Surgery Commons^™

Global Survey On Pancreatic Surgery During The Covid-19 Pandemic., A. Oba, T. F. Stoop, M. Löhr, T. Hackert, N. Zyromski, W. H. Nealon, M. Unno, R. D. Schulick, M. H. Al-Musawi, M. Del Chiaro, +6 Additional Authors

Journal Articles

OBJECTIVE:The aim of this study was to clarify the role of pancreatic surgery during the COVID-19 pandemic to optimize patients' and clinicians' safety and safeguard health care capacity. SUMMARY BACKGROUND DATA:The COVID-19 pandemic heavily impacts health care systems worldwide. Cancer patients appear to have an increased risk for adverse events when infected by COVID-19, but the inability to receive oncological care seems may be an even larger threat, particularly in case of pancreatic cancer. METHODS:An online survey was submitted to all members of seven international pancreatic associations and study groups, investigating the impact of the COVID-19 pandemic on pancreatic surgery …

Opioid Tolerance Influences Outcomes After Lumbar Fusion In Patients With Degenerative Pathology, Noah Levy, Max Detweiler, Dhruv K.C. Goyal, Ariana Reyes, Alexander R. Vaccaro

Phase 1

Introduction: Extended opioid use prior to surgery has been implicated in poorer postoperative outcomes. However, it remains unclear if there is a significant difference in postoperative outcomes among preoperative opioid-naïve and opioid-tolerant patients who undergo lumbar spinal fusion. The purpose of this study was to determine the effect of preoperative opioid use on patient-reported outcome measures in patients undergoing lumbar spinal fusion.

Methods: This retrospective cohort analysis identified 260 patients who underwent lumbar spinal fusion at a high-volume, single institution. There were two cohorts: patients who were opioid-naïve (defined as total opioid consumption of ≤ 7 days in …

Can The Fut 2 Gene Variant Have An Effect On The Body Weight Of Patients Undergoing Bariatric Surgery? - Preliminary, Exploratory Study, Natalia Komorniak, Alexandra Martynova-Van Kley, Armen Nalian, Wiktoria Wardziukiewicz, Karolina Skoniecznaa-Zydecka, Daniel Styburski, Joanna Palma, Bartosz Kowalewski, Krzysztof Kaseja, Ewa Stachowska

Faculty Publications

Background: The FUT2 gene (Se gene) encoding the enzyme α-1,2-L-fucosyltransferase 2 seems to have a significant effect on the number and type of bacteria colonizing the intestines. Methods: In a group of 19 patients after bariatric surgery, the polymorphism (rs601338) of FUT2 gene was analyzed in combination with body mass reduction, intestinal microbiome (16S RNA sequencing), and short chain fatty acids (SCFA) measurements in stools. Results: Among the secretors (Se/Se polymorphism of the FUT2 gene rs601338, carriers of GG variant), correlations between waist-hip ratio (WHR) and propionate content and an increase in Prevotella, Escherichia, Shigella, and Bacteroides were observed. On …

Reduced Length Of Stay In Major Hepatectomy Surgery After Implementation Of An Enhanced Recovery Pathway In The United States Veteran Population, Yvonne Nguyen Md, Marilyn Mcnulty Np, Leopoldo Fernandez Md, Michael R. Kazior Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction

Enhanced recovery after surgery (ERAS) pathways are associated with better postoperative recovery, however, evidence is lacking in major liver surgery, .This study aimed to evaluate the impact of an ERAS pathway in U.S. veterans undergoing major hepatectomy surgery. We hypothesized that the adoption of an ERAS pathway reduces decreased length of stay (LOS).

Methods

After approval from the Hunter Holmes McGuire VA Medical Center IRB, we compared data from consecutive patients undergoing elective open hepatectomy within an ERAS pathway (January 2019-December 2019) to a previous cohort of patients before introduction of ERAS (July 2016-December 2017). One surgeon performed all …

Treatment Of Persistent Air Leaks Using Endobronchial Valves, Michael Zimmerman, Cole Zingas, Achala Donuru, Scott W. Cowan, Nathaniel Evans Iii, Boyd Hehn

Phase 1

Introduction: Persistent air leaks (PAL) are from bronchopleural fistula resulting from communication between the bronchial tree and pleural space. Endobronchial valves (EBVs) are unidirectional valves placed bronchoscopically preventing airflow to the diseased lung lobe. For non-operable patients with PALs, EBVs offer a potential non-invasive treatment approach to stop air leak and allow lung healing. The purpose of this study is to retrospectively analyze EBV placement to treat non-operable adult patients with PALs.

Methods: We retrospectively analyzed all adult patients that underwent EBV placement for PAL treatment at our institution from January 2016 to June 2019. All patients failed conservative …

Late Complications Of Free Flaps In Head And Neck Microvascular Reconstruction, Swapna Vasudevan, Cory Bovenzi, Md

Phase 1

Introduction: Late free flap complications (LFFC) in head and neck reconstructive surgery occur over 72 hours postoperatively and result in flap loss in 97% of cases. Due to the rarity of LFFC, there is minimal research regarding risk factors for their development. Identifying risk factors for LFFC will result in improved monitoring of patients to prevent flap loss. This study aims to identify risk factors for the development of LFFC.

Methods: The target population of this retrospective cohort study was 116 patients who had undergone an Orbital Exenteration at Thomas Jefferson University Hospital (TJUH) and had LFFC. Data was …

Cardiovascular: Outcomes And Innovations Report, Maine Medical Center

Annual Reports

2020 Annual Report

Quality And Clinical Care Development In Spine Surgery-Connecting The Dots: An Expanded Clinical Narrative., Sarah Hopkins, Polly Brune, Jens R Chapman, Marc Horton, Rod J Oskouian, Akshal Patel, Marc D Moisi

Articles, Abstracts, and Reports

Our health care system is an evidenced-based quality-centric environment. Pursuit of quality is a process that encompasses knowledge development and care advancements through collaboration and expertise. Depicted here is the foundational knowledge, process, and contributions that hallmark successful clinical quality programs. Beginning with methodology, followed by process and form, we create the foundational knowledge and exemplars demonstrating framework and continuum of process in pursuit and attainment of successful clinical quality and care development for patients. Although our protocol has been devised for complex spine care, this could be implemented across all health care specialties to provide individualized and high-quality care …

Congenital Morgagni Hernia Presenting As Complete Small Bowel Obstruction In The Adult - A Case Report, Sabah Uddin Saqib, Kulsoom Hamid, Tabish Umer Chawla

Section of General Surgery

Introduction: Congenital Diaphragmatic hernia (CDH) is a condition in which there is a defect in the diaphragm present at the time of birth. Morgagni hernia is one of the two most common types of CDH which constitutes 2%-4% of diaphragmatic hernias. They mostly remain silent or discovered as an incidental finding on radiological studies. Symptomatic adult Morgagni hernias are extremely rare.
Presentation of case: Elderly woman presented with a 1-day history of abdominal pain, vomiting, and acute onset of respiratory distress. There was no history of trauma to the chest or abdomen. After initial resuscitation, a Chest x-ray was performed …

First Pass Effect In Patients Treated With The Trevo Stent-Retriever: A Track Registry Study Analysis., Maxim Mokin, Christopher T Primiani, Alicia C Castonguay, Raul G Nogueira, Diogo C Haussen, Joey D English, Sudhakar R Satti, Jennifer Chen, Hamed Farid, Candace Borders, Erol Veznedaroglu, Mandy J Binning, Ajit Puri, Nirav A Vora, Ron F Budzik, Guilherme Dabus, Italo Linfante, Vallabh Janardhan, Amer Alshekhlee, Michael G Abraham, Randall Edgell, Muhammad Asif Taqi, Ramy El Khoury, Aniel Q Majjhoo, Mouhammed R Kabbani, Michael T Froehler, Ira Finch, Sameer A Ansari, Roberta Novakovic, Thanh N Nguyen, Osama O Zaidat

Articles, Abstracts, and Reports

Background and Objective: The first pass effect (FPE; achieving complete recanalization with a single thrombectomy device pass) has been shown to be associated with higher rates of good clinical outcomes in patients with acute ischemic stroke. Here, we investigate clinical and radiographic factors associated with FPE in a large U.S. post-marketing registry (TRACK, Trevo Stent-Retriever Acute Stroke). Methods: We analyzed the TRACK database (multicenter registry of 634 patients from 23 centers from March 2013 through August 2015), which 609 patients were included in the final analysis. FPE was defined as a single pass/use of device, TICI 2c/3 recanalization, and no …

Confirmation And Identification Of Biomarkers Implicating Environmental Triggers In The Pathogenesis Of Type 1 Diabetes, Robert Z. Harms, Katie R. Ostlund, Monina S. Cabrera, Earline Edwards, Marisa Fisher, Nora Sarvetnick

Journal Articles: Surgery

Multiple environmental triggers have been proposed to explain the increased incidence of type 1 diabetes (T1D). These include viral infections, microbiome disturbances, metabolic disorders, and vitamin D deficiency. Here, we used ELISA to examine blood plasma from juvenile T1D subjects and age-matched controls for the abundance of several circulating factors relevant to these hypotheses. We screened plasma for sCD14, mannose binding lectin (MBL), lipopolysaccharide binding protein (LBP), c-reactive protein (CRP), fatty acid binding protein 2 (FABP2), human growth hormone, leptin, total adiponectin, high molecular weight (HMW) adiponectin, total IgG, total IgA, total IgM, endotoxin core antibodies (EndoCAbs), 25(OH) vitamin D, …

Complexation-Induced Resolution Enhancement Of 3d-Printed Hydrogel Constructs, Jiaxing Gong, Carl C. L. Schuurmans, Anne Metje Van Genderen, Xia Cao, Wanlu Li, Feng Cheng, Jacqueline Jialu He, Arturo López, Valentin Huerta, Jennifer Manríquez, Ruiquan Li, Hongbin Li, Clément Delavaux, Shikha Sebastian, Pamela E. Capendale, Huiming Wang, Jingwei Xie, Mengfei Yu, Rosalinde Masereeuw, Tina Vermonden, Yu Shrike Zhang

Journal Articles: Surgery

Three-dimensional (3D) hydrogel printing enables production of volumetric architectures containing desired structures using programmed automation processes. Our study reports a unique method of resolution enhancement purely relying on post-printing treatment of hydrogel constructs. By immersing a 3D-printed patterned hydrogel consisting of a hydrophilic polyionic polymer network in a solution of polyions of the opposite net charge, shrinking can rapidly occur resulting in various degrees of reduced dimensions comparing to the original pattern. This phenomenon, caused by complex coacervation and water expulsion, enables us to reduce linear dimensions of printed constructs while maintaining cytocompatible conditions in a cell type-dependent manner. We …

Middle Fossa Extension Of Posterior Fossa Meningiomas Is Associated With Poorer Clinical Outcomes, David Morgan, Donald Y. Ye, Md, Michael P. Baldassari, Omaditya Khanna, Md, Aria Mahtabfar, Md, Tyler Henry, Haley Wendt, David W. Andrews, Md, Christopher J. Farrell, Md, James J. Evans, Md, Kevin D. Judy, Md

Phase 1

Introduction: Progression of posterior fossa meningiomas (PFMs) can lead to extension into the middle cranial fossa. Pre-operative imaging allows for quantification of middle fossa extension (MFE). We aimed to determine the clinical impact of MFE on surgical and clinical outcomes during resection of PFMs.

Methods: Craniotomies for meningiomas performed at a large single center academic institution from January 2012 to December 2018 were identified. Preoperative MRI and CT imaging was reviewed to determine the presence of MFE of posterior fossa meningiomas and correlated to post-operative outcomes.

Results: 65 PFMs were identified and mean follow-up was 28.8 ± 20.1 months. 13/65 …

Early Perioperative Fluid Benchmarking To Predict Pancreaticoduodenectomy (Pd) Outcomes, David Moskal, Carrie D. Walsh, Sofia Duque, Charles Yeo, Md, Facs, Harish Lavu, Md, Facs

Phase 1

Introduction: PD is a complex operation associated with a marked systemic inflammatory response and significant fluid shifts. Establishing a benchmark for ideal perioperative fluid management is critical to optimising PD patient recovery.

Methods: In this retrospective study, we evaluated perioperative fluid data for patients undergoing PD. We compared an optimal benchmark group who were discharged home by postoperative day five (≤5day) to a group of patients with an in hospital recovery greater than ten days (≥10day).

Results: Seventy-six patients who underwent PD between June 2015 and November 2016 were evaluated. The ≤5day group had a significantly lower intraoperative fluid administration …

Structural Brain Plasticity In Epilepsy Patients Selected For Laser Interstitial Thermal Therapy: A Study Of Diffusion Tensor Imaging Based Assessment Of Tract Alterations, Umma Fatema, Mahdi Alizadeh

Phase 1

Introduction: The standard of care for drug resistant temporal lobe epilepsy (TLE) involve surgical approaches including anterior temporal lobectomy (ATL) and laser interstitial thermal therapy (LiTT). White matter alterations following ATL are often studied using diffusion tensor imaging (DTI) which utilizes properties of water diffusion to obtain parameters (such as fractional anisotropy or FA) that can be used to detect neural plasticity. Despite being a common procedure, there are very few studies that explore post-surgical neural changes after LiTT. The objective of this study is to evaluate and explore the DTI parameter changes in patients who underwent LiTT.

Methods: DTI …

3d Printing Of Bone Spurs Before Surgical Removal During Total Knee Arthroplasty, John Paul Prodoehl

Phase 1

Project Background: In the United States, total knee arthroplasty (TKA) is the most performed orthopaedic operation. Among the 700,00 patients who received TKA, 21-25% underwent revision due to knee instability. Proper stability of a TKA depends on soft tissue balance for proper alignment in flexion and extension, and improper soft tissue modification is the primary cause of early implant failure. Soft tissue balancing can be complicated by presence of osteophytes on the distal femur or proximal tibia, which may require removal. The three-dimensional structure of osteophytes is often difficult to visualize with imaging, which could cause incomplete removal. Utilizing 3D …

3d Printing Of Bone Spurs Before Surgical Removal, Matthew Chadwick, John Paul Prodoehl, Katelyn Koons, Chris Li, Lauren Schlegel, Jeffrey Henstenburg, Md

Phase 1

Project Background: In the US alone, total knee arthroplasty is the most common performed orthopedic surgery, with over 700,000 cases per year.1 Overall, 21-25% underwent revision due to instability.2 The stability of a TKA depends largely on soft tissue balance for proper alignment in flexion and extension. Soft tissue balancing in TKA depends on posterior femoral condylar osteophytes, which prevent full extension of the knee and increase tension posteriorly. Pre-operative soft tissue visualization is difficult and this leaves an increased chance for implant failure and revision surgery. Having a 3D model of the bone spur before and during the surgery …

Polio To The Rescue; New Frontiers In Glioblastoma Treatment, Syed Sarmad Bukhari, Aneela Darbar, Muhammad Shahzad Shamim

Section of Neurosurgery

Lack of substantial progress in effective treatment of glioblastomamultiforme has led investigators to explore unconventional treatment options including the use of tumour treating fields and oncolyticvirotherapy. Herein the authors have reviewed some of the recent literature on oncolyticvirotherapy for the treatment of glioblastomamultiforme.

Prior Tonsillectomy Is Associated With An Increased Risk Of Esophageal Adenocarcinoma., Katherine S Garman, Teminioluwa A Ajayi, Harold J Boutte, Shih-Ting Chiu, Richard J Von Furstenberg, Benjamin R Lloyd, Cecelia Zhang, Mark W Onaitis, Shein-Chung Chow, Shannon J Mccall

Articles, Abstracts, and Reports

BACKGROUND: Esophageal cancer is a deadly cancer with 5-year survival

METHODS: Cases included 452 esophagectomy cases, including 396 with EAC and 56 who underwent esophagectomy for Barrett's esophagus (BE) with high grade dysplasia (HGD). 1,102 thoracic surgery patients with surgical indications other than dysplastic BE or esophageal cancer represented the controls for our analysis. The association of tonsillectomy and HGD/EAC were primarily evaluated by using univariate tests and then verified by logistic regression analysis. Baseline demographics, medical history, and thoracic surgery controls were compared by using χ2 tests or 95% CIs. Significant risk factors were considered as covariates in the …

Venous Thromboembolism After Penetrating Femoral And Popliteal Artery Injuries: An Opportunity For Increased Prevention, Asanthi Ratnasekera, Odessa Pulido, Sandra Durgin, Sharon Nichols, Alicia Lozano, Danielle Sienko, Alexandra Hanlon, Niels D Martin

General Surgery Resident Research

Background: Trauma patients with penetrating vascular injuries have a higher rate of venous thromboembolism (VTE). The objective of this study was to determine the risk of VTE formation in penetrating femoral and popliteal vascular injuries and the effects of endovascular management of these injuries.

Methods: A retrospective study of Pennsylvania Trauma Outcome Study registry was conducted during a 5-year period (2013-2017). All adult patients with a penetrating mechanism with femoral/popliteal vascular injuries were studied. Primary outcome was incidence of VTE in patients with isolated arterial injuries versus combined arterial/venous injuries. Secondary endpoints were intensive care unit (ICU) length of stay …