Surgery Commons^™

Multilevel Ossification Of The Posterior Longitudinal Ligament Causing Cervical Myelopathy: An Observational Series Of North American Patients, Jonathan A. Ledesma, Tariq Z. Issa, Mark J. Lambrechts, Cannon Greco Hiranaka, Khoa Tran, Patrick O'Connor, Jose A. Canseco, Alan S. Hilibrand, Christopher K. Kepler, Todd J. Albert, Alex R. Vaccaro, Gregory D. Schroeder, David Greg Anderson

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Few studies regarding ossification of the posterior longitudinal ligament (OPLL) outside of Asia currently exist in the literature. A set of patients with multilevel cervical OPLL causing symptomatic myelopathy or radiculopathy from a North American sample is analyzed.

OBJECTIVE: The objective of this study was to describe the demographics, radiographic findings, and surgical outcomes of a cohort of North American patients with degenerative spondylosis presenting for operative management of multilevel (>3 segments) cervical OPLL.

MATERIALS AND METHODS: Forty-three patients diagnosed with multilevel cervical OPLL and degenerative spondylosis presenting with symptomatic cervical myelopathy or radiculopathy were surgically treated over …

State Of The Art Bowel Management For Pediatric Colorectal Problems: Spinal Anomalies., Elizaveta Bokova, Ninad Prasade, John Rosen, Irene Isabel P. Lim, Marc A. Levitt, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction.

METHODS: To define existing approaches and propose state-of-the-art bowel management, a literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published July 2013 and July 2023.

RESULTS: Patients with spinal anomalies have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based …

Clinical Practice Panel: Stand By Me: Using An Enhanced Recovery After Surgery (Eras)Checklist To Guide Early Mobility Of Postoperative Craniotomy Patients On A Progressive Care Unit, Alyssa Mooney, Jerome Codilla, Joanna Arraiza, Sohl Chapman, Nkiru Chukwudi, Ronald Rosales

2023 South Division Nursing Research Conference

No abstract provided.

Laparoscopic Repair Of Pediatric Femoral Hernias: A Scoping Review, Alex Chen, Spencer Wilhelm, Michael Sobolic, Begum Akay, Pavan Brahmamdam, Nathan Novotny

Conference Presentation Abstracts

No abstract provided.

Identification Of Sentinel Lymph Nodes In Esophageal Cancer Patients Using Contrast-Enhanced Eus With Peritumoral Injections, Ji-Bin Liu, Priscilla Machado, John R. Eisenbrey, Sriharsha Gummadi, Flemming Forsberg, Corinne E. Wessner, Anand Raman Kumar, Austin Chiang, Anthony Infantolino, Alexander Schlachterman, Thomas Kowalski, Robert Coben, David Loren

Department of Medicine Faculty Papers

OBJECTIVES: The objective of this pilot study was to compare the performance of contrast-enhanced EUS (CE-EUS)-guided fine-needle aspiration (FNA) with EUS-FNA for lymph node (LN) staging in esophageal cancer.

METHODS: Thirty-seven subjects with esophageal cancer undergoing EUS staging were enrolled, and 30 completed this institutional review board-approved study. A Prosound F75 US system (Hitachi Medical Systems, Tokyo, Japan) with harmonic contrast imaging software and GF-UCT180 curvilinear endoscope (Olympus, Tokyo, Japan) was utilized. All LNs identified by standard EUS were first noted. Sonazoid (dose: 1 mL; GE Healthcare, Oslo, Norway) was administered peritumorally, and all enhanced LNs were recorded. Fine-needle aspiration …

Peripheral Arterial Disease And Complications Of Total Knee Arthroplasty: Indications For Advanced Vascular Imaging And Minimally Invasive Soft Tissue Coverage Procedures, Kristopher Katira, Antony Martin, Anna Garbuzov, James Ferrer, Brian Chuong, Ross Parkerson, George Chimento

School of Medicine Faculty Publications

Soft tissue coverage of knee wounds can be challenging, in particular in the setting of peripheral arterial disease and knee arthroplasty complications. Options for soft-tissue coverage range from conservative wound care to invasive pedicled and free flaps. Unlike traditional wound coverage problems in plastic surgery patients, arthroplasty coverage decisions oblige surgeons to take into account the possibility of secondary orthopedic procedures. The two cases presented in this manuscript demonstrate the importance of vascular imaging, in particular angiography. In both cases, the workhorse medial gastrocnemius flap harvest could have resulted in critical limb ischemia. When secondary orthopedic revision is required at …

Percutaneous Dilatational Tracheostomy In A Cardiac Surgical Intensive Care Unit: A Single-Center Experience, Vignesh Vudatha, Yahya Alwatari, George Ibrahim, Tayler Jacobs, Kyle Alexander, Carlos Puig-Gilbert, Walker Julliard, Rachit Dilip Shah

Department of Surgery Faculty Papers

BACKGROUND: A significant proportion of cardiac surgery intensive care unit (CSICU) patients require long-term ventilation, necessitating tracheostomy placement. The goal of this study was to evaluate the long-term postoperative outcomes and complications associated with percutaneous dilatational tracheostomy (PDT) in CSICU patients.

METHODS: All patients undergoing PDT after cardiac, thoracic, or vascular operations in the CSICU between January 1, 2013 and January 1, 2021 were identified. They were evaluated for mortality, decannulation time, and complications including bleeding, infection, and need for surgical intervention. Multivariable regression models were used to identify predictors of early decannulation and the complication rate.

RESULTS: Ninety-three patients …

Surgical Management Of Congenital Malrotation Presenting In Adulthood., Jacob Holzemer, Krishna Patel, Oscar Ruiz, Jodi Oostra

Surgery Articles

Intestinal malrotation is characterised by positional and congenital fixation abnormalities resulting from a failure in embryonic development in the normal 270° rotation around the axis of the superior mesenteric artery. Intestinal malrotation is primarily thought to affect neonates with an incidence of 1 in 500, however, only 1 in 6000 live births are symptomatic, and these usually present within the first month of life in 40% of cases and within the first year in over 5% of cases as an obstructive pathology or volvulus. In adults, however, the incidence has been documented at 0.2%. These patients usually present with postprandial …

Endoscopic Ultrasound-Guided Transluminal Gallbladder Drainage In Patients With Acute Cholecystitis: A Prospective Multicenter Trial., Shayan S Irani, Neil R. Sharma Md, Andrew C Storm, Raj J Shah, Prabhleen Chahal, Field F Willingham, Lee Swanstrom, Todd H Baron, Eran Shlomovitz, Richard A Kozarek, Joyce A Peetermans, Edmund Mcmullen, Evelyne Ho, Schalk W Van Der Merwe

Other Specialties

OBJECTIVE: To evaluate the safety and efficacy of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS).

BACKGROUND: For patients with acute cholecystitis who are poor surgical candidates, EUS-GBD using a LAMS is an important treatment alternative to percutaneous gallbladder drainage.

METHODS: We conducted a regulatory-compliant, prospective multicenter trial at 7 tertiary referral centers in the United States of America and Belgium. Thirty consecutive patients with mild or moderate acute cholecystitis who were not candidates for cholecystectomy were enrolled between September 2019 and August 2021. Eligible patients had a LAMS placed transmurally with 30 to 60-day indwell if …

United We Might Stand, Divided We Will Certainly Fall!, Simon Maltais, T Sloane Guy, John M. Stulak, Lucman A. Anwer, Louis P. Perrault

Department of Surgery Faculty Papers

No abstract provided.

Maximizing Wound Coverage In Full-Thickness Skin Defects: A Randomized-Controlled Trial Of Autologous Skin Cell Suspension And Widely Meshed Autograft Versus Standard Autografting, Sharon Henry, Steven Mapula, Mark Grevious, Kevin N. Foster, Herbert Phelan, Jeffrey Shupp, Rodney Chan, David Harrington, Neil Mashruwala, David A. Brown, Haaris Mir, George Singer, Alfredo Cordova, Lisa Rae, Theresa Chin, Lourdes Castanon, Derek Bell, William Hughes, Joseph A. Molnar

School of Medicine Faculty Publications

BACKGROUND Traumatic insults, infection, and surgical procedures can leave skin defects that are not amenable to primary closure. Split-thickness skin grafting (STSG) is frequently used to achieve closure of these wounds. Although effective, STSG can be associated with donor site morbidity, compounding the burden of illness in patients undergoing soft tissue reconstruction procedures. With an expansion ratio of 1:80, autologous skin cell suspension (ASCS) has been demonstrated to significantly decrease donor skin requirements compared with traditional STSG in burn injuries. We hypothesized that the clinical performance of ASCS would be similar for soft tissue reconstruction of nonburn wounds. METHODS A …

Gall Bladder Schistosomiasis Diagnosed Incidentally Post Laparoscopic Cholecystectomy: A Case Report, Willbroad Kyejo, Sajida Panjwani, Ally Zain Ismail, Blessing Mathew, Caroline Ngimba, Ally Mwanga

Internal Medicine, East Africa

Introduction and importance: Schistosomiasis is a neglected tropical disease caused by parasitic worms of the genus Schistosoma. It primarily affects the intestines, liver, and urinary tract however, rare cases have been reported where the parasite invades other organs. This case report presents an incidental finding of schistosomiasis, upon histopathology evaluation, in a patient who underwent laparoscopic cholecystectomy for symptomatic gallstone disease with recurrent attacks of cholecystitis.

Case presentation: We present the case of a 42-year-old female patient who presented to the emergency department with symptoms and signs suggestive of acute cholecystitis. She underwent conservative management with interval laparoscopic cholecystectomy …

Outcomes Of Surgical Treatment For Patients With Mild Scoliosis And Age-Appropriate Sagittal Alignment With Minimum 2-Year Follow-Up, Justin K Scheer, Justin S Smith, Peter G Passias, Han Jo Kim, Shay Bess, Douglas C Burton, Eric O Klineberg, Virginie Lafage, Munish Gupta, Christopher P Ames, The International Spine Study Group

Faculty, Staff and Student Publications

OBJECTIVE: The goal of this study was to determine if patients with mild scoliosis and age-appropriate sagittal alignment have favorable outcomes following surgical correction.

METHODS: Retrospective review of a prospective, multicenter adult spinal deformity database. Inclusion criteria: operative patients age ≥18 years, and preoperative pelvic tilt, mismatch between pelvic incidence and lumbar lordosis (PI-LL), and C7 sagittal vertical axis all within established age-adjusted thresholds with minimum 2-year follow-up. Health-related quality of life (HRQoL) scores: Oswestry Disability Index (ODI), 36-item Short Form health survey (SF-36), Scoliosis Research Society-22R (SRS22R), back/leg pain Numerical Rating Scale and minimum clinically important difference (MCID)/substantial clinical …

Monkeypox Presenting As A Hand Consult In The Emergency Department: Two Case Reports, David T Mitchell, James A Mentz, Yuewei Wu-Fienberg, Wendy Chen, Matthew R Greives, Erik S Marques

Faculty, Staff and Student Publications

The ongoing outbreak of the monkeypox virus (now referred to as "mpox") was deemed a public health emergency by the World Health Organization in 2022. The United States now reports the highest number of mpox cases, with 29 980 cases and 21 deaths as of January 11, 2023. The most common presenting symptom is a pruritic, vesicular rash that commonly involves the hands. While covering hand call, our division has encountered 2 cases of mpox in the emergency department for which the chief complaint was a hand lesion. Because hand surgeons will be called upon to make an initial diagnosis, …

Randomized Controlled Trial Of Surgical Rib Fixation To Nonoperative Management In Severe Chest Wall Injury, David E Meyer, John A Harvin, Laura Vincent, Kandice Motley, Michael W Wandling, Thaddeus J Puzio, Laura J Moore, Bryan A Cotton, Charles E Wade, Lillian S Kao

Faculty, Staff and Student Publications

Objective: To compare the effectiveness of surgical stabilization of rib fractures (SSRFs) to nonoperative management in severe chest wall injury.

Background: SSRF has been shown to improve outcomes in patients with clinical flail chest and respiratory failure. However, the effect of SSRF outcomes in severe chest wall injuries without clinical flail chest is unknown.

Methods: Randomized controlled trial comparing SSRF to nonoperative management in severe chest wall injury, defined as: (1) a radiographic flail segment without clinical flail or (2) ≥5 consecutive rib fractures or (3) any rib fracture with bicortical displacement. Randomization was stratified by the unit of admission …

Cannabis Use Disorder And Perioperative Complications, Paul P Potnuru, Srikar Jonna, George W Williams

Faculty, Staff and Student Publications

Importance: Cannabis use is growing in the US and is increasingly perceived as harmless. However, the perioperative impact of cannabis use remains uncertain.

Objective: To assess whether cannabis use disorder is associated with increased morbidity and mortality after major elective, inpatient, noncardiac surgery.

Design, setting, and participants: This retrospective, population-based, matched cohort study used data from the National Inpatient Sample for adult patients aged 18 to 65 years who underwent major elective inpatient surgery (including cholecystectomy, colectomy, inguinal hernia repair, femoral hernia repair, mastectomy, lumpectomy, hip arthroplasty, knee arthroplasty, hysterectomy, spinal fusion, and vertebral discectomy) from January 2016 to December …

Complete Enucleation Of A Complicated Solid Pseudopapillary Neoplasm Of Pancreas: A Case Report, Mohammad Saydul Aman, Bidhan Chandra Das, Md Najmul Haque, Sarwar Ahmed Sobhan, Ashis Saha

Faculty, Staff and Student Publications

INTRODUCTION: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare pancreatic tumor, usually affecting young females. It is categorized as a low-grade malignant tumor without any specific epithelial differentiation, which can occur anywhere in the pancreas.

CASE PRESENTATION: Here, we present the case of a 35-year-old lady who presented to us with abdominal pain and a pancreatic mass. She had a prior laparotomy at a different center without any specific intervention for the lump. After presenting to our center, she was managed through proper evaluation and adequate preparation for surgery. The diagnosis was challenging, and so was the surgery. …

Early Prediction Of Massive Transfusion For Patients With Traumatic Hemorrhage: Development Of A Multivariable Machine Learning Model, Andrew J Benjamin, Andrew J Young, John B Holcomb, Erin E Fox, Charles E Wade, Chris Meador, Jeremy W Cannon

Faculty, Staff and Student Publications

OBJECTIVE: Develop a novel machine learning (ML) model to rapidly identify trauma patients with severe hemorrhage at risk of early mortality.

BACKGROUND: The critical administration threshold (CAT, 3 or more units of red blood cells in a 60-minute period) indicates severe hemorrhage and predicts mortality, whereas early identification of such patients improves survival.

METHODS: Patients from the PRospective, Observational, Multicenter, Major Trauma Transfusion and Pragmatic, Randomized Optimal Platelet, and Plasma Ratio studies were identified as either CAT+ or CAT-. Candidate variables were separated into 4 tiers based on the anticipated time of availability during the patient's assessment. ML models were …

Trial Participation And Outcomes Among English-Speaking And Spanish-Speaking Patients With Appendicitis Randomized To Antibiotics: A Secondary Analysis Of The Coda Randomized Clinical Trial, Elina Serrano, Emily C Voldal, David Machado-Aranda, Daniel A Deugarte, Lillian Kao, Thurston Drake, Robert Winchell, Joseph Cuschieri, Anusha Krishnadasan, David A Talan, Nicole Siparsky, Patricia Ayoung-Chee, Wesley H Self, Patrick Mcgonagill, Katherine A Mandell, Mike K Liang, Shan-Jahan Dodwad, Callie M Thompson, Reynaldo M Padilla, Ross Fleischman, Thea P Price, Alan Jones, Karla Bernardi, Luis Garcia, Heather L Evans, Sabrina E Sanchez, Stephen Odom, Bryan A Comstock, Patrick J Heagerty, Sarah O Lawrence, Sarah E Monsell, Erin E C Fannon, Larry G Kessler, David R Flum, Giana H Davidson

Faculty, Staff and Student Publications

IMPORTANCE: Spanish-speaking participants are underrepresented in clinical trials, limiting study generalizability and contributing to ongoing health inequity. The Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial intentionally included Spanish-speaking participants.

OBJECTIVE: To describe trial participation and compare clinical and patient-reported outcomes among Spanish-speaking and English-speaking participants with acute appendicitis randomized to antibiotics.

DESIGN, SETTING, AND PARTICIPANTS: This study is a secondary analysis of the CODA trial, a pragmatic randomized trial comparing antibiotic therapy with appendectomy in adult patients with imaging-confirmed appendicitis enrolled at 25 centers across the US from May 1, 2016, to February 28, 2020. The trial …

Come Take Call With Me-A Plea For Action On Gun Violence, Thaddeus J Puzio

Faculty, Staff and Student Publications

No abstract provided.