(1) Background: Bowel management contributes throughout the pathway of care for children with Hirschsprung. Preoperative bowel management prepares the child and family for the pull-through surgery. Perioperative bowel management supports early recovery and tailored bowel management in the follow-up supports the achievement of social continence. (2) Methods: We conducted a cross-sectional assessment of our institutional bowel management program to illustrate the pre-, peri- and postoperative bowel management strategies. (3) Results: A total of 31 children underwent primary pull-through, 23 without a stoma and 8 with a stoma, at a median age of 9 months. All children without a stoma were prepared for surgery by using rectal irrigations. Children with a stoma were prepared for surgery with a transfer of stoma effluent. Transanal irrigation supported early recovery. (4) Conclusions: Bowel management is a key pillar of the management of children with Hirschsprung disease. Incorporating bowel management in the pathway of care facilitates primary pull-through and supports perioperative recovery.

BACKGROUND: Postgraduate medical education in trauma and orthopedic surgery residents largely relates to learning and teaching surgery. During this crucial stage of surgical development some of the didactic challenges are caused by heterogeneous and contradictory expectations of trainees and trainers alike. So how do residents prepare for emergency surgery? To date there is neither an expert consensus nor scientific investigations in the clinical context on this topic.
METHODS: Between February and April 2015 questionnaires were issued to all physicians active in the field of trauma and orthopedic surgery within the Trauma Network East Bavaria (27 clinics, 255 physicians). The participants were asked to rate the importance of certain elements functioning in the preparation of two emergency operations using a Likert scale. The intensity with which residents generally realize these elements of preparation was also documented. The aim was to objectify if and to what extent the presumed normal practices diverge from clinical reality.
RESULTS: A total of 150 questionnaires were analyzed (return rate 59%). Discussion with the consultant (85.3%, n = 128), examination of the patient (80.0%, n = 120), surgical approach (76.0%, n = 114) and study of patient files (68.0%, n = 102) were considered to be the most important elements; however, many of the participants admitted that these elements of preparation are not sufficiently performed.
CONCLUSIONS: The personal preparation of residents for an emergency operation should be classified as extremely important; however, the requirements and reality do not seem to hold true in the clinical environment. This seems to be most likely due to structural and organizational issues.
UNASSIGNED: HINTERGRUND: Die Weiterbildung im Fach Orthopädie/Unfallchirurgie ist wesentlich geprägt von „Operieren lehren und lernen“. In dieser elementaren Phase der chirurgischen Entwicklung dominieren aus didaktischer Sicht verschiedenste konträre Erwartungen und traditionelle Praktiken. Wie bereiten sich Weiterbildungsassistenten auf Notfalloperationen vor? Bis dato gibt es weder Expertenkonsens noch Untersuchungen im klinischen Kontext zu diesem Thema.
UNASSIGNED: Von Februar bis April 2015 wurden an alle klinisch tätigen Ärzte des Fachs Orthopädie/Unfallchirurgie im Traumanetzwerk Ostbayern (27 Kliniken, 255 Ärzte) anonymisierte Fragebögen ausgegeben. Jeder Teilnehmer konnte über Likert-Skalen die Wichtigkeit bestimmter Vorbereitungselemente für zwei Notfalloperationen bewerten sowie die Intensität, mit der Weiterbildungsassistenten generell diese Vorbereitungselemente realisieren. Die zentrale Fragestellung war, inwiefern Anspruch und Realität der Operationsvorbereitung voneinander abweichen.
UNASSIGNED: Der Rücklauf der Fragebögen lag bei 59 %, 150 Bögen wurden analysiert. Die höchste Priorität wurde den Vorbereitungselementen „Kommunikation mit dem 1. Assistenten“ (85,3 % [n = 128]), Patientenvisite (80,0 % [n = 120]), Zugangsweg (76,0 % [n = 114]) und Studium Patientenakte (68,0 % [n = 102]) zugesprochen. Ein großer Teil der Befragten räumte ein, dass diese Vorbereitungselemente nicht suffizient realisiert würden.
UNASSIGNED: Die persönliche Vorbereitung eines Weiterbildungsassistenten auf eine Notfalloperation ist als äußerst wichtig einzustufen. Anspruch und Realität zeigen im klinischen Setting jedoch eine relevante Asymmetrie. Ursächlich stehen hierbei am ehesten strukturelle und organisatorische Probleme im Vordergrund.

When patients are brought to the operating theatre a series of checks are performed to reduce harm or potential harm to our patients. One harm that can cause significant morbidity and mortality to our patients is surgical site infection (SSI). Reducing SSIs requires a multi-faceted approach prior to the incision. Prophylactic antibiotics are given, if indicated, along with glucose and temperature control as part of an SSI bundle. Meticulous attention is paid by the team to ensure that the surgical field is prepared with antiseptic solutions such as chlorhexidine or betadine. The airflow changes in theatres also help minimise the risk of infection. The surgeon and scrub team are trained to undertake strict asepsis when \'scrubbing up\'. The rest of the team are careful to ensure hand hygiene and appropriate glove use at all times.