Surgery Commons^™

Biology Of Glycocalyx: The Essential Role In Maintaining Epithelial Barrier: A Mini-Review, Toar J.M. Lalisang

The New Ropanasuri Journal of Surgery

No abstract provided.

Open Surgery With Intraoperative Enteroscopy In Jejunoileal Massive Bleeding In Pediatric Patient: An Evidence-Based Case Report, Rini Y. Husni, Kshetra Rinaldhy

The New Ropanasuri Journal of Surgery

Introduction. A case report of surgical exploratory laparotomy with intraoperative enteroscopy (IOE) as a treatment in massive jejunoileal bleeding in children.

Method. We conducted a literature search on databases such as Cochrane, PubMed, ScienceDirect, and Google Scholar. Abstract and title screening was done based on exclusion criteria, inclusion criteria, and double filtering. The selected article then reviewed using critical appraisal tools based on its validity, importance, and applicability. Selected articles were benchmark to the discussion.

Results. The application of open surgery with IOE as the final treatment that can be recommended in the critical or life-threatening condition …

Pulmonary Resection In Complicated Primary Pediatric Pulmonary Tuberculosis: An Evidence-Based Case Report, Hendra Wibowo, Suprayitno Wardoyo, Dhama Shinta

The New Ropanasuri Journal of Surgery

Introduction. Paediatric pulmonary tuberculosis incidence was increasing, with many undetected cases. Antituberculosis regiments are known to be the treatment of choice for tuberculosis. Even though pulmonary resection for pulmonary tuberculosis has reduced in daily practice, it remains continues to play an important role in several advanced conditions and complications. Currently, there are no specific practical guidelines concerning surgical indications and approaches for pulmonary tuberculosis. We report a case with complicated primary paediatric pulmonary tuberculosis underwent resection and looking for the literature of the best evidence.

Method. A case report completed with a discussion based on the best evidence. …

A Rare Presentation Of A Giant Epidermal Cyst Of The Parietooccipital Region: A Case Reports, David Kereh, Septiman Septiman

The New Ropanasuri Journal of Surgery

Introduction. Epidermal cysts are common benign cutaneous cysts. An epidermal cyst may be classified as a giant epidermal cyst if it exceeds 5 cm. Giant epidermal cysts with a diameter of 5 cm or more are rare but have been reported. The epidermal cyst rarely discloses malignancy. Although rare, a case of malignant change of benign epidermal cyst is possible. We describe here a rare case of a giant epidermal cyst of the parietooccipital region in a 35-year-old man.

Case Illustration. A 35-year-old man was admitted to the hospital with a huge swelling over the scalp for the …

Effect Of Hospital Volume On Outcomes Of Total Hip Arthroplasty: A Systematic Review And Meta-Analysis, Syed Hamza Mufarrih, Muhammad Owais Abdul Ghani, Russell S. Martins, Nada Qaisar Qureshi, Sayyeda Aleena Mufarrih, Azeem Tariq Malik, Shahryar Noordin

Department of Biological & Biomedical Sciences

Background: A shift in the healthcare system towards the centralization of common yet costly surgeries, such as total hip arthroplasty (THA), to high-volume centers of excellence, is an attempt to control the economic burden while simultaneously enhancing patient outcomes. The "volume-outcome" relationship suggests that hospitals performing more treatment of a given type exhibit better outcomes than hospitals performing fewer. This theory has surfaced as an important factor in determining patient outcomes following THA. We performed a systematic review with meta-analyses to review the available evidence on the impact of hospital volume on outcomes of THA.
Materials and methods: We conducted …

Virtual Surgical Planning In Subscapular System Free Flap Reconstruction Of Midface Defects., Brian P. Swendseid, Dylan F. Roden, Swar Vimawala, Tony Richa, Larissa Sweeny, Richard A. Goldman, Adam Luginbuhl, Ryan N. Heffelfinger, Shachika Khanna, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES: Reconstruction of the midface has many inherent challenges, including orbital support, skull base reconstruction, optimizing midface projection, separation of the nasal cavity and dental rehabilitation. Subscapular system free flaps (SF) have sufficient bone stock to support complex reconstruction and the option of separate soft tissue components. This study analyzes the effect of virtual surgical planning (VSP) in SF for midface on subsite reconstruction, bone segment contact and anatomic position.

MATERIALS AND METHODS: Retrospective cohort of patients with midface defects that underwent SF reconstruction at a single tertiary care institution.

RESULTS: Nine cases with VSP were compared to fourteen cases …

Transanal-Only Swenson-Like Pull-Through For Late Diagnosed Hirschsprung Disease., Rebecca M. Rentea, Devin R. Halleran, Hira Ahmad, Elias Maloof, Richard J. Wood, Marc A. Levitt

Manuscripts, Articles, Book Chapters and Other Papers

Hirschsprung disease (HD) is an obstructive colonic process usually diagnosed in the neonatal period. A small subset of cases are diagnosed late, present with severe constipation without enterocolitis and have low rectosigmoid disease. A transanal-only pull-through is a well-described approach but in the newborn period risks a situation whereby the transition zone is higher than the sigmoid. We present our experience with the unique patient population of older HD patients in whom the transition zone was reliably reachable via a single-stage transanal approach, performed in prone position. Patients between 2 and 6 years of age with a rectal or sigmoid …

Feasibility Of Diffusion And Probabilistic White Matter Analysis In Patients Implanted With A Deep Brain Stimulator., J. Muller, M. Alizadeh, L. Li, S. Thalheimer, C. Matias, M. Tantawi, J. Miao, M. D. Silverman, V. Zhang, G. Yun, V. Romo, F. B. Mohamed, C. Wu

Department of Neurosurgery Faculty Papers

Deep brain stimulation (DBS) for Parkinson's disease (PD) is an established advanced therapy that produces therapeutic effects through high frequency stimulation. Although this therapeutic option leads to improved clinical outcomes, the mechanisms of the underlying efficacy of this treatment are not well understood. Therefore, investigation of DBS and its postoperative effects on brain architecture is of great interest. Diffusion weighted imaging (DWI) is an advanced imaging technique, which has the ability to estimate the structure of white matter fibers; however, clinical application of DWI after DBS implantation is challenging due to the strong susceptibility artifacts caused by implanted devices. This …

Sarcoidosis Of The Mandibular Condyle: A Rare Disease That Can Mimic Malignancy, Chad Sloan, Ben Lacrosse, Lei Yu, Alexander Braun, Scott Lauer, Timothy Donovan, John Baker, Jason Untrauer

Graduate Medical Education Research Journal

Sarcoidosis can involve any of the organs, however intraosseous involvement is rare and ranges from 5 to 15%, with lesions of the mandible being even rarer – currently with few known cases reported. Intraosseous lesions involving the mandible have been noted to be asymptomatic or associated with chronic jaw pain. Additionally, mandibular involvement can present as a lytic bone lesion mimicking osseous malignancy. Chronic polyarthritis is commonly associated with the progression of sarcoidosis and intraosseous involvement has been considered a late-stage sequelae. We report a case of biopsy-proven sarcoidosis within the mandibular condyle in an asymptomatic 56-year-old Caucasian female who …

Long Term Outcomes Of Surgical And Clinical Symptoms Following Minimally Invasive Heller Myotomy: A Retrospective Clinical Database Review, Laura E. Flores, Priscila Rodrigues Armijo, Bhavani Pokala, Sarah Samreen, Dmitry Oleynikov

Graduate Medical Education Research Journal

I

Introduction

Minimally invasive Heller myotomy rates have increased, but little evidence is available regarding long term clinical and surgical outcomes. Our aim was to evaluate long term symptom improvement and medication resolution for patients undergoing minimally invasive Heller myotomy.

Methods

A single-institution database was retrospectively reviewed for patients undergoing laparoscopic Heller myotomy (LHM) or robotic Heller myotomy (RHM) during 2007-2018. Patients with primary HM followed by a Dor fundoplication were included. Demographics and surgical data were analyzed. Esophageal symptoms, testing, and medication use were collected preoperatively (pre-op), at 6-month (6-mo), 12-month (12-mo), and long-term (LT; 12-mo+) follow-up. Analysis was …

Necrotizing Enterocolitis Following Gastroschisis Repair: An Update, Rachel K. Schlueter, Shahab F. Abdessalam, Stephen C. Raynor, Robert A. Cusick

Graduate Medical Education Research Journal

Purpose:

Necrotizing enterocolitis (NEC) is a known complication of gastroschisis with an incidence above the expected rate in the neonatal population. While many physicians today are aware of this association, the last publication to explore this association in detail and identify possible risk factors of NEC in gastroschisis patients was published over twenty years ago. From our large database of patients with gastroschisis managed by a single group of pediatric surgeons, we reviewed our experience and the recent literature to update what is known about gastroschisis and NEC.

Methods:

From 2001 to 2017, a gastroschisis registry was maintained. Data from …

Reattachment Of The Multifidus Tendon In Lumbar Surgery To Decrease Postoperative Back Pain: A Technical Note., Neil Klinger, Emre Yilmaz, Dia R Halalmeh, R Shane Tubbs, Marc D Moisi

Articles, Abstracts, and Reports

The posterior midline approach to the lumbar spine requires significant manipulation of the paraspinal muscles. Muscle detachment and retraction results in iatrogenic damage such as crush injury, devascularization, and denervation, all of which have been associated with postoperative pain. The muscle most directly affected by the posterior approach is the lumbar multifidus (LM), the largest and most medial of the deep lumbar paraspinal muscles. The effects of the posterior approach on the integrity of the LM is concerning, as multiple studies have demonstrated that intraoperative injuries sustained by the LM lead to postoperative muscle atrophy and potentially worsening low back …

Optimizing Cancer Cure Dialog: An Analysis Of Pancreatic Cancer Patients' Views Regarding Survival And Cure., Avinoam Nevler, Scott W. Keith, Harish Lavu, Theresa P. Yeo, Shawnna Cannaday, Charles J. Yeo, Jordan M. Winter

Department of Surgery Faculty Papers

BACKGROUND: Pancreatic ductal adenocarcinoma (PDA) is a highly lethal cancer. Clinicians commonly refer to surgical therapy as resection with curative intent. However, PDA cure rates after resection remain unknown and the definition of cure remains vague. We investigated how patients (the majority undergoing resection), family members, and clinicians understand the concept of cure, to better inform discussions with patients regarding PDA prognosis.

METHODS: In a prospective survey, cohorts were asked to indicate the best definition of cure from three choices: 5-year survival endpoint (typically used in the literature), a biological endpoint without biochemical or radiographic signs of disease (similar to …

Single Versus Multi-Center Surgeons' Risk-Adjusted Mitral Valve Repair Procedural Outcomes, Anne Bennett, Thomas Bogue, Samuel Greenberg, Joshua Zhu, Samantha Novotny, Joseph Pizzuti, Lee A. Santore, Robert H. Habib, Annie Laurie Laurie Shroyer, Jonathan Price, Henry Tannous, Thomas Bilfinger

Department of Surgery Faculty Publications

The purpose of this study is to explore strategies to improve mitral valve repair (MVr) outcomes. This research explores postoperative outcomes of patients undergoing MVr surgery by single center surgeons versus patients of multicenter surgeons. Specific outcomes of interest include 30-day operative mortality, major operative complications (e.g., deep sternal wound infection, permanent stroke, renal dysfunction requiring dialysis, reoperation, and prolonged ventilation), length of stay, and 30-day readmissions.

In brief, the serisk-adjusted outcome rates for surgeons that perform mitral valve repair procedures will be compared for surgeons that operate at a single center [i.e. SC surgeons] versus multiple centers [i.e. MC …

Chronic Muscle Weakness And Mitochondrial Dysfunction In The Absence Of Sustained Atrophy In A Preclinical Sepsis Model, Allison M. Owen, Samir P. Patel, Jeffrey D. Smith, Beverly K. Balasuriya, Stephanie F. Mori, Gregory S. Hawk, Arnold J. Stromberg, Naohide Kuriyama, Masao Kaneki, Alexander G. Rabchevsky, Timothy A. Butterfield, Karyn A. Esser, Charlotte A. Peterson, Marlene E. Starr, Hiroshi Saito

Physiology Faculty Publications

Chronic critical illness is a global clinical issue affecting millions of sepsis survivors annually. Survivors report chronic skeletal muscle weakness and development of new functional limitations that persist for years. To delineate mechanisms of sepsis-induced chronic weakness, we first surpassed a critical barrier by establishing a murine model of sepsis with ICU-like interventions that allows for the study of survivors. We show that sepsis survivors have profound weakness for at least 1 month, even after recovery of muscle mass. Abnormal mitochondrial ultrastructure, impaired respiration and electron transport chain activities, and persistent protein oxidative damage were evident in the muscle of …

Fracture Repair Requires Trka Signaling By Skeletal Sensory Nerves., Zhu Li, Carolyn A Meyers, Leslie Chang, Seungyong Lee, Zhi Li, Ryan Tomlinson, Ahmet Hoke, Thomas L Clemens, Aaron W James

Department of Orthopaedic Surgery Faculty Papers

Bone is richly innervated by nerve growth factor-responsive (NGF-responsive) tropomyosin receptor kinase A-expressing (TrKa-expressing) sensory nerve fibers, which are required for osteochondral progenitor expansion during mammalian skeletal development. Aside from pain sensation, little is known regarding the role of sensory innervation in bone repair. Here, we characterized the reinnervation of tissue following experimental ulnar stress fracture and assessed the impact of loss of TrkA signaling in this process. Sequential histological data obtained in reporter mice subjected to fracture demonstrated a marked upregulation of NGF expression in periosteal stromal progenitors and fracture-associated macrophages. Sprouting and arborization of CGRP+TrkA+ sensory nerve fibers …

Totally Robotic Vs Hybrid Abdominoperineal Resection: A Retrospective Multicenter Analysis, Jonathan Douissard, Vincent Obias, Craig S. Johnson, Monika E. Hagen, Deborah Keller, James R. Ouellette, Minia Hellan

Department of Surgery Faculty Publications

Introduction

Laparoscopic abdominoperineal resection (APR) for low rectal cancers is technically demanding. Robotic assistance may be of help and can be hybrid (HAPR) or totally robotic (RAPR). The present study describes outcomes of robotic APR and compares both approaches.

Material and methods

A multicentric retrospective analysis of rectal cancer patients undergoing either HAPR or RAPR was conducted. Patients' demographics, surgeons' experience, oncologic results, and intraoperative and postoperative outcomes were collected.

Results

One hundred twenty‐five patients were included, 48 in HAPR group and 77 in RAPR group. Demographics and comorbidities were comparable. Operative time was reduced in RAPR group (266.9 ± …

The Functional Outcome Of Direct Lateral Approach For Fixation Of Proximal Humeral Fractures: A Case Series From A Tertiary Care Hospital, Mujahid Jamil, Irfan Anwer, Muhammed Tabish Saleem, Ahmed Abdul Habib Khan, Mohammad Zohaib Nawaz Khan

Section of Orthopaedic Surgery

Displaced proximal humeral fractures warrant surgical fixation for early rehabilitation and better functional outcome. These fractures are traditionally fixed by delto pectoral surgical approach. Direct lateral approach has recently gained interest as it involves less soft tissue dissection and is particularly helpful in certain fracture patterns. However, there have been concerns of axillary nerve damage with this approach. We report a case series of proximal humerus fractures fixed by direct lateral approach from our institution. All displaced Type 2 and 3 fractures were included in our study. Pathological and comminuted Type 4 fractures and fractures with ipsilateral clavicle or elbow …

Factors Associated With C5 Palsy Following Cervical Spine Surgery: A Systematic Review., Andrew Jack, Wyatt L Ramey, Joseph R Dettori, Zane Tymchak, Rod J Oskouian, Robert A Hart, Jens R Chapman, Dan Riew

Articles, Abstracts, and Reports

Study Design: Systematic review.

Objectives: C5 palsy (C5P) is a not uncommon and disabling postoperative complication with a reported incidence varying between 0% and 30%. Among others, one explanation for its occurrence includes foraminal nerve root tethering. Although different risk factors have been reported, controversy about its causation and prevention persists. Inconsistent study findings contribute to the persistent ambiguity leading to an assumption of a multifactorial nature of the underlying C5P pathophysiology. Here, we report the results of a systematic review on C5P with narrow inclusion criteria in the hope of elucidating risk factors for C5P due to a common …

The Identification Of Long Non-Coding Rna Zfas1 Through An Exploratory Rna-Sequencing Analysis And Its Association With Epithelial-To-Mesenchymal Transition In Colon Cancer Adenocarcinoma., Stephen J. O'Brien

Electronic Theses and Dissertations

Colorectal adenocarcinoma is the fourth most common cancer diagnosed worldwide and is a significant cause of morbidity and mortality. This dissertation performed an exploratory RNA-sequencing analysis comparing gene expression between colon adenocarcinoma tissue and paired normal colon epithelium. After identification of a number of lncRNAs that were increased in expression in colon adenocarcinoma compared to normal colon epithelium, we aimed to validate the expression and investigate their function in vitro. Specifically, we focused on the lncRNA ZFAS1 and its association with epithelial-to-mesenchymal transition. These studies found the following: 1. Seven candidate lncRNAs were identified from the exploratory RNA-sequencing analysis to …