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Journal Review in Colorectal Surgery Local Excision for Rectal Cancer

You have a patient who underwent local excision of a rectal cancer. Final pathology demonstrates a T2 lesion. What is the rate of local recurrence? Is excision alone sufficient? Should the patient undergo radical resection or should chemoradiation be offered? Tune in to find out!

Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Jose Guillem MD, MPH, MBA as they discuss high yield papers discussing local excision for Rectal Cancer.

Learning Objectives
1. Describe the features that increase risk of lymph node involvement in early stage rectal cancer
2. Discuss the different options for management of early-stage rectal cancer
3. Describe patient related factors that favor local excision of rectal cancer

References:
Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC. Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum. 2015 Jan;58(1):122-40. doi: 10.1097/DCR.0000000000000293. PMID: 25489704.

Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW, Lynn PB, Thomas CR Jr, Chan E, Cataldo PA, Marcet JE, Medich DS, Johnson CS, Oommen SC, Wolff BG, Pigazzi A, McNevin SM, Pons RK, Bleday R. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015 Nov;16(15):1537-1546. doi: 10.1016/S1470-2045(15)00215-6. Epub 2015 Oct 22. PMID: 26474521; PMCID: PMC4984260.

Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguílar J. Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum. 2002 Jul;45(7):875-9. doi: 10.1007/s10350-004-6320-z. PMID: 12130873.

Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002 Feb;45(2):200-6. doi: 10.1007/s10350-004-6147-7. PMID: 11852333.

O’Neill CH, Platz J, Moore JS, Callas PW, Cataldo PA. Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience. Dis Colon Rectum. 2017 Feb;60(2):152-160. doi: 10.1097/DCR.0000000000000764. PMID: 28059911.

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Journal Review in Vascular Surgery: Introduction to Endovascular Surgery – A Primer

Vascular surgery is full of awesome anatomy and big open vessel exposures, but endovascular surgery is here to stay and can be hard to get into, particularly as a learner. The basics of endovascular surgery share very little with the basics of open surgery and getting up to speed can be a big challenge. This episode is an introduction to all things endovascular surgery, from wires, catheters and sheaths to balloons and stents. Take a listen to get up to speed quickly in prep for an upcoming vascular rotation and skip the pain of trying to follow your attendings words so you can instead pay attention to the actual case.
Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan.
Dr. Craig Brown is a PGY-7 in the General Surgery program and the upcoming 2023 vascular surgery fellow at the University of Michigan.

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Clinical Challenges in Colorectal Surgery: Management of Small Bowel Strictures in Crohn’s Disease

You have a young patient with longstanding Crohn’s disease with a history of small bowel resections presenting with recurrent obstructions from a stricture. The patient has exhausted all medical options and requires surgery. How should you work up this patient prior to surgery? Should you perform a bowel resection or perform a strictureplasty? Which strictureplasty do you choose and why?

Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Fabrizio Michelassi as they discuss the management of small bowel strictures in Crohn’s disease.

Learning Objectives
1. Describe the evaluation for small bowel strictures and indications for operating in patients with Crohn’s disease
2. Discuss the different surgical options in managing small bowel strictures
3. Explain the rationale behind use of different strictureplasty approaches

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

If you liked this episode, check out other Colorectal Surgery episodes here: https://behindtheknife.org/podcast-category/colorectal/

Innovations in Surgery: Artificial Intelligence

This video supplements our podcast episode titled “Innovations in Surgery: Artificial Intelligence “.

This video is an example of the application of artificial intelligence in the OR.

Daniel Hashimoto is assistant professor of surgery at the Hospital of the University of Pennsylvania and director of the Penn Computer Assisted Surgery and Outcomes (PCASO) Laboratory. He received his MD and MS in translational research from the University of Pennsylvania and completed his general surgery training at Massachusetts General Hospital and Harvard Medical School, where he was also associate director of research of the Surgical AI & Innovation Laboratory. He is vice-chair and co-founder of the Global Surgical AI Collaborative, a nonprofit that oversees and manages a global data-sharing and analytics platform for surgical data. His work focuses on the use of computer vision for the delivery of intraoperative decision support and assessment of surgical performance. He is editor of the textbook Artificial Intelligence in Surgery: Understanding the Role of AI in Surgical Practice, which provides a nontechnical foundation on key concepts in artificial intelligence as it applies to surgical care.

Please visit https://behindtheknife.org/ to access other high-yield surgical education podcasts, videos, and more.

CRS Virtual Education: Mock Oral Boards – 8/28/22

FULL Patient History Below: (Video starts a bit late and does not include full history)
60F w/intense anal itching + burning for 1 mo. Tried using witch hazel + Prep H. No fiber, no laxatives, Western diet. 2 BM per day. No incontinence. Well-controlled DM. Anxiety, no medications. Monogamous, sexually active, no hx STI. CSP 7 years prior.
Exam: external excoriations. No masses. Normal tone.
Flex sig: no proctitis, masses
Causes?
Dietary
Systemic illnesses
Autoimmune + dermatologic conditions
Contact dermatitis (ex: fragrances in her hygiene regimen)
Topical steroid
1 mo. F/U w/o improvement
Consider stopping Metformin
Other treatment options?
Topical capsaicin, refer to Dermatology
Intra-dermal methylene blue injection using 27 Gg, non-hair bearing portion, 1:10 dilution
Complications?
Anaphylaxis, necrosis, temporary incontinence
Alternative: 2 cm perianal lesion distal to anal verge, erythematous + scaly
Poss. Paget’s? Punch BX w/local anesthesia
Inguinal exam
CSP (-)
OR: anal mapping
WLE w/2 mm margin + leave open
Other options? Raise flaps on either side + primarily close
Alternative: CSP showed 3.5 cm mass in rectum 7 cm from anal verge, ant.
BX: adenoCA
Stage w/MRI, CT C/A/P (-)
MRI: T2N0M0
Pathologic features: no adverse
Assess continence
Council re robotic LAR w/DLI
How to treat Paget’s w/rectal CA? APR
Alternative: 85F w/Paget’s only – topical treatment
Alternative: 60F w/pruritis found 3 cm ulcerated lesion in anal verge, tender, soiling, can’t get good exam in office
Additional Qs?
Gyn hx, abnormal paps, HPV vaccine, TOB or XRT, anoreceptive intercourse
Book for EUA w/BX
No invasion in vagina, invades into IAS
Path: SCC
HIV testing
Staging: MRI, CT C/A/P, CEA?
No inguinal LN
p16 (+), what does that mean?
HPV-related
Multiple BL liver lesions suspicious for mets
Refer to Med + RadOnc for neoadjuvant chemoTX w/checkpoint inhibitors
T2N0M0 stage 2
Neoadjuvant Nigro protocol 54Gy XRT, 5-FU, MMC
5 weeks post-TX F/U lesion smaller but wait until 3 mo.
Mass gone but scar remains
MRI, endoscopy
BX? No
Surveillance protocol
MRI, CT at 6 mo. w/anoscopy + exam/CEA Q6 mo.
Mass decreased in size at 3 mo.
Possibly grew at 6 mo.
Re-stage w/MRI + CT
Salvage APR
Metachronous inguinal LAD unilaterally
PET: isolated L groin
L lymphadenectomy – refer to Surg Onc
Inguinal + primary disease
Radiate groin

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Journal Review in Colorectal Surgery: Timing of Biologics and Surgery of Crohn’s Disease

You get consulted on a 34-year-old with ileocolic Crohn’s disease on Humira. You determine he needs surgery for recurrent partial obstructions. When do you do the surgery? How long should he be off his biologic medication? When to restart it post op? Join Drs. Abelson, Marcello and Aulet as they take us through two articles to help us figure it out!

Learning Objectives:
1. Describe the complications of biologic medications in the peri-operative period
2. List the different classifications of medications for Crohn’s disease
3. Discuss the approach to managing timing of surgery for patients with crohn’s disease

Articles:

Cohen BL, Fleshner P, Kane SV et al. Prospective Cohort Study to Investigate the Safety of Preoperative Tumor Necrosis Factor Inhibitor Exposure in Patients With Inflammatory Bowel Disease Undergoing Intra-abdominal Surgery. Gastroenterology. 2022 Apr 10;S0016-5085(22)00359-6. doi: 10.1053/j.gastro.2022.03.057. Online ahead of print.

Brouquet A, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y; GETAID chirurgie group. Anti-TNF Therapy Is Associated With an Increased Risk of Postoperative Morbidity After Surgery for Ileocolonic Crohn Disease: Results of a Prospective Nationwide Cohort. Ann Surg. 2018 Feb;267(2):221-228. doi: 10.1097/SLA.0000000000002017. PMID: 29300710.

Steele S, et al. The ASCRS Textbook of Colon and Rectal Surgery, fourth ed. 2022. https://link.springer.com/book/10.1007/978-3-030-66049-9

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Clinical Challenges in Surgical Critical Care: Point of Care Ultrasound Video

The utilization of point-of-care ultrasound and other non-invasive cardiac output monitoring technologies varies because of knowledge, resource availability and cultural practices. In this Clinical Challenge in Surgery episode from the Surgical Critical Care team at Behind the Knife, we provide a brief history of the use of cardiac-output monitoring in the ICU, introduce a few clinical scenarios in the context of point of care ultra-sound and other less-invasive cardiac-output monitoring technologies.

Learning Objectives:
In this episode, we review the historical uses of central venous pressure monitoring, pulmonary-artery catheters and the more frequently utilized point-of-care-ultrasound (or POCUS) in managing complex ICU patients. We review the outcomes behind these technologies, describe the views and utility of POCUS, and introduce less-invasive or completely non-invasive ways to measure cardiac-output monitoring.

Acknowledgements:
We would like to acknowledge Dr. Hassan Mashbari and the Department of Surgical Critical Care and Anesthesia at the Massachusetts General Hospital and Dr. Christopher Choi and the Department of Anesthesiology at the University of Texas Southwestern for their ultra-sound video contributions.

Hosts:
Brittany Bankhead, MD, MS (@BBankheadMD) is an Assistant Professor of Surgery at Texas Tech University Health Sciences Center.
Ryan Dumas, MD, FACS (@PMH_Trauma_RPD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital.
Caroline Park, MD, MPH, FACS (@CPark_MD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital.

Links to Papers Referenced in this Episode:
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006 May 25;354(21):2213-24. doi: 10.1056/NEJMoa061895. Epub 2006 May 21. PMID: 16714768.

Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill pediatric patients. J Ultrason. 2020 Nov;20(82):e205-e209. doi: 10.15557/JoU.2020.0034. Epub 2020 Sep 28. PMID: 33365158; PMCID: PMC7705480.

Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990 Aug 15;66(4):493-6. doi: 10.1016/0002-9149(90)90711-9. PMID: 2386120.

Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013 Jul;41(7):1774-81. doi: 10.1097/CCM.0b013e31828a25fd. PMID: 23774337.

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Evolution of Rectal Cancer 4-24-22

Dr. Jonathan Abelson is well-known to the CRS Education Series as a founding member of the organization. He is an assistant professor of surgery at Lahey Hospital & Medical Center. He completed his residency at Weill Cornell Medical Center in General Surgery followed by a fellowship in Colon and Rectal Surgery at Washington University in St. Louis. He has a special interest in rectal cancer and will be discussing an extremely important topic for all CRS and general surgeons.

“Lessons from an Old Guy” with Dr. Peter Marcello

This week, Dr. Peter Marcello shares with us “Lessons from an Old Guy” describing how to remain relevant in an ever changing practice environment, tips and tricks for challenging situations, and thoughts from recent DCR journal articles. Dr. Marcello is the Chairman of the Division of Colon and Rectal Surgery at the Lahey Hospital and Medical Center in Burlington, Massachusetts. He has performed more than 3000 laparoscopic colorectal procedures including participation in the COST and ACOSOG trials. He has organized more than 160 postgraduate courses teaching laparoscopic colorectal surgery and more than 20 advanced endoscopic courses. He is currently working on innovations in the endoluminal resection of colorectal neoplasia.

CRS Virtual Education: Mock Oral Boards – 3/6/22

This week is our Spring CRS Mock Oral Boards. Dr. Carrie Peterson, Associate Professor of Surgery and CRS at Medical College of Wisconsin, and Dr. Jonathon Abelson, Assistant Professor of Surgery and CRS at Lahey Medical Center provide excellent scenarios and teaching points for our two examinees, Drs. Fazaldin Moghul and Joceline Vu.

Clinical Challenges in Colorectal Surgery: Rectal Prolapse

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

CRS Virtual Education: Transanal Minimally Invasive Proctectomy

Dr. Justin Maykel is Professor and Chief of Colorectal Surgery at the University of Massachusetts Memorial Medical Center in Worcester, MA. Dr. Maykel has a special interest in Transanal Total Mesorectal Excision and will be discussing this very challenging and important topic with us this week!

CRS Virtual Education: Surgical Management of Ulcerative Colitis in 2021 Setting Stage for Success

This week we host Dr. Stefan Holubar, who is a staff Colorectal Surgeon and Director of IBD Multidisciplinary Team Conference and IBD Surgical Research at the Cleveland Clinic in Cleveland, Ohio. Dr. Holubar is one of the emerging leaders in surgery in clinical and translational research and is working on breakthroughs in the pathophysiology of rectal cancer and treatment of patients with inflammatory bowel disease.

CRS Virtual Education: Short Course, Total Neoadjuvant, Non operative Management of Rectal Cancer

Dr. Lauren E. Henke, MD is an assistant professor of radiation oncology. Her clinical practice and research interests include motion management in the treatment of gastrointestinal cancers, adaptive radiation therapy, advanced image-guided radiation therapy, MRI-guided radiation therapy, technology development, and clinical trial design. This week, she discusses the multi-disciplinary management of rectal cancer.

CRS Virtual Education: Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis

Dr. Feza Remzi is a colorectal surgeon at NYU Langone and is an expert in the surgical management of inflammatory bowel disease. As a national and international expert in colorectal surgery, he has published many articles and book chapters on the surgical management of inflammatory bowel disease, ileal J-pouch surgery, and reoperative abdominopelvic surgery. This week, he discusses technical and real life pearls for IPAA reconstruction.

CRS Virtual Education: Controversies in Diverticulitis

Dr. Sean Langenfeld MD, is an Associate Professor and Section Chief of Colon and Rectal Surgery in the Department of Surgery at the University of Nebraska Medical Center in Omaha, Nebraska. Dr. Langenfeld serves are on several editorial boards including the Journal of Surgical Education, Journal of Gastrointestinal Surgery, and is currently Section Editor for Selected Abstracts for Diseases of the Colon and Rectum. This week, he joins us to discuss the the complex management diverticulitis, an important topic for any general surgeon or colon and rectal surgeon.

cT2N0 Middle Rectal CA Neoadjuvant Therapy or Resect?

Join Behind the Knife’s very own Dr. Scott Steele, Chairman of the Department of Colorectal Surgery at Cleveland Clinic, for a high-level talk on the treatment of T2N0 rectal cancer.

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Colorectal Surgery Virtual Education Series: Mock Oral Exams

The Colorectal Surgery Virtual Education team is back with Mock Oral exams (4 cases). You can also enjoy this content in podcast format.

For more information on the Colorectal Surgery Virtual Education initiative visit www.crsvirtualed.org.

Dominate the Day by visiting www.behindtheknife.org.

A Step-up or Open Approach for Necrotizing Pancreatitis | BTK/RASACS Journal Club #24

Video Credit:
Shiva Jayaraman, VARD (Video Assisted Retroperitoneal Debridement), https://www.youtube.com/watch?v=Gqft-GytlEs

Logo/Figure Credit:
Werner, J., Feuerbach, S., Uhl, W., & Büchler, M. W. (2005). Management of acute pancreatitis: from surgery to interventional intensive care. Gut, 54(3), 426-436.
Shyu, J. Y., Sainani, N. I., Sahni, V. A., Chick, J. F., Chauhan, N. R., Conwell, D. L., … & Silverman, S. G. (2014). Necrotizing pancreatitis: diagnosis, imaging, and intervention. Radiographics, 34(5), 1218-1239.
Van Santvoort, H. C., Besselink, M. G. H., Horvath, K. D., Sinanan, M. N., Bollen, T. L., Van Ramshorst, B., … & Dutch Acute Pancreatis Study Group. (2007). Videoscopic assisted retroperitoneal debridement in infected necrotizing pancreatitis. Hpb, 9(2), 156-159.
Van Santvoort, H. C., Besselink, M. G., Bakker, O. J., Hofker, H. S., Boermeester, M. A., Dejong, C. H., … & Gooszen, H. G. (2010). A step-up approach or open necrosectomy for necrotizing pancreatitis. New England Journal of Medicine, 362(16), 1491-1502.
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Penetrating Esophageal Trauma | BTK/RAS-ACS Journal Club #22

Traumatic esophageal injuries are not common, but when they happen — you need to know how to handle them! Learn what the literature has to say about appropriate initial management of suspected penetrating esophageal trauma.

Make sure to check out other related topics from SCORE:
SCORE module: Neck Injuries – Management (https://www.surgicalcore.org/modulecontent.aspx?id=1000468)

Presented by: Hassan Mashbari, MD; Massachusetts General Hospital

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
SUBSCRIBE to our channel to keep up to date with the latest surgical knowledge!

Check us out on the Web:
https://behindtheknife.org
https://www.facs.org/member-services/ras

Subscribe to the podcast!
https://podcasts.apple.com/us/podcast/behind-the-knife-the-surgery-podcast/id980990143
https://open.spotify.com/show/2yHr0A4N7NJk4NoTcNd1z7

Follow us on Twitter! @BehindTheKnife https://twitter.com/behindtheknife?lang=en
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BTK Decision Making: Anastomotic Leaks

Anastomotic leaks come in many different flavors. Join Drs. Scott Steele and Patrick Georgoff as they work through the diagnosis and treatment of a variety of anastomotic leaks. Don’t miss this nuanced discussion!

Clinical Challenges in Colorectal Surgery: Endoscopic Management of Advanced Colorectal Polyps

You find a 2.3 cm polyp in the right colon during a screening colonoscopy. Does this patient need a colectomy? Is polypectomy ok? What should I do?? Join Drs. Peter Marcello, Jonathan Abelson and Tess Aulet as they discuss the endoscopic management of advanced colorectal polyps.

This video is accompanied by a podcast, which can be streamed via Apple (https://podcasts.apple.com/us/podcast/behind-the-knife-the-surgery-podcast/id980990143), Spotify (https://open.spotify.com/show/2yHr0A4N7NJk4NoTcNd1z7), and all other podcast platforms.

Interested in learning more about specific topics in Colorectal Surgery? Check out the Virtual Education Series in Colorectal Surgery on Sunday Evenings at 7 pm EST @CRSVirtualEd or visit our website at http://jc.kethman.org.

References:

Cohan JN, Donahue C, Pantel HJ, Ricciardi R, Kleiman DA, Read TE, Marcello PW. Endoscopic Step Up: A Colon-Sparing Alternative to Colectomy to Improve Outcomes and Reduce Costs for Patients With Advanced Neoplastic Polyps. Dis Colon Rectum. 2020 Jun;63(6):842-849. doi: 10.1097/DCR.0000000000001645. PMID: 32118624.
https://pubmed.ncbi.nlm.nih.gov/32118624/

NCCN guidelines: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1428

Kudo Classification: Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14 [PMID:8836710]

UpToDate. Chromoendoscopy. Author:Marcia Irene Canto, MD, MHSSection Editor:John R Saltzman, MD, FACP, FACG, FASGE, AGAFDeputy Editor:Kristen M Robson, MD, MBA, FACG. Literature review current through: May 2021. | This topic last updated: Jan 14, 2021.

Haggit and Kikuchi classification: Haggitt RC, Glotzbch RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985; 89: 328-36.

Adjuvant Radiation for Extremity Soft Tissue Sarcoma | BTK/RAS-ACS Journal Club #21

Limb preservation for soft tissue sarcoma of the extremities is a principle goal of therapy. In this episode we review landmark evidence for the use of adjuvant radiation.

Make sure to check out other related topics from SCORE:
SCORE module: Soft Tissue Sarcomas: https://www.surgicalcore.org/modulecontent.aspx?id=1000462

Presented by: Austin D. Williams, MD; Lankenau Medical Center

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
SUBSCRIBE to our channel to keep up to date with the latest surgical knowledge!

Check us out on the Web:
https://behindtheknife.org
https://www.facs.org/member-services/ras

Subscribe to the podcast!
https://podcasts.apple.com/us/podcast/behind-the-knife-the-surgery-podcast/id980990143
https://open.spotify.com/show/2yHr0A4N7NJk4NoTcNd1z7

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Biologic Mesh for Hiatal (Paraesophageal) Hernia Repair | BTK/RAS-ACS Journal Club #20

Mesh use can increase the longevity of a paraesophageal hernia repair, but they can be associated with erosion and perforation of the esophagus. So how does biologic mesh stack up?

Make sure to check out other related topics from SCORE:
https://www.surgicalcore.org/modulecontent.aspx?id=1000574 Paraesophageal Hernia Repair

Presented by: Sirivan Seng, MD; Crozer-Chester Medical Center

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
SUBSCRIBE to our channel to keep up to date with the latest surgical knowledge!

Check us out on the Web:
https://behindtheknife.org
https://www.facs.org/member-services/ras

Subscribe to the podcast!
https://podcasts.apple.com/us/podcast/behind-the-knife-the-surgery-podcast/id980990143
https://open.spotify.com/show/2yHr0A4N7NJk4NoTcNd1z7

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Treatment of Caustic Esophageal Stricture | BTK/RAS-ACS Journal Club #19

Foley catheters are routinely left after colorectal surgery. Patients hate having a tube in their urethra, and catheters represent an infection risk that hospitals dread. But removing them too early can lead to a situation where patients are unable to urinate. When is the best time to remove these catheters?

Make sure to check out other related topics from SCORE:
Esophgeal Caustic Ingestions and Foreign Bodies
https://www.surgicalcore.org/modulecontent.aspx?id=1000489

Presented by: Kaitlin A. Ritter, MD; Denver Health Medical Center/University of Colorado

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
SUBSCRIBE to our channel to keep up to date with the latest surgical knowledge!

Check us out on the Web:
https://behindtheknife.org
https://www.facs.org/member-services/ras

Subscribe to the podcast!
https://podcasts.apple.com/us/podcast/behind-the-knife-the-surgery-podcast/id980990143
https://open.spotify.com/show/2yHr0A4N7NJk4NoTcNd1z7

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When Should Foley (Urinary) Catheter be Removed? (Colorectal Surgery) | BTK/RASACS Journal Club #18

Foley catheters are routinely left after colorectal surgery. Patients hate having a tube in their urethra, and catheters represent an infection risk that hospitals dread. But removing them too early can lead to a situation where patients are unable to urinate. When is the best time to remove these catheters?

If you haven’t seen our Chest Tube procedure instruction video, definitely check that out! https://youtu.be/o5HuiD51Su0

Make sure to check out other related topics from SCORE
Acute Urinary Retention: https://www.surgicalcore.org/modulecontent.aspx?id=160175

Presented by: Michael Tonzi, MD; University of Tennessee College of Medicine – Chattanooga

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
SUBSCRIBE to our channel to keep up to date with the latest surgical knowledge!

Check us out on the Web:
https://behindtheknife.org
https://www.facs.org/member-services/ras

Subscribe to the podcast!
https://podcasts.apple.com/us/podcast/behind-the-knife-the-surgery-podcast/id980990143
https://open.spotify.com/show/2yHr0A4N7NJk4NoTcNd1z7

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How Big Should a Chest Tube Be? | BTK/RAS-ACS Journal Club #17

Does size matter when it comes to chest tubes? In this episode of the Journal Cast, we discuss the evidence behind choosing a smaller chest tube the next time you decide to put one in.

If you haven’t seen our Chest Tube procedure instruction video, definitely check that out! https://youtu.be/o5HuiD51Su0

Make sure to check out other related topics from SCORE
Tube Thoracostomy: https://www.surgicalcore.org/modulecontent.aspx?id=1000528
Pneumothorax: https://www.surgicalcore.org/modulecontent.aspx?id=1000495

Presented by: Victoria Miles, MD, University of Tennessee COM

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
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Perforated Diverticulitis: Hartmann or Primary Anastomosis? DIVERTI | BTK/RAS-ACS Journal Club #16

Severe perforated diverticulitis is a surgical emergency. When the abdomen is badly contaminated, in the past a Hartmann procedure has been the treatment of choice, due to fears of a threatened anastomosis (intestinal connection). But the DIVERTI trial changed the way we think about this problem. Learn about it here!

Make sure to check out other related topics from SCORE on total, subtotal, and partial colectomy (http://www.surgicalcore.org/modulecontent.aspx?id=1000583 and https://www.surgicalcore.org/modulecontent.aspx?id=129670) from the TWIS topic of large intestine!

Presented by: Shayan Khalafi, MD, University of Miami

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
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Carotid Endarterectomy for Carotid Stenosis – The NASCET Trial | BTK/RAS-ACS Journal Club #15

Carotid endarterectomy is a surgery where plaque build-up is removed from the inside of the carotid artery. How bad does the build-up (stenosis) need to be before it’s worth doing this big surgery? The NASCET trial is a classic study that tells us the answer.

Don’t forget to check out the TWIS topics: Carotid Endarterectomy (https://surgicalcore.org/modulecontent.aspx?id=150413) and Cerebrovascular Disease (https://surgicalcore.org/modulecontent.aspx?id=149545) for more information!

Presented by: Madhuri Nagaraj, MD, UT Southwestern

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
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Breast Cancer Reconstruction with Plastic Surgeon Dr. John Kim from Northwestern University

Over 100,000 women every year receive breast reconstruction after cancer treatment. Breast reconstruction is a complex topic! Listen to Dr. John Kim go in-depth with us about his approach to breast reconstruction.

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
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Blood, Plasma, and Platelets – 1:1:1 Resuscitation – The PROPPR Trial | BTK/RAS-ACS Journal Club #14

Resuscitation in severe trauma should be done with early administration of blood products. Learn about the PROPPR trial, which evaluated the difference between 1:1:1 versus 1:1:2 blood product resuscitation!

Be sure to check out the TWIS topics on trauma!
Initial Assessment and Management of Trauma: https://www.surgicalcore.org/modulecontent.aspx?id=1000540
Abdominal Exploration for Trauma: https://www.surgicalcore.org/modulecontent.aspx?id=1000552

Presented by: Alainna Simpson, DO, Oklahoma State University Medical Center

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
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https://www.facs.org/member-services/ras

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https://podcasts.apple.com/us/podcast/behind-the-knife-the-surgery-podcast/id980990143
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-~-~~-~~~-~~-~-
Please watch: “How to Do a Central Line (Central Venous Catheter) – Behind the Knife – Bedside Procedures Episode 2 ”
https://www.youtube.com/watch?v=DgQbQSBYeQU
-~-~~-~~~-~~-~-

ABSITE Mnemonic Review UPDATED 2021 – Behind the Knife

*CORRECTION: In our benzodiazepine versus barbiturate mnemonic, the idea is that benzodiazepines and barbiturates both act as positive allosteric modulators of the GABA receptor. However, benzos increase the frequency of opening of the channel while barbiturates increase the duration of channel opening. In fact there is no consistent difference between the drug classes in regards to dosing timing. That’s my mistake! I didn’t fully understand this particular mnemonic when describing it!

Do you have a mnemonic you think is really useful? PLEASE SHARE IT in the comments section below! Watch this quick-fire video to see some of the best mnemonic devices we use to DOMINATE the ABSITE!

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
SUBSCRIBE to our channel to keep up to date with the latest surgical knowledge!

Check us out on the Web:
https://behindtheknife.org

Subscribe to the podcast!
https://podcasts.apple.com/us/podcast/behind-the-knife-the-surgery-podcast/id980990143
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Follow us on Twitter! @BehindTheKnife https://twitter.com/behindtheknife?lang=en
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-~-~~-~~~-~~-~-
Please watch: “How to Do a Central Line (Central Venous Catheter) – Behind the Knife – Bedside Procedures Episode 2 ”
https://www.youtube.com/watch?v=DgQbQSBYeQU
-~-~~-~~~-~~-~-

Normal Saline or Lactated Ringers? – The SMART Trial | BTK/RAS-ACS Journal Club #13

It’s an age-old question that often mirrors a divide between medical specialties! Learn about a trial that attempted to answer this question in a population of critically ill patients.

Be sure to check out the TWIS topics on SCORE about electrolyte derangement and renal failure for some more information:
https://www.surgicalcore.org/modulecontent.aspx?id=140947
https://www.surgicalcore.org/modulecontent.aspx?id=140716

Presented by: Ryan Huttinger, DO; General Surgery Resident; Cape Fear Valley Medical Center

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
SUBSCRIBE to our channel to keep up to date with the latest surgical knowledge!

Check us out on the Web:
https://behindtheknife.org
https://www.facs.org/member-services/ras

Subscribe to the podcast!
https://podcasts.apple.com/us/podcast/behind-the-knife-the-surgery-podcast/id980990143
https://open.spotify.com/show/2yHr0A4N7NJk4NoTcNd1z7

Follow us on Twitter! @BehindTheKnife https://twitter.com/behindtheknife?lang=en
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Follow us on Facebook! https://www.facebook.com/behindtheknife/

-~-~~-~~~-~~-~-
Please watch: “How to Do a Central Line (Central Venous Catheter) – Behind the Knife – Bedside Procedures Episode 2 ”
https://www.youtube.com/watch?v=DgQbQSBYeQU
-~-~~-~~~-~~-~-

Ileus – What Do Randomized Controlled Trials Tell Us About Treatment? | BTK/RAS-ACS Journal Club #12

Your patient just had abdominal surgery and now their bowel just won’t wake up. A classic and frustrating reason for prolonged hospital course! We do all sorts of things to try to get that gut working again faster. What works and what does not work?

Review the Paralytic Ileus SCORE Module for a refresher on the background, workup, and treatment of ileus: https://surgicalcore.org/modulecontent.aspx?id=167603

Presented by: Austin D. Williams, MD MSEd; General Surgery Resident; Lankenau Medical Center

Are you trying to MATCH into your dream surgery program, DOMINATE the ABSITE, or continue HONING your surgical MASTERY?
SUBSCRIBE to our channel to keep up to date with the latest surgical knowledge!

Check us out on the Web:
https://behindtheknife.org
https://www.facs.org/member-services/ras

Subscribe to the podcast!
https://podcasts.apple.com/us/podcast/behind-the-knife-the-surgery-podcast/id980990143
https://open.spotify.com/show/2yHr0A4N7NJk4NoTcNd1z7

Follow us on Twitter! @BehindTheKnife https://twitter.com/behindtheknife?lang=en
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Follow us on Facebook! https://www.facebook.com/behindtheknife/

-~-~~-~~~-~~-~-
Please watch: “How to Do a Central Line (Central Venous Catheter) – Behind the Knife – Bedside Procedures Episode 2 ”
https://www.youtube.com/watch?v=DgQbQSBYeQU
-~-~~-~~~-~~-~-

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