Surgery Commons^™

Migration Of Copper Bullet Fragment Through The Orbit And Conjunctiva, Maxwell A. Levi, Mehron G. Kouhestani, Giovanni Disandro, Peter A. Netland

Department of Ophthalmology Faculty Publications

This is a case report of a 31-year-old female who sustained a gunshot wound to the left orbit, resulting in a ruptured globe and retained bullet fragments extending into the frontal lobe. The patient underwent enucleation without orbital implant, and no metallic fragments were recovered intraoperatively. Three months later, she returned with bloody conjunctival discharge. Examination revealed a 1.25-cm copper-colored metallic bullet jacket fragment spontaneously protruding through the conjunctiva. Serial CT imaging confirmed anterior and inferior migration of the bullet fragment over time, with a total migration distance of 32.9 mm through the orbit. The shrapnel was removed in clinic …

Outcomes After Orif Of Closed Bimalleolar And Trimalleolar Ankle Fractures In Patients With Autoimmune Disease, Mckenna Box, Troy B. Puga, Lachlan Anderson, Alyssa Kozlowski, John T. Riehl

North Texas GME Research Forum 2026

Background: Autoimmune disease is associated with chronic systemic inflammation, immunosuppressive therapy, and increased medical comorbidity, which may influence postoperative outcomes following fracture fixation. Data evaluating outcomes after ankle fracture surgery in this population remain limited. We hypothesized that autoimmune disease would be associated with higher postoperative complication rates following open reduction and internal fixation (ORIF) of closed ankle fractures.

Methods: We performed a retrospective cohort study using a multi-hospital dataset (2017-2025) to identify adult patients undergoing ORIF for closed bimalleolar or trimalleolar ankle fractures. Patients with autoimmune disease were propensity score matched 1:2 to patients without autoimmune disease based on …

Internal Jugular Injuries: Outcomes From The American Association For The Surgery Of Trauma Prospective Observational Vascular Injury Treatment (Proovit) Multicenter Registry, April Miller, Pranay Arora, Devika Pavuluri, John Bini

North Texas GME Research Forum 2026

Introduction: Since March 2013, the PROOVIT database has been a prospective, multi-center observational trial established for the study of vascular trauma. Here we present the data for the management of internal jugular vein injuries due to blunt and penetrating trauma.

Methods: Inclusion criteria for the PROOVIT study included patients age >2 years with radiologic or clinical/operative diagnosis of injury to named vessels in trauma patients at participating facilities. The database was reviewed to examine injury presentation, surgical management, postprocedural medical management with antiplatelet or anticoagulant therapy, and mortality. SPSS software was used to perform the descriptive and exploratory analysis for …

Surgical Management Of A Giant Colonic Diverticulum, Courtney Koplyay, Mason Workman, Michael Truitt, Muhammad T. Siddique

North Texas GME Research Forum 2026

INTRODUCTION: Giant colonic diverticulum (GCD), defined as a diverticulum >4 cm, is a rare manifestation of diverticular disease with less than 200 reported case reports. CT imaging is the preferred imaging modality to identify and confirm the presence of a GCD, which provides an accurate depiction of the size, location, and contents of the diverticulum GCD can present with nonspecific abdominal symptoms, abdominal pain, bloody stools, or an enlarging mass. Given the risk of serious complications, including diverticulitis, bowel obstruction, and perforation, early recognition and management are essential to prevent further complications. Surgical management with diverticulectomy or partial colectomy is …

Gastroduodenal Artery Coil Erosion Causing Pyloric Obstruction And Upper Gi Bleeding, Corey Newman, Mahad Rehman, Cody Beltran, Michael Carrick

North Texas GME Research Forum 2026

Background Trans-arterial embolization (TAE) of the gastroduodenal artery (GDA) is a well-established and effective treatment for peptic ulcer bleeding and visceral pseudoaneurysms. Although generally safe, delayed migration or erosion of embolization coils into the gastrointestinal lumen is a rare but recognized complication that may occur months to years after the procedure. Proposed mechanisms include ischemic mucosal injury, mechanical pressure from the coil mass, and chronic inflammation. Clinical manifestations vary widely, ranging from occult bleeding and ulceration to perforation or gastric-outlet obstruction. Only a limited number of cases describing GDA coil erosion presenting with both bleeding and obstruction have been reported. …

Occupational Human Papillomavirus Exposure Risks For Laryngeal Surgeons And Phoniatricians: A Joint European Laryngological Society (Els) And Union Of European Phoniatricians (Uep) Delphi Clinical Consensus Statement, Shiying Hey, Alberto Maria Saibene, Milan Amin, Jennifer Anderson, Christoph Arens, Simon Best, Guillermo Campos, Craig Derkay, Gauthier Desuter, Frederik G. Dikkers, Isabel Garcia-Lopez, Ahmed Geneid, Anastasios Hantzakos, Markus Hess, Yakubu Karagama, Marina Mat Baki, Napur Kapoor Nerurkar, Daniel Novakovic, Haldun Oguz, Shazia Peer, Jasmine Prasad, Carlo Robotti, David Vokes, Chi-Te Wang, Malgorzata Wierzbicka, Michal Zabrodsky, Nicolien Van Der Poel

Department of Otolaryngology (ENT) Faculty Publications

Purpose

Laser surgical management of human papillomavirus (HPV)-related disease, such as recurrent respiratory papillomatosis (RRP), in the upper aerodigestive tract generates surgical smoke, which may represent a source of occupational viral exposure for laryngeal surgeons, phoniatricians, anesthesia providers and scrub nurses. Despite growing awareness, protective measures remain inconsistently implemented. This study aimed to develop an evidence-informed clinical consensus statement (CCS) to guide occupational HPV risk management in laryngology.

Methods

A modified Delphi consensus process was conducted under the auspices of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP). A panel of 26 international experts undertook …

Leveraging Virtual Reality And Haptics To Teach Surgical Skills: A Usability Study On Retropubic Midurethral Slings, Lauren Siff, Ginger S. Watson, Jerome Dixon, Moshe Feldman, Franklin Bost, Philippe J. Giabbanelli

VMASC Publications

Traditional methods to learn soft-tissue surgical procedures rely on cadaver labs or patient-based learning, which are costly and geographically limited, and raise ethical questions. Virtual reality (VR) with haptic feedback offers a scalable alternative, but most current platforms emphasize bone-based rather than soft-tissue procedures learned by feel. We developed a VR+haptic simulation for preoperative training of retropubic midurethral sling (MUS) surgery. This study examines the usability of this platform with thirteen expert urogynecologic surgeons and subsequently makes improvements (e.g., in haptics) to evaluate the platform with twelve trainees based on the NASA Task Load Index for workload and a UTAUT-informed …

The Impact Of Gastric Sleeve And Roux-En-Y Gastric Bypass On Chief Cell Function And Protein Digestion In Obese Patients, Garikoitz Mikel Gainza

Honors Undergraduate Theses

Obesity has become one of the largest global health concerns of the 21^st century, correlating with numerous associated diseases. To help address the growing prevalence and burden of obesity, sleeve gastrectomy and Roux-en-Y gastric bypass have become two commonly performed surgical procedures done to promote weight loss by altering the anatomical structure of the stomach and surrounding organs of the gastrointestinal system. Although the benefits of improved metabolism linked to these surgical procedures are well studied, their impact on the physiology of gastric cells, and more specifically chief cells as they relate to protein digestion post-surgery, is yet to …

Smarca4-Deficient Carcinoma Of The Gastroesophageal Junction, Hanna Riga, Austin Lehr

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Esophageal Stents: How High Can You Go? A Traumatic Injury Treated With High Esophageal Stent Placement, John W. Surbeck, Anthony P. Melillo, James S. Scott

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Case Report: Spontaneous Gastric Intramural Hematoma With Intramural Dissection, Pedro De Castro, Rachel Steffes, John Surbeck, Anthony Melillo, Vince Narciso, Mohsin Soliman

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Large Language Models Improve Readability Of Patient Education Materials On Vascular Conditions, Melissa Chen Xu, Nicola Habash, Justin Do, Jiaying Bi, Dawn Salvatore, Paul J Dimuzio, Michael Nooromid, Babak Abai

Department of Surgery Faculty Papers

Objective: Patient education materials frequently exceed the recommended sixth-grade reading level. Although large language models (LLMs) have shown inconsistent accuracy in medical query responses, they have demonstrated promise in simplifying complex text. This capability has not yet been studied in vascular patient education materials. This study evaluates whether ChatGPT-4o and Gemini 1.5 Pro can improve the readability of Society for Vascular Surgery (SVS) patient education flyers. Methods: SVS health flyers were selected based on five common vascular conditions: abdominal aortic aneurysm, carotid artery disease, deep vein thrombosis, peripheral artery disease, and varicose veins. Each flyer was submitted to ChatGPT-4o and …

Infected Intra-Abdominal Hematoma Post-Laparoscopic One-Anastomosis Mini Gastric Bypass: Case Report And Literature Review, Musa Machibya, Hellen Mram, Jackline Gabone, Ally Mwanga, Tanseer Asghar, Authar Ali

General Surgery, East Africa

Introduction: Laparoscopic one-anastomosis gastric bypass (OAGB) is a widely performed bariatric procedure with favorable outcomes; however, it carries a risk of postoperative complications. An infected intra-abdominal hematoma is a rare but potentially serious complication, often presenting with nonspecific features that can delay diagnosis.

Case presentation: A 29-year-old female with class II obesity (BMI 36 kg/m2 ) underwent elective laparoscopic OAGB. The immediate postoperative course was uneventful, and she was discharged in stable condition. Eleven days later, she presented with fever and systemic symptoms without significant abdominal findings. Laboratory investigations suggested sepsis. Imaging revealed a large perigastric collection consistent with …

Reversible Hemi-Parkinsonism Syndrome Secondary To Bilateral Subdural Hematomas: Case Report And Literature Review, Musa Machibya, Godlove Mlay, Kelvin Sawe, Zainab Ali, Mugisha Clement, Philip Adebayo

General Surgery, East Africa

Introduction: Chronic subdural hematoma (CSDH) is a rare but reversible cause of secondary parkinsonism. Bilateral CSDH presenting with unilateral parkinsonian features is exceptionally uncommon.

Case presentation: A 61-year-old male from Comoros developed a right-hand tremor, intermittent dystonia, and mild right-sided motor deficits months after a motor vehicle accident. Medical therapy was ineffective. Imaging revealed bilateral frontoparietal subdural collections with a right hematoma causing a midline shift. Bilateral burr-hole evacuation led to marked improvement, with the UPDRS Part III score improving from approximately 7 to 1–2 points and near-complete hematoma resolution on follow-up.

Discussion: This case demonstrates the variable …

Durable Left-Ventricular Assist Device Inflow Thrombosis Following External Outflow Graft Obstruction, Mohammad J. Malik, Jin Woo Chung, Matthias Loebe, John C. Gurley, Emma J. Birks, Dhruv Kothari, Masashi Kawabori

Surgery Faculty Publications

Background: External outflow graft obstruction (EOGO) is an emerging complication due to improved pump durability. We experienced a rare sequence of complications, inflow thrombus formation following EOGO with reduced left-ventricular assist device flow.

Case Summary: A 41-year-old man, 2 years post HeartMate 3 (HM3) implantation, presented with low-flow from EOGO. Outflow graft stenting resulted in improvement but returned 1 month later with persistent low flow. Pump thrombosis was excluded. Flow had minimal response to RPM increase. Outflow graft was widely patent. Inflow obstruction was suspected, and HM3-to-HM3 exchange revealed extensive thrombus formation within the inflow cannula. Left-ventricular assist device flow …

Radial And Carotid Arterial Pulse Signals For Assessing Cardiovascular Function At Rest And During Post-Exercise Recovery In A Heart Transplant Patient: A Case Study, Md Mahfuzur Rahman, Mamun Hasan, Jennifer F. May, John M. Herre, Leryn Reynolds, Zhili Hao

Mechanical & Aerospace Engineering Faculty Publications

Aim: This study investigates the feasibility of using radial and carotid arterial pulse signals to assess cardiovascular (CV) function at rest and during post-exercise recovery in a heart transplant (HTx) patient. Method: Two micro-fabricated tactile sensors were used to simultaneously acquire arterial pulse signals at the radial artery (RA) and carotid artery (CA). Measurements were taken at rest and at multiple time points post-exercise on three subjects: an HTx patient, a percutaneous coronary intervention (PCI; coronary stent) patient and a healthy control. An SDOF-TF-based time-frequency analysis algorithm was applied to extract a comprehensive set of CV parameters, including heart rate …

Enhancing Graduate Surgical Education: Recommendations For Development Of Common Surgery Education And Training Accreditation Standards, Edwin Christopher Ellison, David B. Hoyt, L. D. Britt, Gerald B. Healy, John R. Potts Iii, Michael M. Awad, Eric A. Gantwerker, Apostolos Gaitanidis, Carol R. Bradford, Robert Phillip Burns, Mary T. Hawn, John G. Hunter, Cheryl T. Lee, Keith D. Lillemoe, Najjia N. Mahmoud, Jeffrey B. Matthews, Michael W. Neumeister, Kathleen C. Y. Sie, The Independent Committee For Graduate Surgical Education

Department Surgery Faculty Publications

Background:

Concerns persist within the surgical community that completion of an accredited surgical residency no longer consistently ensures that trainees are ready for independent practice. In response, the Independent Committee for Graduate Surgical Education (ICGSE) was established in January 2025 to address the unique requirements of surgical training. The committee’s mandate was to recommend program standards that would potentially optimize education and training for surgical residents, with the goal of improving patient care.

Methods:

The ICGSE, consisting of 71 surgeons across 16 specialties, reviewed the history of surgical accreditation and relevant literature. Workgroup-led discussions identified strategies for improving trainee readiness …

Prognostic Factors For Patients Under 45 Undergoing Surgery For Colorectal Liver Metastases: A Seer Population-Based Study, Gabrielle Grob, Fang Fang, Matvey Karpov, Eric Feliberti, Marybeth Hughes, Rachel Burke, Winifred Lo

Department Surgery Faculty Publications

Background and Objectives: Colorectal cancer (CRC) has been on the rise in adults younger than 50. Surgical resection is a potentially curative treatment option for patients with colorectal liver metastases (CRLM). The aim of this study was to describe patient and tumor characteristics associated with disease-specific survival in young patients (<  45 years) versus older patients (≥ 45 years) with isolated CRLM.

Methods: The SEER database was queried for patients with CRLM who underwent colon and liver resection from 2010 to 2021. Patients under age 20, with metastases beyond the liver, or who had not had surgery for liver metastases were excluded. Cox regression was used to analyze demographic factors, tumor …

Literature Review On Osteoarthritis Management, Robert A. Weinberg

MEDI 9331 Scholarly Activities Clinical Years

Knee osteoarthritis (OA) is the most common cause of long-term knee pain in adults over 45, and a leading cause of disability worldwide. About one in two people will develop it in their lifetime. This review brings together current evidence on how knee OA is diagnosed and treated, using the main clinical guidelines and the most important trials of the past ten years. The evidence points to a simple, step-by-step plan. Exercise, weight loss, and patient education are the strongly recommended first steps. Oral and topical non-steroidal anti-inflammatory drugs (NSAIDs) are the first-choice medicines. Steroid injections into the joint help …

Literature Review On The Effectiveness Of Surgical Vs Non-Surgical Management In Elderly Patients With Distal Radius Fractures, Robert A. Weinberg

MEDI 9331 Scholarly Activities Clinical Years

Distal radius fractures are common in patients aged sixty years and older. The best management strategy remains debated, particularly in elderly patients where complications risk, radiological outcomes and functional recovery need to be considered. Several studies have compared surgical interventions including open reduction and internal fixation with conservative management including closed reduction and immobilization. The aim of this literature review is to synthesize current evidence on these outcomes for elderly patients with a distal radius fracture who were treated with surgical treatment or non-surgical treatment.