Umbilical hernias a common diagnoses that general surgeons must manage. Though these hernias are considered relatively simple problems to resolve, certain populations of patients are prone to higher rates of complications. As abdominal wall surgery has advanced, so to have the options that exist in management of primary umbilical hernias. The session will review common clinical circumstances and high-risk patient presentations. We will generally review the approaches to repair and the thought processing and data driving decision making.   ·       Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair.  ·       Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. ·       Dr. Shahrose Rahman is a resident in General Surgery at Oregon Health & Science University.  Seminal Papers in Umbilical Hernia Management Guidelines for treatment of umbilical and epigastric hernias (Henriksen et al. Br J Surg. 2020.): https://pubmed.ncbi.nlm.nih.gov/31916607/ Hernia-Neck Ratio: Predicting Factors for Complications of Umbilical Hernias (Fueter et al. WJS. 2016.): https://pubmed.ncbi.nlm.nih.gov/27194561/ Safety and effectiveness of umbilical hernia repair in patients with cirrhosis (Hew et al. Hernia. 2018.):https://pubmed.ncbi.nlm.nih.gov/29589135/ Fix it while you can...Mortality after umbilical hernia repair in cirrhotic patients (Hill et al. Amer Journal of Surgery. 2020.): https://pubmed.ncbi.nlm.nih.gov/32988606/ Postoperative complications with retromuscular mesh placement in emergency incisional hernia repair (Juul et al. Scand J Surg. 2021.): https://pubmed.ncbi.nlm.nih.gov/33092472/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Warning!  There is magic contained in this podcast.  Real magic.  The kind of magic that allows you to understand how to manage the axilla in breast cancer patients.    The standard of care approach to management of the axilla in patients with breast cancer has evolved rapidly. While a complete axillary dissection was historically indicated following identification of any positive nodes, that is no longer the case; indeed, axillary dissections are now uncommonly performed. Join Drs. Michael Alvarado, Rita Mukhtar, and Alexa Glencer as they discuss the impact of the ACOSOG Z0011, AMAROS, and ACOSOG Z1071 trials in defining the role of sentinel lymph node dissection and radiotherapy in patients with early-stage breast cancer with limited lymph node involvement as well as the approach when neoadjuvant chemotherapy has been received. Learning Objectives: ·       Describe the study design and results of the ACOSOG Z0011 trial and its impact on the use of sentinel lymph node biopsy as an alternative to complete axillary lymph node dissection in clinically node-negative patients with T1 or T2 breast cancer ·       Describe the study design and results of the AMAROS trial and its implications for use of axillary radiation as an alternative to axillary lymph node dissection for patients with clinically node-negative T1 or T2 breast cancer ·       Understand the risk of lymphedema related to complete axillary lymph node dissection, as demonstrated by the AMAROS trial ·       Describe the study design and results of the ACOSOG Z1071 trial and how interpretation of its subgroup analysis has been applied to our approach of offering sentinel lymph node biopsy as a means of staging the axilla following neoadjuvant chemotherapy in patients with clinical node-positive disease at the time of diagnosis Journal Article Links: ACOSOG Z0011: https://jamanetwork.com/journals/jama/article-abstract/2653737 AMAROS: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70460-7/fulltext ACOSOG Z1071: https://jamanetwork.com/journals/jama/fullarticle/1748149%20 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Join our Emergency General Surgery Team as they discuss EGS in patients > 65.  Introduction - > 65 = 40% of EGS admissions  - In-hospital mortality for EGS in older adults is approximately 7-12% and the one-year mortality is around 30-38%. - High risk due to decreased reserve, poor nutritional status, and chronic medical conditions  - Frailty correlates with poor post-operative outcomes Paper #1: Mehta A, Dultz LA, Joseph B, Canner JK, Stevens K, Jones C, Haut ER, Efron DT, Sakran JV. Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes. J Trauma Acute Care Surg. 2018 Jun;84(6):864-875.  - retrospective population-based cross-sectional study using administrative data.  - looks at the association between surgeon and hospital annual experience with outcomes in geriatric patients with EGS conditions. - Note Table 2 provides outcomes broken down by type of surgery - Key finding: patients operated on by a low-volume surgeon had about twice the odds of mortality, and 1.7X the odds of failure to rescue Paper #2: Guttman MP, Tillmann BW, Nathens AB, Saskin R, Bronskill SE, Huang A, Haas B. Alive and at home: Five-year outcomes in older adults following emergency general surgery. J Trauma Acute Care Surg. 2021 Feb 1;90(2):287-295.  - large-scale population-based retrospective cohort study looking at long-term outcomes of older adults with admissions for emergency general surgery diagnoses - primary outcome of interest is “aging in place” or being able to reside in one’s home for as long as possible.  - Key finding: being admitted for an EGS diagnosis reduces your survival and time in your home by about 7 months. - Very little reduction in low-risk diagnoses (acute appendicitis/cholecystitis) - 57% of patients were alive and in their home 5 years later Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Thoughts of esophageal perforations keeping you up at night? Actual esophageal perforations keeping you up at night?  Drs. Brian Louie, Peter White, and Megan Lenihan discuss both the tried-and-true and the cutting-edge management of this challenging problem. Learning Objectives - Understand basic principles of management - Review differences in management based on different underlying pathology and location - Learn indications and techniques for advanced endoscopic interventions for perforations - Discuss nutrition planning  Referenced Material - Thornblade LW, Cheng AM, Wood DE et al. A Nationwide Rise in the Use of Stents for Benign Esophageal Perforation. Ann Thorac Surg 2017; 104(1):227-233. DOI: 10.1016/j.athoracsur.2017.03.069 http://dx.doi.org/10.1016/j.athoracsur.2017.03.069 - Watkins JR and Farivar AS. Endoluminal Therapies for Esophageal Perforations and Leaks. Thorac Surg Clin 2018; 28(4):541-554. DOI: 10.1016/j.thorsurg.2018.07.002 https://doi.org/10.1016/j.thorsurg.2018.07.002 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more. 

A trauma patient rolls into the bay.  CPR started 10 minutes ago.  They are pulseless, the entire trauma team is looking to you for leadership, and the thoracotomy tray is prepped and ready.  Do you pick up the knife and cut?   Welcome back to the BIG T TRAUMA series.  Join Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill for a high-level discussion on the one surgical procedure that trumps them all – the ED thoracotomy.  This is episode 2 of 2.  In episode 1 we discussed who should get an ED thoracotomy.  Today, we cover how to do it.    Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

A trauma patient rolls into the bay.  CPR started 10 minutes ago.  They are pulseless, the entire trauma team is looking to you for leadership, and the thoracotomy tray is prepped and ready.  Do you pick up the knife and cut?   Welcome back to the BIG T TRAUMA series.  Join Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill for a high-level discussion on the one surgical procedure that trumps them all – the ED thoracotomy.  This is episode 1 of 2.  In episode 1 we discuss who should get an ED thoracotomy and in episode 2 we cover how to do it.    Listen to learn about the guidelines, signs of life, ultrasound, survival, and when NOT to do an ED thoracotomy.    EAST: https://www.east.org/education-career-development/practice-management-guidelines/details/emergency-department-thoracotomy  WTA: https://www.westerntrauma.org/wp-content/uploads/2020/08/Resuscitative-Thoracotomy_FINAL.svg  WakeMed Blunt Pulseless Trauma Resuscitation Guideline: https://www.wakemed.org/sites/default/files/hg_features/mercury_standard_layout/031abaa9027e1685ad340ac8f662e86a.pdf Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In the episode we will cover the following learning objectives: ·       Listeners should be able to describe the evolution and changes in definitions sepsis over the past three decades ·       Listeners should be familiar with the three randomized controlled trials that studies early-goal directed therapy ·       Listeners should be able to describe the major changes in the new 2021 SCCM Sepsis Guidelines ·       Listeners should be able to describe the fundamental principles of sepsis management in the ICU References: https://www.nejm.org/doi/full/10.1056/nejmoa1500896 https://www.nejm.org/doi/full/10.1056/nejmoa1404380 https://www.nejm.org/doi/full/10.1056/nejmoa1701380 https://www.nejm.org/doi/full/10.1056/nejmoa1401602 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more. 

You are seeing a young female patient in the clinic with rectal prolapse. When do you offer surgery?  Does she get a perineal approach or a transabdominal approach?  Open or minimally invasive?  Mesh or no mesh?  Sigmoid resection or no resection?  Join Drs. Abelson, Marcello and Aulet as they take us through the wide world of rectal prolapse! Learning Objectives: 1.     Describe the difference between rectal prolapse and hemorrhoidal prolapse 2.     List the different approaches to surgical management of rectal prolapse 3.     Discuss the approach to recurrent rectal prolapse Be sure to check out the associated video below.  Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In this episode from the Endocrine Surgery team at BTK we go through three controversial topics in endocrine surgery and cite pertinent articles during a lively debate format. We debate the role of four-gland exploration versus focused exploration for parathyroid disease. Indications for parathyroidectomy are hotly contested. And finally, we discuss the role and relevance of using a nerve monitor. Tune in to see if Dr. Yeh and Dr. Wu remain collegiate after recording this episode…               Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.  Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research  Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.  Important Papers  Norlén O, Wang KC, Tay YK, Johnson WR, Grodski S, Yeung M, Serpell J, Sidhu S, Sywak M, Delbridge L. No need to abandon focused parathyroidectomy: a multicenter study of long-term outcome after surgery for primary hyperparathyroidism. Ann Surg. 2015 May;261(5):991-6. doi: 10.1097/SLA.0000000000000715. PMID: 25565223. Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012 Dec;152(6):1008-15. doi: 10.1016/j.surg.2012.08.022. Epub 2012 Oct 12. PMID: 23063313; PMCID: PMC3501613. Jinih M, O'Connell E, O'Leary DP, Liew A, Redmond HP. Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2017 Jul;24(7):1924-1934. doi: 10.1245/s10434-016-5694-1. Epub 2016 Nov 28. PMID: 27896505. Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999 Oct 21;341(17):1249-55. doi: 10.1056/NEJM199910213411701. Erratum in: N Engl J Med 2000 Jan 13;342(2):144. PMID: 10528034. Seib CD, Meng T, Suh I, Harris AHS, Covinsky KE, Shoback DM, Trickey AW, Kebebew E, Tamura MK. Risk of Fracture Among Older Adults With Primary Hyperparathyroidism Receiving Parathyroidectomy vs Nonoperative Management. JAMA Intern Med. 2022 Jan 1;182(1):10-18. doi: 10.1001/jamainternmed.2021.6437. PMID: 34842909; PMCID: PMC8630642. Yeh MW, Zhou H, Adams AL, Ituarte PH, Li N, Liu IL, Haigh PI. The Relationship of Parathyroidectomy and Bisphosphonates With Fracture Risk in Primary Hyperparathyroidism: An Observational Study. Ann Intern Med. 2016 Jun 7;164(11):715-23. doi: 10.7326/M15-1232. Epub 2016 Apr 5. PMID: 27043778. Zanocco K, Butt Z, Kaltman D, Elaraj D, Cella D, Holl JL, Sturgeon C. Improvement in patient-reported physical and mental health after parathyroidectomy for primary hyperparathyroidism. Surgery. 2015 Sep;158(3):837-45. doi: 10.1016/j.surg.2015.03.054. Epub 2015 May 29. PMID: 26032828. Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009 Mar;96(3):240-6. doi: 10.1002/bjs.6417. PMID: 19177420. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. 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 general 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 Oral Board Review episodes at https://behindtheknife.org/premium/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.