Surgery Commons^™

Parenteral Nutritional Support In Surgical Patients: Expert Consensus Statements Regarding Intravenous Lipid Emulsions Containing Omega-3 Fatty Acids., Robert G Martindale, David C Evans, Dan Waitzberg, Malissa Warren, Manpreet S Mundi, Stanislaw Klek, Paul E Wischmeyer, Martin D Rosenthal

Surgery Articles

OBJECTIVES: The International Lipids in Parenteral Nutrition (PN) Summit was convened to offer practical guidance and expert consensus opinion regarding the use of intravenous lipid emulsions (ILEs) in various clinical settings. Herein, we briefly review aspects from this summit that are of particular importance for surgical/hospitalized patients.

METHODS: Summit participants identified and discussed new evidence, data, and analyses, that potentially influence the benefits and risks of ILEs in PN or their use in clinical practice. The summit meeting consisted of expert presentations that assessed recent clinical data and best practice, followed by periodic panel discussions to formulate consensus statements. Consensus …

Levothyroxine-Associated Thyrotoxicosis And Hyperbilirubinemia On Preoperative Screening Evaluation., Carly J Suriano, Ian P Erkkila, Thomas M Vara

Surgery Articles

BACKGROUND: Levothyroxine is a commonly prescribed medication for treatment of hypothyroidism in the United States. This drug is titrated based on weight and serial laboratory evaluation and is often very well tolerated with few adverse effects. Levothyroxine-associated liver injury and cholestatic disease are regarded as rare phenomena. We report an additional case of levothyroxine-associated hepatic dysfunction with resolution upon decreased dosage and continued tolerance of the medication.

CASE PRESENTATION: We report a case of a 60-year-old male presenting for preoperative clearance for umbilical hernia repair with previous history of thyroidectomy for multinodular goiter. Laboratory work-up suggested thyrotoxicosis-associated hepatic dysfunction secondary …

Successful Treatment Of An Atypical Presentation Of Disseminated Retroperitoneal Seminoma: A Case Report, Mahmoud Abd-El-Hafez, Kylie Johnson, Joe Cates, Alosh Madala

HCA Healthcare Journal of Medicine

Background

Testicular seminoma is the most common malignant tumor of the testis. It occurs at a rate of 5 per 100 000 men, primarily between the ages of 15 to 34. While seminomas typically occur in the testis, other primary sites include the mediastinum, the retroperitoneum, or other extra-gonadal sites. Due to the curable nature of the malignancy (5-year survival rate > 95%), detection at early stages of the disease is key. This case presentation explores the delayed diagnosis and treatments of an atypical presentation of disseminated seminoma.

Case Presentation

We present the unusual case of a 56-year-old male who had …

Endovascular Repair Of A Superior Mesenteric Arteriovenous Fistula And Pseudoaneurysm After A Single Gunshot Wound To The Abdomen, Robert Ringersen Iii, Michael Shockley, Sanjiv Gray, Tracy Bilski, Julio Calderin, Philip Kondylis

HCA Healthcare Journal of Medicine

Background

Traumatic arteriovenous fistulas (AVFs) are rare entities, especially when referring to visceral arterioportal AVFs. Currently, there are no large epidemiological studies looking specifically at traumatic visceral AVFs. When traumatic AVFs have been discussed in the literature, it is in the form of case reports or case series and focused on peripheral AVFs. The following case is a presentation of a traumatic arterioportal AVF and its management with an endovascular approach.

Case Presentation

A 16-year-old adolescent boy presented tachycardic and hypotensive with a single gunshot wound in his left abdomen. Multiple operations were required. His intensive care unit course was …

Assessment Of The European Hernia Society Classification Of Ventral Hernias And Clinical Outcomes, Oluwatunmininu A. Anwoju, Ashtyn Barrientes, Connor Hogan, Erik Askenasy, Jacob Greenberg, Keith Jerrod, Scott J. Roth, Zuhair Ali, Mike K. Liang

HCA Healthcare Journal of Medicine

Background

Ventral hernias are a common but heterogeneous disease. Communication among key stakeholders (eg, patients, clinicians, administrators, payers, and researchers) can be augmented by a widely utilized classification system. The European Hernia Society (EHS) developed an expert-opinion-based hernia classification system organized by hernia type (primary versus incisional) and size. We sought to assess what components of the EHS ventral hernia classification system were correlated to real-world clinical outcomes.

Methods

This was a multicenter cohort study. All hospitals contributing to the database were affiliated with 1 of 6 academic institutions. All adult patients who underwent ventral hernia repair over a 4-year …

Navigating Wound Closure Strategies: Primary Closure Vs. Delayed Primary Closure In Digestive Surgery—A Systematic Review And Meta-Analysis On Surgical Site Infections, Lam Sihardo, Arnetta Nl Lalisang, Afid B. Putra, Bagus A. Suryawiditya

The New Ropanasuri Journal of Surgery

Introduction. Surgical site infection (SSI) is a significant concern following digestive surgery, with varying incidence rates based on wound contamination levels. The choice between Primary Closure (PC) and Delayed Primary Closure (DPC) impacts SSI occurrence, making it essential to evaluate their comparative effectiveness. DPC is hypothesized superior to PC to prevent SSI or wound infection after a contaminated abdominal surgery.

Methods. This systematic review study was carried out through PubMed, Scopus, and Cochrane (CENTRAL). Quality was assessed using Risk of Bias (ROB-2) tool. All results were summarized, and quantitative analysis was performed using a random-effect model. This study …

Bacillus Calmette-Guerin (Bcg) As An Intralesional Therapy For Cutaneous Metastatic Malignant Melanoma: A Literature Review, Farisa B. Dina, Ahmad Kurnia

The New Ropanasuri Journal of Surgery

Introduction. Malignant melanoma is the most lethal form of skin cancer and is the third most common cause of death of all malignancies in the world. Cutaneous metastatic lesions are the earliest and the most frequently encountered metastatic lesions in malignant melanoma. The use of Bacillus Calmette-Guerin (BCG) as an intradermal therapy agent has been long debated due to its effectiveness and adverse effects. This literature review aims to provide a comprehensive explanation regarding the use of intralesional BCG in establishing local control and preventing recurrence in cutaneous metastatic malignant melanoma.

Method. A literature search was conducted on various …

Infrarenal Abdominal Aortic Pseudoaneurysm With Suspected Behcet Disease: A Unique Case Report, Harsya D. Gunardi, Danny Pratama, Andrio W. Prabowo, Nanang W. Hidayat, M Aprizal Putera, Grady Krisandi

The New Ropanasuri Journal of Surgery

Introduction. Abdominal aortic pseudoaneurysm caused by autoimmune vasculitis is a rare complication. Clinical presentation of patients is often late with life–threatening complications.

Case Illustration: A 62–year–old male patient with infrarenal abdominal aortic pseudoaneurysm presenting with a 2–week worsening severe abdominal and lumbar pain with a history of uncontrolled hypertension and a history of oral ulcer. He was successfully treated with tube grafting through open surgical repair.

Conclusion: The pseudoaneurysm was successfully removed and replaced with a polyester tube graft with no perioperative complications and was discharged 5 days later

C-Reactive Protein As An Early Predictor Of Anastomosis Leakage After Colorectal Surgery: A Literature Review, Lucky Permana, Ridho A. Syaiful

The New Ropanasuri Journal of Surgery

Introduction. Anastomosis leakage is a defect in the intestinal wall at the anastomosis site after surgery. This condition is a serious complication causing increased morbidity and mortality. CRP is commonly used as an acute postoperative indicator after abdominal surgery. The use of CRP as an early predictor of anastomosis leakage after colorectal surgery is supported by several studies showing its good diagnostic value. However, using CRP as a biomarker is not standard at Cipto Mangunkusumo National Hospital. Therefore, this literature review aims to support the evidence for CRP in the early detection of anastomosis leakage after colorectal surgery.

Method. …

The Role Of Active Surveillance Of Papillary Thyroid Microcarcinoma: A Literature Review, Prasojo Prasojo, I Gusti Ngurah Gunawan Gunawan Wibisana

The New Ropanasuri Journal of Surgery

Introduction: Thyroid cancer is one of the most common cancers in the world, with incidence 144,7: 100.000 population. The incidence has risen up to 211% within the last 30 years, and one–third of thyroid cancer is papillary thyroid microcarcinoma. There are still controversies regarding whether immediate surgery or active surveillance is the better option for treating this condition. This review aims to evaluate the safety and efficacy of active papillary thyroid microcarcinoma surveillance.

Methods: Cochrane, PubMed, EBSCOHost, and ProQuest were searched for relevant studies of active surveillance of papillary thyroid microcarcinoma.

Results: Six publications were selected after a literature search …

Transformation Of Accreditation Of Higher Education In Health In Indonesia: Qualitative Assessment, Yefta Moenadjat, Insan Sosiawan A. Tunru, Sutrisno Soemardjo

The New Ropanasuri Journal of Surgery

Accreditation of higher education in health in Indonesia shifts to the qualitative assessment driven to ensure quality improvement. The method replaces the former quantitative assessment method that has been applied since 2012; it will be effective in January 2025. The driving factors and rationale of transformation are outlined in this article. The rationale of the qualitative assessment that applies principle–based accreditation and the quantitative assessment that applies rule–based accreditation is reviewed here. Information on the accreditation procedure and the goal is presented, aiming for institutions to prepare for this new version of accreditation.

Surgical Treatment For Hepatocellular Carcinoma With Right Atrium Tumor Thrombus: A Literature Review, Mohammad Z. Hazmi, Ridho A. Syaiful

The New Ropanasuri Journal of Surgery

Introduction. The prognosis of patients with hepatocellular carcinoma (HCC) with right atrial tumor thrombus (RATT) is poor, with a mortality rate of 60 to 90%. Along with the development of multimodality management and surgical techniques in cases of HCC, surgery is still an option for curative purposes. This study aims to review the indications, appropriate surgical techniques, and postoperative survival outcomes in HCC with RATT.

Methods. This literature review conducted using online databases, including Cochrane Library, PubMed, ScienceDirect, EBSCOhost, and ProQuest.

Results. Six case reports and four retrospective studies were reviewed. Surgery for HCC with RATT has one, three, and …

A Review Of Managing Catastrophes In Robotic-Assisted Thoracic Surgery, Shamele Battan-Wraith, Kevin Wang, Ahmed Elkamel, Kameron Durante, Hope Conrad, Kayla Iannarelli, Olugbenga Okusanya, Praveen Sridhar, Stephanie G. Worrell

Department of Surgery Faculty Papers

Lung cancer is the most commonly diagnosed cancer worldwide in 2022, with over 2.5 million new cases, or 1 in 8 of all cancers diagnosed worldwide. Lung cancer is the leading cause of cancer related mortality in the United States, with non-small cell lung cancer (NSCLC) being the most prevalent type. For early-stage NSCLC, lung resection with anatomic lobectomy remains the standard of care. Robot-assisted lobectomy is gaining popularity over video-assisted thoracoscopic surgery (VATS) and open thoracotomy due to improved visualization, ergonomics, and instrumentation. Despite these advancements, intraoperative complications and a steep learning curve present significant barriers to the widespread …

Comparing Functional Outcomes Between 3d Printed Acetabular Cups And Traditional Prosthetic Implants In Hip Arthroplasty: A Systematic Review And Meta Analysis, Ryan St. John, Seth Spicer, Mo Hadaya, Hanna Brancaccio, Seungkyu Park, Sean Mcmillan

Rowan-Virtua School of Osteopathic Medicine Departmental Research

OBJECTIVE: The primary research aim was to determine if the use of traditional or 3D printed prosthesis resulted in better functional outcome scores in hip arthroplasty.

METHODS: A systematic review and meta-analysis was conducted utilizing the PRISMA 2020 guidelines. Six databases (PubMed, Embase, Scopus, WebOfScience, and Cochrane Library, Google Scholar) were searched yielding 1117 article titles and abstracts. Rayyan.ai was used to detect duplicates (n = 246) and for manual screening for inclusion and exclusion criteria. Included were controlled studies of any publication time that assessed Harris Hip Score (HHS) at baseline and twelve months. Six papers were sought for …

Prolonged Cardiopulmonary Bypass Time-Induced Endothelial Dysfunction Via Glypican-1 Shedding, Inflammation, And Matrix Metalloproteinase 9 In Patients Undergoing Cardiac Surgery, Shiyi Li, Katherine V Nordick, Iván Murrieta-Álvarez, Randall P Kirby, Rishav Bhattacharya, Ismael Garcia, Camila Hochman-Mendez, Todd K Rosengart, Kenneth K Liao, Nandan K Mondal

Faculty, Staff and Students Publications

OBJECTIVES: A prolonged cardiopulmonary bypass (CPB) time of over 180 min is linked to poorer outcomes and higher mortality in cardiac surgery. This study examines how glypican-1 shedding, matrix metallopeptidase 9 (MMP9), and the pro-inflammatory cytokine IL-1β may contribute to endothelial dysfunction in patients undergoing on-pump surgery with an extended CPB.

METHODS: Fifty-one patients undergoing cardiac surgical procedures were divided into two groups based on the intraoperative CPB duration: (i) normal CPB (<180 >min,

RESULTS: Before surgery, the plasma levels of glypican-1, MMP9, and IL-1β were comparable between the normal CPB and the prolonged CPB groups. However, after the end …

Multisociety Endorsement Of The 2024 European Guideline Recommendations On Coronary Revascularization, Victor Dayan, Joseph F Sabik, Minoru Ono, Marc Ruel, Song Wan, Lars G Svensson, Leonard N Girardi, Y Joseph Woo, Vinay Badhwar, Marc R Moon, Wilson Y Szeto, Vinod H Thourani, Rui M S Almeida, Zhe Zheng, Walter J Gomes, Dawn S Hui, Rosemary F Kelly, Miguel Sousa Uva, Joanna Chikwe, Faisal G Bakaeen

Faculty, Staff and Students Publications

No abstract provided.

Pancreaticoduodenectomy In Trauma Patients With Grade Iv-V Duodenal Or Pancreatic Injuries: A Post Hoc Analysis Of An East Multicenter Trial, Rachel Leah Choron, Charoo Piplani, Julia Kuzinar, Amanda L. Teichman, Christopher Bargoud, Jason D. Sciarretta, Randi N. Smith, Dustin Hanos, Iman N. Afif, Jessica H. Beard, Navpreet Kaur Dhillon, Ashling Zhang, Mira Ghneim, Rebekah Devasahayam, Oliver Gunter, Alison A. Smith, Brandi Sun, Chloe S. Cao, Jessica K. Reynolds, Lauren A. Hilt, Daniel N. Holena, Grace Chang, Meghan Jonikas, Karla Echeverria-Rosario, Nathaniel S. Fung, Aaron Anderson, Caitlin A. Fitzgerald, Ryan Peter Dumas, Jeremy H. Levin, Christine T. Trankiem, Jaehee Yoon, Jacqueline Blank, Joshua P. Hazelton, Christopher J. Mclaughlin, Rami Al-Aref, Jordan Michael Kirsch, Daniel S. Howard, Dane R. Scantling, Kate Dellonte, Michael A. Vella, Brent Hopkins, Chloe Shell, Pascal Udekwu, Evan G. Wong, Bellal Joseph, Howard Lieberman, Walter A. Ramsey, Collin H. Stewart, Claudia Alvarez, John D. Berne, Jeffry Nahmias, Ivan Puente, Joe Patton, Ilya Rakitin, Lindsey Perea, Odessa Pulido, Hashim Ahmed, Jane Keating, Lisa M Kodadek, Jason Wade, Henry Reynold, Martin Schreiber, Andrew Benjamin, Abid Khan, Laura K. Mann, Caleb Mentzer, Vasileios Mousafeiris, Francesk Mulita, Shari Reid-Gruner, Erica Sais, Christopher W. Foote, Carlos H. Palacio, Dias Argandykov, Haytham Kaafarani, Michelle T. Bover Manderski, Lilamarie Moko, Mayur Narayan, Mark Seamon

SKMC Student Presentations and Publications

INTRODUCTION: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries.

METHODS: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD.

RESULTS: The sample (n=95) was young (26 years), male (82%), …

Influence Of Antibody–Drug Conjugate Cleavability, Drug-To-Antibody Ratio, And Free Payload Concentration On Systemic Toxicities: A Systematic Review And Meta-Analysis, Shou Ching Tang, Carrie Wynn, Tran Le, Martin Mccandless, Yunxi Zhang, Ritesh Patel, Nita Maihle, William Hillegass

School of Medicine Faculty Publications

While in theory antibody drug conjugates (ADCs) deliver high-dose chemotherapy directly to target cells, numerous side effects are observed in clinical practice. We sought to determine the effect of linker design (cleavable versus non-cleavable), drug-to-antibody ratio (DAR), and free payload concentration on systemic toxicity. Two systematic reviews were performed via PubMed search of clinical trials published between January 1998—July 2022. Eligible studies: (1) clinical trial for cancer therapy in adults, (2) ≥ 1 study arm included a single-agent ADC, (3) ADC used was commercially available/FDA-approved. Data was extracted and pooled using generalized linear mixed effects logistic models. 40 clinical trials …

Patient-Reported Outcome Measures For Mohs Reconstruction: A Systematic Review, Neha Garg, Shreya Mandloi, Natalia Queenan, Jay Trivedi, Adam Mccann, Vivian Xu, Dev Amin, Howard Krein, Ryan Heffelfinger

Jefferson Hospital Staff Papers and Presentations

OBJECTIVE: Mohs micrographic surgery (MMS) and subsequent reconstructive procedures for the treatment of facial nonmelanoma skin cancers (NMSCs) significantly impact quality of life (QoL). A validated patient-reported outcome measure (PROM) for patients who undergo Mohs reconstruction is not yet established. This study aims to systematically assess the quality of existing PROMs to determine their effectiveness in capturing the challenges faced after Mohs reconstruction for facial NMSC.

DATA SOURCES: A systematic review following established Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was performed. Medline, PubMed, Scopus, and Cochrane databases were searched using keywords relevant to MMS, NMSC, facial reconstruction, …

Aspiration Of Left Atrial Masses Using The Large-Bore Manual Aspiration System: The Aspirate La Procedure, Shaurya Srivastava, Hussam Al Hennawi, Ahmad Abulshamat, Appa Bandi, Mohammed Qintar

Abington Jefferson Health Papers

Transcatheter mass extraction of left-sided cardiac masses has gained popularity in recent years, with scarce data on effectiveness, safety, and types of devices used. Mostly, left-sided aspirations use mechanical and continuous-flow–mediated devices (the AngioVac [AngioDynamics] and Penumbra systems [Penumbra]). To our knowledge, the use of manual aspiration devices has not been reported yet. Here, we report the first case series on the use of the AlphaVac (AngioDynamics) (a large-bore manual aspiration device) system for left-sided intracardiac masses.