Surgeons' perspectives on operation report documentation.

BACKGROUND: Operation report documentation is essential for safe patient care and team communication, yet it is often imperfect. This qualitative study aims to understand surgeons' perspectives on operation report documentation, with surgeons reviewing cleft palate repair operation reports. It aims to determine how surgeons write an operation report (in narrative and synoptic report formats) and explore the consequences of incomplete documentation on patient care. METHODS: A qualitative semi-structured interview was conducted with cleft surgeons who were asked to consider operation reports and hypothetical clinical cases. Eight operation reports performed at one centre for cleft palate repair were randomly selected for review. RESULTS: An operation report's purpose-patient care, complication documentation, future surgery, and research-will influence the detail documented. All cleft palate repair operation reports had important information missing. Synoptic report writing provides clearer documentation; however, narrative report writing may be a more robust communication and education tool. Surgeons described a bell-curve response in the level of training required to document an operation report-residents knew too little, fellows documented clearly, and Consultants documented briefer reports to highlight salient points. CONCLUSIONS: An understanding of surgeons' perspectives on operation report documentation is richer after this study. Surgeons know that clear documentation is essential for patient care and a skill that must be taught to trainees; barriers may be the documentation method. The flexibility of a hybrid operation report format is necessary for surgical care.

Stricturing ileocaecal endometriosis: a rare concurrent aetiology in a patient with Crohn's disease.

A 34-year-old female presented with colicky abdominal pain and symptoms suggestive of subacute small bowel obstruction in the setting of Crohn's disease (CD). She was on maximal medical therapy and had undergone endoscopic balloon dilatation of a terminal ileal stricture on two occasions. Magnetic resonance enterography demonstrated acute inflammation in two segments of the terminal ileum. The patient proceeded to laparoscopic ileocolic resection. The histopathology revealed a segment of stricturing CD with chronic inflammatory change. There was also an unexpected finding of a segment of stricturing ileal disease secondary to endometriosis. Endometriosis affecting the ileum is uncommon, and concurrent CR and endometriosis is very rare. Further research is required to understand whether these two conditions are associated. Here, we present a discussion on the histopathology differences between endometriosis and CD. Clinicians are reminded of these rare concurrent conditions, as the symptomatology may mimic one another, thus impacting the treatment and management.

The Early Operative Burden for Children Born with Cleft lip and Palate.

OBJECTIVES: to audit the surgical management of infants born with non-syndromic cleft lip and palate (CLP) at an Australian cleft unit in a large tertiary paediatric hospital. DESIGN: Retrospective cohort study. SETTING: A tertiary Cleft centre. PATIENTS: 193 infants born with non-syndromic CLP were referred to the centre and underwent primary repair of their CLP between 2009 and 2020.Main Outcome Measures: (1) The timing and surgical repairs performed; (2) the frequency of postoperative complications; (3) the frequency of secondary Cleft surgery; and (4) the total Cleft-related operations performed for infants born with CLP. RESULTS: Four different surgical repair techniques were performed by six surgeons, and postoperative complications were uncommon (n = 14). Rates of oronasal fistula surgery (10.5% at five years of age; 14.3% at eight years of age) and velopharyngeal insufficiency surgery (8.7% at five years of age; 14.3% at eight years of age) were not significantly different across the surgical repair groups (p-value >0.05) and were comparable to international Cleft centres. Children underwent an average of four operative procedures in this audit period, including primary Cleft repair, ear, nose and throat surgery, and dental care. Surgery for managing Eustachian tube dysfunction was the most common surgical intervention following primary Cleft repair. CONCLUSIONS: Children born with non-syndromic CLP have a high early operative burden, with outcomes similar across the spectrum of techniques and surgeons.

Telemedicine versus face-to-face follow up in general surgery: a randomized controlled trial.

BACKGROUND: Telemedicine provides healthcare to patients at a distance from their treating clinician. There is a lack of high-quality evidence to support the safety and acceptability of telemedicine for postoperative outpatient follow-up. This randomized controlled trial-conducted before the COVID-19 pandemic-aimed to assess patient satisfaction and safety (as determined by readmission, reoperation and complication rates) by telephone compared to face-to-face follow-up after uncomplicated general surgical procedures. METHODS: Patients following laparoscopic appendicectomy or cholecystectomy and laparoscopic or open umbilical or inguinal hernia repairs were randomized to a telephone or face-to-face outpatient clinic. Patient demographics, perioperative details and postoperative outcomes were compared. Patient satisfaction was assessed via a standardized Likert-style scale. RESULTS: One hundred and twenty-three patients were randomized over 12 months. Mean consultation times were significantly shorter for telemedicine than face-to-face clinics (telemedicine 10.52 ± 7.2 min, face-to-face 15.95 ± 9.96 min, P = 0.0021). There was no difference between groups in the attendance rates, nor the incidence or detection of postoperative complications. Of the 58 patients randomized to the telemedicine arm, 40% reported high, and 60% reported very high satisfaction with the method of clinic follow-up. CONCLUSION: Telemedicine postoperative follow-up is safe and acceptable to patients and could be considered in patients undergoing uncomplicated benign general surgery.

Gynaecomastia-like change of a female breast with tri-layer ductal epithelium as described in the male breast.

A 31-year-old female presented with asymmetrical fullness in the right breast and was found to have a large span of fibrocystic change and nodular glandular tissue on magnetic resonance imaging. Breast malignancy could not be excluded, and thus excisional biopsy was performed. Histopathology revealed a rare finding of gynaecomastia-like histopathological changes of a female breast. Gynaecomastia is traditionally a clinical condition affecting the male breast and characterized by ductal hyperplasia, periductal fibrosis and oedema of the tissue. We describe the first finding of gynaecomastia-like change with a tri-layer ductal epithelium in a female breast, as previously described in the male breast.