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Background: Laparoscopic surgery may become the standard of care for the treatment of colorectal disease. Little is known regarding North American patterns of practice or the limiting factors and strategies for adoption among surgeons. Methods: We sent a 28-item questionnaire to all general surgeon members of the Royal College of Physicians and Surgeons of Canada. We derived descriptive and correlative information using [chi square], Wilcoxon rank sum and Student t tests and multivariate logistic regression. Results: The return rate was 55% (694/1266). A total of 67% (462/694; 95% confidence interval 63%-70%) of respondents perform colorectal surgery. Of these, 54% perform laparoscopic colorectal surgery. Multivariate logistic regression identified 5 factors related to performing laparoscopic colorectal surgery: fewer years in practice (p < 0.001), male sex (p = 0.015), practising in the province of Quebec (p = 0.005), university-hospital affiliation (p = 0.034) and minimally invasive surgery fellowship training (p = 0.023). Lack of adequate operating time and formal training were the main reasons cited by surgeons not offering laparoscopic colon resections. Most surgeons (67%) felt that site visits from a minimally invasive surgeon would represent the most effective training method for acquiring advanced laparoscopic skills. Conclusion: About half of Canadian general surgeons offer laparoscopic colorectal resections. Recent graduation, male sex, practice location, university-hospital affiliation and minimally invasive surgery training are significant predictors for offering a laparoscopic approach. Lack of operative time and formal training are the main barriers to adoption of the technique. Site visits by trained laparoscopic surgeons is the preferred method of acquiring advanced skills. Contexte : La chirurgie par laparoscopie est devenue la norme de soins pour le traitement des maladies colorectales. On ne connait guere les tendances de la pratique en Amerique du Nord ou les facteurs limiteurs et les strategies d'adoption chez les chirurgiens. Methodes : Nous avons envoye un questionnaire en 28 points a tous les chirurgiens generaux membres du College royal des medecins et chirurgiens du Canada. Nous avons derive l'information descriptive et correlative au moyen des tests [khi carre], de Wilcoxon et t de Student, ainsi que par regression logistique a variables multiples. Resultats : Le taux de reponse s'est etabli a 55% (694/1266). Au total, 67% (462/694; intervalle de confiance a 9%, 63% a 70%) des repondants pratiquent la chirurgie colorectale. De ce nombre, 54% pratiquent la chirurgie colorectale par laparoscopie. La regression logistique a variables multiples a degage 5 facteurs relies a la chirurgie colorectale par laparoscopie : moins d'annees de pratique (p < 0,001), sexe masculin (p = 0,015), pratique dans la province de Quebec (p = 0,005), affiliation a un hopital universitaire (p = 0,034) et fellowship en chirurgie a effraction minimale (p = 0,023). Le manque de temps suffisant pour operer et de formation structuree cons tituait la principale raison invoquee par les chirurgiens pour ne pas offrir la resection du colon par laparoscopie. La plupart des chirurgiens (67%) etaient d'avis que la methode de formation la plus efficace pour leur permettre d'acquerir des techniques avancees de laparoscopie consisterait en visites sur place d'un chirurgien pratiquant la chirurgie a effraction minimale. Conclusion : Environ la moitie des chirurgiens generaux canadiens offrent la resection colorectale par laparoscopie. Le diplome recent, le sexe masculin, le lieu de pratique, l'affiliation a un hopital universitaire et une formation en chirurgie a effraction minimale sont des predicteurs importants de l'approche laparoscopique. Le manque de temps pour operer et de formation structuree constitue le principal obstacle a l'adoption de la technique. Des visites sur place par des chirurgiens formes en laparoscopie constituent la methode preferee d'acquisition de techniques avancees., Three main methods are currently used to perform a colorectal resection: the traditional 'open' technique via a laparotomy, the laparoscopic approach and a hybrid hand-assisted laparoscopic approach using a device [...]

Background: The surgical approach to paraesophageal hernias (PEH) has changed with the advent of laparoscopic techniques. Variation in both perioperative outcomes and hernia recurrence rates are reported in the literature. [...]

Abstract Background Publicly insured women usually have a different demographic background to privately insured women, which is related to poor neonatal outcomes after birth. Given the difference in nature and risk of preterm versus term births, it would be important to compare adverse neonatal outcomes after preterm birth between these groups of women after eliminating the demographic differences between the groups. Methods The study population included 3085 publicly insured and 3380 privately insured, singleton, preterm deliveries (32–36 weeks gestation) from Western Australia during 1998–2008. From the study population, 1016 publicly insured women were matched with 1016 privately insured women according to the propensity score of maternal demographic characteristics and pre-existing medical conditions. Neonatal outcomes were compared in the propensity score matched cohorts using conditional log-binomial regression, adjusted for antenatal risk factors. Outcomes included Apgar scores less than 7 at five minutes after birth, time until establishment of unassisted breathing (>1 minute), neonatal resuscitation (endotracheal intubation or external cardiac massage) and admission to a neonatal special care unit. Results Compared with infants of privately insured women, infants of publicly insured women were more likely to receive a low Apgar score (ARR = 2.63, 95% CI = 1.06-6.52) and take longer to establish unassisted breathing (ARR = 1.61, 95% CI = 1.25-2.07), yet, they were less likely to be admitted to a special care unit (ARR = 0.84, 95% CI = 0.80-0.87). No significant differences were evident in neonatal resuscitation between the groups (ARR = 1.20, 95% CI = 0.54-2.67). Conclusions The underlying reasons for the lower rate of special care admissions in infants of publicly insured women compared with privately insured women despite the higher rate of low Apgar scores is yet to be determined. Future research is warranted in order to clarify the meaning of our findings for future obstetric care and whether more equitable use of paediatric services should be recommended.

Abstract Background Increasing incidence and lack of survival improvement in adolescents and young adults (AYAs) with cancer have led to increased awareness of the cancer burden in this population. The objective of this study was to describe overall and type-specific cancer incidence and mortality trends among AYAs in Western Australia from 1982–2007. Methods Age–adjusted incidence and mortality rates were calculated for all malignancies combined and for each of the most common diagnostic groups, using five-year age–specific rates. Joinpoint regression analysis was used to derive annual percentage changes (APC) for incidence and mortality rates. Results The annual incidence rate for all cancers combined increased in males from 1982 until 2000 (APC = 1.5%, 95%CI: 0.9%; 2.1%) and then plateaued, whilst rates for females remained stable across the study period (APC = −0.1%; 95%CI: −0.2%; 0.4%) across the study period. For males, significant incidence rate increases were observed for germ cell tumors, lymphoblastic leukemia and thyroid cancer. In females, the incidence of Hodgkin’s lymphoma, colorectal and breast cancers increased. Significant incidence rate reductions were noted for cervical, central nervous system and lung cancers. Mortality rates for all cancers combined decreased from 1982 to 2005 for both males (APC = −2.6%, 95%CI:−3.3%;−2.0%) and females (APC = −4.6%, 95%CI:−5.1%;−4.1%). With the exception of bone sarcoma and lung cancer in females, mortality rates for specific cancer types decreased significantly for both sexes during the study period. Conclusions Incidence of certain AYA cancers increased, whilst it decreased for others. Mortality rates decreased for most cancers, with the largest improvement observed for breast carcinomas. Further research is needed to identify the reasons for the increasing incidence of certain cancers.

Background: Cesarean birth (CB) rates have increased in high‐resource countries during the past two decades, yet it is not known whether CB rates have changed according to maternal age and/or gestational age. Methods: All singleton live births in Iceland between 1997 and 2015 were identified from the Icelandic Medical Birth Registry (80 130). Rates of cesarean births (intrapartum and prelabor) were calculated overall and separately for maternal age groups and gestational age groups and by parity. Logit binomial regression was used to calculate odds ratios (ORs) and confidence intervals (CIs) for annual change in cesarean birth rates adjusted for maternal characteristics and clinical indication groups. Results: The overall CB rate was 15.7% in 1997 and 15.8% in 2015; the CB rate did not change significantly during the study period. The overall CB rate for early‐term deliveries (37‐38 weeks) decreased for multiparas (annual aOR = 0.99 [95% CI = 0.98‐0.99]), and the preterm (<37 weeks) prelabor cesarean rate increased significantly (1.11 [1.09‐1.14]) for both primiparas and multiparas. For multiparas only, the intrapartum CB rate decreased (0.97 [0.97‐0.98]), whereas the prelabor CB rate increased, predominantly for women aged over 35 years (1.03 [1.02‐1.04]). Adjustment for clinical indication groups did not change these results. Conclusions: Findings indicate a rise in prelabor cesarean for preterm births and women aged over 35 years (multiparas only). As adjustment for clinical indications did not affect these results, changes in obstetric practice are more likely to have affected these rate changes rather than changes in clinical indications. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative pain control remains a major challenge for surgical procedures, including laparoscopic gastric bypass. Pain management is particularly relevant in obese patients who experience a higher number of cardiovascular and pulmonary events. Effective pain management may reduce their risk of serious postoperative complication, such as deep vein thrombosis and pulmonary emboli. The objective of this study is to evaluate the efficacy of intraperitoneal local anaesthetic, ropivacaine, to reduce postoperative pain in patients undergoing laparoscopic Roux-en-Y gastric bypass. Methods and analysis: A randomised controlled trial will be conducted to compare intraperitoneal ropivacaine (intervention) versus normal saline ( placebo) in 120 adult patients undergoing bariatric bypass surgery. Ropivacaine will be infused over the oesophageal hiatus and throughout the abdomen. Patients in the control arm will undergo the same treatment with normal saline. The primary end point will be postoperative pain at 1, 2 and 4 h postoperatively. Pain measurements will then occur every 4 h for 24 h and every 8 h until discharge. Secondary end points will include opioid use, peak expiratory flow, 6 min walk distance and quality of life assessed in the immediate postoperative period. Intention-to-treat analysis will be used and repeated measures will be analysed using mixed modelling approach. Post-hoc pairwise comparison of the treatment groups at different time points will be carried out using multiple comparisons with adjustment to the type 1 error. Results of the study will inform the feasibility of recruitment and inform sample size of a larger definitive randomised trial to evaluate the effectiveness of intraperitoneal ropivacaine. Ethics and dissemination: This study has been approved by the Ottawa Health Science Network Research Ethics Board and Health Canada in April 2014. The findings of the study will be disseminated through national and international conferences and peer-reviewed journals. Trial registration number: Clinicaltrial.gov NCT02154763. [ABSTRACT FROM AUTHOR]