Surgical Training for a Disaster: Preparation of Surgical Trainees for Victims of Conflict.

Introduction: With increasing global unrest and military physician shortages potentially leading to a surgeon draft, we sought to evaluate the readiness of graduating general surgery residents to care for casualties of war.

Materials And Methods: We evaluated the National Data Reports of Surgery Case Logs for general surgery residents from 2009 to 2018 to quantify experience with key procedures that provide critical skills required for wartime surgery. Reported cases from the Accreditation Council for Graduate Medical Education for graduating residents from civilian and military residency programs were analyzed for 28 individual procedures determined to be critical for the care of combat casualties.

Maintaining Wellness and Instilling Resilience in General Surgeons.

Obtaining wellness and enhancing resilience will be increasingly more important for General Surgeons. Although these concepts are not new, the increased complexity of health care delivery has elevated the importance of these essential attributes. Instilling these practices should be emphasized during surgery residency and be modeled by surgical educators and surgeon leaders.

Phase I Trial of Encapsulated Rapamycin in Patients with Prostate Cancer Under Active Surveillance to Prevent Progression.

No approved medical therapies prevent progression of low-grade prostate cancer. Rapamycin inhibits cell proliferation and augments immune responses, producing an antitumor effect. Encapsulated rapamycin (eRapa) incorporates rapamycin into a pH-sensitive polymer, ensuring consistent dosing.

Mobile Smartphone Thermal Imaging Characterization and Identification of Microvascular Flow Insufficiencies in Deep Inferior Epigastric Artery Perforator Free Flaps.

Background: Mobile smartphone thermal imaging (MTI) devices correlate with blood flow, which makes them appealing adjuncts during reconstructive surgery. MTI was assessed in the setting of deep inferior epigastric artery perforator (DIEAP) free flaps. We hypothesized that MTI can be a surrogate for blood flow to identify microvascular flow insufficiencies.

Focused Changes in Opioid Prescribing Yield Far-reaching Benefits Through Culture Change and Attention to Opioid Minimization.

Objective: Standardization of prescriptions after specific procedures (laparoscopic appendectomy, cholecystectomy, inguinal/umbilical hernia repair) significantly reduces opioid prescriptions for these targeted procedures. We sought to determine the impact of increased attention to responsible opioid prescribing in the absence of protocolization.

Design: Prescription practices of Laparoscopic Sleeve Gastrectomies and Roux-en-y Gastric Bypasses at a tertiary medical center (October 1, 2016-September 30, 2018) were retrospectively reviewed.

Senior surgical resident autonomy and teaching assistant cases: A prospective observational study.

Introduction: Teaching assistant (TA) cases allow senior residents (SR) to gain autonomy. We compared the safety profiles of TA cases performed under direct vs. indirect staff supervision.

Stemming the Tide of Opioid Addiction-Dramatic Reductions in Postoperative Opioid Requirements Through Preoperative Education and a Standardized Analgesic Regimen.

Introduction: Surgery is a known gateway to opioid use that may result in long-term morbidity. Given the paucity of evidence regarding the appropriate amount of postoperative opioid analgesia and variable prescribing education, we investigated prescribing habits before and after institution of a multimodal postoperative pain management protocol.

Materials And Methods: Laparoscopic appendectomies, laparoscopic cholecystectomies, inguinal hernia repairs, and umbilical hernia repairs performed at a tertiary military medical center from 01 October 2016 until 30 September 2017 were examined.

Poor compliance despite equal access: Military experience with screening breast MRI in high risk women.

Background: Using the military as a model for an equal-access, no-cost healthcare system, we sought to (1) describe screening breast MRI compliance rates and (2) identify patient-perceived barriers to screening.

Methods: In this retrospective cohort study of a prospectively maintained database at a tertiary level center, we compared compliance among women at ≥20% risk of developing breast cancer (Tyrer-Cuzick) and conducted structured phone interviews with women at ≥30% risk.

Results: From 2015 to 2016, 1,052 women met criteria for screening MRI.

Sage wisdom or anecdotal dictum? Equivalent opioid use after open, laparoscopic, and robotic inguinal hernia repair.

Background: Purported benefits of minimally-invasive inguinal hernia repair techniques include less postoperative pain, but objective data is lacking. We analyzed prescribing habits and opiate requirements to provide an objective comparison.

Methodology: Inguinal hernia repairs performed on patients aged 18-65 from October 2016 through February 2018 were examined.

Is bigger better? Twenty-year institutional experience of atypical ductal hyperplasia discovered by core needle biopsy.

Objectives: The increasing accuracy of large-bore (11- or 8-gauge) vacuum-assisted core needle biopsies (VACNB) has challenged the commonly-accepted practice that surgery is needed for definitive diagnosis when atypical ductal hyperplasia (ADH) is found on VACNB. This study seeks to demonstrate the impact of increased VACNB caliber on the pathologic upgrade rate of ADH.

Methods: Patients diagnosed with isolated ADH by VACNB who subsequently underwent surgical excision at our tertiary medical center were retrospectively studied.

Cost-effectiveness of simultaneous resection and RFA versus 2-stage hepatectomy for bilobar colorectal liver metastases.

Background And Objectives: The current healthcare climate demands evaluation of treatment modalities in terms of costs and benefits. We compared the cost-effectiveness of two different strategies for bilobar colorectal liver metastases (bCRLM).

Methods: Patients with bCRLM treated with either resection/RFA or planned 2-stage hepatectomy at our institution between 1999 and 2011 were reviewed.

Pain management in the pediatric surgical patient.

Surgeons performing painful, invasive procedures in pediatric patients must be cognizant of both the potential short- and long-term detrimental effects of inadequate analgesia. This article reviews the available tools, sedation procedures, the management of intraoperative, postoperative, and postprocedural pain, and the issues surrounding neonatal addiction.

Incidence of low vitamin A levels and ocular symptoms after Roux-en-Y gastric bypass.

Background: Previous reports have demonstrated a significant incidence of fat-soluble vitamin deficiency after bariatric surgery. The purpose of the present study was to determine the incidence of vitamin A deficiency after Roux-en-Y gastric bypass and to correlate the laboratory findings with ocular symptoms potentially related to vitamin A deficiency.

Methods: All patients who had undergone Roux-en-Y gastric bypass were invited to participate in a nutritional screening.

The treatment of radial scars in the modern era--surgical excision is not required.

The clinical significance of isolated radial scars (RS) diagnosed on core needle biopsy (CNB) remains unclear. By determining the pathologic concordance rate, we sought to define the indications for surgical excision for RS diagnosed on CNB. Between January 1994 and December 2007, 38 RS were diagnosed by CNB.

Temperature control and the role of supplemental oxygen.

Unrecognized and untreated intraoperative hypothermia remains a common avoidable scenario in the modern operating room. Failure to properly address this seemingly small aspect of the total operative care has been shown to have profound negative patient consequences including increased incidence of postoperative discomfort, surgical bleeding, requirement of allogenic blood transfusion, wound infections, and morbid cardiac events. All of these ultimately lead to longer hospitalizations and higher mortality.

Functional and survival outcomes in traumatic blunt thoracic aortic injuries: An analysis of the National Trauma Databank.

Objective: Blunt thoracic aortic injury (BAI) remains a leading cause of trauma deaths, and off-label use of endovascular devices has been increasingly utilized in an effort to reduce the morbidity and mortality in this population. Utilizing a nationwide database, we determined the incidence of BAI, and analyzed both functional and survival outcomes at discharge compared with matched controls.

Methods: Patients with BAI were identified by International Classification of Disease-9 codes from the National Trauma Data Bank (Version 6.

Efficacy of three topical hemostatic agents applied by medics in a lethal groin injury model.

Background: Advanced topical hemostatic agents are increasingly utilized to control traumatic hemorrhage. We sought to determine the efficacy of three chitosan based hemostatic agents in a lethal groin injury model when applied by combat medic first responders.

Methods: After creation of a standardized femoral artery injury in a goat model, medics attempted hemorrhage control with standard gauze dressing followed by randomization to one of three hemostatic agents in this two tiered study.

Bioprosthetic repair of complex duodenal injury in a porcine model.

Background: Complex duodenal injury remains a challenging problem for the trauma surgeon. Although primary repair of small injuries is often possible, extensive damage requires complex enteric reconstruction and drainage procedures. We sought to determine the efficacy of a bioprosthetic repair for large duodenal wounds in a porcine model.

Demographics, treatment, and early outcomes in penetrating vascular combat trauma.

Objectives: To describe arterial and venous injuries and their management and short-term outcomes in a wartime hospital.

Design: Retrospective review of patients with vascular injuries. Mechanism, location, method of repair, and outcomes were analyzed with descriptive and inferential statistics.

A comparison of open versus closed techniques using the Harmonic Scalpel in outpatient hemorrhoid surgery.

Background: Surgical excision using the Harmonic Scalpel is a modern technique for symptomatic third- and fourth-degree hemorrhoids. The resulting mucosal defect is then left open or sutured closed depending on surgeon preference.

Purpose: The purpose of this study was to compare the open vs.

Ultrasound-guided access improves rate of access-related complications for totally percutaneous aortic aneurysm repair.

Previous experience with totally percutaneous aortic aneurysm repair has identified morbid obesity and larger sheath sizes (> or =20F) as complicating factors for percutaneous access closure. We sought to evaluate the impact of ultrasound-guided femoral access on rates of technical success, conversion to open femoral repair, and access-related complications. A retrospective review of a prospectively maintained database was performed.

Race does not impact colorectal cancer treatment or outcomes with equal access.

Background: Ethnicity is implicated as a factor for disparate outcomes in colorectal cancer. We sought to evaluate this relationship at a military medical center organized to deliver equitable health care.

Methods: Retrospective analysis of colorectal cancer patients comparing demographics, grade, American Joint Committee on Cancer (AJCC) stage, and adjuvant therapy.

Incidental pathologic findings in open resectional gastric bypass specimens with routine cholecystectomy and appendectomy.

Background: Morbid obesity has become a public health epidemic in the United States. With this epidemic, the demand for surgical intervention has led to rapid growth in the field of bariatric surgery. Although various procedures exist, one of the procedures offered at our institution is resectional Roux-en-Y gastric bypass with incidental cholecystectomy and appendectomy.

Colonic ischemia complicating open vs endovascular abdominal aortic aneurysm repair.

Objective: Colonic ischemia (CI) is a known complication of both open abdominal aortic aneurysm (AAA) repair and endovascular aneurysm repair (EVAR). Despite a relatively low incidence of 1% to 6%, the associated morbidity and mortality are high. We sought to analyze factors that affect the development of CI on the basis of type of repair as well as associated outcomes from a large nationwide database.