Surgery Commons^™

Impact Of The Mental Skills Curriculum On Stress Response Of Surgical Residents Performing A Simulated Task, Andrew Angus, Kathryn K. Howard, Harkirat Jawanda, Kathryn M. Ziegler, Victoria Roach

Conference Presentation Abstracts

No abstract provided.

P118. Colonic Stent Presenting With Stent Impaction And Erosion Through The Colonic Wall, Benjamin Randall Hart, Jon Hain

Conference Presentation Abstracts

Background: Colonic stenting has been shown to be effective as a palliative measure in colorectal cancer when

patients present with obstructing symptoms. However, its efficacy when used for complications of colonic anastomoses are less well-studied. We present a case report of an elderly gentleman with a colonic stent placed for anastomotic stricture, which led to stent migration stent impaction with erosion in the sigmoid colon.

A 92-year-old gentleman presented to the ED with several days worth of nausea and vomiting. He had recently undergone a partial colectomy with an ileocolonic anastomosis approximately one year prior and then had a covered …

Variability And Outcomes Of Medical And Lifestyle Management Of Peripheral Arterial Disease At The Time Of Lower Extremity Bypass, Ryan Howard, Jeremy Albright, Matthew Corriere, Nicholas Osborne, Eugene Laveroni, Peter Henke

Conference Presentation Abstracts

Background: First-line treatment of peripheral arterial disease (PAD) involves medical therapy and lifestyle modification. Specifically, the 2016 American Heart Association/American College of Cardiology guidelines for the management of PAD make Class I recommendations for antiplatelet therapy, statin therapy, antihypertensive therapy, and cilostazol therapy, as well as exercise therapy and smoking cessation. Although evidence supports medical and lifestyle management of PAD before surgical intervention, it is currently unclear whether clinical practice reflects this. Moreover, it is also unknown whether variability in medical and lifestyle optimization before revascularization affects short- and long-term outcomes. This study was conducted to determine the proportion of …

National Trends And Survival Outcomes Of Performing Immediate Breast Reconstruction For Male Breast Cancer Patients, Neha Sarvepalli, Nayana Dekhne, Mohamad Sebai, Patrick Karabon

Conference Presentation Abstracts

INTRODUCTION: Immediate breast reconstruction after a mastectomy was reported in 43.3% of female patients in 2014; and has been associated with improved quality of life and adherence to adjuvant therapies. While there are many studies regarding immediate breast reconstruction in women, little has been reported about reconstruction rates and outcomes in male breast cancer. The purpose of this study is to examine the trends and outcomes of performing Immediate Breast Reconstruction (IBR) in male breast cancer (MBC) patients following a mastectomy. METHODS: The National Cancer Database (NCDB) registry from 2004 to 2014 was used to identify non-metastatic MBC patients who …

Laparoscopic Assisted Robotic Radical Prostatectomy With Pelvic Lymph Node Dissection Using Viable Cryopreserved Umbilical Tissue To Improve Cavernosal Nerve Function., Joshua Volin, Brett Watson, Lior Kopel, Samantha Kraemer, Jason Hafron

Conference Presentation Abstracts

Radical prostatectomy is the preferred treatment for patients with clinically localized prostate cancer and is typically performed using a robotic approach. Surgical techniques that preserve the neurovascular bundle minimize the risk of incontinence and erectile dysfunction post-operatively. Umbilical cord tissue is a relatively new technique, which has been shown to reduce inflammation and promote regenerative healing. In this video we show a robotic radical prostatectomy with bilateral nerve sparing technique utilizing a cryopreserved umbilical cord allograft nerve wrap.

Robotic Spleen Preserving Distal Pancreatectomy (Warshaw Techniqe) In A 12-Year-Old Female., Rachel Harvey, Begum Akay, Pavan Brahmamdam

Conference Presentation Abstracts

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare entity seen in young females. Complete surgical resection is often curative. This video shows a robotic spleen preserving distal pancreatectomy for a SPN in a 12-year-old female using the Warshaw technique. This technique preserves the short gastric and left gastroepiploic vessels allowing for splenic survival after ligation of the splenic vessels. This video demonstrates the feasibility of using the robot to perform this procedure in a pediatric patient. MRI at 18 months follow up showed that the spleen was completely perfused, with no evidence of recurrence or metastasis.

Perioperative Antibiotic Use In Neonatal General Surgery: A Survey Of Apsa Membership, Ashley Williams, Samuel K. Osei, Pavan Brahmamdam, Begum Akay, Diane Studzinski

Conference Presentation Abstracts

Background: Surgical site infections (SSIs) are a significant source of perioperative morbidity. There is limited data regarding antibiotic prophylaxis in pediatrics, and there are no standardized guidelines in neonates. Thus, peri-operative antibiotic use is based on surgeon experience and preference. To explore this knowledge gap, we sought to describe the practice patterns of pediatric surgeons with regard to antibiotic prophylaxis for SSIs in neonatal surgery

Methods: A survey was distributed to the American Pediatric Surgical Association (APSA). Members were asked to respond to 6 hypothetical case scenarios: Tracheoesophageal fistula/Esophageal atresia, Hirschsprung’s disease, Gastroschisis, Congenital diaphragmatic hernia repair, Neonatal intestinal obstruction …

Indications For A "Surgery First" Approach For The Treatment Of Lower Extremity Arterial Disease, Mohineesh Kumar, Steven D. Rimar, Graham W. Long, Diane M. Studzinski, O W. Brown

Conference Presentation Abstracts

No abstract provided.

Institutional Factors In General Surgery Resident Wellness And Burnout: Identification Via A Modified Delphi Technique, Darci C. Foote, Gurjit Sandhu, Kathryn Ziegler, James Lau

Conference Presentation Abstracts

Background: While there has been significant focus on individual and programmatic factors impacting general surgical residents wellbeing and burnout, the effect of the greater institutional macrocosm has not been well studied. Our work seeks to identify organizational factors that may be implicated in resident wellness. Summary of Work: Using a modified Delphi technique, a survey structured around six domains of the Maslach Burnout Theory (workload, control, reward, community, fairness, values) was distributed to wellness stakeholders at two institutions. Participants identified factors that may be implicated in resident wellness and burnout. Two subsequent multiple-choice survey iterations were distributed to stakeholders who …

A Rare Case Of Jejunal Perforation Due To Post-Transplant Lymphoproliferative Disease 27 Years After Liver Transplant, Marcos Rosado, Thomas Serena, Zophia Martinez, Erich Schwartz, Harris Mainster

Articles

Post-transplant lymphoproliferative disease (PTLD) is a well-known post-transplant malignancy common in both solid organ and stem cell transplants. The incidence of PTLD in adult liver transplant recipients is approximately 2.8%. While most often presenting in the first year after transplant, PTLD can occur at any time. This case report narrates a 61-year-old female with a history of liver transplant in 1992 for autoimmune hepatitis that was found to have a jejunal perforation due to PTLD 27 years later. The patient presented to the hospital with a fifteen hour history of left sided abdominal pain that was progressively worsening. The patient …

Robotic Gastrotomy And Bezoar Removal In A Six-Year-Old., Lior Kopel, Joshua Volin, Anthony Iacco, Begum Akay, Pavan Brahmamdam

Conference Presentation Abstracts

No abstract provided.

Intraoperative Uses Of Near-Infrared Fluorescence Spectroscopy In Pediatric Surgery: A Systematic Review, Heba Alghoul, Farah Al Farajat, Osaid Alser, Andrea Rogers-Snyr, Carroll Harmon, Nathan Novotny

Conference Presentation Abstracts

No abstract provided.

Esophageal Magnamosis For The Treatment Of Type-B Esophageal Atresia In A Child With Prohibitive Operative Risk: A Novel Device And Indication., Irving J. Zamora, Muhammad Oa Ghani, Lauren L. Evans, Nathan M. Novotny, Lyndy J. Wilcox, Harold N. Lovvorn, Kristina A. Betters, Mohammad Sahlabadi, Matthew R. Lucas, Jeffrey S. Upperman, Oliver J. Muensterer, Michael R. Harrison

Conference Presentation Abstracts

No abstract provided.

Developing A 2-Week Surgery Bootcamp: A Needs Assessment Of Aspiring General Surgeons, Darci C. Foote, Victoria A. Roach

Conference Presentation Abstracts

No abstract provided.

Pegloprastide-Based Ratiometric Fluorescence Imaging Detects Intraoperative Positive Margins In Real-Time, Sarah A. Mclaughlin, M Catherine Lee, Sheldon M. Feldman, Barry Rosen, Valerie P. Grignol, Anne M. Wallace, Nayana S. Dekhne

Conference Presentation Abstracts

Background/Objective: Positive margins detected after breast conservation surgery can result in the need for a re-excision or completion mastectomy. We hypothesized that pegloprastide combined with a ratiometric fluorescence imaging system would allow surgeons to detect positive margins in real time. Methods: Pegloprastide (AVB-620) was to be administered to patients 3-20 hours before the start of surgery. During the operation, initial primary tumor removal was performed unaided. Following primary resection, a fluorescence imaging system optimized for use with pegloprastide was used to assess the primary specimen and the cavity. Cavity shaves were taken when fluorescence above pre-specified thresholds were noted. Additional …

Trends Contributing To Disparities In Inflammatory Breast Cancer, Anna Lehrberg, Nayana Dekhne, Amita Desai, Sayee Kiran

Conference Presentation Abstracts

Background/Objective: Breast cancer overall survival rate in Black American (BA) women is lower compared to White American (WA) women. Inflammatory breast cancer (IBC) is a rare but aggressive subtype of breast cancer that is found at higher incidence in the BA patients. The objective of this study was to evaluate trends and identify factors that contribute to racial disparities in outcomes of women with IBC. Methods: The National Cancer Database (NCDB) was used to evaluate patients with Stage III IBC from 2004 to 2014. Patient demographics, tumor characteristics, treatments and survival trends were stratified by race for comparison. Results: A …

The Evolving Effectiveness Of Biologics In Avoiding Surgery In Children With Ulcerative Colitis., Mohineesh Kumar, Samuel K. Osei, Ayesha Fatima, Rachel N. Harvey, Alexander Menning, Anthony Stallion, Nathan Novotny

Conference Presentation Abstracts

Purpose

Pediatric ulcerative colitis (UC) treatment has changed dramatically with the introduction of multiple biologics in recent years. The purpose of this study was to assess effectiveness of biologic agents in achieving remission and incidence of surgery.

Methods

We retrospectively analyzed UC patients that were seen at gastroenterology clinic between January 2012-August 2020. We analyzed demographic characteristics, colonoscopy, clinic and hospital records. Patients were divided into four groups: 1) patients treated medically without biologics or surgery; 2) patients treated with one biologic; 3) patients treated with multiple biologics; and 4) patients that underwent colectomy. Pearson Chi-square test was used to …

Are Surgeons Still Doing Sentinel Node Biopsies In Older Women, Eric A. Brown

Conference Presentation Abstracts

INTRODUCTION: SSO published guidelines suggesting that surgeons should not routinely perform sentinel lymph node (SLN) biopsies for patients (pts) * 70 years of age (yo) with hormone receptor positive, her2 negative (HR+her2-) early stage invasive breast cancer (IBC). METHODS: We evaluated HR+her2- early stage IBC patients (pts) who were accrued to a multicenter trial between 2016-2018. Lymph node (LN) evaluation was left to the discretion of the treating surgeon. We sought to determine whether those * 70 yo were treated differently in terms of LN staging than their younger counterparts, the results of the SLN biopsy, and its impact on …

Does Breast Cancer Subtype Impact Margin Status In Patients Undergoing Partial Mastectomy?, Andrew Fenton, Elisabeth Dupont, Theodore Tsangaris, Carlos Garcia-Cantu, Marissa Howard-Mcnatt, Akiko Chiba, Adam Berger, Edward Levine, Jennifer Gass, Kristalyn Gallagher, Sharon Lum, Ricardo Martinez, Alliric Willis, Sonali Pandya, Eric A. Brown, Amanda Mendiola, Naveenraj Solomon, Maheswari Senthil, David Ollila, David Edmonson, Melissa Lazar, Jukes Namm, Fangyong Li, Meghan Butler, Noreen Mcgowan, Maria Herrera, Yoana Avitan, Brian Yoder, Laura L. Walters, Tara Mcpartland, Victor Haddad, Hongwei Ma, Ming Xie, Anees Chagpar

Conference Presentation Abstracts

BACKGROUND: Molecular subtype in invasive breast cancer guides systemic therapy. It is unknown whether molecular subtype should also be considered to tailor surgical therapy. The present investigation was designed to evaluate whether breast cancer subtype impacted surgical margins in patients with invasive breast cancer stage I through III undergoing breast-conserving therapy.

METHODS: Data from 2 randomized trials evaluating cavity shave margins (CSM) on margin status in patients undergoing partial mastectomy (PM) were used for this analysis. Patients were included if invasive carcinoma was present in the PM specimen and data for all 3 receptors (ER, PR, and HER2) were known. …

Association Of Metabolomic Biomarkers With Sleeve Gastrectomy Weight Loss Outcomes, Wendy Miller, Kathryn Ziegler, Stewart Graham, Michael Maddens, Matthew Sims

Articles

Background: Factors influencing weight loss variability following sleeve gastrectomy (SG) are not well understood. We evaluated the correlation of metabolomic biomarkers with weight loss outcomes. Methods: This prospective study evaluated the metabolomic profile of feces and serum prior to SG and three months post-SG, along with weight loss outcomes at three months post-SG (N=45). Serum and fecal samples were quantitatively profiled using a combination of 1H NMR and DI-LC-MS/MS (AbsoluteIDQ P180 kit (Biocrates, Innsbruck)). Results: Percent total weight loss (%TWL) for the lowest versus the highest weight loss tertiles (T1 vs T3) was 11.1 + 0.8% and 17.0 + 1.3%, …

Trends, Survival Outcomes, And Predictors Of Non-Adherence To Mastectomy Guidelines For Non-Metastatic Inflammatory Breast Cancer: Stage-Stratified Propensity Scoring Analysis Of Ncdb, Mohamad Sebai, Patrick Karabon, David Lee, Sayee Kiran, Nayana Dekhne

Articles

Background/Objective: Current National Comprehensive Cancer Network (NCCN) guidelines recommend modified radical mastectomy (MRM) as the surgical treatment of choice for nonmetastatic inflammatory breast cancer (IBC). Using data from the National Cancer Database (NCDB), our study compared the national trends and outcomes of breast-conserving surgery (BCS) vs. MRM for the treatment of IBC. Methods: NCDB data from 2004 to 2014 were retrospectively analyzed. Patients’ demographics, tumor characteristics, and overall mortality (OM) trends were compared between BCS and MRM cases of IBC. Univariate, multivariate, and propensity score weighted analyses were done to compare study groups and build a predictive model for undergoing …

Gender Differences And Survival Outcomes In Breast Cancer Patients: Stage Stratified Propensity Scoring Analysis Of The National Cancer Database, M Sebai, Pe Karabon, T Luan, S Kiran, N Dekhne

Articles

Background: There is limited research examining breast cancer gender differences. This study compares the trends and survival outcomes over the years between male (MBC) and female (FBC) breast cancer patients using the National Cancer Database (NCDB). Methods: We retrospectively analyzed the NCDB registry for MBC and FBC cases diagnosed between 2004 and 2014. Patient demographics, tumor characteristics, overall mortality (OM), and trends were compared between MBC and FBC Patients. Univariate, multivariate, and propensity score weighted analyses were done to compare MBC and FBC. Results: 19,488 MBC patients (0.9%) and 2,138,730 FBC patients (99.1%) were identified. Median follow-up was 59.63 months. …