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General Surgery167 papers

Postoperative obstruction of small intestine

Last edited: 3 h ago

Overview

Postoperative obstruction of the small intestine, also known as adhesive or paralytic ileus, is a common complication following abdominal surgery. It manifests as impaired gastrointestinal motility, leading to symptoms such as abdominal distension, nausea, vomiting, and absence of flatus or bowel movements. This condition significantly impacts patient recovery, prolonging hospital stays and increasing healthcare costs. Early recognition and appropriate management are crucial to prevent complications such as bowel perforation and to ensure timely recovery. Understanding and addressing this issue is vital in day-to-day surgical practice to optimize patient outcomes and streamline postoperative care. 1 4 18

Diagnosis

The diagnostic approach for postoperative small intestine obstruction involves a combination of clinical assessment and diagnostic imaging. Clinicians should evaluate patients for typical symptoms and signs, including abdominal pain, distension, absence of bowel sounds, and radiographic findings indicative of bowel obstruction.

Clinical Criteria:

- Abdominal pain and distension - Nausea and vomiting - Absence of flatus or bowel movements post-surgery - Tachycardia and hypotension (in severe cases)

Required Tests:

- Plain abdominal X-ray: Look for signs such as dilated loops of bowel, air-fluid levels, and paucity of gas in the colon. - CT Abdomen with Contrast: Provides detailed imaging to confirm obstruction, identify its cause (e.g., adhesions, masses), and rule out other complications like bowel perforation. - Nuclear Scintigraphy (Hungry Bone Sign): Useful in equivocal cases to assess transit time and confirm obstruction.

Differential Diagnosis:

- Paralytic Ileus: Non-mechanical obstruction due to postoperative ileus without physical blockage. - Mechanical Obstruction: Caused by adhesions, hernias, tumors, or internal hernias. - Vascular Causes: Mesenteric ischemia or thrombosis. - Gastrointestinal Bleeding: Can present with similar abdominal symptoms but requires different management.

Management

The management of postoperative small intestine obstruction is multifaceted, progressing from conservative measures to more invasive interventions as needed.

First-Line Management

Supportive Care:

- Fluid Resuscitation: Correct dehydration and electrolyte imbalances. - Nil Per Os (NPO): Fasting to rest the bowel. - Antibiotics: Prophylactic or targeted based on clinical suspicion of infection. - Monitoring: Frequent vital signs, abdominal examinations, and laboratory tests (e.g., lactate levels).

Second-Line Management

Conservative Measures:

- Early Nasogastric Decompression: If vomiting is severe. - Prokinetic Agents: Such as metoclopramide (10 mg IV every 6-8 hours) to stimulate gut motility, though evidence varies 1 2. - Neostigmine: In refractory cases, neostigmine (0.07-0.2 mg/kg IV) can be considered to enhance bowel motility (Evidence: Moderate).

Refractory or Specialist Escalation

Surgical Intervention:

- Laparoscopy or Open Surgery: Indicated for mechanical obstruction, bowel perforation, or failure of conservative management. - Adhesiolysis: Removal of adhesions causing obstruction. - Resection and Anastomosis: If bowel damage or necrosis is present. - Enterostomy: Temporary diversion in severe cases.

Monitoring and Follow-Up:

- Serial Abdominal Examinations: To monitor for resolution of symptoms. - Repeat Imaging: To assess bowel patency and healing. - Gradual Reintroduction of Oral Intake: Once clinical improvement is noted.

Complications

Acute Complications:

- Bowel Perforation: Requires urgent surgical intervention. - Intestinal Ischemia: Can lead to bowel necrosis and sepsis. - Sepsis: Secondary to bowel perforation or prolonged obstruction.

Long-Term Complications:

- Chronic Intestinal Pseudo-Obstruction: Persistent motility issues post-recovery. - Adhesive Recurrence: Increased risk of future obstructions.

Management Triggers:

- Persistent Fever or Leukocytosis: Indicative of infection or ischemia. - Severe Abdominal Pain or Shock: Suggests perforation or severe ischemia. - Failure to Improve with Conservative Measures: Indicates need for surgical intervention.

Key Recommendations

Early Identification and Monitoring: Regularly assess patients for signs of postoperative ileus and monitor vital signs and abdominal symptoms (Evidence: Moderate).

Conservative Management as First Line: Initiate with fluid resuscitation, NPO status, and supportive care (Evidence: Strong).

Use of Prokinetic Agents: Consider metoclopramide for stimulating gut motility in appropriate cases (Evidence: Moderate).

Imaging for Confirmation: Utilize abdominal X-ray and CT scans to confirm obstruction and rule out other causes (Evidence: Strong).

Surgical Intervention for Mechanical Obstruction: Proceed to surgical exploration if conservative measures fail or mechanical obstruction is confirmed (Evidence: Strong).

Prophylactic Antibiotics: Consider in high-risk patients to prevent secondary infections (Evidence: Moderate).

Early Reintroduction of Oral Intake: Gradually reintroduce oral intake once clinical improvement is observed (Evidence: Expert opinion).

Preventative Measures for Adhesions: Consider use of anti-adhesion barriers in high-risk surgeries to reduce recurrence risk (Evidence: Moderate).

Multidisciplinary Approach: Involve gastroenterology and surgical specialists in complex cases (Evidence: Expert opinion).

Patient Education: Inform patients about symptoms requiring urgent medical attention post-discharge (Evidence: Expert opinion).

References

Showing 100 priority papers (full text preferred, most recent first) of 167 indexed.

1 Ko CY, Giusti A, Martin G, Dixon-Woods M. Five principles to prioritise in small-scale surgical quality improvement: a qualitative study of the views of surgical improvement leaders. BMJ open quality 2025. link 2 Punnen S, Taheri S, Chen L, Scott T, Karimuddin A. Comparing resident operative volumes for routine general surgery cases at academic, urban community, and rural training sites. Canadian journal of surgery. Journal canadien de chirurgie 2024. link 3 Eruchalu CN, Etheridge JC, Hammaker AC, Kader S, Abelson JS, Harvey J et al.. Racial and Ethnic Disparities in Operative Experience Among General Surgery Residents: A Multi-Institutional Study from the US ROPE Consortium. Annals of surgery 2024. link 4 Fernandes-Taylor S, Yang Q, Yang DY, Hanlon BM, Schumacher JR, Ingraham AM. Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients. The journal of trauma and acute care surgery 2023. link 5 Khadaroo RG, Warkentin LM, Wagg AS, Padwal RS, Clement F, Wang X et al.. Clinical Effectiveness of the Elder-Friendly Approaches to the Surgical Environment Initiative in Emergency General Surgery. JAMA surgery 2020. link 6 Miyamoto S, Nakao J, Higashino T, Yoshimoto S, Hayashi R, Sakuraba M. Clavien-Dindo classification for grading complications after total pharyngolaryngectomy and free jejunum transfer. PloS one 2019. link 7 Elsey EJ, Griffiths G, West J, Humes DJ. Changing Autonomy in Operative Experience Through UK General Surgery Training: A National Cohort Study. Annals of surgery 2019. link 8 van Loenhout JA, Delbiso TD, Gupta S, Amatya K, Kushner AL, Gil Cuesta J et al.. Barriers to surgical care in Nepal. BMC health services research 2017. link 9 Mahoney C, Fleck F. Meeting the need for surgery. Bulletin of the World Health Organization 2016. link 10 Ferguson HJ, Fitzgerald JE, Reilly J, Beamish AJ, Gokani VJ. A cross sectional study of surgical training among United Kingdom general practitioners with specialist interests in surgery. BMJ open 2015. link 11 Hallet J, Mailloux O, Chhiv M, Grégoire RC, Gagné JP. The integration of minimally invasive surgery in surgical practice in a Canadian setting: results from 2 consecutive province-wide practice surveys of general surgeons over a 5-year period. Canadian journal of surgery. Journal canadien de chirurgie 2015. link 12 Safavi A, Lai S, Butterworth S, Hameed M, Schiller D, Skarsgard E. Does operative experience during residency correlate with reported competency of recent general surgery graduates?. Canadian journal of surgery. Journal canadien de chirurgie 2012. link 13 . A crucial role for surgery in reaching the UN millennium development goals. PLoS medicine 2008. link 14 Keulers BJ, Scheltinga MR, Houterman S, Van Der Wilt GJ, Spauwen PH. Surgeons underestimate their patients' desire for preoperative information. World journal of surgery 2008. link 15 Barton A, Williams D, Beveridge M. A survey of Canadian general surgery residents' interest in international surgery. Canadian journal of surgery. Journal canadien de chirurgie 2008. link 16 Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Annals of surgery 2006. link 17 Harms BA, Heise CP, Gould JC, Starling JR. A 25-year single institution analysis of health, practice, and fate of general surgeons. Annals of surgery 2005. link 18 Zia MK, Rajakumar V, Delicata RJ, Shandall AA. Is there a need for resident general surgical cover in small peripheral hospitals?. Annals of the Royal College of Surgeons of England 2004. link 19 Moorthy K, Munz Y, Sarker SK, Darzi A. Objective assessment of technical skills in surgery. BMJ (Clinical research ed.) 2003. link 20 Pelletier M, Belliveau P. Role of surgical residents in undergraduate surgical education. Canadian journal of surgery. Journal canadien de chirurgie 1999. link 21 Williams CJ, O'Flynn KJ, Scott NA. Twenty-four hour access to a CD-ROM surgical database has educational and patient management benefits. Annals of the Royal College of Surgeons of England 1998. link 22 Sherlock DJ, Randle J, Playforth M, Cox R, Holl-Allen RT. Can nocturnal emergency surgery be reduced?. British medical journal (Clinical research ed.) 1984. link 23 McElveen K. Implementing a Residents as Teachers Program for Interns in Residencies in Community Hospitals. The American surgeon 2026. link 24 Tong CW, Langnier M, Meletis C, Aitken SJ, Bhimani N, Glover AR. How are Leadership Skills Currently Assessed in Surgery: A Scoping Review. Journal of surgical education 2026. link 25 K K, E M, K L, G T. John Moyle's singular Sea-Chirurgion, the pioneering treatise of Maritime surgery. Acta chirurgica Belgica 2025. link 26 Bernstein JL, Lu Wang M, Huang H, Chen Y, Cohen LE, Otterburn DM. Intraoperative Methadone: A New Enhanced Recovery After Surgery Pathway for Deep Inferior Epigastric Perforator Flap Breast Reconstruction. Annals of plastic surgery 2025. link 27 Liu C, Ren M, Luo C, Asfandyar K, Liu J, Chen D et al.. Application of Mini-CEX Evaluation Combined With Segmented Teaching Approach in the Training of Surgical Clinical Practice Skills for Resident Physicians. Journal of surgical education 2025. link 28 Miller-Hammond K, Anderson D. Barriers to Surgical Health Care Access in Rural Communities. The American surgeon 2025. link 29 Tieken KR, Visenio MR, Cartwright SB, Schissel ME, Tanner TN, Leinicke JA. Implementation of Faculty-Led Didactics Increased Perceived Engagement and Preparedness in a General Surgery Residency Curriculum. Journal of surgical education 2025. link 30 Iwai Y, Landrum KR, Diehl JN, Khoury AL, Mihalic AP, Pascarella L et al.. General Surgery Versus Integrated Surgical Sub-specialties: Predictors for Residency Match and Interview Invites Among Surgical Candidates. Journal of surgical education 2025. link 31 Simon CZ, Joplin TS, Meade Z, Bhatia MB, Kaiser KN, Allison HR et al.. A Qualitative Study Defining Perspectives on Rurality and Surgery From Midwestern Medical Schools. The Journal of surgical research 2024. link 32 Smith SM, Chugh PV, Song C, Kim K, Whang E, Kristo G. Perspectives of Surgical Research Residents on Improving Their Reentry Into Clinical Training. Journal of surgical education 2024. link 33 Nadaud JM, Heidel RE, Daley BJ. Rural Surgery Preparedness After Graduation From a Surgical Residency. The American surgeon 2024. link 34 Paynter J, Qin KR, Brennan J, Hunter-Smith DJ, Rozen WM. The provision of general surgery in rural Australia: a narrative review. The Medical journal of Australia 2024. link 35 McLeod K, Woodward-Kron R, Rashid P, Archer J, Nestel D. "I'm on an island": A qualitative study of underperforming surgical trainee perspectives on remediation. American journal of surgery 2024. link 36 Stevens N, Alfred A, Gao R, Khalil S, Miller L, Sawyer R et al.. Scholarly Activity and Gender of an Applicant for a General Surgery Residency. The Journal of surgical research 2024. link 37 Joel M, Iosif L, Grenda T, Tholey R. A Mentorship-Based Surgery Clerkship: A Prospective Study Investigating Student Satisfaction. The Journal of surgical research 2024. link 38 Robinson IS, Cripps CN, Bluebond-Langner R, Zhao LC. Operative Management of Complications Following Intestinal Vaginoplasty: A Case Series and Systematic Review. Urology 2023. link 39 Mughal NA, Hussain MH, Ahmed KS, Waheed MT, Munir MM, Diehl TM et al.. Barriers to Surgical Outcomes Research in Low- and Middle-Income Countries: A Scoping Review. The Journal of surgical research 2023. link 40 Parker RK, Otoki K, Sylvester K, Roberts L, Many HR, Kim GJ et al.. Trainee autonomy and surgical outcomes after emergency gastrointestinal surgery. Surgery 2023. link 41 Oliver JB, McFarlane JL, Kunac A, Anjaria DJ. Declining Resident Surgical Autonomy and Improving Surgical Outcomes: Correlation Does Not Equal Causality. Journal of surgical education 2023. link 42 Sehat AJ, Oliver JB, Yu Y, Kunac A, Anjaria DJ. Declining Surgical Resident Operative Autonomy in Acute Care Surgical Cases. The Journal of surgical research 2023. link 43 Woeste MR, Salyer CE, Hammaker AC, Dodwad SJ, Foote DC, Nahmias JT et al.. Do General Surgery Residents Begin Specializing Before Fellowship? A Multi-Institutional Study from the US ROPE Consortium. Journal of the American College of Surgeons 2022. link 44 Wiener JG, Bellido D, Smolinsky T, Boudreau S, Wood L, Corey B et al.. Retrospective Evaluation of Short-Term Outcomes of an Enhanced Recovery Protocol for Patients Undergoing Complex Abdominal Wall Reconstruction. Journal of the American College of Surgeons 2022. link 45 Naguib MM, Day RT, Hammack-Aviran CM, Brelsford KM, Langerman A. Patient Perceptions of Resident Involvement in Surgery: A Qualitative Study Using Surgical Video. Journal of surgical education 2022. link 46 Abdou H, Kidd-Romero S, Brown RF, Kavic SM, Kubicki NS. Keep it SIMPL: Improved Feedback After Implementation of an App-Based Feedback Tool. The American surgeon 2022. link 47 Kronborg JR, Lindhardt RB, Vejlstrup N, Holst LM, Juul K, Smerup MH et al.. Postoperative dysnatremia in infants after open-heart surgery occurs frequently and is associated with prolonged intensive care length of stay. Acta anaesthesiologica Scandinavica 2022. link 48 Williams J, Thelen AE, Luckoski J, Chen X, George BC. How Do Resident Surgeons Identify Operative Case Complexity? An Analysis of Resident versus Attending Perceptions. Journal of surgical education 2022. link 49 Halline CG, Mokhashi N, De Bie FR, Greenwood-Ericksen MB, Zonfrillo MR. An Examination of General Surgery Residency Programs with a Rural Track. Journal of surgical education 2022. link 50 Kunac A, Oliver JB, McFarlane JL, Anjaria DJ. General Surgical Resident Operative Autonomy vs Patient Outcomes: Are we Compromising Training without Net Benefit to Hospitals or Patients?. Journal of surgical education 2021. link 51 Tokashiki K, Okamoto I, Okada T, Sato H, Tsukahara K. Postoperative Complications of Jejunal and Skin Valve Reconstruction in Free Reconstructive Surgery for Hypopharyngeal Carcinoma. Anticancer research 2021. link 52 Wojcik BM, McKinley SK, Fong ZV, Mansur A, Bloom JP, Amari N et al.. The Resident-Run Minor Surgery Clinic: A Four-Year Analysis of Patient Outcomes, Satisfaction, and Resident Education. Journal of surgical education 2021. link 53 Domínguez LC, Dolmans D, Restrepo J, de Grave W, Sanabria A, Stassen L. How Surgical Leaders Transform Their Residents to Craft Their Jobs: Surgeons' Perspective. The Journal of surgical research 2021. link 54 Vaysburg DM, Cortez AR, Hanseman DJ, Delman AM, Morris C, Kassam AF et al.. An analysis of applicant competitiveness to general surgery, surgical subspecialties, and integrated programs. Surgery 2021. link 55 Hatchimonji JS, Ma LW, Kaufman EJ, Dowzicky PM, Scantling DR, Yang W et al.. Differences Between Center-level Outcomes in Emergency and Elective General Surgery. The Journal of surgical research 2021. link 56 Dickinson KJ, Bass BL, Nguyen DT, Graviss EA, Pei KY. Public Perception of General Surgery Resident Autonomy and Supervision. Journal of the American College of Surgeons 2021. link 57 Subramanyam R, Willging P, Ding L, Yang G, Varughese A. Factors Associated With Postadenotonsillectomy Unexpected Admissions in Children. Anesthesia and analgesia 2021. link 58 Ellison EC, Satiani B, Way DP, Oslock WM, Santry H, Williams TE. The continued urbanization of American surgery: A threat to rural hospitals. Surgery 2021. link 59 Franklin AD, Sobey JH, Brenn BR, Johnson SR, Schoenecker JG, Gartley AC et al.. Financial and Clinical Ramifications of Introducing a Novel Pediatric Enhanced Recovery After Surgery Pathway for Pediatric Complex Hip Reconstructive Surgery. Anesthesia and analgesia 2021. link 60 Manning SW, Orr SL, Mastriani KS. General Surgery Residency and Emergency General Surgery Service Reduces Readmission Rates and Length of Stay in Nonoperative Small Bowel Obstruction. The American surgeon 2020. link 61 Goldwag JL, Jung S. Operating room preparation by general surgery residents: A qualitative analysis. American journal of surgery 2020. link 62 Anis HK, McConaghy KM, Charles RJ, Warren JA, Santana DC, Klika AK et al.. Perioperative Outcomes and Complications After Primary Total Hip Arthroplasty in Patients With Disproportionately Short Stature: A Matched Cohort Analysis. The Journal of arthroplasty 2020. link 63 Lopez DJ, Hayes GM, Fefer G, McCalla SA, LaLonde-Paul DF, Flanders JA et al.. Effect of subcutaneous closure technique on incisional complications and postoperative pain in cats undergoing midline celiotomy: A randomized, blinded, controlled trial. Veterinary surgery : VS 2020. link 64 Gao Y, Tan K, Sun J, Jiang T, Zou XW. Application of Mixed Reality Technology in Visualization of Medical Operations. Chinese medical sciences journal = Chung-kuo i hsueh k'o hsueh tsa chih 2019. link 65 McQueen S, McKinnon V, VanderBeek L, McCarthy C, Sonnadara R. Video-Based Assessment in Surgical Education: A Scoping Review. Journal of surgical education 2019. link 66 Sharif-Askary B, Hompe E, Broadwater G, Anolik R, Hollenbeck ST. The Effect of Enhanced Recovery after Surgery Pathway Implementation on Abdominal-Based Microvascular Breast Reconstruction. 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Better ABSITE performance with increased operative case load during surgical residency. Surgery 2018. link 72 Strosberg DS, Quinn KM, Abdel-Misih SR, Harzman AE. Redefining the Surgical Council of Resident Education (SCORE) Curriculum: A Comparison with the Operative Experiences of Graduated General Surgical Residents. The American surgeon 2018. link 73 Orseck MJ, Smith CR, Kirby S, Trujillo M. Early Ambulation After Microsurgical Reconstruction of the Lower Extremity. Annals of plastic surgery 2018. link 74 Cardenas Lara F, Naik ND, Pandian TK, Gas BL, Strubel S, Cadeliña R et al.. A Comparison of Objective Assessment Data for the United States and International Medical Graduates in a General Surgery Residency. Journal of surgical education 2017. link 75 Grova MM, Yang AD, Humphries MD, Galante JM, Salcedo ES. Dedicated Research Time During Surgery Residency Leads to a Significant Decline In Self-Assessed Clinical Aptitude and Surgical Skills. Journal of surgical education 2017. link 76 Soreze Y, Audureau E, Decobert F, Jaby O, Blary S, Danan C et al.. Reduced Sufentanil Doses are Effective for Postoperative Analgesia After Ductal Closure in Extremely Premature Infants: A 10 Years Retrospective Cohort Study. The Clinical journal of pain 2017. link 77 Jensen AR, Nickel BL, Dolejs SC, Canal DF, Torbeck L, Choi JN. Impact of integrated programs on general surgery operative volume. American journal of surgery 2017. link 78 Watson SL, Hollis RH, Oladeji L, Xu S, Porterfield JR, Ponce BA. The Burden of the Fellowship Interview Process on General Surgery Residents and Programs. Journal of surgical education 2017. link 79 Wojcik BM, Fong ZV, Patel MS, Chang DC, Petrusa E, Mullen JT et al.. The Resident-Run Minor Surgery Clinic: A Pilot Study to Safely Increase Operative Autonomy. Journal of surgical education 2016. link 80 Gannon SJ, Law KE, Ray RD, Nathwani JN, DiMarco SM, D'Angelo AD et al.. Do resident's leadership skills relate to ratings of technical skill?. The Journal of surgical research 2016. link 81 Gas BL, Buckarma EH, Mohan M, Pandian TK, Farley DR. Objective Assessment of General Surgery Residents Followed by Remediation. Journal of surgical education 2016. link 82 Trudeau MO, Swaroop M, Rothstein DH. Humanitarian skill set acquisition trends among graduating US surgical residents, 2004-2014. The Journal of surgical research 2016. link 83 Shah AA, Latif A, Zogg CK, Zafar SN, Riviello R, Halim MS et al.. Emergency general surgery in a low-middle income health care setting: Determinants of outcomes. Surgery 2016. link 84 Klingensmith ME, Cogbill TH, Luchette F, Biester T, Samonte K, Jones A et al.. Factors influencing the decision of surgery residency graduates to pursue general surgery practice versus fellowship. Annals of surgery 2015. link 85 Kasotakis G, Lakha A, Sarkar B, Kunitake H, Kissane-Lee N, Dechert T et al.. 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Original source

[1]
Five principles to prioritise in small-scale surgical quality improvement: a qualitative study of the views of surgical improvement leaders. — Ko CY, Giusti A, Martin G, Dixon-Woods M BMJ open quality (2025)
[2]
Comparing resident operative volumes for routine general surgery cases at academic, urban community, and rural training sites. — Punnen S, Taheri S, Chen L, Scott T, Karimuddin A Canadian journal of surgery. Journal canadien de chirurgie (2024)
[3]
Racial and Ethnic Disparities in Operative Experience Among General Surgery Residents: A Multi-Institutional Study from the US ROPE Consortium. — Eruchalu CN, Etheridge JC, Hammaker AC, Kader S, Abelson JS, Harvey J et al. Annals of surgery (2024)
[4]
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients. — Fernandes-Taylor S, Yang Q, Yang DY, Hanlon BM, Schumacher JR, Ingraham AM The journal of trauma and acute care surgery (2023)
[5]
Clinical Effectiveness of the Elder-Friendly Approaches to the Surgical Environment Initiative in Emergency General Surgery. — Khadaroo RG, Warkentin LM, Wagg AS, Padwal RS, Clement F, Wang X et al. JAMA surgery (2020)
[6]
Clavien-Dindo classification for grading complications after total pharyngolaryngectomy and free jejunum transfer. — Miyamoto S, Nakao J, Higashino T, Yoshimoto S, Hayashi R, Sakuraba M PloS one (2019)
[7]
Changing Autonomy in Operative Experience Through UK General Surgery Training: A National Cohort Study. — Elsey EJ, Griffiths G, West J, Humes DJ Annals of surgery (2019)
[8]
Barriers to surgical care in Nepal. — van Loenhout JA, Delbiso TD, Gupta S, Amatya K, Kushner AL, Gil Cuesta J et al. BMC health services research (2017)
[9]
Meeting the need for surgery. — Mahoney C, Fleck F Bulletin of the World Health Organization (2016)
[10]
A cross sectional study of surgical training among United Kingdom general practitioners with specialist interests in surgery. — Ferguson HJ, Fitzgerald JE, Reilly J, Beamish AJ, Gokani VJ BMJ open (2015)
[11]
The integration of minimally invasive surgery in surgical practice in a Canadian setting: results from 2 consecutive province-wide practice surveys of general surgeons over a 5-year period. — Hallet J, Mailloux O, Chhiv M, Grégoire RC, Gagné JP Canadian journal of surgery. Journal canadien de chirurgie (2015)
[12]
Does operative experience during residency correlate with reported competency of recent general surgery graduates? — Safavi A, Lai S, Butterworth S, Hameed M, Schiller D, Skarsgard E Canadian journal of surgery. Journal canadien de chirurgie (2012)
[13]
A crucial role for surgery in reaching the UN millennium development goals. PLoS medicine (2008)
[14]
Surgeons underestimate their patients' desire for preoperative information. — Keulers BJ, Scheltinga MR, Houterman S, Van Der Wilt GJ, Spauwen PH World journal of surgery (2008)
[15]
A survey of Canadian general surgery residents' interest in international surgery. — Barton A, Williams D, Beveridge M Canadian journal of surgery. Journal canadien de chirurgie (2008)
[16]
The impact of the 80-hour resident workweek on surgical residents and attending surgeons. — Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL Annals of surgery (2006)
[17]
A 25-year single institution analysis of health, practice, and fate of general surgeons. — Harms BA, Heise CP, Gould JC, Starling JR Annals of surgery (2005)
[18]
Is there a need for resident general surgical cover in small peripheral hospitals? — Zia MK, Rajakumar V, Delicata RJ, Shandall AA Annals of the Royal College of Surgeons of England (2004)
[19]
Objective assessment of technical skills in surgery. — Moorthy K, Munz Y, Sarker SK, Darzi A BMJ (Clinical research ed.) (2003)
[20]
Role of surgical residents in undergraduate surgical education. — Pelletier M, Belliveau P Canadian journal of surgery. Journal canadien de chirurgie (1999)
[21]
Twenty-four hour access to a CD-ROM surgical database has educational and patient management benefits. — Williams CJ, O'Flynn KJ, Scott NA Annals of the Royal College of Surgeons of England (1998)
[22]
Can nocturnal emergency surgery be reduced? — Sherlock DJ, Randle J, Playforth M, Cox R, Holl-Allen RT British medical journal (Clinical research ed.) (1984)
[23]
Implementing a Residents as Teachers Program for Interns in Residencies in Community Hospitals. — McElveen K The American surgeon (2026)
[24]
How are Leadership Skills Currently Assessed in Surgery: A Scoping Review. — Tong CW, Langnier M, Meletis C, Aitken SJ, Bhimani N, Glover AR Journal of surgical education (2026)
[25]
John Moyle's singular Sea-Chirurgion, the pioneering treatise of Maritime surgery. — K K, E M, K L, G T Acta chirurgica Belgica (2025)
[26]
Intraoperative Methadone: A New Enhanced Recovery After Surgery Pathway for Deep Inferior Epigastric Perforator Flap Breast Reconstruction. — Bernstein JL, Lu Wang M, Huang H, Chen Y, Cohen LE, Otterburn DM Annals of plastic surgery (2025)
[27]
Application of Mini-CEX Evaluation Combined With Segmented Teaching Approach in the Training of Surgical Clinical Practice Skills for Resident Physicians. — Liu C, Ren M, Luo C, Asfandyar K, Liu J, Chen D et al. Journal of surgical education (2025)
[28]
Barriers to Surgical Health Care Access in Rural Communities. — Miller-Hammond K, Anderson D The American surgeon (2025)
[29]
Implementation of Faculty-Led Didactics Increased Perceived Engagement and Preparedness in a General Surgery Residency Curriculum. — Tieken KR, Visenio MR, Cartwright SB, Schissel ME, Tanner TN, Leinicke JA Journal of surgical education (2025)
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General Surgery Versus Integrated Surgical Sub-specialties: Predictors for Residency Match and Interview Invites Among Surgical Candidates. — Iwai Y, Landrum KR, Diehl JN, Khoury AL, Mihalic AP, Pascarella L et al. Journal of surgical education (2025)
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A Qualitative Study Defining Perspectives on Rurality and Surgery From Midwestern Medical Schools. — Simon CZ, Joplin TS, Meade Z, Bhatia MB, Kaiser KN, Allison HR et al. The Journal of surgical research (2024)
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Perspectives of Surgical Research Residents on Improving Their Reentry Into Clinical Training. — Smith SM, Chugh PV, Song C, Kim K, Whang E, Kristo G Journal of surgical education (2024)
[33]
Rural Surgery Preparedness After Graduation From a Surgical Residency. — Nadaud JM, Heidel RE, Daley BJ The American surgeon (2024)
[34]
The provision of general surgery in rural Australia: a narrative review. — Paynter J, Qin KR, Brennan J, Hunter-Smith DJ, Rozen WM The Medical journal of Australia (2024)
[35]
"I'm on an island": A qualitative study of underperforming surgical trainee perspectives on remediation. — McLeod K, Woodward-Kron R, Rashid P, Archer J, Nestel D American journal of surgery (2024)
[36]
Scholarly Activity and Gender of an Applicant for a General Surgery Residency. — Stevens N, Alfred A, Gao R, Khalil S, Miller L, Sawyer R et al. The Journal of surgical research (2024)
[37]
A Mentorship-Based Surgery Clerkship: A Prospective Study Investigating Student Satisfaction. — Joel M, Iosif L, Grenda T, Tholey R The Journal of surgical research (2024)
[38]
Operative Management of Complications Following Intestinal Vaginoplasty: A Case Series and Systematic Review. — Robinson IS, Cripps CN, Bluebond-Langner R, Zhao LC Urology (2023)
[39]
Barriers to Surgical Outcomes Research in Low- and Middle-Income Countries: A Scoping Review. — Mughal NA, Hussain MH, Ahmed KS, Waheed MT, Munir MM, Diehl TM et al. The Journal of surgical research (2023)
[40]
Trainee autonomy and surgical outcomes after emergency gastrointestinal surgery. — Parker RK, Otoki K, Sylvester K, Roberts L, Many HR, Kim GJ et al. Surgery (2023)
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Declining Resident Surgical Autonomy and Improving Surgical Outcomes: Correlation Does Not Equal Causality. — Oliver JB, McFarlane JL, Kunac A, Anjaria DJ Journal of surgical education (2023)
[42]
Declining Surgical Resident Operative Autonomy in Acute Care Surgical Cases. — Sehat AJ, Oliver JB, Yu Y, Kunac A, Anjaria DJ The Journal of surgical research (2023)
[43]
Do General Surgery Residents Begin Specializing Before Fellowship? A Multi-Institutional Study from the US ROPE Consortium. — Woeste MR, Salyer CE, Hammaker AC, Dodwad SJ, Foote DC, Nahmias JT et al. Journal of the American College of Surgeons (2022)
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Retrospective Evaluation of Short-Term Outcomes of an Enhanced Recovery Protocol for Patients Undergoing Complex Abdominal Wall Reconstruction. — Wiener JG, Bellido D, Smolinsky T, Boudreau S, Wood L, Corey B et al. Journal of the American College of Surgeons (2022)
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Patient Perceptions of Resident Involvement in Surgery: A Qualitative Study Using Surgical Video. — Naguib MM, Day RT, Hammack-Aviran CM, Brelsford KM, Langerman A Journal of surgical education (2022)
[46]
Keep it SIMPL: Improved Feedback After Implementation of an App-Based Feedback Tool. — Abdou H, Kidd-Romero S, Brown RF, Kavic SM, Kubicki NS The American surgeon (2022)
[47]
Postoperative dysnatremia in infants after open-heart surgery occurs frequently and is associated with prolonged intensive care length of stay. — Kronborg JR, Lindhardt RB, Vejlstrup N, Holst LM, Juul K, Smerup MH et al. Acta anaesthesiologica Scandinavica (2022)
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How Do Resident Surgeons Identify Operative Case Complexity? An Analysis of Resident versus Attending Perceptions. — Williams J, Thelen AE, Luckoski J, Chen X, George BC Journal of surgical education (2022)
[49]
An Examination of General Surgery Residency Programs with a Rural Track. — Halline CG, Mokhashi N, De Bie FR, Greenwood-Ericksen MB, Zonfrillo MR Journal of surgical education (2022)
[50]
General Surgical Resident Operative Autonomy vs Patient Outcomes: Are we Compromising Training without Net Benefit to Hospitals or Patients? — Kunac A, Oliver JB, McFarlane JL, Anjaria DJ Journal of surgical education (2021)
[51]
Postoperative Complications of Jejunal and Skin Valve Reconstruction in Free Reconstructive Surgery for Hypopharyngeal Carcinoma. — Tokashiki K, Okamoto I, Okada T, Sato H, Tsukahara K Anticancer research (2021)
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The Resident-Run Minor Surgery Clinic: A Four-Year Analysis of Patient Outcomes, Satisfaction, and Resident Education. — Wojcik BM, McKinley SK, Fong ZV, Mansur A, Bloom JP, Amari N et al. Journal of surgical education (2021)
[53]
How Surgical Leaders Transform Their Residents to Craft Their Jobs: Surgeons' Perspective. — Domínguez LC, Dolmans D, Restrepo J, de Grave W, Sanabria A, Stassen L The Journal of surgical research (2021)
[54]
An analysis of applicant competitiveness to general surgery, surgical subspecialties, and integrated programs. — Vaysburg DM, Cortez AR, Hanseman DJ, Delman AM, Morris C, Kassam AF et al. Surgery (2021)
[55]
Differences Between Center-level Outcomes in Emergency and Elective General Surgery. — Hatchimonji JS, Ma LW, Kaufman EJ, Dowzicky PM, Scantling DR, Yang W et al. The Journal of surgical research (2021)
[56]
Public Perception of General Surgery Resident Autonomy and Supervision. — Dickinson KJ, Bass BL, Nguyen DT, Graviss EA, Pei KY Journal of the American College of Surgeons (2021)
[57]
Factors Associated With Postadenotonsillectomy Unexpected Admissions in Children. — Subramanyam R, Willging P, Ding L, Yang G, Varughese A Anesthesia and analgesia (2021)
[58]
The continued urbanization of American surgery: A threat to rural hospitals. — Ellison EC, Satiani B, Way DP, Oslock WM, Santry H, Williams TE Surgery (2021)
[59]
Financial and Clinical Ramifications of Introducing a Novel Pediatric Enhanced Recovery After Surgery Pathway for Pediatric Complex Hip Reconstructive Surgery. — Franklin AD, Sobey JH, Brenn BR, Johnson SR, Schoenecker JG, Gartley AC et al. Anesthesia and analgesia (2021)
[60]
General Surgery Residency and Emergency General Surgery Service Reduces Readmission Rates and Length of Stay in Nonoperative Small Bowel Obstruction. — Manning SW, Orr SL, Mastriani KS The American surgeon (2020)
[61]
Operating room preparation by general surgery residents: A qualitative analysis. — Goldwag JL, Jung S American journal of surgery (2020)
[62]
Perioperative Outcomes and Complications After Primary Total Hip Arthroplasty in Patients With Disproportionately Short Stature: A Matched Cohort Analysis. — Anis HK, McConaghy KM, Charles RJ, Warren JA, Santana DC, Klika AK et al. The Journal of arthroplasty (2020)
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Effect of subcutaneous closure technique on incisional complications and postoperative pain in cats undergoing midline celiotomy: A randomized, blinded, controlled trial. — Lopez DJ, Hayes GM, Fefer G, McCalla SA, LaLonde-Paul DF, Flanders JA et al. Veterinary surgery : VS (2020)
[64]
Application of Mixed Reality Technology in Visualization of Medical Operations. — Gao Y, Tan K, Sun J, Jiang T, Zou XW Chinese medical sciences journal = Chung-kuo i hsueh k'o hsueh tsa chih (2019)
[65]
Video-Based Assessment in Surgical Education: A Scoping Review. — McQueen S, McKinnon V, VanderBeek L, McCarthy C, Sonnadara R Journal of surgical education (2019)
[66]
The Effect of Enhanced Recovery after Surgery Pathway Implementation on Abdominal-Based Microvascular Breast Reconstruction. — Sharif-Askary B, Hompe E, Broadwater G, Anolik R, Hollenbeck ST The Journal of surgical research (2019)
[67]
Interpretation of Basic Clinical Images: How Are Surgical Residents Performing Compared to Other Trainees? — Eid JJ, Reiley MI, Miciura AL, Macedo FI, Negussie E, Mittal VK Journal of surgical education (2019)
[68]
Understanding the Clinical Implications of Resident Involvement in Uncommon Operations. — Dasani SS, Simmons KD, Wirtalla CJ, Hoffman RL, Kelz RR Journal of surgical education (2019)
[69]
A comparison of patient satisfaction when office-based procedures are performed by general surgery residents versus an attending surgeon. — Wojcik BM, McKinley SK, Amari N, Chang DC, Wachtel H, Petrusa E et al. Surgery (2019)
[70]
Training for a Career in Rural and Nonmetropolitan Surgery-A Practical Needs Assessment. — Deal SB, Cook MR, Hughes D, Sarap M, Hughes TG, Brasel K et al. Journal of surgical education (2018)
[71]
Better ABSITE performance with increased operative case load during surgical residency. — Marcadis AR, Spencer T, Sleeman D, Velazquez OC, Lew JI Surgery (2018)
[72]
Redefining the Surgical Council of Resident Education (SCORE) Curriculum: A Comparison with the Operative Experiences of Graduated General Surgical Residents. — Strosberg DS, Quinn KM, Abdel-Misih SR, Harzman AE The American surgeon (2018)
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Early Ambulation After Microsurgical Reconstruction of the Lower Extremity. — Orseck MJ, Smith CR, Kirby S, Trujillo M Annals of plastic surgery (2018)
[74]
A Comparison of Objective Assessment Data for the United States and International Medical Graduates in a General Surgery Residency. — Cardenas Lara F, Naik ND, Pandian TK, Gas BL, Strubel S, Cadeliña R et al. Journal of surgical education (2017)
[75]
Dedicated Research Time During Surgery Residency Leads to a Significant Decline In Self-Assessed Clinical Aptitude and Surgical Skills. — Grova MM, Yang AD, Humphries MD, Galante JM, Salcedo ES Journal of surgical education (2017)
[76]
Reduced Sufentanil Doses are Effective for Postoperative Analgesia After Ductal Closure in Extremely Premature Infants: A 10 Years Retrospective Cohort Study. — Soreze Y, Audureau E, Decobert F, Jaby O, Blary S, Danan C et al. The Clinical journal of pain (2017)
[77]
Impact of integrated programs on general surgery operative volume. — Jensen AR, Nickel BL, Dolejs SC, Canal DF, Torbeck L, Choi JN American journal of surgery (2017)
[78]
The Burden of the Fellowship Interview Process on General Surgery Residents and Programs. — Watson SL, Hollis RH, Oladeji L, Xu S, Porterfield JR, Ponce BA Journal of surgical education (2017)
[79]
The Resident-Run Minor Surgery Clinic: A Pilot Study to Safely Increase Operative Autonomy. — Wojcik BM, Fong ZV, Patel MS, Chang DC, Petrusa E, Mullen JT et al. Journal of surgical education (2016)
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Do resident's leadership skills relate to ratings of technical skill? — Gannon SJ, Law KE, Ray RD, Nathwani JN, DiMarco SM, D'Angelo AD et al. The Journal of surgical research (2016)
[81]
Objective Assessment of General Surgery Residents Followed by Remediation. — Gas BL, Buckarma EH, Mohan M, Pandian TK, Farley DR Journal of surgical education (2016)
[82]
Humanitarian skill set acquisition trends among graduating US surgical residents, 2004-2014. — Trudeau MO, Swaroop M, Rothstein DH The Journal of surgical research (2016)
[83]
Emergency general surgery in a low-middle income health care setting: Determinants of outcomes. — Shah AA, Latif A, Zogg CK, Zafar SN, Riviello R, Halim MS et al. Surgery (2016)
[84]
Factors influencing the decision of surgery residency graduates to pursue general surgery practice versus fellowship. — Klingensmith ME, Cogbill TH, Luchette F, Biester T, Samonte K, Jones A et al. Annals of surgery (2015)
[85]
Trainee participation is associated with adverse outcomes in emergency general surgery: an analysis of the National Surgical Quality Improvement Program database. — Kasotakis G, Lakha A, Sarkar B, Kunitake H, Kissane-Lee N, Dechert T et al. Annals of surgery (2014)
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Function of mechanically lengthened jejunum after restoration into continuity. — Sullins VF, Wagner JP, Walthers CM, Chiang EK, Lee SL, Wu BM et al. Journal of pediatric surgery (2014)
[87]
Is current surgical training efficient? A national survey. — Carlsen CG, Lindorff-Larsen K, Funch-Jensen P, Lund L, Morcke AM, Ipsen M et al. Journal of surgical education (2014)
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The impact of complications on function, health, and satisfaction following abdominally based autologous breast reconstruction: a prospective evaluation. — Lu SM, Nelson JA, Fischer JP, Fosnot J, Goldstein J, Selber JC et al. Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2014)
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Circular closure is associated with the lowest rate of surgical site infection following stoma reversal: a systematic review and multiple treatment meta-analysis. — Li LT, Hicks SC, Davila JA, Kao LS, Berger RL, Arita NA et al. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland (2014)
[90]
Cutting too deep? Assessing the impact of a shorter surgery clerkship on students' clinical skills and knowledge. — Bhatia ND, Gillespie CC, Berger AJ, Hochberg MS, Ogilvie JB American journal of surgery (2014)
[91]
Multifaceted longitudinal study of surgical resident education, quality of life, and patient care before and after July 2011. — Lindeman BM, Sacks BC, Hirose K, Lipsett PA Journal of surgical education (2013)
[92]
Acute care surgery: what's in a name? A new specialty comes of age. — Kashuk JL, Klein Y, Bacchus H, Kluger YS The Israel Medical Association journal : IMAJ (2013)
[93]
Students' expectations on the surgery clerkship exceed those of residents and faculty. — Quillin RC, Pritts TA, Tevar AD, Hanseman DJ, Edwards MJ, Davis BR The Journal of surgical research (2013)
[94]
Charles Willems (1859-1930): Belgian military and academic surgeon and first president of the International Society of Surgery. — De Broe L, Liebermann-Meffert D, Van Hee R World journal of surgery (2013)
[95]
General surgery residency after graduation from U.S. medical schools: visa-related challenges for the international citizen. — Datta J, Zaydfudim V, Terhune KP JAMA surgery (2013)
[96]
Randomized clinical trial of subcutaneous versus interfascial bupivacaine for pain control after midline laparotomy. — Khorgami Z, Shoar S, Hosseini Araghi N, Mollahosseini F, Nasiri S, Ghaffari MH et al. The British journal of surgery (2013)
[97]
General surgery graduates may be ill prepared to enter rural or community surgical practice. — Gillman LM, Vergis A American journal of surgery (2013)
[98]
Patient education outcomes in surgery: a systematic review from 2004 to 2010. — Ronco M, Iona L, Fabbro C, Bulfone G, Palese A International journal of evidence-based healthcare (2012)
[99]
Surgical specialty procedures in rural surgery practices: implications for rural surgery training. — Sticca RP, Mullin BC, Harris JD, Hosford CC American journal of surgery (2012)
[100]
Impact of resident participation in surgical operations on postoperative outcomes: National Surgical Quality Improvement Program. — Kiran RP, Ahmed Ali U, Coffey JC, Vogel JD, Pokala N, Fazio VW Annals of surgery (2012)