Behind The Knife: The Surgery Podcast Behind The Knife: The Surgery Podcast

Join Drs. Jason Bingham (@BinghamMd) and Patrick Georgoff (@georgoff) for a thought-provoking discussion with titans of hernia surgery Drs. Todd Heniford (@THeniford) and Michael Rosen (@MikeRosenMD).  You don't want to miss this one!  This episode goes deep, touching on some of the most vexing questions in the world of abdominal wall reconstruction.  

Highlights: 


Hernia is chronic disease process.  Surgeons should act like it and patients need to understand this.  
Follow-up data is hard to come by and therefore limited.  Studies must be interpreted with this in mind.
Hernia surgery is sexy, which is both exciting and concerning.
"Technology is not useful until it is boring."  New techniques and devices can hurt patients.  
Complicated hernias should be sent to hernia centers.  Otherwise, general surgeons are more than capable of doing the repair.

Link to paper: https://jamanetwork.com/journals/jamasurgery/fullarticle/2816986

Link to ACHQC: https://achqc.org/

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Join the Behind the Knife Surgical Oncology Team as we discuss the presentation, work-up, and management of gastric cancer.

Hosts:
- Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
- Connor Chick, MD (@connor_chick) is a Surgical Oncology fellow at Ohio State University.
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-6 General Surgery resident at Brooke Army Medical Center
- Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-5 General Surgery resident at Brooke Army Medical Center

Learning Objectives:
In this episode, we review the basics of gastric cancer, including presentation, work-up, staging, and treatment modalities as well as high yield topics including the Siewert classification system. We also briefly discuss trials establishing peri-operative chemotherapy regimens for gastric cancer and the controversy of D1 vs. D2 lymphadenectomy.

Links to Papers Referenced in this Episode

Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer.
NEJM 2006 Jul;355(1):11-20.
https://www.nejm.org/doi/full/10.1056/NEJMoa055531

Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesphageal junction adenocarcinoma (FLOT4): a randomized, phase2/3 trial
Lancet 2019 May;393(10184):1948-1957.
https://pubmed.ncbi.nlm.nih.gov/30982686/

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Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Philip Fleshner as they discuss the management of small bowel strictures in Crohn’s disease. 



Learning Objectives
1.    Discuss the role for J-pouch in a patient with inflammatory bowel disease
2.    Identify the key steps in creation of the J-pouch and technical considerations.
3.    Describe post operative complications and management in patients with a J-pouch

Video Link: https://www.youtube.com/watch?v=_PMFaQHah5A

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

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How is each release of the TAR contributing to the final tension on the anterior and posterior fascia? Join Drs. Michael Rosen, Benjamin T. Miller, Sara Maskal, and Ryan C. Ellis as they discuss their group’s recent cohort study of tensiometry in 100 TARs. 

Hosts: 
- Michael Rosen, Cleveland Clinic
- Benjamin T. Miller, Cleveland Clinic
- Sara Maskal, Cleveland Clinic
- Ryan C. Ellis, Cleveland Clinic, @ryanellismd

Learning objectives: 
- Review the steps of a TAR
- Understand the changes in tension on the anterior and posterior fascia with each step of the TAR
- Think about the application this data has to similar operations

References: 

Miller BT, Ellis RC, Petro CC, Krpata DM, Prabhu AS, Beffa LRA, Huang LC, Tu C, Rosen MJ. Quantitative Tension on the Abdominal Wall in Posterior Components Separation With Transversus Abdominis Release. JAMA Surg. 2023 Dec 1;158(12):1321-1326. doi: 10.1001/jamasurg.2023.4847. PMID: 37792324; PMCID: PMC10551814. https://pubmed.ncbi.nlm.nih.gov/37792324/

Miller BT, Ellis RC, Walsh RM, Joyce D, Simon R, Almassi N, Lee B, DeBernardo R, Steele S, Haywood S, Beffa L, Tu C, Rosen MJ. Physiologic tension of the abdominal wall. Surg Endosc. 2023 Dec;37(12):9347-9350. doi: 10.1007/s00464-023-10346-w. Epub 2023 Aug 28. PMID: 37640951. https://pubmed.ncbi.nlm.nih.gov/37640951/

Ramirez OM, Ruas E, Dellon AL. "Components separation" method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990 Sep;86(3):519-26. doi: 10.1097/00006534-199009000-00023. PMID: 2143588. https://pubmed.ncbi.nlm.nih.gov/2143588/

Hope WW, Williams ZF, Rawles JW 3rd, Hooks WB 3rd, Clancy TV, Eckhauser FE. Rationale and Technique for Measuring Abdominal Wall Tension in Hernia Repair. Am Surg. 2018 Sep 1;84(9):1446-1449. PMID: 30268173. https://pubmed.ncbi.nlm.nih.gov/30268173/

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

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Welcome to Humanism in Surgery, a new series where we take a deep dive into the extremes of humanity within the field of surgery. As surgeons, there are times when we feel deeply human and times when we feel we have lost our humanity. These experiences impact us immensely and shape our careers in important ways. It's time these stories are told! For those of you who are fans of NPR, think of this as Story Core for surgery. 

Today, Dr. Patrick Georgoff is joined by Dr. Tamara Fitzgerald, Associate Professor of Pediatric Surgery at Duke University, and Dr. Ted Pappas, Professor of Surgery and Master Surgeon at Duke University. 

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

A patient with a large TBSA burn injury presents to a local emergency department and you are the only surgeon on duty that evening. With snow covered roads and poor visibility, the patient requires initial stabilization prior to transfer to the regional burn center. You are faced with some difficult clinical decisions as you begin their resuscitation. Join Drs. Tam Pham, Rob Cartotto, Julie Rizzo, Alex Morzycki and Jamie Oh as they discuss the clinical challenges in initiating burn resuscitation, pitfalls in long-distance transport, and more. 

Hosts:
·       Dr. Tam Pham: UW Medicine Regional Burn Center

·       Dr. Robert Cartotto: University of Toronto, Ross Tilley Burn Centre 

·       Dr. Julie Rizzo: Brooke Army Medical Center 

·       Dr. Alex Morzycki: UW Medicine Regional Burn Center

·       Dr. Jamie Oh: UW Medicine Regional Burn Center

Learning Objectives:
·       Describe initial fluid strategies, including the recommendations of the Advanced Burn Life Support (ABLS) course, traditional resuscitation formulas, and the Rule of 10.  

·       Describe logistical and medical challenges of long-distance transport to a regional burn center.

·       Understand recent advances learned from recent conflicts in military burn casualty care. 

·       List options for intravenous access. 

·       Understand endpoints of resuscitation, including adjuncts which may help guide fluid titration. 


1.     Cartotto R, Johnson LS, Savetamal A, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res 2023

https://pubmed.ncbi.nlm.nih.gov/38051821/

2.     Renz EM, Cancio LC, Barillo DJ, et al. Long-Range Transport of War-Related Burn Casualties. J Trauma 2008 https://pubmed.ncbi.nlm.nih.gov/18376156/

3.     Adibfar A, Camacho F, Rogers AD, Cartotto R. The Use of Vasopressors During Acute Burn Resuscitation. Burns 2021 https://pubmed.ncbi.nlm.nih.gov/33293152/

4.     Chung KK, Wolf SE, Cancio LC, et al. Resuscitaiton of Severely Burned Military Casualties: Fluid Begets More Fluid. J Trauma 2009 https://pubmed.ncbi.nlm.nih.gov/19667873/

5.     Chung KK, Salinas J, Renz EM, et al. Simple Derivation of the Initial Fluid Rate for the Resuscitation of Severely Burned Adult Combat Casualties: in Silico Validation of the Rule of 10, J Trauma 2009 https://pubmed.ncbi.nlm.nih.gov/20622619/

Joint Trauma System Clinical Practice Guideline (CPG)-Burn Care, updated 2022

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen