Dr. Marta Barros

How to Achieve Work/Life Balance and Manage my Time in Residence

As the word “resident” implies, doctors at this stage may find themselves practically living at the hospital. Depending on the specialty and where one is in the world, during residency a doctor may be expected to work anywhere from 50-80 hours a week. The toll of this is often noticeable when it comes to health in general, and mental health in particular. Anxiety, depression and insomnia, are just a few of the side effects related to burnout. While work-life balance in the context of residency may sound paradoxical, to survive this period choices do have to be made. What kind of sacrifices will be necessary? What kind of time management strategies might come in handy, and what insight can be gleaned from those who have gone through it? We have gathered a panel of expert doctors who will discuss these very topics in the next session of our Resilient Resident Series.

With Johnson & Johnson MedTech

Surgical Anatomy of the Abdominal Wall

In this Surgical Open Classroom we will be reviewing the surgical anatomy of the abdominal wall, in-depth knowledge of which is key when performing hernia surgery.  There are several anatomical structures which must bw taken into account. First, regarding the anatomy of the abdominal wall, the most important structures are: transversus abdominal muscle, internal oblique muscle, external oblique muscle and rectus abdominis muscles. Together they form the wall that protects the structures contained in the abdominal cavity. Their points of origin and insertion as well as the relationship between them and with other structures must be taken into account to have a better understanding of the pathology of the abdominal wall. Regarding the anatomy of the inguinal canal, it is around 4 cm long and its direction is descendent and oblique. It has two rings and a conduct. The anatomical characteristics of the inguinal canal will be explained in detail.  Two anatomical areas must be considered in order to perform a safe surgery. First, the triangle of Doom or vascular triangle, which contains major vessels: external iliac artery and vein.  It is limited by the gonadal vessels and vas deferens in men or the round ligament in women. We also have to be careful with the triangle of pain, which contains the lateral femoral cutaneous nerve, the femoral branch of the genitofemoral nerve and the femoral nerve. Its limits are gonadal vessels and the inguinal ligament.

Management of Acute Diverticulitis: Current Practices

In this SOC we review the general recommendations of both the American and the European Societies’ Guidelines regarding the management of acute colonic diverticulitis. None of the existing classifications for left-sided colonic diverticulitis has proved superiority. The most used one is Hinchey’s modified classification. The World Society of Emergency Surgery (WSES) proposes a new one, which divides acute diverticulitis into uncomplicated and complicated. The European Society of Coloproctology (ESCP) defines diverticulosis and divides diverticular disease into 3 entities: Symptomatic Uncomplicated Diverticular Disease (SUDS), diverticulitis (acute or chronic, complicated or uncomplicated) and diverticular bleeding. Prevalence of diverticulitis is hard to estimate. However, it is clear that is increasing throughout the world, even in younger patients. Its pathogenesis is multifactorial. This disease can sometimes be difficult to differentiate from colorectal cancer. Because of this, it is accepted to make a control colonoscopy in complicated cases. For diagnosis, a Contrast-enhanced CT scan is generally recommended. Ultrasound can also be a correct image test, although it has some limitations. Regarding treatment, uncomplicated diverticulitis can be treated in a conservative way, with antibiotics, or even without using them in non-septic patients. These patients can also be treated as outpatients. Management of abscesses depends on their size; when larger than 4-5cm, percutaneous drainage should be considered. Urgent surgery is performed in patients with generalized sepsis and clinical peritonitis, extraluminal air in imaging tests or free fluid. When there is fecal peritonitis, surgical resection must be performed. When peritonitis is purulent, laparoscopic lavage can be an option, although this is still a matter of controversy. There are no significant differences regarding morbimortality between Hartmann’s procedure and primary anastomosis.  Elective surgery is only justified to improve quality of life or if there are  persistent abscesses or fistulas. There is no evidence of differences between laparoscopic and open surgery.  If the source control has been adequate, a 4-day postoperative antibiotic therapy is recommended.