Surgery Commons^™

Promising Response Of Olaparib In Patient With Germline Atm-Mutated Metastatic Gastric Cancer, Kok Hoe Chan, Darius Rutazanaa, Curtis Wray, Nirav Thosani, Victor Yang, Putao Cen

Faculty, Staff and Student Publications

Gastric cancer ranks as the fifth leading cause of global cancer incidences, exhibiting varied prevalence influenced by geographical, ethnic, and lifestyle factors, as well as

Far Posterior Approach For Rib Fracture Fixation: Surgical Technique And Tips., Taylor J Manes, Daniel T Degenova, Benjamin C Taylor, Jignesh N Patel

Surgery Articles

BACKGROUND: The present video article describes the far posterior or paraspinal approach to posterior rib fractures. This approach is utilized to optimize visualization intraoperatively in cases of far-posterior rib fractures. This technique is also muscle-sparing, and muscle-sparing posterolateral, axillary, and anterior approaches have been shown to return up to 95% of periscapular strength by 6 months postoperatively

DESCRIPTION: Like most fractures, the skin incision depends on the fracture position. The vertical incision is made either just medial to a line equidistant between the palpable spinous processes and medial scapular border or directly centered over the fracture line in this region. …

Comprehensive Analysis Of Craniopharyngioma: Epidemiology, Clinical Characteristics, Management Strategies, And Role Of Radiotherapy, Amir Mushtaq, Mohsin Fayaz, Abdul Rashid Bhat, Abbas F Abdul Hussein, Gianluca Ferini, Giuseppe Emmanuele Umana, Gianluca Scalia, Feroze Ahmad Mir, Aizul Khursheed, Bipin Chaurasia

Faculty, Staff and Student Publications

BACKGROUND/AIM: Craniopharyngiomas pose challenges in diagnosis and management due to their rare occurrence and diverse clinical manifestations. This study aimed to provide a comprehensive analysis of cranio-pharyngioma, including its epidemiological trends, clinical presentations, radiological characteristics, surgical interventions, and the role of radiotherapy.

PATIENTS AND METHODS: A retrospective observational study was conducted on 23 patients diagnosed with craniopharyngioma at our hospital from August 2017 to July 2019. Data regarding demographics, clinical presentation, radiological findings, surgical interventions, and adjuvant therapies were collected and analyzed.

RESULTS: Craniopharyngiomas exhibited a bimodal age distribution, with peaks in childhood and late adulthood. Clinical presentations varied between …

Innovations In Molecular Biomarkers And Biomaterial-Based Immunotherapies For Head & Neck Cancer, Sarah Anne Wong, Victoria A Manon, Simon Young, Chi T Viet

Faculty, Staff and Student Publications

Purpose of review: Oral squamous cell carcinoma (OSCC) survival rates have remained stagnant due to a lack of targeted therapies and diagnostic tools. Patient risk is currently determined solely through clinicopathologic features, primarily tumor staging, which lacks the necessary precision to stratify patients by risk and accurately dictate adjuvant treatment. Similarly, conventional OSCC therapies have well-established toxicities and limited efficacy.

Recent findings: Recent studies show that patient risk can now be assessed using non-invasive techniques, at earlier time points, and with greater accuracy using molecular biomarker panels. Additionally, novel immunotherapies not only utilize the host's immune response to combat disease …

Hybrid Open-Endovascular Onyx Embolization Of Spinal Type Ivb Perimedullary Spinal Arteriovenous Fistula Through Direct Posterior Spinal Vein Access: A Case Report, Romulo Augusto Andrade De Almeida, Francisco Call-Orellana, Christopher C Young, Franco Rubino, Sara L Thrower, Stephen R Chen, Robert Y North

Faculty, Staff and Student Publications

Background: Spinal arteriovenous fistulas (SAVFs) are direct communication between arteries and veins without intervening abnormal vessel nidus, which often results in venous congestion and spinal cord dysfunction. Ventrally located SAVF can be challenging to treat through traditional open or endovascular approaches.

Case description: We describe a hybrid (open/endovascular) procedure in a 72-year-old male with a Takai Type IVb SAVF presenting with paraparesis and sphincter dysfunction. Imaging revealed a conus medullaris SAVF in which the main fistulous connection was located ventrally. The conventional endovascular approach was deemed risky, and open surgery failed in the first attempt. The SAVF was resolved using …

Repeat Cytoreduction And Hyperthermic Intraperitoneal Chemotherapy For Recurrent Mucinous Appendiceal Adenocarcinoma: A Viable Treatment Strategy With Demonstrable Benefit, Neal Bhutiani, Travis E Grotz, Seth J Concors, Michael G White, Beth A Helmink, Kanwal P Raghav, Melissa W Taggart, Karen A Beaty, Richard E Royal, Michael J Overman, Aurelio Matamoros, Christopher P Scally, Safia Rafeeq, Paul F Mansfield, Keith F Fournier

Faculty, Staff and Student Publications

INTRODUCTION: Many patients with mucinous appendiceal adenocarcinoma experience peritoneal recurrence despite complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Prior work has demonstrated that repeat CRS/HIPEC can prolong survival in select patients. We sought to validate these findings using outcomes from a high-volume center.

PATIENTS AND METHODS: Patients with mucinous appendiceal adenocarcinoma who underwent CRS/HIPEC at MD Anderson Cancer Center between 2004 and 2021 were stratified by whether they underwent CRS/HIPEC for recurrent disease or as part of initial treatment. Only patients who underwent complete CRS/HIPEC were included. Initial and recurrent groups were compared.

RESULTS: Of 437 CRS/HIPECs performed …

Volar V-Y Advancement Flaps In Reconstructing Fingertip Injuries, Sawsan Abiad

BAU Journal - Science and Technology

Fingertip injuries with exposed bones and joints require immediate or early closure for the preservation of function and avoidance of complications. The ideal procedure should maintain the length of the finger and cover the defect with non-tender, well-padded skin with normal sensation. The aim of this study was to evaluate the role of the different types of volar V-Y advancement flaps in reconstructing and resurfacing injuries of the fingertips at different levels and angles. Thirty patients (N=30) sustaining fingertip injuries of variable etiology and lost components, type III & IV according to Allen’s classification were divided into two groups (n=15) …

The Role Of Diagnostic Laparoscopy In Management Of Non-Specific Abdominal Pain: A Prospective Observational Study, Suraj Pai, Ashfaque Mohammed

Manipal Journal of Medical Sciences

Non-specific abdominal pain (NSAP) presents a diagnostic challenge due to its varied etiologies and often inconclusive clinical and radiological findings. Diagnostic laparoscopy has emerged as a valuable minimally invasive tool that allows direct visualization of the abdominal cavity, facilitating early and accurate diagnosis. This study evaluates the role of diagnostic laparoscopy in patients presenting with NSAP, highlighting its diagnostic accuracy, safety profile, and impact on clinical management. Evidence suggests that laparoscopy not only aids in identifying underlying pathologies—ranging from appendicitis and gynecological disorders to early peritonitis—but also reduces unnecessary laparotomies and hospital stay duration. Additionally, therapeutic interventions can often be …

Outcome Of Endovascular Procedure In Chronic Limb Ischemia Femoropopliteal Lesion: A Literature Review, Alexander J. Utama, Robby E. Thio

The New Ropanasuri Journal of Surgery

Introduction. Angioplasty and stenting are the two main endovascular treatments for femoropopliteal lesions associated with chronic limb ischemia. To summarize the research in this area, this article examines the state of these treatments today, diving into clinical subtleties and new trends. The objectives was to thoroughly analyze the body of research, combining knowledge about the results of endovascular angioplasty and stenting.

Methods: Literature was searched in some databases (Cochrane, PubMed, and EBSCO) from June to July 2021.

Results: Five articles that met the inclusion and exclusion criteria were identified. There were two randomized control trials and three cohort …

Open Sympathectomy Effectiveness On Buerger's Disease’S Pain: An Evidence–Based Case Report, Rangga S. Prawiro, Alexander J. Utama

The New Ropanasuri Journal of Surgery

Introduction. Thromboangiitis obliterans, often referred to as Buerger's disease, is a vascular disease that causes chronic inflammatory conditions, edema, and vascular obstruction due to blood clots. In Cipto Mangunkusumo General Hospital (CMGH), sympathectomy is a rarely done procedure. This evidence–based case report aimed to prove the effectiveness of sympathectomy for Buerger's Disease to reduce pain.

Method. We reported a case of 44–year–old male with progressive pain and a history of darkened fingers of left limbs six months before admission. The patient underwent a lumbar sympathectomy, and there was no recurrence of symptoms after one year of follow–up. A systematic literature …

Correlation Of Thyroid Stimulating Hormone (Tsh), T3, And T4 Hormones With Histopathological Characteristics Of Thyroid Cancer At Cipto Mangunkusumo General Hospital, Ahmad Kurnia, Kristaninta Bangun, Fatahillah Muazdhani

The New Ropanasuri Journal of Surgery

Introduction. In a study spanning 2008 to 2012 at Cipto Mangunkusumo General Hospital (CMGH) Jakarta, 668 cases of thyroid cancer were identified among 18,216 cancer cases. Globally, the papillary subtype is prevalent, and prior research indicates a link between thyroid hormone changes and thyroid carcinoma risk. To improve surgical care, this study aims to find the association between thyroid hormone levels and histological subtypes in thyroid carcinoma patients.

Method. This cross-sectional study focused on thyroid cancer patients managed from 2013 to 2017. Despite subjects' characteristics, thyroid hormone levels and histopathological findings were the variables of interest. The findings were analyzed …

D-Dimer And Ultrasonography As The Early-Diagnostic Tools For Lower-Limb Trauma Patients With Deep Vein Thrombosis: A Literature Review, Faranita Muchtar, Akhmadu Muradi

The New Ropanasuri Journal of Surgery

Introduction. The mortality of venous thromboembolism increased among trauma patients. Both the D-dimer test and ultrasonography are selected to diagnose venous thromboembolism due to non-traumatic causes but are rarely utilized in emergency trauma settings.

Objectives. This literature review comprehensively explains the accuracy of the D-dimer test and ultrasonography for deep vein thrombosis (DVT) diagnosis. This study finding might broaden the diagnostic recommendation for traumatic patients with deep vein thrombosis.

Method. This study used articles from four distinct journal databases. Only eight of the 480 articles found during searching proceeded with the screening process. Thus, five articles were included …

Neutrophil-Lymphocyte-Ratio As Predictor Of Morbidity And Mortality In Adults With Gastrointestinal Obstruction, Agi S. Putranto, Bimo D. Pramesta

The New Ropanasuri Journal of Surgery

Introduction. Gastrointestinal (GI) obstruction is a condition that often requires surgery and can lead to severe complications. The neutrophil-to-lymphocyte ratio (NLR) has been used as an inflammation indicator in various medical conditions, but research on the relationship between NLR and GI obstruction is still limited. Therefore, this study aims to evaluate the role of NLR as a cost-effective and simple preoperative predictor of postoperative mortality and morbidity, mainly surgical site infection, in adult patients with GI obstruction.

Method. This cross-sectional study was conducted at Cipto Mangunkusumo General Hospital in Jakarta. The study sample consists of 150 adult patients with GI …

Preoperative Neutrophil–Lymphocyte Ratio And Serum Carcinoembryonic Antigen As Predictive Factors Of Colorectal Cancer Survival, Agi S. Putranto, Jackson Kamaruddin

The New Ropanasuri Journal of Surgery

Introduction. Colorectal cancer is the second leading cause of death worldwide, with a high mortality rate. This study investigates the predictive value of the neutrophil–lymphocyte ratio (NLR) and carcinoembryonic antigen (CEA) in predicting the survival rates of colorectal cancer patients in Indonesia.

Method. This retrospective cohort study enrolled the colorectal cancer stage I–IV patients treated at Cipto Mangunkusumo General Hospital (CMGH). The independent variables are NLR and CEA, while the dependent variable is the five–year survival of colorectal cancer. The log rank test proceeded to find a correlation between NLR and CEA with 5–year survival, and the Cox proportional hazard …

Factors Influencing Ulcer Healing In Chronic Limb Threatening Ischemia Patients After Endovascular Angioplasty At Cipto Mangunkusumo General Hospital, Raden Suhartono, Ghany H. Wijaya, Akhmadu Muradi

The New Ropanasuri Journal of Surgery

Introduction. Chronic limb–threatening ischemia (CLTI) can cause rest pain in the lower extremities and the formation of ulcers or gangrene. Revascularization, which can be done using open surgery or endovascular procedures, is the first line of treatment in CLTI management. CLTI patients at CMGH usually came with advanced conditions and high re–amputation rates even after revascularization. This study aimed to determine factors associated with the outcome of endovascular angioplasty, especially ulcer healing.

Method. A cross–sectional study was conducted at CMGH, enrolling CLTI patients with Rutherford grades 5 and 6 who underwent angioplasty. Age, gender, history of smoking, hypertension, atrial fibrillation, …

Epilepsy Networks And Their Surgical Relevance, Kevin Hines, Chengyuan Wu

Department of Neurosurgery Faculty Papers

Surgical epilepsy is a rapidly evolved field. As the understanding and concepts of epilepsy shift towards a network disorder, surgical outcomes may shed light on numerous components of these systems. This review documents the evolution of the understanding of epilepsy networks and examines the data generated by resective, ablative, neuromodulation, and invasive monitoring surgeries in epilepsy patients. As these network tools are better integrated into epilepsy practice, they may eventually inform surgical decisions and improve clinical outcomes.

Recurrent Polymicrobial Bloodstream Infections As Harbingers Of A Duodenal-Inferior Vena Cava Fistula, Gregory E. Koval, Richard J. Hankins, Jasmine R. Marcelin

Graduate Medical Education Research Journal

This is a case of an 82-year-old patient who presented with recurrent polymicrobial bloodstream infections and no obvious undrained source of infection. She had prior double barrel iliocaval stenting for post thrombotic syndrome. The patient underwent exploratory laparotomy and primary repair of a duodenal-caval fistula with a fascia lata patch and an omental pedicle flap. No further bloodstream infections were documented after the repair. This discussion highlights an uncommon complication of IVC stenting, its presentation as well as the operative approach used to repair the fistula.

A Novel Multimodal Postoperative Pain Protocol For 1- To 2-Level Open Lumbar Fusions: A Retrospective Cohort Study, Michael Markowitz, Barrett I. Woods, Gregory D. Schroeder, Christopher K Kepler, David Kaye, Mark Kurd, Joshua Armstrong, Alex R. Vaccaro, Kris Radcliff

Rothman Institute Papers

BACKGROUND: There has been increased interest in exploring methods to reduce postoperative pain without opioid medications. In 2015, a multimodal analgesia protocol was used involving the perioperative use of celecoxib, gabapentin, intravenous acetaminophen, lidocaine, and liposomal bupivacaine. Overall, the goal was to reduce the utilization of scheduled opioids in favor of nonopioid pain management.

METHODS: The results of a consecutive series of 1- to 2-level open primary lumbar fusions were compared to a cohort of patients after the implementation the perioperative multimodal pain management protocol. Primary endpoints included patient-reported pain scores and secondary endpoints included length of stay.

RESULTS: There …

The 2023 Orthopedic Research Society's International Consensus Meeting On Musculoskeletal Infection: Summary From The In Vitro Section, Noreen J. Hickok, Bingyun Li, Ebru Oral, Sebastian A.J. Zaat, David A. Armbruster, Gerald J. Atkins, Antonia F. Chen, Débora C. Coraça-Huber, Tianhong Dai, Edward M. Greenfield, Rajendra Kasinath, Matthew Libera, Cláudia N.H. Marques, T. Fintan Moriarty, K. Scott Phillips, Kapil Raghuraman, Dacheng Ren, Lia Rimondini, Kordo Saeed, Thomas P. Schaer, Edward M. Schwarz, Christopher Spiegel, Paul Stoodley, Vi Khanh Truong, Shao-Ting Jerry Tsang, Britt Wildemann, Anja R. Zelmer, Annelies S. Zinkernagel

Department of Orthopaedic Surgery Faculty Papers

Antimicrobial strategies for musculoskeletal infections are typically first developed with in vitro models. The In Vitro Section of the 2023 Orthopedic Research Society Musculoskeletal Infection international consensus meeting (ICM) probed our state of knowledge of in vitro systems with respect to bacteria and biofilm phenotype, standards, in vitro activity, and the ability to predict in vivo efficacy. A subset of ICM delegates performed systematic reviews on 15 questions and made recommendations and assessment of the level of evidence that were then voted on by 72 ICM delegates. Here, we report recommendations and rationale from the reviews and the results of …

Autocrine Igf-Ii-Associated Cancers: From A Rare Paraneoplastic Event To A Hallmark In Malignancy, Pierluigi Scalia, Ignazio R. Marino, Salvatore Asero, Giuseppe Pandini, Adda Grimberg, Wafik S. El-Deiry, Stephen J. Williams

Department of Surgery Faculty Papers

The paraneoplastic syndrome referred in the literature as non-islet-cell tumor hypoglycemia (NICTH) and extra-pancreatic tumor hypoglycemia (EPTH) was first reported almost a century ago, and the role of cancer-secreted IGF-II in causing this blood glucose-lowering condition has been widely established. The landscape emerging in the last few decades, based on molecular and cellular findings, supports a broader role for IGF-II in cancer biology beyond its involvement in the paraneoplastic syndrome. In particular, a few key findings are constantly observed during tumorigenesis, (a) a relative and absolute increase in fetal insulin receptor isoform (IR^A) content, with (b) an increase …