Background Sacrococcygeal pilonidal sinus disease (SPD) is a common general surgical condition encountered in practice and predominantly affects young males. Surgical practice parameters for the management of SPD are variable. This study aimed to review current surgical practice parameters for SPD management in Western Australia. Methodology This study conducted a de-identified 30-item multiple-response ranking, dichotomous, quantitative, and qualitative survey of self-reported surgeon practice preferences and outcomes. The survey was sent to 115 Royal Australian College of Surgeons - Western Australia general/colorectal surgical fellows. Data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results The survey response rate was 66% (N = 77). The cohort comprised mostly senior collegiate (n = 50, 74.6%), and most were low-volume practitioners (n = 49, 73.1%). For local disease control, most surgeons perform a complete wide local excision (n = 63, 94%). The preferred wound closure method was an off-midline primary closure (n = 47, 70.1%). Self-reported SPD recurrence, wound infection, and wound dehiscence rates were 10%, 10%, and 15%, respectively. The three high-ranked closure techniques were the Karydakis flap, Limberg’s flap (LF), and Z-Plasty flap. Each surgeon’s median annual SPD procedures were 10 (interquartile range = 15). The surgeons could utilize their preferred SPD closure technique (mean = 83.5%, standard deviation = ±15.6). Univariate analysis showed significant associations between years of experience and SPD flap techniques utilized, with senior surgeons significantly less likely to use either the LF (p = 0.009) or the Bascom procedure (BP) (p = 0.034). Instead, there was a preference for using healing by secondary-intention technique (SIT) compared to younger fellows (p = 0.017). A significant negative correlation existed between practice volume and SPD flap technique utilization, with low-volume surgeons less likely to prefer the gluteal fascia-cutaneous rotational flap (p = 0.049) or the BP (p = 0.010). However, low-volume practice surgeons were significantly more likely to use SITs (p = 0.023). The three most important patient factors in choosing SPD techniques were comorbidities, likely patient compliance, and attitude toward the disease. Meanwhile, factors influencing local conditions included the proximity of the disease to the anus, the number and location of pits and sinuses, and previous definitive SPD surgery. Key informants for technique preference were perceived low recurrence rate, familiarity, and overall good patient outcomes. Conclusions Surgical practice parameters for managing SPD remain highly variable. Most surgeons perform midline excision with off-midline primary closure as the gold standard. There is a clear and present need for clear, concise, and yet comprehensive guidelines on managing this chronic and often disabling condition to ensure the ...

Background Digital rectal examination (DRE) is a valuable diagnostic tool for diagnosing multiple conditions, but its use has declined in practice. This study sought to provide perspectives on current attitudes, enablers, and barriers to performing DRE for doctors-in-training (DiTs) and explore strategies to improve and facilitate consistent, efficient, and effective execution of DRE.​​​​​​​ Methodology Self-reported DRE practice among DiTs (n = 1,652) across three metropolitan health service regions in Western Australia was surveyed using a de-identified multiple-response ranking, dichotomous quantitative and qualitative survey. Data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results A total of 452 (27%) DiTs responded to the survey, with an even distribution of key demographics between regions and specialties. The median post-graduate year was 2. Half of DiTs reported being comfortable with performing DRE. Most had training in medical school (71%), while 9.7% had no training in DRE. Chaperone availability, perceived invasiveness, and lack of confidence were key barriers; key enablers were formal training and senior colleague/departmental support. The multivariate logistic regression showed that DiTs who reported being comfortable in performing DRE were significantly and independently associated with being a high-volume practitioner (p < 0.001), confident in diagnosing benign (p < 0.001) or malignant pathology (p < 0.001), perceived adequate DRE training (p < 0.001), prior formal DRE training (p = 0.007), and surgical subspeciality interest (p = 0.030). Conclusions Low levels of confidence and comfort in the performance of DRE among DiTs have resulted in the underutilization of a critical diagnostic tool. Future curriculum and departmental clinical practice interventions should address barriers while promoting enablers.

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Background Surgical informed consent (SIC) is paramount in modern-day litigious surgical practice, yet numerous complaints remain about the consenting process. This paper investigated current attitudes, enablers, and barriers to obtaining SIC in clinical practice for doctors-in-training (DiT). Methodology Self-reported SIC practice among DiT (N=1,652) across three metropolitan health service regions in Western Australia (WA) was surveyed using a de-identified 20-item multiple response ranking, dichotomous quantitative and qualitative online survey. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 27 (IBM Corp., Armonk, NY, USA). Results The response rate was 23% (n=380). There was an even distribution of key demographics across all three health regions; the median postgraduate year (PGY) was two. Only 57.4% of DiT strongly felt comfortable and confident obtaining a SIC. Of the responders, 67.4% correctly identified key SIC components. There were significant positive associations between comfort and confidence with obtaining SIC and the seniority level of the DiT (p<0.001), identification of SIC components (p<0.001), and prior training in SIC (p<0.001). Most DiTs highlighted the necessity for formal SIC training with a preference for interactive workshops supported by e-learning modules. Conclusions Most DiTs can identify the key factors that constitute a valid SIC; however, the practical conversion of this skill could be better. The key enablers to improved SIC techniques were well-supported departments, with further training and clear guidelines within the institutions. The identified barriers were time constraints, inexperience, and a lack of senior support. Future practices and interventions should address these key barriers while promoting the enablers of sustainable and efficient SIC practice.