Surgery Commons^™

History Of Bariatric Surgery Is Not Associated With Worse Clinical Outcomes At 5 Years In Patients Who Undergo Liver Transplantation, Do Han Kim Md, Donghyun Ko, Pedro Palacios Argueta Md, Wilhelm S. Basegoda Md, Jose A. Porres, Klaus E. Monkemuller, Paul T. Kroner Md

Posters

This study explores and compares outcomes of LT alone with LT in patients with a prior history of RYGB or SG, using a large multinational database.

Impact Of Post-Operative Radiation Therapy On Survival In Nsclc Patients With Incomplete Surgical Resection, Farrah R. Khan Md

Posters

Postoperative radiation therapy (PORT) has a limited role in the management of resectable non-small cell lung carcinoma (NSCLC). A relatively strong indication for its use is in the presence of residual tumor after surgical resection, as PORT has been shown to improve survival in such patients. However, it is unclear how much of the survival detriment of incomplete resection PORT is able to offset compared to negative margins. We aim to answer this question in our study

Impact Of Michigan Public Act 246 On Opioid Prescribing For Pediatric Surgical Patients, Madison Saunders, Pavan Brahmamdam

Posters

1. Opioid misuse is an epidemic in the U.S. affecting 3.1% of pediatric patients.2,3.

2. Most common way adolescence obtain access to opioids is by their own prescription or a family member. 3,4 3.

3. In December 2017, Michigan enacted Public Act 246 (P246) in an attempt to address rising opioid misuse.

4. P246 states that as of June 1, 2018, a prescriber of a controlled substance must discuss the risks of opioid usage minor and the minor’s parent or guardian and sign a consent form.

Does The Possibility Of No Surgery In Watch And Wait For Rectal Cancer Affect Patient Decision-Making?, Joanna F. Wasvary, Ga-Ram Han, Jacob A. Applegarth, Matthew A. Ziegler

Posters

INTRODUCTION & OBJECTIVE

Prior studies have established that the watch and wait protocol for rectal cancer is a reasonable approach in patients with excellent response to total neoadjuvant therapy (TNT). Current guidelines stipulate that patients eligible for this protocol have no residual tumor on re-staging imaging and endoscopy. Patients who have evidence of residual disease are referred for surgery. This study assessed all patients in our institution who underwent TNT for rectal cancer and the subsequent recommendations for treatment. Primary aim: assess patient compliance with surgeon recommendations for residual disease after TNT.

Secondary aim: assessment of oncologic outcomes and the …

Implementation Of An Opioid Free Pediatric Hernia Repair Protocol, Corey Shafer, Antonela Muca, Randy Hilleary, Kristin Lemarbe, Diane Studzinsk, Kaveh Aslani, Nathan Novotny, Pavan Brahmamdam, Begum Akay

Posters

Surgery most often provides children with their first exposure to opioids which may lead to misuse and overuse. Protocolizing pain management perioperatively can reduce opioid exposure in children while still providing adequate pain management.

Enhancing Reproductive Anatomy Education: A Comprehensive Approach Integrating Near-Peer And Reciprocal Peer Tutoring, Hope Hefferan, Emelie-Jo Scheffler, Erin Mueller, Varna Taranikanti

Posters

• Near-peer tutoring (NPT): Tutors are more advanced than tutees, typically offering support in understanding complex concepts.1

• Reciprocal peer tutoring (RPT): Students with similar levels of training alternate between tutor and tutee roles, facilitating collaborative learning.1

• Peer tutoring fosters professional development and improves long-term retention of complex medical concepts.3,4,5

• Reproductive anatomy is a challenging area for many medical students; Innovative peer tutoring methods may help improve understanding and retention of anatomical structures.

• We hypothesize that integrating NPT and RPT within the laboratory setting in the reproductive organ system course will enhance student motivation, self-efficacy, and long-term …

Safety And Utility Of Robotics In Pediatric Surgery: Implementation, Luke J. Man, Kristin Lemarbe, Nathan Novotny, Anthony Stallion, Begum Akay, Pavan Brahmamdam

Posters

• Minimally invasive laparoscopic surgery is considered standard of care for adult and pediatric patients .

• Robotic surgery (RS) for adult patients has been widely adopted due to superior ergonomics, visualization, depth perception, and access to deeper anatomical structures2,3.

• Historically, RS is associated with longer operative times, higher cost, and lacks haptic feedback1,2.

• RS has had inconsistent adoption in the pediatric surgery community2.

Improving Treatment For Infant Perianal Abscesses, Artem Dadamyan, Nathan Novotny, Ngan Nguyen

Posters

Perianal abscesses: • Tender masses located at the anal verge, typically in the 3 o’clock and 9 o’clock positions1

• Develop due to infection in abnormally deep crypts of Morgagni 1

• If left untreated, can extend into the ischioanal space or intersphincteric space since these areas are continuous with the perianal space.2

• Some may develop into fistula in ano, which can be difficult to treat3 Treatment:

• The standard has always been incision and drainage (I&D), but non-invasive management of Sitz baths is increasingly being used.

Surgical Site Infection Bundle For Babies: Preliminary Data, Cullen Woodley, John Nida, Alexis Lonjin, Katelyn Ward, Diane Studzinski, Begum Akay

Posters

Surgical Site Infections (SSIs) are infections that occur in or around the area where a surgery was recently performed. They are estimated to account for 20% of all healthcare associated infection, and lead to an increase in morbidity and mortality. Perioperative care bundles show promise in reducing SSIs in adults but are not often used in neonatal surgery. Infections in babies after surgery are less common than adults but carry significant morbidity in a fragile patient.

Index Cost Comparison Of Laparoscopic Vs Robotic Surgery In Colon And Rectal Cancer Resection: A Retrospective Financial Investigation Of Surgical Methodology Innovation At A Single Institution, Ekene Ezeokoli, Roula Hilli, Harry J. Wasvary

Posters

Robotic assisted colorectal cancer resection (R-CR) has become increasingly commonplace in contrast to traditional laparoscopic cancer resection (L-CR). The aim of this study was to compare the total direct costs of R-CR to that of L-CR and to compare the groups with respect to costs related to LOS.

Eye Dissection Video Guide: An Innovative Approach To Anatomy Education Of The Orbit, Eye, And Intraocular Lens, Jack Dryden, Malli Barremkala

Posters

No abstract provided.

Calling The Burn Center: Why Do Our Referring Hospitals Call Us?, Moon Usman Md, Alisa Savetamal

Posters

This study seeks to analyze and evaluate referral data received by a single state burn center, focusing on the allocation of resources for referrals and consultations, and determining the proportion of these that result in patient admissions.

A Heart Full Of Nails: Complex Management Of Multiple Nail Gun Cardiac Injuries, Shaun Abid Md, Stuart Zarich

Posters

A 54-year-old male presented after a suicide attempt, suffering severe cardiac and extracardiac injuries from firing a nail gun into both temples (Figure 1A) and his chest. Imaging showed six 5cm nails embedded in his heart: two in the left ventricle, two in the right ventricle, one traversing the ascending aorta into the left atrium, and one entering the right ventricle from the left parasternal chest wall (Figure 1B, C, D). These injuries resulted in hemorrhagic pericardial effusion with tamponade, acute aortic regurgitation, mitral valve/pulmonary artery perforations, and a ventricular septal defect.

The Profound Role Of An Adult Survivor Program Adaptive Sports Retreat On Quality Of Life And Self Perception For Adult Burn Survivors, Roselle E. Crombie Md/Mph, Facs, Faba, Theresa E. Abrams Lcsw, Phd, Cindy Rutter Bsn, Lmft, Josh Mishell Ba, Philip E. Fidler Md

Posters

Mental health struggles amongst adult burn survivors has recently been documented as an ongoing need for therapy in peer reviewed journals.1 Although there are many robust programs, camps, reintegration programs and support systems through child life for children, the analogous programs for adults are lacking in comparison to the pediatric ones. Ten years ago, a subset of this author group ran an adult adaptive sports survivor program in conjunction with a national burn meeting. At that time, all the participants, mental health providers and participating surgeons were able to experience the profound impact a program like this can have on …

Limbgod(Pat. Pending): Wearable Garment For Amputation Prevention, Naomi Choi Dpm, Mba, Phuc An Dinh Bs, Ms, Eric Lee Bs, Francois M. Lokenye Dpm

Posters

Approximately 1.6 million people in the U.S. have lower limb amputations, which is expected to double by 2050 (Wong et al.). Socio-economic factors: income, education, rural residency & race, impact amputation risk (Okesina et al.), with Black Americans 70% are more likely to undergo major lower limb amputations than white Americans, even after adjusting for care access & comorbidities (Feinglass et al., Holman et al., Regenbogen et al.). Within 5 years, up to 50% of first-time amputees require another amputation (Dilingham et al., Glaser et al.) & those with comorbidities face a 77% five-year mortality rate (Fortington et al.).

Discussion Of “Biggest” Problems Facing Burn Units Today; A Survey Based Analysis And Discussion From Our Aba Burn Surgeon Forum Workgroups 2024, Roselle E. Crombie Md/Mph Facs Faba, Alexandra Lacey Md, Facs, Faba, Kathleen Romanowski Md, Facs, Faba

Posters

Burn Units are a unique environment and microcosm of patients. Additionally, there have been certain factors contributing to what burn care providers consider the most important challenges facing optimal delivery of care. Formally exploring these issues may elucidate solutions by gathering different perspectives.

Prevention Of Transmetatarsal Amputation In A Diabetic Patient With A Chronic Foot Ulcer Including Osteomyelitis By Minimally Invasive Surgery Floating Lesser Metatarsal Osteotomies In Conjunction With Adipose Injectable Filler, Francois M. Lokenye Dpm, Orlexia Thomas Dpm, Lady Paula Dejesus Dpm, Facfas, Facpm, Dwsp

Posters

Problem: Diabetic foot ulcers (DFUs) complicated by osteomyelitis often result in transmetatarsal amputations, leading to significant morbidity.

Objective: To evaluate a minimally invasive surgical approach combining floating lesser metatarsal osteotomies with adipose injectable filler to prevent transmetatarsal amputation, enhance wound resolution, and improve foot biomechanics

Outcomes Of Alcohol-Associated Hepatitis In Hospitalized Patients With Prior Bariatric Surgery: A Nationwide Analysis, 2016-2020, Sarpong Boateng, Prince A. Ameyaw, Karthik Mathialagan, Basile Njei

Posters

Alcohol-associated hepatitis (AAH) is a severe liver condition often necessitating hospitalization and has a one-year mortality of 40%. The increasing prevalence of obesity has led to a rise in bariatric surgery (BS), which can alter the outcomes of various comorbid conditions. There are some concerns about possible increased risk and severity of alcohol related disorders in patients with a history of BS due to alteration in alcohol metabolism after surgery.

Are Patients With Mash- Or Alcohol-Associated Cirrhosis More Likely To Develop Hepatic Hydrothorax? A National Transplant Database Analysis, Sarpong Boateng

Posters

Hepatic hydrothorax (HH) is a complication of end-stage liver disease involving the accumulation of pleural fluid in patients with cirrhosis, in the absence of other cardiopulmonary disease. HH occurs in 10% of patients with decompensated cirrhosis, conferring a 5-fold increased risk of mortality.¹ Alcohol-associated liver disease (ALD) and metabolic dysfunction associated steatohepatitis (MASH), which accounts for 80% of liver cirrhosis in the US are known risk factors for HH. ²

REFERENCES

1. Asrani, Sumeet K., et al. "Burden of liver diseases in the world." Journal of hepatology 70.1 (2019): 151-171.

2. Banini, Bubu A., et al. "Multidisciplinary management of …

Incidence Of Symptomatic Upper Extremity Deep Vein Thrombosis In Respect To Subcutaneous Port Venous Access Site In Adults: A Retrospective Review, Catherine Bark, Alexsandra Biel, Corinne G. Bowditch, Paul Bove, Jimmi Mangla

Posters

Subcutaneous ports are an essential component of care in patients who require long-term central venous access and are commonly indicated for patients that require chemotherapy, infusions, intravenous (IV) antibiotics or frequent blood draws.1,2 The catheter of the subcutaneous port is commonly inserted through the subclavian vein and internal jugular vein via percutaneous insertion, or the external jugular vein and cephalic vein via surgical cutdown of the vein.

One of the most common port-related complications is venous thromboembolic (VTE) events with rates of symptomatic VTE as high as 13.6%.4,6–11 Patients with symptomatic upper extremity deep vein thrombosis (DVT) can present with …

A Retrospective Review Of Cosmetic Surgery Medical Tourism Complications During Covid-19 Pandemic, Rachel Blaisdell, Claire Mcnary, Catherine Barkach, Emanuela Peshel, Elizabeth Boudiab, Lauren Oliver, Samuel Mucci

Posters

• Cosmetic surgery medical tourism refers to traveling outside one’s geographic region for the purpose of a cosmetic procedure
• Benefits include reduced cost, shorter wait times, and newer “trendy” procedures
• Potential problems include a lack of continuity of care for patients, travel after surgery, and exposure to foreign pathogens

Heart Rate Metrics In Surgical Residents Performing An Educational Task Under Stress, Harkirat Jawanda, Kathryn K. Howard, Rose E. Callahan

Posters

Although a moderate amount of stress can be beneficial for performance, excess stress can lead to a decrease in fine motor skills, focus, decision-making skills, and communication.1-3.

• These effects can be especially detrimental in the operating room, where a stress-induced lapse in performance can lead to catastrophic outcomes for patients.
• One unique stressor experienced by surgical residents is observation by an attending surgeon during procedures, which has been shown to lead to an increase in stress related behaviors.4
• Mimicking the stress of the operating room in simulation environments presents the opportunity for residents to improve their ability to recognize and …

Comparing Plastic Surgeon Operative Time For Deep Inferior Epigastric Perforator (Diep) Flap Breast Reconstruction, Christopher J. Issa, Elizabeth M. Boudiab, Jeffrey Desano, Neil S. Sachanandani, Jeremy Powers, Kongkrit Chaiyasate

Posters

The deep inferior epigastric perforator (DIEP) flap has remained the gold standard for perforator flap reconstruction due to its consistent anatomy and low morbidity. Despite higher longterm patient satisfaction in autologous breast reconstruction compared to breast implants,1–3 implant-based reconstruction remains more common due to shorter operative time.

Several studies have examined the issue of optimizing efficiency of autologous breast reconstruction but were typically performed in the context of immediate reconstruction. In our institution and others, however, two-stage delayed reconstruction is the norm — a tissue expander is placed at the first stage for preservation of the skin envelope; after expansion …

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

Posters

• Guidelines for antibiotic prophylaxis for surgical site infection (SSI) are widely used for adult patients.
• There is limited data on prophylaxis in pediatrics, and there are no standardized guidelines for neonates.
• Perioperative antibiotic use in neonates based on the surgeon’s preference.

Emergency Department Treatment Of Elevated Blood Pressure In The Headache Patient, Lauren Eberhardt, Michelle Jankowski, Brett Todd

Posters

• Headache is an extremely common emergency department (ED) chief complaint, accounting for 1-3% of emergency department (ED) visits per year globally.
• Headache is often associated with elevated blood pressure and the most frequent clinical manifestation of hypertensive urgency, occurring in 35.9% of patients.5
• First line treatments used for acute headache management in the ED include intravenous fluid (IVF), anti-dopaminergic agents, aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), and ketorolac.6
• Rescue analgesia is needed for pain management in 16% to 18.1% of patients.8,9.
• Rescue analgesia includes: additional doses of first line analgesia or initiation of a second line medication1,6,10,11 such as magnesium sulfate, …

Water-Soluble Contrast Challenge In The Management Of Pediatric Adhesive Small Bowel Obstruction: A Systematic Review, Max Fliegner, Daniel Finn, Spencer Wilhelm, Nathan Novotny, Anthony Stallion

Posters

Background: Adhesive small bowel obstruction (ASBO) is a serious complication of intra-abdominal surgery1 Water-soluble contrast (WSC) challenges have been used for medical management in the adult population2,3

Knowledge Gap: The therapeutic value of water-soluble contrast challenge in the pediatric population with ASBO is under-studied3,4

Research Question: Does administration of water-soluble contrast challenge reduce the need for surgery in pediatric patients with adhesive small bowel obstruction?

A Metabolic, Mechanical, Multi-Organ Masterpiece: Dural Device Support Bridge To En-Bloc Heart-Liver Transplantation In Propionic Acidemia, Rebecca Juhl, Brian Birnbaum, Aliessa P. Barnes, William Gibson, Bhargava Mullapudi, Beth Lang, Megan Faseler, Daniel E. Heble, Victoria Urban, Ryan T. Fischer, Jennifer L. Gannon, David Sutcliffe

Posters

Introduction: Propionic Acidemia (PA) is a disorder related to abnormal protein and lipid metabolism resulting in progressive neurological injury and dilated cardiomyopathy (DCM). Interventions for PA and secondary disease manifestations can require multi-organ transplantation. Herein we report the case of a child with PA and end-stage DCM requiring left ventricular assist device (LVAD) support with eventual heart-liver transplant. Case Report: A 17 year old male diagnosed in childhood with PA developed chronically progressive DCM culminating in end stage heart failure with acute decompensations. In a recurrent admission, he progressed to require dual inotropic support and systemic anticoagulation for new LV …

Management Of Primary Spontaneous Pneumothorax: A Single Institution Protocol Analysis, Shai Stewart Md, James A. Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Posters

Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis

Background: The Midwest Pediatric Surgery Consortium (MWPSC) has suggested a management algorithm to include simple aspiration of primary spontaneous pneumothorax (PSP), failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes in patients who have been managed with this suggested protocol.

Methods: An Institutional Review Board (IRB) approved, single institution retrospective analysis was conducted on all patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2022. Initial management consisted of aspiration alone with a 12F Thal-Quick chest tube followed by …

Endoscopic Retrograde Cholangiography Using A Colonoscope In A Pediatric Liver Transplant Patient With Roux-En-Y Biliary Anastomosis, Nadia Ibrahimi, Thomas M. Attard, Ryan T. Fischer, Voytek Slowik, Richard J. Hendrickson, Bhargava Mullapudi, Moises Alatorre-Jimenez, Syed Jafri

Posters

Introduction: Biliary ducal sequelae including occlusions, strictures, leaks, or necrosis frequently complicate pediatric liver transplantation. The underlying etiology includes prolonged intraoperative ischemia or postoperative arterial inflow obstruction. In adult patients the role of endoscopic retrograde cholangiography (ERC) is well established in the management of biliary complications post-liver transplantation. In contrast, in the pediatric population, due to the combination of small patient size and the complexity of Roux-en-Y anastomotic techniques, ERC has been described as difficult or virtually impossible. This limits the options available for managing biliary duct complications to percutaneous techniques Endoscopic management of biliary complications in pediatric patients with …

Clearance Of The Cervical Spine In Obtunded Pediatric Blunt Trauma Patients: Quality Assessment Of An Existing Clearance Pathway, Rachel Kalthoff, Elizabeth Boudiab, Diane Studzinski, Nathan Novotny, Pavan Brahmamdam, Begum Akay

Posters

INTRODUCTION
Obtunded patients following blunt trauma need clearance of the cervical spine (c-spine) that cannot depend on a clinical exam. Our center’s current pediatric c-spine evaluation pathway includes both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). The objective of this study was to review our use of both CT and MRI for obtunded pediatric trauma patients to assess the quality of our pathway and utility of MRI.