Methods: International Hepato-Pancreato-Biliary Association India 2017 provided great opportunity to organize basic hepato-pancreatico-biliary (HPB) anatomy workshop clubbed with HPB radiology and other advanced surgical techniques. It was attended by advanced surgical residents and practicing junior faculty. Post-program survey was conducted and results implied.Results: 131 surgeons attended and 90 (80% residents, 15.6% practicing surgeons) completed the survey. Majority (97.5%) felt that the HPB anatomy was adequately demonstrated by spending enough time for dissection techniques and discussion. Most (84.7%) never attended cadaveric dissection during or after their training program. 95.1% think that dedicated anatomy or dissection teaching sessions are either very useful or useful for their level of surgical training. All participants found cadaveric workshop either very useful (73.3%) or useful (26.7%) learning tool. Majority (73.3%) felt that demonstrated HPB procedures were appropriate for their level. All participants (100%) felt that cadaveric workshops will improve their surgical skills and many (93.4%) felt these improve their confidence in operation theatres.Conclusions: This cadaver based HPB teaching program is an initial step for unique HPB surgical education and useful adjunct for advanced surgical trainees in modern era. Residents consider this as good learning tool and possibly improve surgical skills and confidence. The translation of cadaver based HPB surgical learning into better surgical care needs evaluation in future.
ABSTRACT
Background: Pre-operative nutritional support is of paramount in malnourished patients undergoing major gastrointestinal (GI) surgery. We aimed to investigate the outcomes of short term pre-operative parenteral nutrition in nutritionally depleted patients undergoing major GI surgeries.Methods: A retrospective study from tertiary care centre in South India, where nutritionally at risk patients undergoing major GI surgeries from 2016-2018 were identified and reviewed. Two groups –who received total or peripheral parenteral nutrition (TPN and PPN) and only enteral nutrition..Results: Of 80 patients who were nutritionally depleted underwent major GI surgery, 38 patients received pre-operative parenteral nutrition (PN) support for mean 11 days. Patients who received pre-op PN had similar outcomes (overall complication rate n=26, 68.4% vs n=32, 76.2% p=0.43), when compared to patients who received pre-op enteral nutrition conditioning. Though a small group of patients received peripheral PN supplementation, there was no difference in overall complication rate, when compared with TPN group (n=14, 58.3% vs n=12, 85.7%, p=0.08).Conclusions: Parenteral nutrition either total or supplemental is a useful adjunct pre-operatively for poorly nourished patients and should be utilized to build nutrition prior to major GI surgery. Pre-operative peripheral parenteral nutrition as supplement seems to be beneficial in patients undergoing GI surgery, pending large studies.