Clinical Outcomes and Financial Impact of a POEM Program at a Rural Tertiary Medical Center: Our First five Years.

Objective: The purpose of this study was to assess the 5-year impact of a per oral endoscopic myotomy (POEM) program on both clinical and financial outcomes for our hospital system and the rural community we serve.

Methods: We evaluated the clinical and financial outcomes of all patients who underwent POEM for achalasia. Patients were also contacted by phone to complete the Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) questionnaire postoperatively.

Endobronchial Valves for Management of Persistent Air Leaks in Patients With Chronic Lung Disease.

Background: Persistent air leak (PAL) is a challenging problem in patients with spontaneous pneumothorax and chronic lung disease who are poor surgical candidates. Conventional management consists of long-term thoracostomy tube placement; however, in some cases, patients are unable to leave the hospital because of the need for continuous negative pressure. We investigated the application of endobronchial valves (EBVs) in the management of patients with air leak for whom surgical intervention was contraindicated.

Laparoscopic peritoneopericardial herniorrhaphy in 2 dogs.

Two peritoneopericardial hernias (PPDH) repaired laparoscopically are reported. Both PPDHs were approached with the dog in dorsal recumbency. Herniated organs (gallbladder and 2 liver lobes in Case 1 and omental fat in Case 2) were dissected and reduced.

Multimodal Pain Management Protocol to Decrease Opioid Use and to Improve Pain Control After Thoracic Surgery.

Background: Opioid addiction continues to be a devastating problem in our communities, and up to 40% of patients begin their addiction with legally prescribed opioids after injury or surgical procedure. An opioid-free multimodal pain regimen was developed with the goal of decreasing opioid exposure while maintaining adequate pain control.

Methods: A retrospective single-institution study was conducted of 313 consecutive patients undergoing minimally invasive lobectomy before (n = 211) and after (n = 102) implementation of an opioid-free protocol from 2016 to 2020.

Giant Bochdalek Hernia: A Minimally Invasive Transabdominal Approach.

A Bochdalek hernia is the most common congenital diaphragmatic hernia (CDH). It can rarely evade prenatal detection and persist into adulthood with minimal symptoms. Large CDH repair has often required an open approach in the past.

Tracheal Transection From Gunshot Wound to the Neck.

A male patient presented with a gunshot wound superior to his left scapula and difficulty breathing. En route to the emergency department, he rapidly became unresponsive, culminating in a cricothyroidotomy by paramedics. Oxygen saturation was 70% on arrival, and a tracheobronchial injury was suspected.

Fundic gastropexy for high risk of recurrence laparoscopic hiatal hernia repair and esophageal sphincter augmentation (LINX) improves outcomes without altering perioperative course.

Background: The aim of this study is to show that the addition of a fundic gastropexy to a laparoscopic hiatal hernia repair (HHR) and magnetic sphincter augmentation (MSA) with LINX (Johnson and Johnson, New Brunswick, NJ) in patients with high risk for hiatal hernia recurrence improves outcomes without altering perioperative course.

Methods: An IRB approved, single institution retrospective review of patient outcomes after hiatal hernia repair with magnetic sphincter augmentation was performed. Data were obtained from the electronic health record and stored in a REDCap database.

Establishment of a per oral endoscopic myotomy program at a rural tertiary care center.

Background: This study's purpose is to determine the application and effectiveness of a POEM program in the rural healthcare setting. Achalasia has a substantial impact on the lives of afflicted patients. Traditionally, a Heller myotomy with fundoplication has been the standard of care for treatment.

Robotic-Assisted Thoracoscopic Repair of Right-Sided Bochdalek Hernia in Adults: A Two-Case Series.

Bochdalek hernia is a congenital diaphragmatic hernia that presents rarely in adulthood. Because of the paucity of cases, no standard repair technique has been identified. Here we present two cases of robotic, thoracoscopic repair of this rare hernia defect.

ACR Appropriateness Criteria Chronic Dyspnea-Noncardiovascular Origin.

Chronic dyspnea may result from a variety of disorders of cardiovascular, pulmonary, gastrointestinal, neuromuscular, systemic, and psychogenic etiology. This article discusses guidelines for the initial imaging of six variants for chronic dyspnea of noncardiovascular origin: (1) Chronic dyspnea of unclear etiology; (2) Chronic dyspnea with suspected chronic obstructive pulmonary disease; (3) Chronic dyspnea with suspected central airways disease; (4) Chronic dyspnea with suspected interstitial lung disease; (5) Chronic dyspnea with suspected disease of the pleura or chest wall; and (6) Chronic dyspnea with suspected diaphragm dysfunction. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel.

ACR Appropriateness Criteria Acute Respiratory Illness in Immunocompetent Patients.

Acute respiratory illness, defined as cough, sputum production, chest pain, and/or dyspnea (with or without fever), is a major public health issue, accounting for millions of doctor office and emergency department visits every year. While most cases are due to self-limited viral infections, a significant number of cases are due to more serious respiratory infections where delay in diagnosis can lead to morbidity and mortality. Imaging plays a key role in the initial diagnosis and management of acute respiratory illness.

Screening Patients with Esophageal Cancer to Determine Eligibility for Adjuvant Treatment Trials.

Background: The tolerability of adjuvant chemotherapy in esophageal cancer is unclear.

Patients And Methods: This was a phase II trial of adjuvant paclitaxel in patients with esophageal cancer after trimodality treatment. Patients with residual viable tumor after resection were eligible for study inclusion.

Delay in Oral Feeding is Associated With a Decrease in Anastomotic Leak Following Transhiatal Esophagectomy.

The cervical anastomotic leak is a major complication of transhiatal esophagectomy and results in chronic strictures in up to half of patients. A change in postoperative protocol to delaying initiation of oral intake was made with the goal of reducing anastomotic leak rate and associated sequelae. A postoperative protocol change was applied to all patients undergoing elective transhiatal esophagectomy.

Does cramming work? Impact of National Web-Based Thoracic Surgery Curriculum login frequency on thoracic surgery in-training exam performance.

Objective: Web-based curricula provide login data that can be advantageously used to characterize and analyze study habits. We sought to compare thoracic surgical trainee In-Training Examination percentiles with regard to their study habits (ie, cramming), as characterized by curriculum login frequency to the national Web-based Thoracic Surgery Curriculum. Furthermore, we then aimed to characterize the curriculum login frequency of trainees as stratified by their performance on the In-Training Examination and their improvement on the In-Training Examination over subsequent years.

ACR Appropriateness Criteria Suspected Pulmonary Hypertension.

Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations that may be helpful in diagnosing and determining the etiology of pulmonary hypertension are discussed. Imaging examinations that may aid in the diagnosis of pulmonary hypertension include chest radiography, ultrasound echocardiography, ventilation/perfusion scans, CT, MRI, right heart catheterization, pulmonary angiography, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT.

Impact of Moodle-Based Online Curriculum on Thoracic Surgery In-Training Examination Scores.

Background: The feasibility and efficacy of a web-based curriculum in supplementing thoracic surgical training was previously shown. However, the impact of curricular participation on validated knowledge tests remains unknown. We compared in-service training examination (ITE) results among trainees, stratified by curricular use.

Are There Gaps in Current Thoracic Surgery Residency Training Programs?

Background: Cardiothoracic surgery is rapidly evolving to adapt to a changing health care environment and a wider application of innovative techniques. The Society of Thoracic Surgeons Workforce on Thoracic Surgery Resident Issues Transition to Practice Task Force sought to identify new or existing gaps of training in contemporary thoracic surgery residency training programs.

Methods: A voluntary survey consisting of 24 questions was distributed to recent graduates of thoracic surgery residency programs in the United States during the 2014 American Board of Thoracic Surgery oral examination application process.

Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy.

Background: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy.

Methods: Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated.