Andreas H. Meier

When Is a Petersen's Hernia Not a Petersen's Hernia

F e a v Chir 1900;62:95. urious about the origin of the eponymous “Petersen’s heria” so frequently noted in the bariatric literature, we perormed a literature search for the original description of this ernia. What we found was surprising, not only because of the emote publication date of the article, but because on translaion from the original German, Dr Petersen’s actual description f the hernia bears little if any similarity to modern usage of he terms Petersen’s hernia, 3,4,6,8-10,12,13,15,17,19,21,24,26-28,31,33,34,35 efect,space,site,or indow used to describe internal hernia formation after Rouxn-Y gastric bypass (RYGB) procedures. In 1900, DrWalther Petersen, first clinical assistant surgeon t the Surgical Clinic in Heidelberg, Germany published a 0-page article entitled “Ueber Darmverschlingung nach der astro-Enterostomie” (“Concerning Twisting of the Intesines Following a Gastroenterostomy”). In it, he described hree similar cases of internal small bowel herniation fter creation of a loop gastrojejunostomy. All three cases esulted in death, and Dr Petersen subsequently decribed the autopsy findings in great detail. Within the rticle, he acknowledged previously published forms of nternal herniation after this procedure, but differentited his observations from earlier reports with this tatement:

Completely minimally invasive approach to restorative total proctocolectomy with j-pouch construction in children.

Restorative total proctocolectomy with J-pouch is a procedure used for children with severe ulcerative colitis or premalignant conditions like familial polyposis. The classic approach requires a laparotomy incision. Most published minimally invasive techniques still require a somewhat smaller incision to complete the procedure. We present a completely minimally invasive approach to accomplish the same goal, using a combined laparoscopic and endorectal technique and present our current clinical results with this method.

Running a Surgical Education Center: From Small to Large

In the last 2 decades, surgical education has experienced a transformative paradigm shift from the purely service-based Halstedian system to a curriculum-driven model based on educational theory. With the advent of minimally invasive surgery and its educational challenges, fostered by the simultaneously occurring rapid advances of computer technology and graphics and further promoted by rising concerns about patient safety, simulation and skills training has become a well-established tool in the arsenal of the surgical educator. Although most training institutions now have access to skills laboratories and simulation centers, running and integrating these facilities into the surgical curriculum remains a challenge. This article outlines general principles that are relevant for training facilities of all sizes and covers aspects from the initial phase of planning and establishing the center until its ultimately successful integration into the surgical education program.

Intradiaphragmatic extralobar sequestration—a rare pulmonary anomaly

Extralobar pulmonary sequestrations are most commonly found within the thoracic cavity, but have been described within the abdomen. We present the case of a 16-month-old boy with an intradiaphragmatic pulmonary sequestration and demonstrate a computed tomographic scan finding that might help identify this extremely rare abnormality preoperatively.

Computerized rounding reports: individualized solutions might work better.

The paper by Drs. Wohlauer, Rove, and colleagues [1] covers a very important problem that healthcare systems and providers are increasingly faced with today. Well-conducted patient sign-outs and handovers are critical for patient safety, but if done poorly, these care transition points can lead to significant breaks in communication. There is strong evidence that flaws in provider-to-provider hand-offs can directly lead to patient harm [2]. Opportunities for such communication breaks unfortunately will increase even further as we embark on ever-tighter restrictions of work hours. These affect especially the more junior residents, who often represent the primary provider group engaged in hand-over activities. The authors’ premise that a computerized hand-off system might be beneficial in this process is valid and important. The national push towards electronic medical records (EMR) and the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provide additional incentive to think about implementing such systems and integrating them with the EMR. As the authors mention, their study confirms earlier work from the University of Washington that a computerized and web-based rounding and sign-out system can have significant impact on quality and efficiency of patient hand-overs [3]. Wohlauer’s paper focuses more on the process how to successfully implement such a system, which includes an initial evaluation of the currently utilized sign-out practices, a formal needs assessment, collaboration between program directors, hospital information technology departments and residents, and a stepwise roll-out of the system with frequent feedback from the end-users. During their process, they also realized that even well-developed tools like University of Washington’s UWCORES does not represent a ‘‘one size fits all’’ solution, as the needs for other healthcare institutions might be quite different. It is interesting to note that their ‘‘better way’’ of sign-out model explicitlymentions the benefits of face-to-face communication, as a recently presented study from the Mayo Clinic has come to a very similar conclusion [4]. Even though the authors suggest significant improvements in the efficiency of the hand-over process, they rightly caution that the study is somewhat limited by its non-randomized nature and potential for selection bias, as the size and the composition of preand post-intervention groups differ markedly. I absolutely agree with their emphasis that an improved and more efficient sign-off system does not replace a formal didactic curriculum regarding transitioning care between providers, but, like the EMR,