Introductory Video as a Supplemental Application for General Surgery Residency Candidates: Concept, Implementation, Preliminary Outcomes, and Future Directions.

Objective: The residency selection process has changed dramatically over the past several years, primarily due to the COVID-19 pandemic causing a transition to virtual interviews and limiting sub-internship opportunities. Another new major change is the transition of the USMLE Step 1 examination from a numerical score to pass/fail as of January 2022. In anticipation of this major change, our program asked applicants to submit a short video clip expressing their interest.

Components of high-resolution manometry that change surgical decisions.

Background: High-resolution manometry (HRM) is vital in evaluating patients for surgery at the gastroesophageal (GE) junction. Previously, we reported manometry alters surgery choices at the GE junction over 50% of the time, and its components, i.e.

Inverted Meckel's Diverticulum Causing Adult Intussusception after Blunt Trauma.

Meckel's diverticulum is an uncommon though well described clinical entity. There are few cases of a Meckel's diverticulum having been identified as the lead point for adult intussusception. We report the surgical management of a 45-year-old patient with an inverted Meckel's diverticulum causing distal ileal intussusception after blunt abdominal trauma requiring small bowel resection.

Perforated Appendicitis With Migrated Inguinal Mesh Involvement.

Mesh-plug hernioplasty has been recognized as a safe and effective surgical repair for primary inguinal hernias and is a common procedure in the United States. Critics of the mesh-plug system describe erosion, migration, and chronic pain as reasons not to employ mesh plugs in primary hernia repair. To our knowledge, mesh graft infection associated with perforated acute appendicitis has been documented only once before in the surgical literature, highlighting an exceedingly rare but possible complication.

Clinical and Financial Implications of Consulting Physicians in the Management of Surgical Patients.

Background: The present study was designed to evaluate the immediate consequences that the number of consulting physicians has on length of stay (LOS), in-hospital mortality, 30-day readmission rates, direct health care costs, and contribution margins.

Methods: A retrospective review of administrative databases for the years 2013 and 2014 was performed at the Florida Hospital Adventist Healthcare System.

Results: 11 274 patients were included in the analysis.

Mycotic Superior Mesenteric Artery Aneurysm: Case Report and Literature Review.

Superior mesenteric artery (SMA) aneurysm is the third most common splanchnic artery aneurysm. A 73-year-old woman presented with a minimally symptomatic SMA aneurysm, which was resected by laparoscopic surgical technique. The patient recovered quickly and remained well after 8 months of follow-up.

Early experience with the Senhance®-laparoscopic/robotic platform in the US.

The introduction of new robotic platforms will grow considerably in the near future as several manufacturers are in the developing stages of different innovative systems. One of the newest systems, the Senhance® platform (TransEnterix Surgical Inc., Morrisville, NC, USA) has been utilized in a variety of cases in Europe but only recently approved for limited clinical use in the United States.

Routine versus selective upper gastrointestinal contrast series after omental patch repair for gastric or duodenal perforation.

Background: There are no guidelines on the routine or selective use of contrast upper gastrointestinal series (UGI) after omental patch repair (OPR) of a gastric (GP) or duodenal perforation (DP). This study aims to elucidate whether the use of selective versus routine contrast study will lead to worse clinical outcomes.

Methods: A retrospective analysis of 115 (n = 115) patients with OPR of GP or DP was performed.

Approach to patients with esophageal Dysphagia.

Patients frequently present to a physician with complaints of difficulty swallowing. The approach to systematically evaluating these problems can be challenging for those who do not manage this type of patient regularly. The potential for life-threatening malignancies is present and makes this evaluation a priority.

Emission reductions from woody biomass waste for energy as an alternative to open burning.

Woody biomass waste is generated throughout California from forest management, hazardous fuel reduction, and agricultural operations. Open pile burning in the vicinity of generation is frequently the only economic disposal option. A framework is developed to quantify air emissions reductions for projects that alternatively utilize biomass waste as fuel for energy production.

Inclusion of a nitric oxide congener in the insufflation gas repletes S-nitrosohemoglobin and stabilizes physiologic status during prolonged carbon dioxide pneumoperitoneum.

A method to maintain organ blood flow during laparoscopic surgery has not been developed. Here we determined if ethyl nitrite, an S-nitrosylating agent that would maintain nitric oxide bioactivity (the major regulator of tissue perfusion), might be an effective intervention to preserve physiologic status during prolonged pneumoperitoneum. The study was conducted on appropriately anesthetized adult swine; the period of pneumoperitoneum was 240 minutes.

Use of endoscopic stents to treat anastomotic complications after bariatric surgery.

Background: Complications after bariatric surgery often require longterm parenteral nutrition to achieve healing. Recently, endoscopic treatments have become available that provide healing while allowing for oral nutrition. The purpose of this study was to present outcomes of the largest series to date treating staple line complications after bariatric surgery with endoscopic covered stents.

Detecting pheochromocytoma: defining the most sensitive test.

Objective: To define the most sensitive biochemical test to establish the diagnosis of pheochromocytoma and also to assess the potential role of iodine 131-labeled metaiodobenzylguanidine scintigraphy (I-MIBG) in the diagnosis of this tumor.

Summary Background Data: Pheochromocytoma is a rare, catecholamine-producing tumor with preferential localization in the adrenal gland. Despite its importance, the most sensitive test to establish the diagnosis remains to be defined.

A review of surgical simulation with attention to validation methodology.

The use of simulation technology for teaching and evaluating surgical skills has gained considerable attention in recent years. This is driven by interest in quality of care, concerns over increasing operative complexity, constraints on the use of animal models, limited available patient material, medicolegal pressures, and fiscal mandates for cost-effective performance. Traditional mechanical models are yielding to techniques dependent on electronic technology, including virtual reality.

General anesthesia improves fetal cerebral oxygenation without evidence of subsequent neuronal injury.

Anesthetic exposure during pregnancy is viewed as a relatively routine medical practice. However, recent rodent studies have suggested that common anesthetic agents can damage the developing brain. Here we assessed this claim in a higher order species by exposing previously instrumented near-term pregnant sheep at gestational day 122 (+/-1) to a combination of midazolam, sodium thiopental, and isoflurane at clinically relevant doses and means of anesthetic delivery (i.

A method to attenuate pneumoperitoneum-induced reductions in splanchnic blood flow.

Objective: To determine if increasing nitric oxide bioactivity by inclusion of ethyl nitrite (ENO) in the insufflation admixture would attenuate pneumoperitoneum-induced decreases in splanchnic perfusion.

Summary Background Data: Organ blood flow is reduced during pneumoperitoneum and can contribute to laparoscopy-associated morbidity and mortality. Previous attempts to control such decreases in flow have been ineffective.

Maternal insufflation during the second trimester equivalent produces hypercapnia, acidosis, and prolonged hypoxia in fetal sheep.

Background: Anecdotal reports suggest that the second trimester is the safest time to conduct a laparoscopic procedure on a pregnant patient, but this supposition has not been tested empirically.

Methods: Previously instrumented preterm sheep (total n = 8) at gestational day 90 (term, 145 days) were anesthetized and then insufflated with carbon dioxide for 60 min at a pressure of 15 mmHg. Cardiovascular parameters were continuously recorded while blood gas status was determined before and at 15-min intervals during and up to 2 h after insufflation.

Robotically assisted laparoscopic Roux-en-Y hepaticojejunostomy.

Introduction: This study evaluates the feasibility and safety of using robotically assisted laparoscopy to perform a Roux-en-Y hepaticojejunostomy. This new method was compared with the open and standard laparoscopic approaches.

Methods: Eighteen pigs underwent a needlescopic common bile duct ligation to create a jaundice model.

A randomized comparison of a multimodal management strategy versus combination antiemetics for the prevention of postoperative nausea and vomiting.

A multimodal management strategy for the prevention of postoperative nausea and vomiting (PONV) appears to be superior to single-drug prophylaxis. We tested the hypothesis that a multimodal PONV prophylaxis regimen incorporating total IV anesthesia (TIVA) with propofol and a combination of ondansetron and droperidol is more effective than a combination of these antiemetics in the presence of an inhaled anesthetic. Ninety patients undergoing laparoscopic cholecystectomy were randomized to one of three groups.

Laparoscopic appendectomy in the elderly.

Background: Evidence suggests that laparoscopic appendectomy (LA) has advantages over open appendectomy (OA) in the treatment of appendicitis. It remains, however, unclear whether LA is indicated in the elderly patient population.

Methods: Patients with primary International Classification of Diseases, revision 9, procedure codes for LA (n=32406 patients) and OA (n=112884 patients) were selected from the 1998, 1999, and 2000 Nationwide Inpatient Samples.

A review of laparoscopy for non-obstetric-related surgery during pregnancy.

Purpose: Similar to the general population, parturients (and their fetuses) could benefit from the reduced manipulation associated with laparoscopy. The purpose of this article is to review the current state of knowledge (both clinical and experimental) with respect to the fetal effects of maternal laparoscopy for non-obstetric-related surgery during pregnancy.

Methods: Human and experimental animal results are examined, and we present preliminary data from our own laboratory.

Laparoscopic Nissen fundoplication for treating reflux in lung transplant recipients.

Gastroesophageal reflux disease may contribute to pulmonary injury and the development of bronchiolitis obliterans syndrome in lung transplant patients. As a result, such individuals are increasingly likely to undergo corrective gastrointestinal surgery. The present study collected outcome data for 28 lung transplant patients with documented reflux who underwent an uncomplicated laparoscopic Nissen fundoplication at our institution.