Journal of the American College of Surgeons
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Multicenter Study
Hartmann's Procedure vs Primary Anastomosis with Diverting Loop Ileostomy for Acute Diverticulitis: Nationwide Analysis of 2,729 Emergency Surgery Patients.
Recent small randomized trials suggest that primary anastomosis with a diverting loop ileostomy (PADLI) is a safe alternative to Hartmann's procedure (HP) for patients with acute diverticulitis necessitating emergent operation. We sought to examine the 30-day outcomes of patients undergoing emergent HP vs PADLI. ⋯ Currently, surgeons perform HP more frequently than PADLI. When controlling for patient population differences, PADLI appears to be at least a safe alternative to HP for select patient populations needing emergent surgical management of acute diverticulitis.
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The effect of subspecialty programs on associated general surgery programs is largely undocumented. This study examined the effect of new pediatric surgery fellowship (PSF) programs on the pediatric surgical experience of residents in the associated general surgery programs. ⋯ Establishment of a new PSF program results in a significant decline in the pediatric surgery experience as surgeon for residents in the associated general surgery program. This outcome should be carefully weighed in the decision to establish a new PSF program.