Surgery Commons^™

Intraoperative Pancreatic Assessment In Pancreaticoduodenectomy The Correlation With Pancreatic Fistula Formation, Yarman Mazni, Ardani F. Syafiuddin, Agi S. Putranto

The New Ropanasuri Journal of Surgery

Background Pancreatic cancer affects 25,000 to 30,000 people in the United States each year and is the fourth or fifth leading cause of cancer-related death in this country. It is generally resected by pancreaticoduodenectomy, with or without preservation of the pylorus and proximal duodenum. Anastomotic leaks, intra-abdominal abscesses, and delayed gastric emptying account for most of the perioperative complications after pancreaticoduodenectomy. Anastomotic leaks of pancreas are resulted pancreatic fistula about 45%. A lot of study that have been done to find risk factors of postoperative pancreatic fistula (POPF) with contradictive results.

Method This study was done for 70 patients …

Risk Factors That Influence Hospital Length Of Stay In Diabetic Foot Ulcer With Negative Pressure Wound Therapy At Rs. Dr. Cipto Mangunkusumo, Prabowo W. Simbolon, Hilman Ibrahim

The New Ropanasuri Journal of Surgery

Introduction. It is estimated that around 15% of diabetic patients will experience diabetic foot ulcer (DFU) in their lifetime. Negative Pressure Wound Therapy (NPWT) is proven to be more effective than conventional treatments. NPWT creates a moist wound environment, increases local blood flow and stimulates tissue granulation thereby accelerating wound healing. This study was conducted to determine the risk factors that affect the length of stay of DFU with NPWT. Knowing this risk factors may be helpful for optimizing management strategy.

Method. This research was a retrospective study with a cross-sectional analytic design in 105 subjects treated in January 2016 …

Postoperative Wound Irrigation Using Distilled Water In Preventing Surgical Site Infection In A Tertiary Hospital: A Retrospective Cohort And Cost-Effective Study, Wifanto S. Jeo, Dennis W. Pratama, Yoni Vanto, Aria Kekalih, Yefta Moenadjat

The New Ropanasuri Journal of Surgery

Background. The incidence of surgical site infections (SSIs) is reducing following the global campaign that requires all the stakeholder involvement. However, of all hospital-acquired infection prevention programs, wound irrigation is hard to be implemented in our hospital. There is a belief that the wound irrigation procedure leading to the spreading of infection. In contrast, the use of antiseptic and topical antibiotic, as well as systemic antibiotic, is uncontrolled high. Thus, we run a cost-effective study of wound irrigation to change the practice.

Method. We carried out a prospective cohort study comparing wound irrigation and the standard protocol in wound …

Evaluation Of The Implementation Of Eras Protocol In Colorectal Surgery At Dr. Cipto Mangunkusumo General Hospital, Jakarta, Wifanto S. Jeo, Yarman Mazni, Andre S. Suryadi

The New Ropanasuri Journal of Surgery

Background: The enhanced recovery after surgery (ERAS) protocol, an evidence-based perioperative strategy, has been proven in reduces the postoperative length of stay and perioperative complications rates in colorectal surgery. The implementation of ERAS defined by 15 components. However, the evaluation of ERAS component that have been applied to the outcomes in unclear.

Methods: A retrospective study was performed on 63 patients who undergone elective colorectal surgery based on ERAS protocol from January 2015 to December 2017 at Cipto Mangunkusumo Hospital. Patient characteristics, demographic, clinical findings, and length of stay (LOS) colleted from medical records. The relationship between the number of …

Telemedicine For The Spine Surgeon In The Age Of Covid-19: Multicenter Experiences Of Feasibility And Implementation Strategies., Daniel Franco, Thiago Montenegro, Glenn A Gonzalez, Kevin Hines, Aria Mahtabfar, Melvin D Helgeson, Rakesh Patel, James Harrop

Department of Neurosurgery Faculty Papers

STUDY DESIGN: Multicenter study.

OBJECTIVES: The COVID-19 pandemic has obligated physicians to recur to additional resources and make drastic changes regarding the standard physician-patient encounter. In the last century, there has been a substantial improvement in technology, which over the years has opened the door to a new form of medical practicing known as telemedicine.

METHODS: Healthcare workers from three hospitals involved in the care for COVID-19 patients in the united states were invited to share their experience using telemedicine to deliver clinical care to their patients.

RESULTS: Since the appearance of this worldwide outbreak, social distancing has been a …

Endoluminal Graft System And Method Of Implanting The Same, David J. Minion

Surgery Faculty Patents

An endoluminal graft system comprising an endoluminal graft including a framework and a flexible fabric surrounding the framework, a deflection means configured for placement through an opening to a branching vessel, and a delivery catheter configured to position the endoluminal graft within a primary vessel. A method of implanting the endoluminal graft includes positioning the endoluminal graft within a primary vessel with a leading edge of the endoluminal graft adjacent to an opening to a branching vessel. A deflecting means is positioned through the opening to the branching vessel adjacent to the leading edge of the endoluminal graft. The endoluminal …

Feminizing Genitoplasty In A Young Girl With Glanzmann's Thrombasthenia-Management Of Haemostasis, Kashaf Khalid Turk, Zafar Nazir

Section of Paediatric Surgery

We report peri- and post-operative management of haemostasis in a 11-year old girl with Glanzmann Thrombasthenia (GT) who had feminizing genitoplasty for genital ambiguity due to Congenital Adrenal Hyperplasia (CAH-21 Hydroxylase deficiency). A blend of Glanzmann Thrombasthenia (GT) and DSD 46XX due to CAH is not reported in literature. Surgery particularly genitourinary reconstruction in patients with GT is challenging due to risk of intra and post-operative bleeding. Haemostasis can successfully be achieved with platelet transfusions, antifibrinolytic (Tranexamic acid) and judicious use of recombinant factor VIIa (rFVIIa) even in a resource limited setting.

Permanent Pre-Operative Cerebrospinal Fluid Diversion In Paediatric Patients With Posterior Fossa Tumours, Ummey Hani, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Management options for obstructive hydrocephalus in children with posterior fossa tumours have been debated upon throughout the course of neurosurgical practice. Permanent pre-operative CSF diversion via ventricular shunts or endoscopic third ventriculostomy have been employed to prevent the possible persistence of hydrocephalus after tumour removal, but is considered unnecessary and even dangerous amongst a large group of neurosurgeons. In this paper, we have reviewed the literature for the merits and demerits of pre-operative permanent CSF diversion in paediatric patients presenting with posterior fossa tumours.

Medial Femoral Condyle Vascularized Bone Graft For Treatment Of Midshaft Clavicle Recalcitrant Nonunion With Use Of The Transverse Cervical Artery As An Anastomosis., Christopher M Belyea, Jefferson L Lansford, Joseph B Golden, Emily H Shin, Rey D L Gumboc

Articles, Abstracts, and Reports

Vascularized medial femoral condyle bone grafts have been reported to be a reliable treatment for recalcitrant bony nonunions of the extremities. Although clavicle fracture nonunions are rare after treatment with open reduction internal fixation, symptomatic nonunions can be a challenge. The medial femoral condyle vascularized bone graft has been described as a treatment option for clavicle nonunions with the thoracoacromial trunk as the recipient anastomosis site. This case illustrates how the transverse cervical artery and accompanying veins can be used as an anastomosis when the thoracoacromial trunk is inaccessible because of previous surgical- and infection-related scaring. At the final follow-up, …

Patient Delay In Breast Cancer Diagnosis In Two Hospitals In Karachi, Pakistan: Preventive And Life-Saving Measures Needed, Uzma Shamsi, Shaista Khan, Syed Iqbal Azam, Shaheryar Usman, Amir Maqbool, Tiffany Gill, Romaina Iqbal, David Callen

Department of Surgery Docs

Purpose: Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them.
Methods: Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review.
Results: The mean (standard deviation) age of patients with …

Inferior Vena Cava Injuries - A Clinical Review, Zia Ur Rehman

Department of Surgery Docs

Inferior vena caval (IVC) injuries are uncommon and challenging to treat. Less than 5% of patients with penetrating abdominal trauma and less than 0.5% of patients with blunt abdominal trauma have this injury. Patient can present with intraperitoneal haemorrhage or with a contained retroperitoneal haematoma. Mostly it is associated with other abdominal structures injuries. Most commonly injured segment is infrarenal IVC. Operative strategy is different for each segment of injured vein. Infrahepatic injuries are exposed by medial visceral rotation. Retrohepatic and suprahepatic injuries need infrequent exposures. Mortality remains high and range between 31-51% for the patient brought alive to the …

Asymptomatic Fluid Collections Following Distal Pancreatectomy – Is Intervention Warranted?, Elwin Tham, Md, Emily Papai, Ms, David Nauheim, Ms, Michael Morano, Ms, Nicole Wagner, Ms, Shawnna Cannaday, Crnp, Theresa P. Yeo, Phd, Geoffrey Krampitz, Md, Phd, Charles J. Yeo, Md, Harish Lavu, Md

Health Equity and Quality Improvement (HEQI) Summit

Objective

To determine the incidence, associated factors, natural history, and interventions for FCs.

General Surgery Mobile Procedure Cart: Providing Safe And Efficient Procedure Based Care To The Bedside, Ryan Lamm, Ellen Caparosa, James Fraser, Lindsay Lynch, Uzma Rahman, Lindsay Weil, Harish Lavu

Health Equity and Quality Improvement (HEQI) Summit

Objective

To create a mobile supply cart with all necessary supplies needed for the most common general surgery bedside procedures in order to decrease the amount of times residents need to “shop” for supplies from other locations and prevent delays in procedures to get supplies that are not available. In turn, this will increase patient safety and quality of procedure-based care delivered.

Thoracostomy Tube Placement: Resident Experience And Confidence At A Large Academic Medical Center, Lisa A. Bevilacqua, Md, Prashanth Palvannan, Md, Mph, Meryl Abrams, Md, D. Brock Hewitt, Md, Mph, Kory London, Md, Francesco Palazzo, Md, Tyler Grenda, Md

Health Equity and Quality Improvement (HEQI) Summit

The goal of this study was to investigate TT placement patterns and resident confidence at one academic medical center. In addition, our second objective was to gather quantitative data on the frequency and context of TT placement, rates of complications, and factors associated with complications among residents at TJUH.

Long-Term Patient-Reported Outcome Measures After Injury: National Trauma Research Action Plan (Ntrap) Scoping Review Protocol, Juan Pablo Herrera-Escobar, Manuel A. Castillo-Angeles, Samia Y. Osman, Claudia P. Orlas, Mahin B. Janjua, Muhammad Abdullah Arain, Emma Reidy, Molly P. Jarman, Michelle A. Price, Adil H. Haider

Medical College Documents

Background: A significant proportion of patients who survive traumatic injury continue to suffer impaired functional status and increased mortality long after discharge. However, despite the need to improve long-term outcomes, trauma registries in the USA do not collect data on outcomes or care processes after discharge. One of the main barriers is the lack of consensus regarding the optimal outcome metrics.
Objectives: To describe the methodology of a scoping review evaluating current evidence on the available measures for tracking functional and patient-reported outcomes after injury. The aim of the review was to identify and summarize measures that are being used …

A Fatal Case Of Primary Amoebic Meningoencephalitis From Recreational Waters., Edward Hamaty, Saif Faiek, Minesh Nandi, David Stidd, Manish Trivedi, Hari Kandukuri

Department of Neurosurgery Faculty Papers

Background: Naegleria Fowleri is a single-cell, thermophilic amphizoid amoeba, and a rare known causative agent for primary amoebic meningoencephalitis with >97% mortality rate. The amoeba resides in freshwater lakes and ponds but can also survive in inadequately chlorinated pools and recreational waters. The mode of infection includes activities such as diving or jumping into freshwater or submerging the head under the water. Although most commonly seen in the southern United States, it is essential to keep this clinical suspicion in mind regardless of geography, as presenting symptoms can be very similar to classic bacterial meningitis.

Conclusion: As per the CDC, …

Global Kidney Exchange Should Expand Wisely., Alvin E Roth, Ignazio R. Marino, Obi Ekwenna, Ty B Dunn, Siegfredo R Paloyo, Miguel Tan, Ricardo Correa-Rotter, Christian S Kuhr, Christopher L Marsh, Jorge Ortiz, Giuliano Testa, Puneet Sindhwani, Dorry L Segev, Jeffrey Rogers, Jeffrey D Punch, Rachel C Forbes, Michael A Zimmerman, Matthew J Ellis, Aparna Rege, Laura Basagoitia, Kimberly D Krawiec, Michael A Rees

Department of Surgery Faculty Papers

We read with great interest and appreciation the careful consideration and analysis by Ambagtsheer et al. of the most critical ethical objections to Global Kidney Exchange (GKE). Ambagtsheer et al. conclude that implementation of GKE is a means to increase access to transplantation ethically and effectively.

Non-Obstetrical Robotic-Assisted Laparoscopic Surgery In Pregnancy: A Systematic Literature Review., Courtney Capella, Joseph Godovchik, Thenappan Chandrasekar, Huda B. Al-Kouatly

Department of Urology Faculty Papers

Urologic and gynecologic surgeons are the top utilizers of robotic surgery; however, non-obstetrical robotic-assisted laparoscopic surgery (RALS) in pregnant patients is infrequent. A systematic literature review was performed to ascertain the frequency, indication and complications of RALS in pregnancy. Results showed thirty-eight pregnancies from eleven publications between 2008-2020. Five cases were for urologic indication and thirty-three for gynecologic indication. Minimal surgical alterations were required. Although no adverse maternal-fetal outcomes were reported, there are not enough cases published to determine safety. This review demonstrates the feasibility of RALS for the pregnant population in the hands of competent robotic surgeons.

Functionally Distinct High And Low Theta Oscillations In The Human Hippocampus., Abhinav Goyal, Jonathan Miller, Salman E Qasim, Andrew J Watrous, Honghui Zhang, Joel M Stein, Cory S Inman, Robert E Gross, Jon T Willie, Bradley Lega, Jui-Jui Lin, Ashwini Sharan, Chengyuan Wu, Michael R Sperling, Sameer A Sheth, Guy M Mckhann, Elliot H Smith, Catherine Schevon, Joshua Jacobs

Department of Neurosurgery Faculty Papers

Based on rodent models, researchers have theorized that the hippocampus supports episodic memory and navigation via the theta oscillation, a ~4-10 Hz rhythm that coordinates brain-wide neural activity. However, recordings from humans have indicated that hippocampal theta oscillations are lower in frequency and less prevalent than in rodents, suggesting interspecies differences in theta's function. To characterize human hippocampal theta, we examine the properties of theta oscillations throughout the anterior-posterior length of the hippocampus as neurosurgical subjects performed a virtual spatial navigation task. During virtual movement, we observe hippocampal oscillations at multiple frequencies from 2 to 14 Hz. The posterior hippocampus …

Pancreatic Stromal Gremlin 1 Expression During Pancreatic Tumorigenesis, Joy M. Davis, Binglu Cheng, Madeline M. Drake, Qiang Yu, Baibing Yang, Jing Li, Chunhui Liu, Mamoun Younes, Xiurong Zhao, Jennifer M. Bailey, Qiang Shen, Tien C. Ko, Yanna Cao

School of Medicine Faculty Publications

Chronic pancreatitis (CP) is a major risk factor of pancreatic ductal adenocarcinoma (PDAC). How CP promotes pancreatic oncogenesis remains unclear. A characteristic feature of PDAC is its prominent desmoplasia in the tumor microenvironment, composed of activated fibroblasts and macrophages. Macrophages can be characterized as M1 or M2, with tumor-inhibiting or -promoting functions, respectively. We reported that Gremlin 1 (GREM1), a key pro-fibrogenic factor, is upregulated in the stroma of CP. The current study aimed to investigate the expression of GREM1 and correlation between GREM1 and macrophages within the pancreas during chronic inflammation and the development of PDAC. By mRNA in …