Behind The Knife: The Surgery Podcast

It’s 1AM and the emergency department is calling about *insert terrifying foregut problem you haven’t seen since you were an intern here* and you wake up in a cold sweat to realize it was just a dream…this time. Tune in to this clinical challenge episode for some tips and tricks for managing foregut nightmares with Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo from the University of Washington’s Minimally Invasive Surgery team.  Referenced articles and videos:  1.     Rodriguez-Garcia HA, Wright AS, Yates RB. Managing obstructive gastric volvulus: challenges and solutions. Open Access Surgery. 2017 https://www.dovepress.com/getfile.php?fileID=35414 2.     Yates RB. Giant PEH: Management Principles for Unique Clinical Circumstances. 2017 SAGES Annual Meeting. Houston, TX. 2017 https://www.youtube.com/watch?v=vq6cZL2-pho 3.     Millet I, Orliac C, Alili C, Guillon F, Taourel P. Computed tomography findings of acute gastric volvulus. Eur Radiol. 2014.  https://pubmed.ncbi.nlm.nih.gov/25278244/ 4.     Mazaheri P, Ballard DH, Neal KA, Raptis DA, Shetty AS, Raptis CA, Mellnick VM. CT of Gastric Volvulus: Interobserver Reliability, Radiologists' Accuracy, and Imaging Findings. AJR Am J Roentgenol. 2019.  https://pubmed.ncbi.nlm.nih.gov/30403524/ 5.     Barmparas G, Alhaj Saleh A, Huang R, Eaton BC, Bruns BR, Raines A, Bryant C, Crane CE, Scherer EP, Schroeppel TJ, Moskowitz E, Regner JL, Frazee R, Campion EM, Bartley M, Mortus JR, Ward J, Margulies DR, Dissanaike S. Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer. Trauma Surg Acute Care Open. 2021. https://pubmed.ncbi.nlm.nih.gov/34079912/ 6.     Horn CB, Coleoglou Centeno AA, Rasane RK, Aldana JA, Fiore NB, Zhang Q, Torres M, Mazuski JE, Ilahi ON, Punch LJ, Bochicchio GV. Pre-Operative Anti-Fungal Therapy Does Not Improve Outcomes in Perforated Peptic Ulcers. Surg Infect (Larchmt). 2018. https://pubmed.ncbi.nlm.nih.gov/30036134/ 7.     Wee JO. Gastric Volvulus in Adults. In: UpToDate, Louie BE (Ed), UpToDate, Waltham, MA. (Accessed on May 15, 2022.) https://www.uptodate.com/contents/gastric-volvulus-in-adults Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Determining when to order imaging for blunt cerebrovascular injury is a diagnostic quandary that has long engendered controversy. Today we discuss a paper that introduced universal CT angiogram of the neck to screen for BCVI in all blunt trauma patients and then compared the result to what would have happened if some of the current screening guidelines were utilized. Join us as we discuss their fascinating results and what it means for blunt trauma patients going forward. Hosts:  Elliott R. Haut, MD, Ph.D., a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).  Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Master's in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.  LITERATURE Black JA, Abraham PJ, Abraham MN, et al. Universal screening for blunt cerebrovascular injury. J Trauma Acute Care Surg. 2021;90(2):224-231. https://pubmed.ncbi.nlm.nih.gov/33502144/ Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. https://pubmed.ncbi.nlm.nih.gov/32176167/ Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, Burch JM. Optimizing screening for blunt cerebrovascular injuries. (1999) American journal of surgery. 178 (6): 517-22. https://pubmed.ncbi.nlm.nih.gov/10670864/ Geddes AE, Burlew CC, Wagenaar AE, Biffl WL, Johnson JL, Pieracci FM, Campion EM, Moore EE. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. (2016) American journal of surgery. 212 (6): 1167-1174. https://pubmed.ncbi.nlm.nih.gov/27751528/ Ciapetti M, Circelli A, Zagli G et-al. Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria. Scand J Trauma Resusc Emerg Med. 2010;18 (1): 61. https://pubmed.ncbi.nlm.nih.gov/21092211/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss TEF management and the use of a post-operative transanastomotic feeding tubes in pediatric surgery. Journal Article links:  Wang, C., Feng, L., Li, Y., & Ji, Y. (2018). What is the impact of the use of transanastomotic feeding tube on patients with esophageal atresia: a systematic review and meta-analysis. BMC Pediatr, 18(1), 385. doi:10.1186/s12887-018-1359-5 https://pubmed.ncbi.nlm.nih.gov/30541487/ Bence, C. M., Rymeski, B., Gadepalli, S., Sato, T. T., Minneci, P. C., Downard, C., . . . Midwest Pediatric Surgery, C. (2021). Clinical outcomes following implementation of a management bundle for esophageal atresia with distal tracheoesophageal fistula. J Pediatr Surg, 56(1), 47-54. doi:10.1016/j.jpedsurg.2020.09.049 https://pubmed.ncbi.nlm.nih.gov/33131776/ LaRusso, K., Joharifard, S., Lakabi, R., Nimer, N., Shahi, A., Kasasni, S. M., . . . Emil, S. (2022). Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula: The Quebec experience. J Pediatr Surg, 57(1), 41-44. doi:10.1016/j.jpedsurg.2021.09.014 https://pubmed.ncbi.nlm.nih.gov/34666898/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Join Shreya Gupta, MD and Jonathan Abelson, MD as they discuss highlights from the American Society of Colon and Rectal Surgeons.  Dr. Sharon Stein and Dr. Erin King-Mullins are the guest speakers. They are discussing female leadership, diversity and inclusion topics, and much more! This is episode 2 of 2. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** Join Shreya Gupta, MD and Jonathan Abelson, MD as they discuss highlights from the American Society of Colon and Rectal Surgeons.  This is episode 1 of 2.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In this insightful discussion, the hosts explore the puzzling relationship between bariatric surgery and gastroesophageal reflux disease (GERD). They question whether weight loss alone can alleviate GERD symptoms and delve into the impact of vertical sleeve gastrectomy on these conditions. The nuances of hiatal hernia repairs and their effect on postoperative GERD are highlighted, as well as contradictions in existing research. The importance of ongoing monitoring and tailored care for patients is emphasized, revealing the complexities of surgical outcomes.

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** How do you decide if a pancreatic head mass is resectable? Does vascular involvement matter? What impacts survival? Join the Surgical Oncology team as they dive into operative considerations when operating on borderline resectable and locally advanced pancreatic cancer. Break the nihilism and find out about the options available for patients with this dreaded malignancy. Learning Objectives:  In this episode, we review the various definitions for resectability in pancreatic cancer, as well as the various prognostic markers and decision points to consider when deciding which patients may benefit from an operation.  Hosts:  Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program. Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center. Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** In January 2022, the University of Maryland Medical Center performed the world’s first transplant involving a genetically modified animal heart. Join Behind the Knife as we discuss this significant transplant milestone with the 2 surgeons who led this historic case - Dr. Bartley Griffith and Dr. Muhammad M. Mohiuddin! Dr. Bartley Griffith is the Thomas E. and Alice Marie Hales Distinguished Professor in Transplant Surgery at UMSOM. Dr. Muhammad Mohiuddin is a Professor of Surgery at UMSOM and established the Cardiac Xenotransplantation Program with Dr. Griffith, the first in the United States.  Tune in to learn about the history of xenotransplantation and the barriers that have been overcome to make xenotransplantation a reality. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** Inspired by recent transplant surgery headlines, in this episode we briefly review the history and challenges of xenotransplantation. We discuss an article recently published in the American Journal of Transplantation describing the transplant of a porcine kidney into a human decedent model. Learning Objectives ·       Understand the timeline of xenotransplantation and its historical challenges ·       Review a recent article that describes the transplantation of a genetically-modified porcine kidney into a brain-dead human model ·       Discuss ongoing obstacles to successful xenotransplantation and next steps   References Porrett, P. M., Orandi, B. J., Kumar, V., Houp, J., Anderson, D., Cozette Killian, A., Hauptfeld-Dolejsek, V., Martin, D. E., Macedon, S., Budd, N., Stegner, K. L., Dandro, A., Kokkinaki, M., Kuravi, K. v., Reed, R. D., Fatima, H., Killian, J. T., Baker, G., Perry, J., … Locke, J. E. (2022). First clinical-grade porcine kidney xenotransplant using a human decedent model. American Journal of Transplantation, 22(4). https://doi.org/10.1111/ajt.16930 Schlich, T., & Lutters, B. (2022). Historical perspectives on xenotransplantation. The Lancet, 399(10331). https://doi.org/10.1016/s0140-6736(22)00529-3 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** You are faced with a young patient with an advanced colon cancer. You suspect Lynch syndrome. He asks if he should undergo total colectomy as opposed to segmental colectomy. How do you approach such a patient?  Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about Lynch syndrome, also known as Hereditary Non-polyposis Colorectal Cancer (HNPCC).  Learning objectives  -       To understand the rationale for universal testing for MMR deficiency of newly diagnosed colorectal cancers.  -       To know when to recommend screening for CRC for patients with LS and to those who have undergone resection   -       To understand the prevalence of cancers other than CRCs associated with Lynch syndrome, especially endometrial cancer.  Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.