Behind The Knife: The Surgery Podcast

Need a dose of inspiration?  You found it here.  This interview with Dr. Ammar Darwish will have you in awe.  Dr. Darwish is a general and trauma surgery at Manchester University NHS Foundation Trust and Medical Director at The David Nott Foundation (https://davidnottfoundation.com/).  Dr. Darwish volunteers for intensely dangerous but highly impactful surgical humanitarian missions in conflict zones around the world. In fact, he has been deployed to over 50 global humanitarian missions in the last 15 years. He is passionate about helping victims of conflict and natural disaster by better equipping and training doctors who care for them.  Want to learn more about the Nott Foundation?  Good!  You should.  Check out their website for more: https://davidnottfoundation.com/ Interview with Dr. David Knott: https://app.behindtheknife.org/podcast/war-doctor-david-nott-on-surgery-in-war-zones 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://app.behindtheknife.org/listen

Join our Emergency General Surgery team as we talk about the dreaded difficult duodenum. We discuss two cases on a common disease that has now become a rarity in surgical management. We cover principles of combined assessment and resuscitation, diagnosis and helpful adjuncts, and multidisciplinary and surgical management. Hosts: Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross We have come a long way from managing duodenal emergencies with vagotomies since the widespread use of proton pump inhibitors. But surgeons and trainees still need to gain competence in managing duodenal emergencies, despite the dearth of operative interventions often encountered. We discuss the two most common presentations related to duodenal ulcers - bleeding and perforation. We focus on resuscitation, damage-control surgery, and the role of non-surgical management options.  Learning Objectives: - Learn to investigate and resuscitate patients with upper gastrointestinal bleeding - Develop an approach to the management of upper gastrointestinal bleeding - Understand the risks and benefits of various surgical techniques for dealing with perforated duodenal ulcers References:  Tarasconi, A., Coccolini, F., Biffl, W.L. et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg 15, 3 (2020). https://doi.org/10.1186/s13017-019-0283-9 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://app.behindtheknife.org/listen

Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss the controversial management of colon cancer of the splenic flexure. What procedure do you perform? Does it matter? Tune in to hear the discussion! Hosts: - Susan Galandiuk MD, University of Louisville, Louisville, Kentucky, @DCREdInChief - Vladimir Bolshinsky MD, Peninsula Health, Victoria, Australia, @bolshinskyv - Sandy Kavalukas MD, University of Louisville, Louisville, Kentucky, @sandykava - Hillary Simon DO, University of Louisville, Louisville, Kentucky, @HillaryLSimon Producer: - Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12 Learning objectives: - Review surgical procedure options for splenic flexure cancer. - Understand the importance of confirming the location of the tumor with imaging and/or endoscopically, perioperatively. - Discuss surgical principles of operating in the left upper quadrant.  References:  de’Angelis, et al. Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis. Surg Endosc. 2021 (35) :661–672.  https://pubmed.ncbi.nlm.nih.gov/32072288/ Degiuli M, et al. Segmental Colonic Resection Is a Safe and Effective Treatment Option for Colon Cancer of the Splenic Flexure: A Nationwide Retrospective Study of the Italian Society of Surgical Oncology-Colorectal Cancer Network Collaborative Group. Dis Colon Rectum. 2020 Oct;63(10):1372-1382.  https://pubmed.ncbi.nlm.nih.gov/32969880/ Manceau G, et al. What Is the Optimal Elective Colectomy for Splenic Flexure Cancer: End of the Debate? A Multicenter Study From the GRECCAR Group With a Propensity Score Analysis. Dis Colon Rectum. 2022 Jan 1;65(1):55-65. https://pubmed.ncbi.nlm.nih.gov/34882628/ Okazaki T, et al. Two Types of Variational Arteries' Courses From the Superior Mesenteric Artery to Supply the Splenic Flexure: Gross Anatomical Study. Dis Colon Rectum. 2024 Jan 1;67(1):120-128. https://pubmed.ncbi.nlm.nih.gov/37493262/ Pang AJ, Marinescu D, Morin N, Vasilevsky CA, Boutros M. Segmental resection of splenic flexure colon cancers provides an adequate lymph node harvest and is a safe operative approach - an analysis of the ACS-NSQIP database. Surg Endosc. 2022 Aug;36(8):5652-5659. https://pubmed.ncbi.nlm.nih.gov/34973078/ Rusli SM, et al. Laparoscopic D3 oncological resection in splenic flexure cancer: Technical details and its impact on long-term survival. Colorectal Dis. 2023 Mar;25(3):431-442. https://pubmed.ncbi.nlm.nih.gov/36281503/ Sakamoto K, et al. Drainage pattern of the splenic flexure vein and its accompanying arteries using three-dimensional computed tomography angiography: a single-centre study of 600 patients. Colorectal Dis. 2023 Aug;25(8):1679-1685. https://pubmed.ncbi.nlm.nih.gov/37221647/ Vargas, HD. Gaining Mesenteric Length following Colorectal Resection: Essential Maneuvers to Avoid Anastomotic Tension. Clin Colon Rectal Surg. 2023 Jan 13;36(1):37-46. https://pubmed.ncbi.nlm.nih.gov/36643828/ Vogel JD, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum. 2022 Feb 1;65(2):148-177. https://pubmed.ncbi.nlm.nih.gov/34775402/ Video References  “Splenic Flexure Cancers.” Lahey Hospital & Medical Center. Disease of the Colon and Rectum Journal Club. February 28, 2022. https://www.youtube.com/watch?v=87HXHQYMxe4&list=PLMBNyGA6TZajQn4UlDyKxrLakFZb7SC_2&index=23 Varela, C. and Yang, S. Laparoscopic-Assisted Colonic Resection for Splenic-Flexure Cancer With D3 Lymphadenectomy, Diseases of the Colon & Rectum 66(6):p e295-e297, June 2023. https://journals.lww.com/dcrjournal/pages/collectiondetails.aspx?TopicalCollectionID=138&ParentCollection=109 ***TRUELEARN LINK: https://truelearn.referralrock.com/l/BTKPODCAST/ Discount code: BTKPODCAST Using the discount code, you can get a discount of $25 off our Residency (General surgery, anesthesiology, OBGYN, Psychiatry, Peds, Neurology, Emergency Medicine, Internal Medicine, and Family Medicine), USMLE, andCOMLEX SmartBank subscriptions of 90-days or more. The code can also be applied for 15% off our allied healthSmartBanks (PA, Nurse Practitioner, Pharmacy, PT, OT, etc.). 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://app.behindtheknife.org/listen

Our Colorectal Surgery Oral Board Audio Review includes 51 high-yield scenarios designed for Colorectal Surgeons by Colorectal Surgeons.   Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as colorectal surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. Learn more about the full set of 51 scenarios here: https://behindtheknife.teachable.com/p/btk-colorectal-surgery-oral-board-review-course Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Our Surgical Oncology Oral Board Audio Review includes 46 high-yield scenarios that cover all of the SCORE CGSO topics designed for Surgical Oncology Surgeons by Surgical Oncology Surgeons.  Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as surgical oncology surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. Learn more about the course and see all the episode topics here: https://app.behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons.   Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as vascular surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. Learn more about the full set of 72 scenarios here: https://app.behindtheknife.org/course-details/vascular-surgery-oral-board-audio-review Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/dp/B0CZ8ZBF83 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Join surgical experts Dr. Vennila Padmanaban, a surgical oncology fellow, Dr. Priya H. Dedhia, an assistant professor specializing in endocrine surgery, and Dr. John Phay, a clinical professor of surgery. They delve into how pregnancy alters thyroid and parathyroid physiology and discuss the complexities of managing thyroid disorders during this critical time. Key topics include the risks of unmanaged hyperthyroidism, the importance of multidisciplinary care, and guidelines for surgery versus medical management during pregnancy. It's an insightful conversation for both patients and practitioners!

Does the adult thymus have a purpose and function? Are there any long-term health effects of thymectomy? Tune in to another Swedish Thoracic surgery journal review where we discuss the recent paper out of the NEJM which reports on the health consequences of thymus removal in adults. This paper has been widely picked up by the media and our patients frequently bring it into the office. Listen as we discuss the study population, methods, and potential applications of this paper. Learning Objectives: - Review the purpose and function of the thymus. - Discuss the population, methods, and results of this trial. - Discuss the application of this paper and how it may or may not impact clinical practice for thoracic surgeons.  Hosts: Chloe E. Hanson, MD, PGY-3 Kelly Daus MD, PGY-4 Peter White, MD, Thoracic Surgery Attending Brian Louie, MD, Thoracic Surgery Attending Reference Material: Kooshesh KA, Foy BH, Sykes DB, Gustafsson K, Scadden DT. Health Consequences of Thymus Removal in Adults. N Engl J Med. 2023;389(5):406-417. https://pubmed.ncbi.nlm.nih.gov/37530823/ Lin TM, Chang YS, Hou TY, et al. Risk of incident autoimmune diseases in patients with thymectomy. Ann Clin Transl Neurol. 2020;7(7):1072-1082. https://pubmed.ncbi.nlm.nih.gov/32478484/ 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://app.behindtheknife.org/listen

Did you know that 13% of trauma patients who go home with an opioid prescription will develop opioid dependence?  Multimodal pain regimens not only reduce opioid consumption, but also improve pain control.  On this episode of the BIG T TRAUMA series, we explore a multimodal approach to pain management...and tackle some surgical dogma along the way.   Hosts: Patrick Georgoff, MD, Trauma Surgeon, Duke University, @georgoff Teddy Puzio, MD, Trauma Surgeon, University of Texas Houston Gabby Hatton, MD, Trauma Surgery fellow, University of Texas Houston  References: 1.     Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2020: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767637 2.     Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey. Injury Prevention 2017: https://pubmed.ncbi.nlm.nih.gov/27597400/ 3.     Ketamine For Acute Pain After Trauma (KAPT): A Pragmatic, Randomized Clinical Trial. J Trauma 2024: https://pubmed.ncbi.nlm.nih.gov/38689402/ 4.     EAST PMG: Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma (2023): https://www.east.org/education-resources/practice-management-guidelines/details/efficacy-and-safety-of-nonsteroidal-antiinflammatory-drugs-nsaids-for-the-treatment-of-acute-pain-af 5.     Systematic Review and Meta-Analysis of the Association Between Non-Steroidal Anti-Inflammatory Drugs and Operative Bleeding in the Perioperative Period. JACS 2021: https://pubmed.ncbi.nlm.nih.gov/33515678/ 6.     Is the use of nonsteroidal anti-inflammatories after bowel anastomosis in trauma safe? J Trauma 2023: https://pubmed.ncbi.nlm.nih.gov/36728125/ 7.     University of Texas at Houston Multimodal Pain Guideline: https://med.uth.edu/surgery/acute-trauma-pain-multimodal-therapy/ 8.     ACS TRAUMA QUALITY PROGRAMS BEST PRACTICES GUIDELINES FOR ACUTE PAIN MANAGEMENT IN TRAUMA PATIENTS: https://www.facs.org/media/exob3dwk/acute_pain_guidelines.pdf 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://app.behindtheknife.org/listen

A 70 year old healthy female is referred to you with a 5.7 cm abdominal aortic aneurysm. As an astute clinician you are aware that current guidelines support surgical repair for her AAA. What if there was new data to suggest this patient may not benefit from repair? What would be the optimal size threshold that she would benefit from AAA repair? Tune into this episode of Behind the Knife, where the vascular surgery subspecialty team discusses a paper that challenges current size threshold guidelines for AAA repair.  Hosts:  Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan. Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. Drew Braet is a PGY-5 Integrated Vascular Surgery Resident at the University of Michigan Learning Objectives - Review the current size threshold guidelines for surgical repair of abdominal aortic aneurysms - Understand the limitations of the aforementioned guidelines - Understand the methodology, findings, limitations, and clinical applications of the manuscript “Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration.” References 1.    Columbo JA, Scali ST, Jacobs BN, et al. Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration. Journal of Vascular Surgery. 2024;79(5):1069-1078.e8. doi:10.1016/j.jvs.2024.01.017 https://pubmed.ncbi.nlm.nih.gov/38262565/ 2.    Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery. 2018;67(1):2-77.e2. doi:10.1016/j.jvs.2017.10.044 https://pubmed.ncbi.nlm.nih.gov/29268916/ 3.    Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. Editor’s Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. European Journal of Vascular and Endovascular Surgery. 2024;67(2):192-331. doi:10.1016/j.ejvs.2023.11.002 https://pubmed.ncbi.nlm.nih.gov/38307694/ 4.    The UK Small Aneurysm Trial Participants, Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms.  Lancet 1998;352 (9141) 1649- 1655 https://pubmed.ncbi.nlm.nih.gov/9853436/ 5.    Lederle  FAWilson  SEJohnson  GR  et al. Aneurysm Detection and Management Veterans Affairs Cooperative Study Group, Immediate repair compared with surveillance of small abdominal aortic aneurysms.  N Engl J Med 2002;346 (19) 1437- 1444 https://pubmed.ncbi.nlm.nih.gov/12000813/ 6.    United Kingdom EVAR Trial Investigators; Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med. 2010 May 20;362(20):1872-80. doi: 10.1056/NEJMoa0911056. Epub 2010 Apr 11. PMID: 20382982. https://pubmed.ncbi.nlm.nih.gov/20382982/ 7.    Lederle FA, Johnson GR, Wilson SE, Ballard DJ, Jordan WD Jr, Blebea J, Littooy FN, Freischlag JA, Bandyk D, Rapp JH, Salam AA; Veterans Affairs Cooperative Study #417 Investigators. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002 Jun 12;287(22):2968-72. doi: 10.1001/jama.287.22.2968. PMID: 12052126. 8.    Lancaster EM, Gologorsky R, Hull MM, Okuhn S, Solomon MD, Avins AL, Adams JL, Chang RW. The natural history of large abdominal aortic aneurysms in patients without timely repair. J Vasc Surg. 2022 Jan;75(1):109-117. doi: 10.1016/j.jvs.2021.07.125. Epub 2021 Jul 26. PMID: 34324972. https://pubmed.ncbi.nlm.nih.gov/34324972/ 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://app.behindtheknife.org/listen