Perineal hernia after abdominoperineal resection - a systematic review.

<b>Introduction:</b> Perineal hernia (PH), also termed pelvic floor hernia, is a protrusion of intraabdominal viscera into the perineum through a defect in the pelvic floor. </br></br> <b>Aim:</b> The study was conducted to evaluate the cases of perineal hernia resulting as a complication of abdominoperineal resection (APR) of rectal cancer. </br></br> <b> Material and methods:</b> 30 cases from 24 articles published in reputable peer reviewed journals were evaluated for eight variables including [I] patient age, [II] gender, [III] time since APR, [IV] clinical presentation, [V] approach to repair, [VI] type of repair, [VII] presence/absence of pelvic adhesions [VIII] complications. </br></br> <b>Results:</b> There was a total of 30 cases (18 males and 12 females) with a mean age of 71.5 years. The time of onset of symptoms ranged from 6 days to 12 years. Perineal lump with pain was the chief presenting feature followed by intestinal obstruction. Different approaches were adopted to repair by various methods. </br></br> <b>Conclusions:</b> Perineal hernia as a complication of abdominoperineal resection is reported increasingly nowadays, as the approach to management of rectal cancer has gradually got shifted from open to minimally invasive in recent years. There is a need to spread awareness about this condition, so that it is actively looked for, during the postoperative follow-up. Management is surgical repair; the approach and type of repair should be individualized.

Awareness, Attitude, and Willingness Toward Bleeding Control by Bystanders in Riyadh.

Background Hemorrhage after trauma is the second leading cause of death in patients in the prehospital environment, and intervention by bystanders before the arrival of professional rescuers has the potential to save lives in such circumstances. No studies have been conducted in Saudi Arabia till date to assess the knowledge and awareness of bleeding control by bystanders. Hence, this study was conducted with an aim to assess the level of awareness, attitude, and willingness toward bleeding control by bystanders in Riyadh city, the capital of Kingdom of Saudi Arabia (KSA). Methodology This is an observational cross-sectional survey design that was conducted from July 2022 to August 2022 using an electronic questionnaire targeting populations who live in Riyadh city. MS Excel 2022 was used for data entry and coding, while SPSS Version 26 (IBM Corp., Armonk, NY) was used for data analysis. Results In this study, 585 adults from Riyadh city were recruited. Among the participants, 62.9% of them were between 16 and 26 years of age; 55.4% were males and 90.3% were Saudi Arabian citizens. Of the participants, 76.1% reported that they did not have any experience in participation in bleeding control related activity. Fear of causing more harm to the patients by attempting bleeding control was expressed by 65.1%. In general, 40.2% of the participants have adequate knowledge considering controlling of bleeding in an emergency setting. Higher level of education and having a previous first aid training were associated with better knowledge significantly (p=0.001 and 0.012, respectively). Conclusion There is a great need to improve the level of awareness about the role of bystanders in bleeding control and to design community-level activities to popularize this important life-saving skill.

Perception of primary health care providers of plastic surgery and its influence on referral.

OBJECTIVES: The aim of this study is to understand the level of knowledge and awareness of plastic surgery among primary health care (PHC) providers in Qassim region, Kingdom of Saudi Arabia. METHODS: This is a cross-sectional study conducted from February 2018 to March 2018 among health care providers in PHC in Qassim region, Saudi Arabia. Overall, 82 health care providers were recruited using simple random sampling. Filling the questionnaire was considered as approval to join the study. The study included general practitioners and family medicine specialists. Other specialties working in PHC were excluded from the study. RESULTS: In total, 82 physicians were enrolled in this study. Physicians considered that out of 28 listed disorders 16 of them have chosen a plastic surgeon as the best surgeon to perform the necessary surgery. The selection of plastic surgeon as the best doctor for a specific disorder was as follows: Burn deformities (93%), liposuction (87.7%), breast reduction/enhancement (86.8%), skin grating (84.4%), surgery for facial wrinkles (79.2%), electrical burns (71.6%), Botox (64.4%), cuts over the face (63.5%), abdominoplasty (62.9%), burns (59.4%), congenital anomalies of ear and nose (51.5%), deformities of leprosy (51.4%), sex change surgery (49.2%), non-healing wound over legs (47.1%), cleft lip and palate (41.7%), and totally, amputee thumb, finger, or hand (36.1%). The selection of other disorders was distributed almost similarly. CONCLUSION: General practitioners need more orientation for plastic surgery discipline. In this study, the majority of the study physicians do not have enough knowledge about the meaning of plastic surgery. As a PHC physician, knowledge about this topic is very essential because the patient is very likely to ask about the best surgeon for referral and the potential positive and negative effect of the reconstructive procedure.

Cosmetic surgery training in Canadian plastic surgery residencies: are we training competent surgeons?

BACKGROUND: With the demand for cosmetic surgery continuing to rise, it is necessary to reevaluate the current state of cosmetic surgery training during plastic surgery residency. An evaluation of cosmetic surgery training in US plastic surgery residency programs in 2006 identified several areas for improvement, resulting in changes to both the duration and content of training. OBJECTIVES: The authors assess the current state of cosmetic surgery training in Canadian plastic surgery residency programs. METHODS: A paper survey of all graduating Canadian plastic surgery residents eligible to complete the 2009 Royal College of Physicians and Surgeons of Canada fellowship examinations was performed (N = 29). The survey was conducted primarily at the Canadian Plastic Surgery Review Course in February 2009, with surveys collected from absent residents by e-mail within 1 month after the course. The survey covered 2 broad areas: (1) specifics regarding resident cosmetic surgery training and (2) confidence and satisfaction associated with this experience. RESULTS: Of the 29 residents surveyed, 28 responded (96%). The majority of Canadian plastic surgery residency programs (75%) have a designated cosmetic surgery rotation, but 90% of respondents felt it has become increasingly difficult to gain exposure to cosmetic procedures as most are performed at private surgery centers. Elective rotations at cosmetic surgery practices and resident cosmetic clinics were considered the most beneficial for cosmetic surgery education. Residents considered cosmetic surgery procedures of the face (such as rhinoplasty and facelift) more challenging, but they had more confidence with breast and body contouring procedures. CONCLUSIONS: Canadian plastic surgery residency programs need to ensure that residents continue to receive comprehensive exposure to both surgical and nonsurgical cosmetic procedures to ensure our specialty's continued leadership in this evolving and highly competitive field. A multidimensional approach utilizing a variety of readily available resources will ensure that the current and future cosmetic surgery educational needs of Canadian plastic surgery residents are met.