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Background:We recently studied attrition in Canadian general surgical programs; however, there are no data on whether residents enrolled in other surgical residencies harbour the same intents as their general surgical peers. We sought to determine how many residents in surgical disciplines in Canada consider leaving their programs and why.Methods: An anonymous survey was administered to all residents in 9 surgical disciplines in Canada. Significance of association was determined using the Pearson χ 2 test. The Canadian Post-MD Education Registry (CAPER) website was used to calculate the response rate. Results:We received 523 responses (27.6% response rate). Of these respondents, 140 (26.8%) were either "somewhat" or "seriously" considering leaving their program. Residents wanting to pursue additional fellowship training and those aspiring to an academic career were significantly less likely to be considering changing specialties (p = 0.003 and p = 0.005, respectively). Poor work-life balance and fear of unemployment/ underemployment were the top reasons why residents would change specialty (55.5% and 40.8%, respectively), although the reasons cited were not significantly different between those considering changing and those who were not (p = 0.64). Residents who were considering changing programs were significantly less likely to enjoy their work and more likely to cite having already invested too much time to change as a reason for continuing (p < 0.001). Conclusion:More than one-quarter of residents in surgical training programs in Canada harbour desires to abandon their surgical careers, primarily because of unsatisfactory work-life balance and limited employment prospects. Efforts to educate prospective residents about the reality of the surgical lifestyle and to optimize employment prospects may improve completion rates.Contexte : Nous avons récemment étudié les taux d'attrition dans les programmes de chirurgie générale canadiens; toutefois, on ne dispose pas de données pour déterminer si les résidents inscrits dans d'autres programmes de chirurgie ont les mêmes intentions que leurs collègues de chirurgie générale. Nous avons voulu savoir combien de résidents des disciplines chirurgicales au Canada envisagent de quitter leur programme et pourquoi.Méthodes : Tous les résidents de 9 disciplines chirurgicales au Canada ont passé un sondage anonyme. La portée de la corrélation a été déterminée à l'aide du test χ 2 de Pearson. Le site Web du Répertoire canadien sur l'éducation post-MD (RCEP) a été utilisé pour calculer le taux de réponse.Résultats : Nous avons reçu 523 réponses (taux de réponse de 27,6 %). Parmi les répon-dants, 140 (26,8 %) envisageaient « peut-être » ou « sérieusement » de quitter leur programme. Les résidents qui souhaitaient suivre une formation de surspécialité et ceux qui aspiraient à une carrière universitaire étaient notablement moins susceptibles d'envisager un changement de programme (p = 0,003 et p = 0,005, respectivement). Les problèmes de conciliation travail-famille et la crainte ...

Background: Small intestine adenocarcinoma is a rare cancer. The current study aims to determine the outcomes of patients with small intestine adenocarcinoma in a Canadian province. Methods: This retrospective population-based cohort study assessed patients with small intestine adenocarcinoma who were diagnosed from 2008 to 2017 in Saskatchewan. A Cox proportional multivariate regression analysis was performed to determine the correlation between survival and exploratory factors. Results: 112 eligible patients with a median age of 73 years and M:F of 47:53 were identified. Overall, 75% had a comorbid illness, and 45% had a WHO performance status >1. Of the 112 patients, 51 (46%) had early-stage disease and 61 (54%) had advanced-stage disease. The median overall survival (mOS) was as follows: stage one, 59 months; stage two, 30 months; stage three, 20 months; and stage four, 3 months (p < 0.001). The median disease-free survival of patients with stage three disease who received adjuvant chemotherapy was 26 months (95% CI:23.1–28.9) vs. 4 months (0.0–9.1) with observation (p = 0.04). Patients who received chemotherapy for advanced disease had a mOS of 10 months (3.5–16.5) vs. 2 months (0.45–3.6) without chemotherapy (p < 0.001). In the multivariate analysis, stage four disease, hazard ratio (HR), 3.20 (1.84–5.40); WHO performance status >1, HR, 2.22 (1.42–3.45); lack of surgery, HR, 2.10 (1.25–3.50); and a neutrophil:lymphocyte ratio of >4.5, HR, 1.72 (1.10–2.71) were significantly correlated with inferior survival. Conclusions: Most patients with small intestine adenocarcinoma were diagnosed with advanced-stage disease. Advanced-stage disease, poor performance status, lack of surgery and a baseline neutrophil:lymphocyte ratio >4.5 were correlated with inferior survival.

Background. Benign perianal disease carries significant morbidity and financial burden on the healthcare system. Given that sitz baths are recommended as a treatment modality, we considered whether using a continuous stream of water, in the form of a bidet, offers a convenient and effective alternative. Bidet use is the predominant form of perianal hygiene in Asia, but its role in perianal disease is unknown. Purpose. To critically analyze and systematically review the current evidence regarding the effect of habitual bidet use on symptoms of benign perianal disease. Data Sources. A database search was conducted on MEDLINE and Epub Ahead of Print, Embase, ClinicalTrials.gov, the Cochrane Library, and ProQuest Dissertations. All studies on bidet use in pruritus ani, hemorrhoids, or anal fissures were included. Data Extraction. The studies were screened and critically analyzed by two independent reviewers in line with PRISMA guidelines. Results. Two prospective trials and 1 cross-sectional study found that habitual use of bidets had no impact on the odds of developing hemorrhoids or hemorrhoidal symptoms. One RCT concluded that using bidets was non-inferior to sitz bath for post-hemorrhoidectomy pain. Two prospective trials and 1 cross-sectional study determined that habitual bidet use may increase the odds of developing pruritus ani. Two case series found that habitual bidet use may cause perianal burns or anterior anal fissures. A meta-analysis was not performed because only a limited number of studies were available, and they were of variable quality. Conclusion. The current evidence does not identify using bidets as a treatment modality for perianal disease, and further research is warranted to study this increasingly utilized technology.

Background:The preferred perineal repair method for full-thickness rectal prolapse is the Altemeier procedure, a perineal proctosigmoidectomy with handsewn anastomosis. A recently described variant of this procedure combines the resection and anastomosis into 1 step by means of linear and transverse stapling. There are few published data comparing the characteristics and outcomes of these 2 approaches.Methods: This retrospective review, performed at 2 Canadian academic hospitals, compares surgical and cost outcomes between the perineal stapled prolapse resection (PSPR) and the Altemeier procedure. All patients who underwent these procedures between 2015 and 2019 were included.Results: There were 25 patients in the PSPR group and 19 in the Altemeier group. Patients in the PSPR group were significantly older than those in the Altemeier group (81 [95% confidence interval (CI) 70-92] yr v. 74 [95% CI 63-85] yr; p = 0.047), had a lower body mass index ]; p = 0.042) and had equivalent American Society of Anesthesiologists scores (2.84 [95% CI 2.09-3.59] v. 2.68 [95% CI 1.93-3.43]; p = 0.49). The operative time for PSPR was significantly less ] min v. 67 [95% CI 43-91] min; p < 0.001), as were the operative costs. Recurrence (28.0% v. 36.8%; p = 0.53) and complication rates were equivalent. Conclusion:PSPR is a safe, efficient and effective approach to perineal proctosigmoidectomy. It is associated with surgical outcomes comparable to those of the Altemeier procedure, but with a significant reduction in operative time and cost. Contexte :La technique de réparation périnéale privilégiée pour le prolapsus rectal de pleine épaisseur est la technique d'Altemeier, une proctosigmoïdectomie périnéale avec anastomose manuelle. Une variante de cette intervention décrite récemment allie la résection et l'anastomose en 1 seule étape, par agrafage linéaire et transverse. Peu de données ont été publiées pour comparer les caractéristiques et les résultats de ces 2 approches. Méthodes: La présente revue rétrospective, effectuée dans 2 centres hospitaliers universitaires canadiens, compare les résultats chirurgicaux et les coûts de la résection du prolapsus par agrafage péritonéal (RPAP) et par technique d'Altemeier. Tous les patients ayant subi ces 2 types d'interventions entre 2015 et 2019 ont été inclus. Résultats : On comptait 25 patients dans le groupe soumis à la RPAP et 19 dans le groupe soumis à la technique d'Altemeier. Les patients du groupe RPAP étaient significativement plus âgés que ceux du groupe Altemeier (81 [intervalle de confiance (IC) de 95 % 70-92] ans c. 74 [IC de 95 % 63-85] ans; p = 0,047), avaient un indice de masse corporelle plus bas (21,4 [IC de 95 % 17,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)1] c. 24,4 [IC de 95 % 18,3]; p = 0,042) et un score de l'American Society of Anesthesiologists semblable (2,84 [IC de 95 % 2,59] c. 2,68 [IC de 95 % 1,43]; p = 0,49). Le temps opératoire pour la RPAP a été significativement moindre (30,3 [IC de 95 % 16,3] min c. 67 [IC de 95 % 43-91] m...