OSABSS: An authentic examination for assessing basic surgical skills in surgical residents.

Objectives: This study aimed to develop and validate the OSABSS (Objective Structured Assessment of Basic Surgical Skills), a modified Objective Structured Clinical Examination (OSCE), to assess basic surgical skills in residents. Design: A developmental study conducted in two phases. Basic skills were identified through literature review and gap analysis. The OSABSS was then designed as a modified OSCE. Setting: This study took place at Alborz University of Medical Sciences in Iran. Interventions: The OSABSS was created using Harden's OSCE (Objective Structured Clinical Examination) methodology. Scenarios, checklists, and station configurations were developed through expert panels. The exam was piloted and implemented with residents as participants and faculty as evaluators. Participants: 32 surgical residents in gynecology, general surgery, orthopedics, and neurosurgery participated. 22 faculty members were evaluators. Primary and secondary outcome measures: The primary outcome was OSABSS exam scores. Secondary outcomes were written exam scores, and national residency entrance ranks. Main results: The mean OSABSS score was 16.59 ± 0.19 across all stations. Criterion validity was demonstrated through correlations between OSABSS scores, written scores and entrance ranks. Reliability was high, with a Cronbach's alpha of 0.87. No significant inter-rater score differences were found. Conclusions: The rigorous OSABSS development process produced an exam demonstrating strong validity and reliability for assessing basic surgical skills. The comprehensive station variety evaluates diverse technical and non-technical competencies. Further research should expand participant samples across surgical disciplines.

A rare case of abdominal foreign bodies; laparoscopic removal of a sewing needle.

Background: Foreign body (FB) ingestion is a common condition. Mostly FBs are found ingested accidently or intentionally in children and adults with mental status alterations. Depending on the type of object, different complications can occur. There exist numerous methods for removing each specific FB. Fortunately, most FBs tend to move uneventfully through the gastrointestinal tract without any intervention; but managing some foreign objects can be difficult and lead to severe complications. Endoscopy helps with the diagnosis and treatment of these cases, but the time of the management plays an important role. Case presentation: A 26-year-old female who intentionally swallowed two sewing needles, presented to our emergency department with abdominal pain two months after the FB ingestion. One of the sewing needles was spontaneously excreted through the bowel, and the other was present in her body for two months. The FB had penetrated the stomach and migrated to the peritoneal cavity. The patient's condition was managed by laparoscopic removal of the FB and repair of the damaged tissue. According to the traumatic nature of the needle to abdominal viscera, and standing outside the GI tract on the pancreas surface, laparoscopic removal of the foreign metallic body was chosen to be performed. No complication was seen during the postoperative period. Conclusion: This report emphasizes the importance of prompt evaluation of FB patients and finding the appropriate method of managing its complications. Preventing complications requires focusing on symptoms and instant management of the ingested FBs.

Accessory spleen presenting with an episode of acute appendicitis; a case report of a very rare case.

INTRODUCTION: The accessory spleen (AS) is a condition that results from improper placement of spleen cells. About 95 % of ASs are located in the splenic hilum proximal to the tail of the pancreas. Here we present a 23-year-old male diagnosed with AS in the appendix, following an episode of acute appendicitis. CASE PRESENTATION: A 23-year-old male patient who presented with typical symptoms of appendicitis and the examination and paraclinical findings were in favor of appendicitis. Intraoperative findings showed an inflamed appendix and a 2 cm solid mass in the mesoappendix. The pathology report showed acute appendicitis and normal spleen tissue. CONCLUSION: The current study indicated an abnormal location of AS placed in the mesoappendix, which was presented with an episode of acute appendicitis.

Bowel obstruction secondary to gallstone ileus within a strangulated inguinal hernia: Report of a rare diagnosis.

INTRODUCTION: Gallstone ileus is rare and inguinal hernias are common causes of intestinal obstruction but combination of them is a very rare cause of intestinal obstruction. It is accepted that in patients with severe comorbidities surgeons can manage inguinal hernias and gallstone conservatively. In this article we report a patient with gallstone and inguinal hernia that managed with conservatively management because of heart failure but admitted with complication of gallstone and hernia and treated successfully. CASE PRESENTATION: An 80-year-old woman with a history of heart failure and two bouts of acute cholecystitis, who presented with pain and swelling in the inguinal region and obstructive symptoms. And due to the urgent nature of the condition, she underwent surgery. CONCLUSION: One of the rare complications of gallstones is cholecystoduodenal fistulas, especially in patients whose episodes of cholecystitis are treated medically. Early diagnosis and appropriate surgical management in these circumstances reduce the mortality and morbidity.

Efficacy of laparoscopic transversus abdominis plane block on postoperative pain management and surgery side effects in laparoscopic bariatric surgeries.

PURPOSE: Transversus abdominis plane (TAP) block is a new option for reducing postoperative pain. This study investigated the effects of laparoscopic TAP block on postoperative adverse events and analgesia and antiemetics requirements after bariatric surgery. METHODS: In this randomized clinical trial study, patients were randomly divided into control (N = 20) or TAP block (N = 20) groups. In the TAP block group, the block was performed under direct laparoscopic guidance after surgery and before the removal of trocars. RESULTS: Fifteen patients (75%) versus four patients (20%) received opioids within the first 6 h in the control and TAP groups, respectively (p-value < 0.001). The cumulative amount of opioids consumed in the 24 and 48 h after surgery was lower in the TAP group (p-value < 0.001). The visual analog scale (VAS) regarding general and wound-specific pain was significantly lower in the TAP group compared to the control group at 6 and 24 h both at rest and in movement. However, there was no significant difference at 48 h postoperatively. The percentages of patients having postoperative nausea and vomiting (PONV), pruritus, and resumption of bowel movement were not significantly different between the two groups at any time (6, 24, and 48 h) postoperatively. CONCLUSION: Laparoscopic-guided TAP block is a pragmatic, applicable, and minimally invasive regional technique and can be part of effective postoperative pain management in morbidly obese patients undergoing bariatric surgery. Applying it laparoscopically without the need for ultrasound is also useful and effective.