Perforación y obstrucción colónica: conducta de los coloproctólogos latinoamericanos / Perforation and obstruction of the colon: behavior of the latin american colon and rectal surgeons

Resumen Objetivo: Conocer las diferentes conductas que realizan los cirujanos coloproctólogos latinoamericanos en relación con las urgencias colónicas. Materiales y Método: Estudio transversal, utilizando encuesta vía web con preguntas de selección múltiple. La encuesta fue enviada a las distintas Sociedades Coloproctológicas Latinoamericanas, así como a la Asociación Latinoamericana de Coloproctología (ALACP), para su distribución. La encuesta fue escrita en español neutro y traducida al portugués. Se utilizó análisis estadísticos descriptivos y analítico. Resultados: 441 encuestas respondidas completamente de 16 países diferentes. El 85% realiza resección y anastomosis sin ostomía de protección en obstrucciones de colon derecho. En las perforaciones del colon izquierdo, se realiza operación de Hartmann en el 63,3% de los casos que presentan peritonitis purulentas y en el 94,5% de las peritonitis fecaloideas. Discusión: En las obstrucciones colónicas, la resección con anastomosis primaria, es una conducta poco discutida en colon derecho, a diferencia de las obstrucciones del lado izquierdo, en donde realizar una operación de Hartmann es una conducta tan válida como la resección y anastomosis. En los cuadros de perforación, la decisión de resección y anastomosis primaria es multifactorial, tomando relevancia la estabilidad hemodinámica del paciente. En estos últimos casos, realizar una resección con ostomía, es la respuesta de gran parte de los encuestados. Conclusiones: Los resultados de cada situación, en su mayoría, presentan una tendencia clara hacia una conducta en particular; solo en el caso de obstrucción de colon izquierdo, se observan dos conductas (operación de Hartmann o anastomosis primaria) ambas validadas por la literatura internacional.

Objective: Learn about the different management options performed by latin american colon and rectal surgeons, in relation to colonic emergencies. Materials and Method: Cross-sectional study, using web survey with multiple-choice questions. The survey was sent to the different Latin America Coloproctological Societies, as well as to ALACP, for distribution. The survey was written in neutral Spanish and translated into Portuguese. Descriptive and analytical statistical analysis was used. Results: 441 complete surveys, from 16 different countries. 85% perform resection and anastomosis without diverting ostomy in obstructions of the right colon. In perforations of the left colon, Hartmann's procedure is performed in 63.3% of case with purulent peritonitis and in 94.5% of fecaloid peritonitis. Discussion: In colonic obstructions, resection with primary anastomosis, is little discussed behavior in the right colon, unlike obstructions on the left side, where performing a Hartmann operation is a behavior as valid as resection and anastomosis. In colonic perforation, the decision of resection and primary anastomosis is multifactorial, taking into account the hemodynamic stability of the patient. In the latter cases, performing an ostomy is the response of a large part of the surveyed. Conclusions: The results in each situation, for the most part, present a clear tendency towards a particular behavior; only in the case of left colon obstruction, two behaviors (Hartmann procedure or primary anastomosis) are both validated by international literature.

Especialidades derivadas de la cirugía general: revisión de brechas e intención de residentes de la especialidad en Chile / Gaps between country needs and intentions to obtain a subspecialty among general surgery trainees in Chile

The fragmentation of a general specialty in subspecialties or derived specialties is a widely spread reality. Chilean health care system is becoming more complex, requiring more specialists. On the other hand, doctors in specialty training increasingly choose a subspecialty to continue their training and professional development. This contrasts with the growing need for well-trained general surgeons. We aimed to compare the evidence about the needs for general surgeons and the perspectives of Chilean physicians about their specialty training. A literature review about the intention of specialization in Chilean general surgery residents and the gaps in the Chilean health system, was performed. As of December 2016, there were 2,103 general surgeons in Chile, of whom 598 (28%) also have a subspecialty. Among the latter, 49% are plastic or vascular surgeons, which are also the specialties with the greatest demand in the public system. According to estimates of the Chilean Ministry of Health, on that year there was a deficit of 285 general surgeons and 142 subspecialists. These figures correspond to 18.5% and 23.8% of the existing resources. A survey published in 2009 reported that 78% of trainees in general surgery would prefer to continue studying a subspecialty, following the trend observed in the USA and Europe. Therefore, there is a disproportion between the intentions of general surgery trainees and the needs for these professionals in Chile.

A cirurgia de mão como uma área de atuação dos cirurgiões plásticos / Hand surgery as a working area of plastic surgeons

INTRODUÇÃO: Estudos prévios têm revelado que o público tem conhecimentos equivocados sobre a atuação dos cirurgiões plásticos em cirurgia da mão. No entanto, não existem dados específicos na literatura científica brasileira. O objetivo deste estudo foi avaliar as percepções do público sobre o papel dos cirurgiões plásticos no campo de cirurgia da mão no Brasil. MÉTODOS: Membros do público brasileiro escolheram um ou dois especialistas que eles acreditassem serem experts para oito cenários relacionados à cirurgia de mão. Os padrões de respostas foram distribuídos como "cirurgiões plásticos" ou "não cirurgiões plásticos". RESULTADOS: "Não cirurgiões plásticos" foram significativamente (p < 0,05 para todas as comparações) mais reconhecidos como experts que "cirurgiões plásticos" em todos os cenários relacionados à cirurgia de mão. CONCLUSÃO: Os conhecimentos e as percepções do público brasileiro sobre o trabalho realizado por cirurgiões plásticos no campo cirurgia da mão são limitados.

INTRODUCTION: Previous studies have shown that the public has misconceptions about the work of plastic surgeons in hand surgery. However, no specific Brazilian data on this issue are available. The objective of this study was to evaluate the public perceptions about the role of plastic surgeons in the field of hand surgery in Brazil. METHODS: Members of the Brazilian public chose one or two specialists whom they believed to be experts in eight scenarios related to hand surgery. The patterns of the responses were distributed into "plastic surgeons" or "non-plastic surgeons." RESULTS: Non-plastic surgeons were significantly (p < 0.05 for all comparisons) more recognized as experts than plastic surgeons in all scenarios related to hand surgery. CONCLUSION: The knowledge and perceptions of the Brazilian public about the work performed by plastic surgeons in the field of hand surgery are limited.