Behind The Knife: The Surgery Podcast

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

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

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.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** Subjective and objective GERD are common amongst bariatric surgery patients. Is weight loss alone enough to improve GERD symptoms? Is the vertical sleeve gastrectomy really associated with worsening GERD? What technical factors of the vertical sleeve gastrectomy lead to improved or worsening GERD? Listen to find out! Journal articles: The Impact of Sleeve Gastrectomy on Gastroesophageal Reflux Disease in Patients with Morbid Obesity https://pubmed.ncbi.nlm.nih.gov/35048247/ Effect of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair on Gastroesophageal Reflux in Patients with Obesity: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/34254259/ 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 *** 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)

*** 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

*** 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.  

The landscape of surgery is shifting, reflecting the diverse composition of graduating medical students and the efforts to recruit the most talented people into the field.  It is one thing to have a diverse group of people within surgery, but it is an entirely different thing to ensure a welcoming, supportive environment for them.  In this Journal Club episode, we review these topics from the perspective of eminent surgeons Drs. Caprice and Jake Greenberg, who share with us their insights on recent articles examining the experience of women surgeons and trainees.  We’re joined by Dr. Cary Schlick, who authored one of these articles, to shed light on a key issue for the field.  Learning Objectives: ·       Identify some of the challenges for women in surgical training programs ·       Discuss how stereotype threat can impact performance ·       Suggest ways to advocate for equity in surgery References: Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Ac

Mattox Vegas TCCACS 2022: Ep. 2  The Trauma, Critical Care, and Acute Care Surgery conference (aka the MATTOX conference, named after trauma surgery legend Kenneth L Mattox) is the longest running show in Las Vegas at 55 consecutive years.  The MATTOX conference is unique in its focus on clinical topics.  Every talk, every panel, and every case discussion is relevant and practical.  Join Behind the Knife as we use case-based discussions to hammer home key points from lectures given by some of the biggest names in trauma, critical care, and acute care surgery.  This is episode 2 of 2.   The lineup:   Hasan Alam, MD (@DrHasanAlam)  Scott Steele, MD (@ScottRSteeleMD)  Joseph Dubose, MD (check out his exceptional podcast here: https://www.tiger-country.org/)  Mathew Martin, MD (@docmartin22)  Red Hoffman, MD (@redMDND, check out her amazing podcast here: https://thesurgicalpalliativecarepodcast.buzzsprout.com/)  Bellal Joseph, MD (@TopKnife_B)  Please visit behindtheknife.org to access other high-yield surgic

The Trauma, Critical Care, and Acute Care Surgery conference (aka the MATTOX conference, named after trauma surgery legend Kenneth L Mattox) is the longest running show in Las Vegas at 55 consecutive years.  The MATTOX conference is unique in its focus on clinical topics.  Every talk, every panel, and every case discussion is relevant and practical.  Join Behind the Knife as we use case-based discussions to hammer home key points from lectures given by some of the biggest names in trauma, critical care, and acute care surgery.  This is episode 1 of 2.   The lineup:   Dennis Kim, MD (@traumaicurounds, check out his amazing podcast here: https://www.traumaicurounds.ca/)  Ali Salim, MD (@alisalimMD)  Jason Smith, MD (@DrJTrauma)  Andre Campbell, MD (@TraumaDocSF) Meghan Lewis, MD   Demetrios Demetriades, MD  Alexander Eastman, MD (@PMHTrauma_ALE)  Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

The mortality rate for unstable pelvic hemorrhage due to blunt trauma remains around 30 percent. However, technological advances promise to finally make a dent. But on the cutting edge, it’s not clear which treatments should be used when to maximize lives saved. With life-threatening pelvic exsanguination, time is critical. Do you know when to rush to pack the pelvis? Do you know when to deploy a REBOA instead? Are there scenarios where you should do both? Join Drs. Urréchaga, Neeman, and Rattan from Ryder Trauma Center in Miami as they try to tease out answers using two studies hot off the presses with seemingly contradictory results. Learning Objectives: Blunt Pelvic Hemorrhage ·       Expanding knowledge of management strategies for blunt pelvic hemorrhage ·       Describe propensity score matching and its use in non-randomized studies ·       Compare outcomes of REBOA and preperitoneal pelvic packing (PPP) ·       Critically appraise study design and methods of studies References 1.     S. Mikdad, I.A.

EPAs are coming in 2023. This isn’t about your carbon emissions, but it will dramatically impact surgery training programs. Join Drs. Karen Brasel, Jeremy Lipman, Judith French, and Amy Han as they discuss Entrustable Professional Activities (EPAs) and how they will change the way we assess trainees. Learning Objectives 1.     Listeners will be able to define entrustable professional activities (EPAs) within the context of competency-based education during General Surgery residency training 2.     Listeners will be able to understand the impetus behind adopting EPA assessments for surgical trainees.  3.     Listeners will be able to interpret and apply EPA assessment data based on the discussion of the example scenarios. References: Brasel KJ, Klingensmith ME, Englander R, Grambau M, Buyske J, Sarosi G, Minter R. Entrustable professional activities in general surgery: development and implementation. Journal of surgical education. 2019 Sep 1;76(5):1174-86. Lindeman B, Brasel K, Minter RM, Buyske J, Grambau

Dr. Michael Rosen returns to Behind the Knife – this time to discuss his RCT investigating biologic vs. synthetic mesh for single-stage repair of contaminated ventral hernias. Read the full article here in JAMA Surgery: https://jamanetwork.com/journals/jamasurgery/article-abstract/2788222 Dr. Rosen is the director for the Center of Abdominal Core Health at the Cleveland Clinic and has written the “Atlas of Abdominal Wall Reconstruction”. Want to learn more about his work and the Hernia Quality Collaborative? Catch up on Dr. Rosen’s previous episode on Behind the Knife:  Episode #21 (August 15, 2015): Hernias, Abdominal Wall Reconstruction, and Quality Collaboratives https://behindtheknife.org/podcast/21-hernias-abdominal-wall-recon-and-quality-collaboratives-dr-michael-rosen/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Welcome to the third of a six-part series focused on the integration of palliative care into the practice of surgery.  Malignant bowel obstructions occur in 5-43 percent of patients with a diagnosis of advanced primary or metastatic intra-abdominal malignancy and both acute care surgeons and surgical oncologists are called upon to manage this condition. Using the case of an elderly gentleman with gastric outlet obstruction secondary to gastric cancer, in this episode we discuss how to approach a patient with a malignant bowel obstruction, review the medical and surgical options for management, discuss the importance of primary palliative care, define palliative surgery and conclude with a short rant about the necessity of being cognizant of one’s feelings and of taking the time and creating the space to discuss them.  Fast Fact #45:  Medical Management of Bowel Obstructions https://www.mypcnow.org/fast-fact/medical-management-of-bowel-obstructions/ Chapter 8, Malignant Bowel Obstruction in Surgical Palliat

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 M

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 a

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

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 vi