Behind The Knife: The Surgery Podcast

Sleeve, bypass, or something new – which surgery really dominates the day?  This Bariatric Surgery Journal Club dives into the debate over which bariatric operation is best. We compare the outcomes of the gastric bypass, sleeve gastrectomy, and the newer Sadie procedure, exploring how bypass may have an edge in long-term diabetes remission and weight loss.  We also discuss revisional options for failed sleeves and the importance of matching the patient to the right operation for their specific needs. Hosts: - Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California)  - Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio) - Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida) - Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) Learning objectives: - Contrast the outcomes of Roux-en-Y gastric bypass, sleeve gastrectomy, and revisional options such as the single-anastomosis duodeno-ileal bypass (SADI) - Article #1: Hauge 2025, Effect of gastric bypass versus sleeve gastrectomy on the remission of type 2 diabetes, weight loss, and cardiovascular risk factors at 5 years (Oseberg): secondary outcomes of a single-centre, triple blind, randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/40185112/ - Describe the design and unique triple-blind methodology of a single-center randomized trial comparing bypass and sleeve in patients with obesity and type 2 diabetes.  - Interpret the clinical relevance of the 5-year outcomes, including 63% diabetes remission with bypass vs 30% with sleeve.  - Examine secondary outcomes such as weight loss and cholesterol reduction, which favored bypass over the sleeve - Formulate patient-centered strategies for selecting bypass versus sleeve in populations with advanced metabolic disease, balancing efficacy with patient preference  - Article #2: The By-Band-Sleeve Collaborative Group 2025, Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy for severe obesity (By-Band-Sleeve): a multicenter, open-label, three-group, randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/40179925/ - Summarize the findings of this multi-center, open-label randomized controlled trial of over 1,300 patients comparing bypass, sleeve, and gastric banding at 5 years - Discuss the relative weight loss outcomes: 67% excess weight loss for bypass, 63% for sleeve, and 28% for adjustable gastric band - Evaluate the improvements in diabetes remission, hypertension control, and lipid management with bypass and sleeve compared to banding. - Analyze the declining role of gastric banding in modern bariatric surgery, while acknowledging its benefits compared to no weight loss treatment - Article #3: Thomopoulos 2024, Long-term results of Roux-en-Y gastric bypass (RYGB) versus single anastomosis duodeno-ileal bypass (SADI) as revisional procedures after failed sleeve gastrectomy: a systematic literature review and pooled analysis https://pubmed.ncbi.nlm.nih.gov/39579238/ - Compare long-term outcomes of bypass versus SADI after failed sleeve gastrectomy, based on pooled analysis of over 1,000 patients  - Interpret the trade-offs: SADI provides greater weight loss and metabolic improvements, but carries a higher risk for malnutrition and fat-soluble vitamin deficiencies  -  Develop strategies for preoperative counseling, nutritional supplementation, and close long-term monitoring, particularly for patients undergoing SADI - Individualize decision-making for revisional surgery, considering factors such as patient goals, comorbidity burden, prior anatomy, BMI, and reliability with follow-up - Evolving revisional strategies will influence the next decade of bariatric surgical innovation   - Overall, bariatric surgery consistently improves weight, diabetes control, and cardiovascular risk. - The procedure of choice should be tailored to the patient through detailed discussion between surgeon and patient, aligning clinical evidence with patient goals and risks.   References 1.     Wågen Hauge J, Borgeraas H, Birkeland KI, Johnson LK, Hertel JK, Hagen M, Gulseth HL, Lindberg M, Lorentzen J, Seip B, Kolotkin RL, Svanevik M, Valderhaug TG, Sandbu R, Hjelmesæth J, Hofsø D. Effect of gastric bypass versus sleeve gastrectomy on the remission of type 2 diabetes, weight loss, and cardiovascular risk factors at 5 years (Oseberg): secondary outcomes of a single-centre, triple-blind, randomised controlled trial. Lancet Diabetes Endocrinol. 2025 May;13(5):397-409. doi: 10.1016/S2213-8587(24)00396-6. Epub 2025 Apr 1. PMID: 40185112. https://pubmed.ncbi.nlm.nih.gov/40185112/ 2.     By-Band-Sleeve Collaborative Group. Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy for severe obesity (By-Band-Sleeve): a multicentre, open label, three-group, randomised controlled trial. Lancet Diabetes Endocrinol. 2025 May;13(5):410-426. doi: 10.1016/S2213-8587(25)00025-7. Epub 2025 Mar 31. PMID: 40179925. https://pubmed.ncbi.nlm.nih.gov/40179925/ 3.     Thomopoulos T, Mantziari S, Joliat GR. Long-term results of Roux-en-Y gastric bypass (RYGB) versus single anastomosis duodeno-ileal bypass (SADI) as revisional procedures after failed sleeve gastrectomy: a systematic literature review and pooled analysis. Langenbecks Arch Surg. 2024 Nov 23;409(1):354. doi: 10.1007/s00423-024-03557-9. PMID: 39579238; PMCID: PMC11585492. https://pubmed.ncbi.nlm.nih.gov/39579238/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Liver transplantation continues to evolve as strategies expand to address organ shortage and optimize outcomes. Normothermic machine perfusion (NMP) offers a novel way to preserve and assess donor livers prior to implantation. In this episode of Behind the Knife, our transplant team at University of Nebraska Medical Center discusses the latest evidence from randomized trials, practical applications in donation after circulatory death (DCD) grafts, and how NMP is shaping clinical decision-making in high-risk transplants.  Hosts -  Madeline Cloonan, MD PhD, General Surgery Resident, University of Nebraska Medical Center, @maddie_cloonan   - Jacqueline Dauch, MD, Assistant Professor, University of Nebraska Medical Center  -  Shaheed Merani, MD PhD, Associate Professor, University of Nebraska Medical Center  - Alan Langnas, DO, Professor, University of Nebraska Medical Center  Learning Objectives - Describe the principles of normothermic machine perfusion (NMP) and how it differs from static cold storage.  - Summarize the design and key outcomes of the PROTECT trial and the Chapman et al. trial on NMP in liver transplantation.  - Recognize the clinical scenarios where NMP provides the greatest benefit, particularly in high-risk grafts (e.g., DCD donors, high donor risk index).  - Apply a practical viability assessment framework for livers on NMP, including hemodynamics, bile production, lactate trajectory, and histology when indicated.  - Discuss the implications of NMP for allocation, system logistics, and future adoption trends in transplantation.  References   1.     Markmann JF, Abouljoud MS, Ghobrial RM, et al. Impact of portable normothermic blood-based machine perfusion on outcomes of liver transplant: the OCS Liver PROTECT randomized clinical trial. JAMA Surg. 2022;157(3):189-198. doi:10.1001/jamasurg.2021.6781. https://pubmed.ncbi.nlm.nih.gov/34985503/ 2.     Chapman WC, Barbas AS, D’Alessandro AM, et al. Normothermic machine perfusion of donor livers for transplantation in the United States: a randomized controlled trial. Ann Surg. 2023;278(5):e912-e921. doi:10.1097/SLA.0000000000005934. https://pubmed.ncbi.nlm.nih.gov/37389552/ 3.     Nasralla D, Coussios CC, Mergental H, et al; Consortium for Organ Preservation in Europe. A randomized trial of normothermic preservation in liver transplantation. Nature. 2018;557(7703):50-56. doi:10.1038/s41586-018-0047-9. https://pubmed.ncbi.nlm.nih.gov/29670285/ 4.     Brubaker AL, Sellers MT, Abt PL, et al. US liver transplant outcomes after normothermic regional perfusion vs standard super rapid recovery. JAMA Surg. 2024;159(6):677-685. doi:10.1001/jamasurg.2024.0520. https://pubmed.ncbi.nlm.nih.gov/38568597/ 5.     Wall A, Snoddy M, Du J, et al. The current landscape of in situ and ex situ machine perfusion utilization for liver grafts from cardiac donation after circulatory death donors in the US. Am J Transplant. 2025;25(3):574-582. doi:10.1016/j.ajt.2024.09.012. https://pubmed.ncbi.nlm.nih.gov/39293517/ 6.     Watson CJE, Gaurav R, Fear C, Swift L, Selves L, Ceresa CDL, Upponi SS, Brais R, Allison M, Macdonald-Wallis C, Taylor R, Butler AJ. Predicting Early Allograft Function After Normothermic Machine Perfusion. Transplantation. 2022 Dec 1;106(12):2391-2398. doi: 10.1097/TP.0000000000004263. https://pubmed.ncbi.nlm.nih.gov/36044364/ 7.     Watson CJE, Hunt F, Messer S, Currie I, Large S, Sutherland A, Crick K, Wigmore SJ, Fear C, Cornateanu S, Randle LV, Terrace JD, Upponi S, Taylor R, Allen E, Butler AJ, Oniscu GC. In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival. Am J Transplant. 2019 Jun;19(6):1745-1758. doi: 10.1111/ajt.15241. https://pubmed.ncbi.nlm.nih.gov/30589499/ 8.     Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010;16(8):943-949. doi:10.1002/lt.22091.https://pubmed.ncbi.nlm.nih.gov/20677285/  9.     Kwong AJ, Kim WR, Lake JR, Schladt DP, Handarova D, Howell J, Schumacher B, Weiss S, Snyder JJ, Israni AK. OPTN/SRTR 2023 Annual Data Report: Liver. Am J Transplant. 2025 Feb;25(2S1):S193-S287. doi: 10.1016/j.ajt.2025.01.022. https://pubmed.ncbi.nlm.nih.gov/39947804/ Ad Disclosures: Visit goremedical.com/btk to learn more about GORE® ENFORM Biomaterial. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this kickoff episode of the Behind the Knife Global Surgery Series, we dive into what global surgery really means—and why it matters to all of us. Five billion people lack access to safe, timely, and affordable surgical care. Our guest, Dr. Juan Carlos Puyana, shares powerful insights on redefining global surgery, building meaningful collaborations, and why surgeons in high-resource countries should care deeply about this work. If you want to broaden your vision of surgery, challenge assumptions, and hear stories that connect operating rooms from South Carolina to South Africa, this is an episode you won’t want to miss. Hosts/Guest: Mike M. Mallah, MD, FACS, FICS Director of Global Surgery at Medical University of South Carolina @MikeMMallahMD @MUSCGlobalSurg mallahm@musc.edu Juan Carlos Puyana, MD, FACS O’Brian Chair of Global Surgery at the Royal College of Surgeons Ireland @jcpuyanamd @RCSI_GlobalSurg Learning objectives: Define global surgery and explain how its meaning has evolved to highlight disparities in access to safe, timely, and affordable surgical care worldwide. Recognize the value of global surgery engagement for trainees and surgeons in high-resource settings, including broadening perspectives and fostering humility. Identify principles of ethical collaboration in global surgery, using real-world examples of partnerships built on trust, mutual respect, and shared goals. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Surgical resection of perihilar cholangiocarcinoma (pCCA) is one of the highest-risk elective operations performed. The obstructive jaundice suffered by patients preoperatively, central location of the tumors, and extensive nature of the resection make pCCA one of the most challenging HPB disease processes. In this episode from the HPB team at Behind the Knife, listen in on the discussion about perioperative strategies to improve outcomes for surgical resection of perihilar cholangiocarcinoma. Hosts Anish J. Jain MD (@anishjayjain) is a current PGY4 General Surgery Resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center. Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology at the University of Texas MD Anderson Cancer Center. He is also the associate program director of the HPB fellowship.  Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center. Learning Objectives ·      Develop an understanding of the three treatment sequences for resection of disease in patients with synchronous liver metastasis from a primary rectal cancer (reverse, combined, and classic approach) ·      Develop an understanding of the benefits, risks, and nuances of each of the three treatment sequences ·      Develop an understanding of which patient cases each treatment sequence is ideal for as well as which cases they are not suitable for. Papers Referenced: 1)    Ribero D, Zimmitti G, Aloia TA, Shindoh J, Fabio F, Amisano M, Passot G, Ferrero A, Vauthey JN. Preoperative Cholangitis and Future Liver Remnant Volume Determine the Risk of Liver Failure in Patients Undergoing Resection for Hilar Cholangiocarcinoma. J Am Coll Surg. 2016 Jul;223(1):87-97. https://pubmed.ncbi.nlm.nih.gov/27049784/ 2)    Jain AJ, Lendoire M, Haddad A, Tzeng CD, Boyev A, Maki H, Chun YS, Arvide EM, Lee S, Hu I, Pant S, Javle M, Tran Cao HS, Vauthey JN, Newhook TE. Improved Outcomes Following Resection of Perihilar Cholangiocarcinoma: A 27-Year Experience. Ann Surg Oncol. 2025 Jun;32(6):4352-4362. https://pubmed.ncbi.nlm.nih.gov/40000564/ Additional Suggested Reading Olthof PB, Erdmann JI, Alikhanov R, Charco R, Guglielmi A, Hagendoorn J, Hakeem A, Hoogwater FJH, Jarnagin WR, Kazemier G, Lang H, Maithel SK, Malago M, Malik HZ, Nadalin S, Neumann U, Olde Damink SWM, Pratschke J, Ratti F, Ravaioli M, Roberts KJ, Schadde E, Schnitzbauer AA, Sparrelid E, Topal B, Troisi RI, Groot Koerkamp B; Perihilar Cholangiocarcinoma Collaboration Group. Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible. Ann Surg Oncol. 2024 Jul;31(7):4405-4412. https://pubmed.ncbi.nlm.nih.gov/38472674/ Mueller M, Breuer E, Mizuno T, Bartsch F, et al. Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers. Ann Surg. 2021 Nov 1;274(5):780-788. https://pubmed.ncbi.nlm.nih.gov/34334638/ Ad Disclosures: Visit goremedical.com/btk to learn more about GORE® ENFORM Biomaterial. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Dive into the fascinating world of pheochromocytomas and their clinical challenges. The hosts discuss key diagnostic steps, including the significance of plasma-free metanephrines over urine testing. Explore the intricate genetic factors involved and the necessity for thorough genetic testing. Surgical strategies are covered, detailing both minimally invasive approaches and the classic open techniques, along with a focus on managing intraoperative hemodynamic risks. The conversation wraps up with insights on postoperative care and long-term surveillance.

“It’s 5pm and your Consultant (attending) has headed off home. A patient arrives in the resuscitation room blood spurting from a stab wound in the armpit. Join Roisin – a junior Major Trauma fellow, Prash – a surgical trainee, Max – a senior trauma surgery fellow, and Chris – a Consultant trauma surgeon, as we talk through decision making from point of injury to aftercare in this challenging trauma surgical case”. • Hosts: Bulleted list of host names, including title, institution, & social media handles if indicated 1.     Mr Prashanth Ramaraj. General Surgery trainee, Edinburgh rotation. @LonTraumaSchool 2.     Dr Roisin Kelly. Major Trauma Junior Clinical Fellow, Royal London Hospital.  3.     Mr Max Marsden. Resuscitative Major Trauma Fellow, Royal London Hospital. @maxmarsden83 4.     Mr Christopher Aylwin. Consultant Trauma & Vascular Surgeon and Co-Programme Director MSc Trauma Sciences at Queen Mary University of London. @cjaylwin • Learning objectives: Bulleted list of learning objectives. A)    To become familiar with prehospital methods of haemorrhage control in penetrating junctional injuries. B)     To recognise the benefits of prehospital blood product resuscitation in some trauma patients. C)     To follow the nuanced decision making in decision for CT scan in a patient with a penetrating junctional injury. D)    To describe the possible approaches to the axillary artery in the context of resuscitative trauma surgery. E)     To become familiar with decision making around intraoperative systemic anticoagulation in the trauma patient. F)     To become familiar with decision making on type of repair and graft material in vascular trauma. G)    To recognise the team approach in holistic trauma care through the continuum of trauma care. • References: Bulleted list of references with PubMed links. 1.    Perkins Z. et al., 2012. Epidemiology and Outcome of Vascular Trauma at a British Major Trauma Centre. EJVES. https://www.ejves.com/article/S1078-5884(12)00337-1/fulltext 2.    Ramaraj P., et al. 2025. The anatomical distribution of penetrating junctional injuries and their resource implications: A retrospective cohort study. Injury. https://www.injuryjournal.com/article/S0020-1383(24)00771-X/ 3.    Smith, S., et al. 2019. The effectiveness of junctional tourniquets: A systematic review and meta-analysis. J Trauma Acute Care Surg. https://journals.lww.com/jtrauma/abstract/2019/03000/the_effectiveness_of_junctional_tourniquets__a.20.aspx 4.    Rijnhout TWH, et al. 2019. Is prehospital blood transfusion effective and safe in haemorrhagic trauma patients? A systematic review and meta-analysis. Injury. https://www.injuryjournal.com/article/S0020-1383(19)30133-0/ 5.    Davenport R, et al. 2023. Prehospital blood transfusion: Can we agree on a standardised approach? Injury. https://www.injuryjournal.com/article/S0020-1383(22)00915-9. 6.    Borgman MA., et al. 2007. The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital. J Trauma Acute Care Surg. https://journals.lww.com/jtrauma/fulltext/2007/10000/the_ratio_of_blood_products_transfused_affects.13.aspx 7.    Holcomb JB., et al. 2013. The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study. Comparative Effectiveness of a Time-Varying Treatment With Competing Risks. JAMA Surgery. https://jamanetwork.com/journals/jamasurgery/fullarticle/1379768 8.    Holcomb JB, et al. 2015. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma. The PROPPR Randomized Clinical Trial. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2107789 9.    Davenport R., et al. 2023. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury. The CRYOSTAT-2 Randomized Clinical Trial. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2810756 10.   Baksaas-Aasen K., et al. 2020. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. ICM. https://link.springer.com/article/10.1007/s00134-020-06266-1 11. Wahlgren CM., et al. 2025. European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Vascular Trauma. EJVES. https://esvs.org/wp-content/uploads/2025/01/2025-Vascular-Trauma-Guidelines.pdf 12. Khan S., et al. 2020. A meta-analysis on anticoagulation after vascular trauma. Eur J Traum Emerg Surg. https://link.springer.com/article/10.1007/s00068-020-01321-4 13. Stonko DP., et al. 2022. Postoperative antiplatelet and/or anticoagulation use does not impact complication or reintervention rates after vein repair of arterial injury: A PROOVIT study. Vascular. https://journals.sagepub.com/doi/10.1177/17085381221082371?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Learn more: https://behindtheknifeoralboardsimulator.org/ It has arrived!  Introducing Behind the Knife's Oral Board Simulator (beta version): Unlimited unique oral board scenarios Available 24/7 Diverse examiners Natural conversation  Detailed, actionable feedback based on SCORE curriculum and American Board of Surgery grading scheme Try it for free for a limited time! Note, this is our FIRST version of the Oral Board Simulator.  To make it better, we need your feedback.  After using the simulator, please take <1 minute to complete the feedback form.  This will help us refine the simulator and improve the user experience.   On this pod, we are thrilled to introduce the newest member of the Behind the Knife team, Dr. Matthew Swenson.  Dr. Swenson is a general surgeon and U.S. Air Force veteran.  He earned his medical degree from the Uniformed Services University and completed his general surgery residency at the University of Nevada in Las Vegas. After training he was stationed in Anchorage, Alaska for 7 years, where he took part in multiple domestic and overseas military exercises. His practice in Alaska also involved partnerships with the local community, including working with residents and local surgeons at the Alaska Native Medical Center. At the completion of his military service, he was recruited to return to Las Vegas as the Associate Program Direct for the Valley Health System General Surgery residency program.  Dr. Swenson's primary passion is ensuring surgical residents are fully prepared for independent practice upon graduation, which has led him to create innovative, AI-powered study tools for oral board exam preparation. Whenever time allows, he enjoys family time and all things outdoors. Hosts: Ayman Ali, MD (PGY-4, Duke Hospital) Patrick Georgoff, MD (Trauma/Critical Care Surgeon, Duke Hospital): @georgoff  Matthew Swenson, MD (General Surgeon, Valley Health System) Talha Rafeeqi, MD (Foregut Surgeon, The Oregon Clinic) Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Joining Dr. Scott Steele today on Behind the Knife is Steve Crandall, a former medical negligence DEFENSE lawyer who, for reasons we will discuss, switched sides and now represents the patient who is suing care providers.  He is a founding partner of Crandall & Pera Law and also has been ranked as both one of the Top 5 Lawyers in Cleveland and Top 10 best Lawyers in Ohio for over 15 years. Crandall, a seasoned plaintiff attorney specializing in medical malpractice, joins the hosts to illuminate the key factors behind common lawsuits in surgery, the pivotal role of informed consent, standout cases with crucial learning points, expert witness strategies, and practical advice for surgeons to stay out of legal trouble. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Welcome to the 6th episode of our BTK/ASGBI series!  During this series, BTK fellow Agnes Premkumar and ASGBI hosts Jared Wohlgemut and Gita Lingam will compare and contrast various aspects of surgery between the United States and the United Kingdom, debating who does what better.  In this episode, we delve into surgical training, current challenges, and hopes for the future of surgical training in the US and the UK. We will be discussing the advent of the EPA curriculum in the US, the current challenge of obtaining a speciality position in the UK, and tips for making the resident to attending/junior faculty transition smoothly. Dr. Jeremy Lipman represents the US while Dr. Phil Pearce represents the UK in this thought-provoking conversation. Dr. Lipman is a colorectal surgeon at the Cleveland Clinic and the director of graduate medical education for all training programs at the Cleveland Clinic. Additionally, he is an Associate Dean for Graduate Medical Education and Professor of Surgery at Case Western Reserve University. He is passionate about surgical training and holds the James E. Sampliner Endowed Chair in Surgical Education.  Dr. Phil Pearce is a consultant in emergency general surgery in Oxford with interests in trauma, complex biliary disease, and most importantly a passion for training. Take a listen and let us know what you think- who does surgical education and training better?  References: Speciality training position in the NHS https://www.ft.com/content/e4b364c3-6a20-42ee-a9a5-ab9eea441c87?utm_source=chatgpt.com https://www.theguardian.com/society/2025/jul/02/nhs-in-england-told-to-slash-recruitment-of-overseas-trained-medics?utm_source=chatgpt.com Surgery job market in the US https://surgpli.com/the-state-of-surgery-as-a-career-in-2025/ EPA curriculum https://www.aamc.org/about-us/mission-areas/medical-education/cbme/core-epas Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Why are we still treating acute uncomplicated diverticulitis with antibiotics? There is plenty of evidence from several randomized controlled trials demonstrating that symptomatic management alone yields similar results. If we should continue prescribing antibiotics for acute uncomplicated diverticulitis, which patients should undergo treatment and when? Join Drs. Jared Hendren, Elissa Dabaghi, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss the management of uncomplicated diverticulitis while reviewing groundbreaking literature. Hosts: -Jared Hendren, MD Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio - Elissa Dabaghi, MD Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio - Joseph Trunzo, MD Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio Social Media Handle: X/Twitter @joseph_trunzo - Ajaratu Keshinro, MD Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio Social Media Handle: X/Twitter- @AJKesh - David Rosen, MD Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio Social Media Handle: X/Twitter- @davidrrosenmd Learning Objectives: By the end of this episode, listeners will be able to: 1.     Identify criteria for managing acute uncomplicated diverticulitis without antibiotics based on recent literature 2.     Define uncomplicated and complicated diverticulitis 3.     Discuss nuanced management decisions of patients with uncomplicated diverticulitis to determine when antibiotics may be appropriate for management References: 1.     Azhar, N., Aref, H., Brorsson, A., Lydrup, M.‑L., Jörgren, F., Schultz, J. K., & Buchwald, P. (2022). Management of acute uncomplicated diverticulitis without antibiotics: Compliance and outcomes – a retrospective cohort study. BMC Emergency Medicine, 22(1), Article 28. https://doi.org/10.1186/s12873‑022‑00584‑X  2.     Mora‑López, L., Ruiz‑Edo, N., Estrada‑Ferrer, O., Piñana‑Campón, M. L., Labró‑Ciurans, M., Escuder‑Perez, J., Sales‑Mallafré, R., Rebasa‑Cladera, P., Navarro‑Soto, S., Serra‑Aracil, X., & DINAMO‑study Group. (2021). Efficacy and safety of nonantibiotic outpatient treatment in mild acute diverticulitis (DINAMO‑study): A multicentre, randomised, open‑label, noninferiority trial. Annals of Surgery, 274(5), e435–e442. https://doi.org/10.1097/SLA.0000000000005031 3.     Daniels, L., Ünlü, Ç., de Korte, N., van Dieren, S., Stockmann, H. B., Vrouenraets, B. C., Consten, E. C., van der Hoeven, J. A., Eijsbouts, Q. A., Faneyte, I. F., Bemelman, W. A., Dijkgraaf, M. G., & Boermeester, M. A. (2017). Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT‑proven uncomplicated acute diverticulitis. British Journal of Surgery, 104(1), 52‑61. https://doi.org/10.1002/bjs.10309 4.     Chabok, A., Påhlman, L., Hjern, F., Haapaniemi, S., & Smedh, K.; AVOD Study Group. (2012). Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. British Journal of Surgery, 99(4), 532–539. https://doi.org/10.1002/bjs.8688 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US