Covid-19’un Karın Duvarı Fıtığı Cerrahi Eğitimine Etkisi

Yıl 2023, , 253 - 258, 01.09.2023

Demet Saridemir , Volkan Doğru , Ali Avanaz , Muhittin Yaprak , Sezer Gürer

https://doi.org/10.53394/akd.1029006

Öz

Giriş: Covid-19 geleneksel genel cerrahi asistan eğitim programlarında alışılagelmedik değişikliklerin yaşanmasına sebep olmuştur. Akdeniz Üniversitesi Hastanesi Genel Cerrahi Kliniği'nin 6 yıllık asistan eğitimi geçmişinin incelendiği bu çalışma, pandemi sonrası karın duvarı fıtıkları için yapılan eğitimsel işlemlerin trendlerindeki değişiklikleri ortaya koymayı amaçlamaktadır.
Yöntem: Batın duvarı fıtığı endikasyonu ile 18 Eylül 2014 ve 17 Eylül 2020 tarihleri arasında kliniğimizde gerçekleştirilen cerrahi prosedürlerin kayıtları incelenmiş Covid-19 etkisindeki dönem, geçmiş yılların trendleri ile karşılaştırılmıştır.
Bulgular: Toplamda gerçekleştirilen 2587 prosedürün 2330’unda (%90) cerrahi ekipte en az 1 asistan katılımı olduğu görülmektedir. Umblikal fıtıklar dışında asistan katılımı olan prosedür sayılarında Covid-19 sonrası anlamlı bir düşüş olmamış; beklenen aylık medyan umblikal prosedür sayısı 5.6 iken gerçek değerin 1.0 olduğu anlaşılmıştır (sırasıyla ÇAA 5.3-6.0 ve 0.0-3.0; p=0.041). İnguinal fıtıklarda operatörlük (sırasıyla, 16.9 ±2.1 ve 9.8 ±5.6; p=0.017) ve eğitici asistan görevi üstlenen asistanların sayısında (sırasıyla, 4.0 ±0.8 ve 1.8 ±1.8; p=0.025) belirgin düşüşler olmuştur.
Sonuç: Covid-19 pandemisi daha çok cerrahi ekipteki görev dağılımını etkilemiştir. Bu dönemde eskiye göre daha kıdemsiz asistanlar batın duvarı fıtıklarında yardımcı cerrah pozisyonunda görevlendirilmişlerdir. Fıtık cerrahisine giriş niteliği taşıyan umblikal fıtıkların Covid-19’dan en çok etkilenen eğitsel prosedürler olduğu ve telafi edilmeleri gerektiği anlaşılmıştır.

Anahtar Kelimeler

Karın duvarı fıtığı, cerrahi eğitim, genel cerrahi, asistanlık

The Effect of Covid-19 on Surgical Training for Abdominal Wall Hernia

Öz

Introduction: Covid-19 has caused unusual changes in traditional general surgery resident training programs. This study, which examines the 6-year residency training history of Akdeniz University Hospital General Surgery Clinic, aims to reveal the changes in the trends of educational procedures for abdominal wall hernias after the pandemic.
Methods: Records of surgical procedures performed in our clinic between 18 September 2014 and 17 September 2020 with the indication of abdominal wall hernia were examined and the period under the influence of Covid-19 was compared with the trends of the past years.
Results: In 2330 (90%) of the 2587 procedures performed in total, at least 1 assistant participated in the surgical team. Except for umbilical hernias, there was no significant decrease in the number of procedures with assistant participation after Covid-19; the expected median number of umbilical procedures per month was 5.6, while the true value was 1.0 (IQR 5.3-6.0 and 0.0-3.0, respectively; p=0.041). There were significant decreases in the number of residents who served as the operator (16.9 ±2.1 and 9.8 ±5.6, respectively; p=0.017; p=0.017, respectively) and the teaching resident (4.0 ±0.8 and 1.8 ±1.8; p=0.025, respectively) in inguinal hernias.
Conclusion: The Covid-19 pandemic mostly affected the distribution of tasks in the surgical team. In this period, more junior residents were assigned as assisting surgeons in abdominal wall hernias compared to the past. It has been understood that umbilical hernias, which are seen as an introduction to hernia surgery, are the educational procedures most affected by Covid-19 and should be compensated.

Anahtar Kelimeler

Abdominal wall hernia, surgical training, general surgery, residency

Kaynakça

• 1. Koh WC, Alikhan MF, Koh D, Wong J. Containing COVID-19: Implementation of Early and Moderately Stringent Social Distancing Measures Can Prevent The Need for Large-Scale Lockdowns. Ann Glob Health. 2020;86(1):88.
• 2. Babidge WJ, Tivey DR, Kovoor JG, et al. Surgery triage during the COVID-19 pandemic. ANZ J Surg. 2020;90(9):1558-1565.
• 3. da Motta Reis JS, De Oliveira Silva F, Espuny M, Alexandre LGL, Barbosa LCFM, Bonassa ACM, Faria AM, de Souza Sampaio NA, Santos G, de Oliveira OJ. The rapid escalation of publications on covid-19: A snapshot of trends in the early months to overcome the pandemic and to improve life quality. Int J Qual Res. 2020;14(3):951-968
• 4. Moletta L, Pierobon ES, Capovilla G, et al. International guidelines and recommendations for surgery during Covid-19 pandemic: A Systematic Review. Int J Surg. 2020;79:180-188.
• 5. Stabilini C, East B, Fortelny R, et al. European Hernia Society (EHS) guidance for the management of adult patients with a hernia during the COVID-19 pandemic [published correction appears in Hernia. 2020 May 23;:]. Hernia. 2020;24(5):977-983.
• 6. Köckerling F, Köckerling D, Schug-Pass C. Elective hernia surgery cancellation due to the COVID-19 pandemic. Hernia. 2020;24(5):1143-1145.
• 7. Blanco-Colino R, Soares AS, Kuiper SZ, Zaffaroni G, Pata F, Pellino G. Surgical Training During and After COVID-19: A Joint Trainee and Trainers Manifesto. Ann Surg. 2020;272(1):e24-e26.
• 8. Chaudhry RM, Hanif A, Chaudhary M, et al. Coronavirus Disease 2019 (COVID-19): Forecast of an Emerging Urgency in Pakistan. Cureus. 2020;12(5):e8346.
• 9. Gyedu A, Stewart B, Wadie R, Antwi J, Donkor P, Mock C. Population-based rates of hernia surgery in Ghana. Hernia. 2020;24(3):617-623.
• 10. Sazhin A, Zolotukhin I, Seliverstov E, et al. Prevalence and risk factors for abdominal wall hernia in the general Russian population. Hernia. 2019;23(6):1237-1242.
• 11. Beadles CA, Meagher AD, Charles AG. Trends in emergent hernia repair in the United States. JAMA Surg. 2015;150(3):194-200.
• 12. Merola G, Cavallaro G, Iorio O, et al. Learning curve in open inguinal hernia repair: a quality improvement multicentre study about Lichtenstein technique. Hernia. 2020;24(3):651-659.
• 13. East B, Pawlak M, de Beaux AC. A manual reduction of hernia under analgesia/sedation (Taxis) in the acute inguinal hernia: a useful technique in COVID-19 times to reduce the need for emergency surgery-a literature review. Hernia. 2020;24(5):937-941.
• 14. Lima DL, Pereira X, Dos Santos DC, Camacho D, Malcher F. Where are the hernias? A paradoxical decrease in emergency hernia surgery during COVID-19 pandemic. Hernia. 2020;24(5):1141-1142.