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  Improving Treatment for Infant Perianal Abscesses

  Artem Dadamyan, Nathan Novotny, and Ngan Nguyen

  Publication Date: 5-2025

  Perianal abscesses: • Tender masses located at the anal verge, typically in the 3 o’clock and 9 o’clock positions1

  • Develop due to infection in abnormally deep crypts of Morgagni 1

  • If left untreated, can extend into the ischioanal space or intersphincteric space since these areas are continuous with the perianal space.2

  • Some may develop into fistula in ano, which can be difficult to treat3 Treatment:

  • The standard has always been incision and drainage (I&D), but non-invasive management of Sitz baths is increasingly being used.

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  Enhancing Reproductive Anatomy Education: A Comprehensive Approach Integrating Near-Peer and Reciprocal Peer Tutoring

  Hope Hefferan, Emelie-jo Scheffler, Erin Mueller, and Varna Taranikanti

  Publication Date: 5-2025

  • Near-peer tutoring (NPT): Tutors are more advanced than tutees, typically offering support in understanding complex concepts.1

  • Reciprocal peer tutoring (RPT): Students with similar levels of training alternate between tutor and tutee roles, facilitating collaborative learning.1

  • Peer tutoring fosters professional development and improves long-term retention of complex medical concepts.3,4,5

  • Reproductive anatomy is a challenging area for many medical students; Innovative peer tutoring methods may help improve understanding and retention of anatomical structures.

  • We hypothesize that integrating NPT and RPT within the laboratory setting in the reproductive organ system course will enhance student motivation, self-efficacy, and long-term retention of reproductive anatomical structures.

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  Safety and Utility of Robotics in Pediatric Surgery: Implementation

  Luke J. Man, Kristin LeMarbe, Nathan Novotny, Anthony Stallion, Begum Akay, and Pavan Brahmamdam

  Publication Date: 5-2025

  • Minimally invasive laparoscopic surgery is considered standard of care for adult and pediatric patients .

  • Robotic surgery (RS) for adult patients has been widely adopted due to superior ergonomics, visualization, depth perception, and access to deeper anatomical structures2,3.

  • Historically, RS is associated with longer operative times, higher cost, and lacks haptic feedback1,2.

  • RS has had inconsistent adoption in the pediatric surgery community2.

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  The Effect of the Adoption of the National Accreditation Program for Rectal Cancer Process on Compliance Standards at A Single Institution

  Garrett W. Peters, Gregory Thomas, Jacob A. Applegarth, Forrest Bohler, Shelli Bergeron, and Harry J. Wasvary

  Publication Date: 5-2025

  • The National Accreditation Program for Rectal Cancer (NAPRC) was developed to decrease variability and increase a multidisciplinary approach among rectal cancer care.

  • There is considerable variability among institutions in compliance with the “Patient Care: Expectations and Protocols” standards, and it is unclear how compliance changes once an institution undergoes the accreditation process.

  • Corewell Health William Beaumont University Hospital (formerly Beaumont Hospital, Royal Oak) is a large-volume institution that adopted the NAPRC process into clinical practice starting in August 2019.

  • In this study, we evaluate institutional compliance before and after NAPRC accreditation adoption was undertaken.

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  Implementation of an Opioid Free Pediatric Hernia Repair Protocol

  Corey Shafer, Antonela Muca, Randy Hilleary, Kristin LeMarbe, Diane Studzinsk, Kaveh Aslani, Nathan Novotny, Pavan Brahmamdam, and Begum Akay

  Publication Date: 5-2025

  Surgery most often provides children with their first exposure to opioids which may lead to misuse and overuse. Protocolizing pain management perioperatively can reduce opioid exposure in children while still providing adequate pain management.

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  Does the possibility of no surgery in watch and wait for rectal cancer affect patient decision-making?

  Joanna F. Wasvary, Ga-ram Han, Jacob A. Applegarth, and Matthew A. Ziegler

  Publication Date: 5-2025

  INTRODUCTION & OBJECTIVE

  Prior studies have established that the watch and wait protocol for rectal cancer is a reasonable approach in patients with excellent response to total neoadjuvant therapy (TNT). Current guidelines stipulate that patients eligible for this protocol have no residual tumor on re-staging imaging and endoscopy. Patients who have evidence of residual disease are referred for surgery. This study assessed all patients in our institution who underwent TNT for rectal cancer and the subsequent recommendations for treatment. Primary aim: assess patient compliance with surgeon recommendations for residual disease after TNT.

  Secondary aim: assessment of oncologic outcomes and the rate of complete pathologic response after surgery.

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  Surgical Site Infection Bundle For Babies: Preliminary Data

  Cullen Woodley, John Nida, Alexis Lonjin, Katelyn Ward, Diane Studzinski, and Begum Akay

  Publication Date: 5-2025

  Surgical Site Infections (SSIs) are infections that occur in or around the area where a surgery was recently performed. They are estimated to account for 20% of all healthcare associated infection, and lead to an increase in morbidity and mortality. Perioperative care bundles show promise in reducing SSIs in adults but are not often used in neonatal surgery. Infections in babies after surgery are less common than adults but carry significant morbidity in a fragile patient.

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  Incidence of Symptomatic Upper Extremity Deep Vein Thrombosis in Respect to Subcutaneous Port Venous Access Site in Adults: A Retrospective Review

  Catherine Bark, Alexsandra Biel, Corinne G. Bowditch, Paul Bove, and Jimmi Mangla

  Publication Date: 5-2024

  Subcutaneous ports are an essential component of care in patients who require long-term central venous access and are commonly indicated for patients that require chemotherapy, infusions, intravenous (IV) antibiotics or frequent blood draws.1,2 The catheter of the subcutaneous port is commonly inserted through the subclavian vein and internal jugular vein via percutaneous insertion, or the external jugular vein and cephalic vein via surgical cutdown of the vein.

  One of the most common port-related complications is venous thromboembolic (VTE) events with rates of symptomatic VTE as high as 13.6%.4,6–11 Patients with symptomatic upper extremity deep vein thrombosis (DVT) can present with symptoms of ipsilateral arm or neck swelling, pain, and erythema.

  The purpose of this study is to evaluate the rate of symptomatic upper extremity deep vein thrombosis based on the subcutaneous port venous access site.

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  A Retrospective Review of Cosmetic Surgery Medical Tourism Complications During COVID-19 Pandemic

  Rachel Blaisdell, Claire McNary, Catherine Barkach, Emanuela Peshel, Elizabeth Boudiab, Lauren Oliver, and Samuel Mucci

  Publication Date: 5-2024

  • Cosmetic surgery medical tourism refers to traveling outside one’s geographic region for the purpose of a cosmetic procedure
  • Benefits include reduced cost, shorter wait times, and newer “trendy” procedures
  • Potential problems include a lack of continuity of care for patients, travel after surgery, and exposure to foreign pathogens

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  Presentation of Ductal Carcinoma in Situ in a Supernumerary Nipple

  Lianne Caceres, Killian Llewellyn, Basma Klump, Miles Menuck, and Cynthia Sandona

  Publication Date: 5-9-2024

  Supernumerary breast tissue is ectopic breast tissue that communicates with the breast skin, nipple or areola (1).

  Approximately 5.6% of the population exhibits supplementary breast tissue (2).

  To date, the National Comprehensive Cancer Network does not provide monitoring and management guidelines for ectopic breast DCIS.

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  Trends in Thoracic Endovascular Aortic Repair in Patients 45 Years Old and Younger

  Brandon Diaz, Alexander Chen, Graham W. Long, Rose Callahan, Diane Studzinski, and Otto W. Brown

  Publication Date: 3-2024

  Objective:Thoracic endovascular aortic repair (TEVAR) is now the preferred method of repair for most aortic pathology. This report explores the indications, morbidity, and long-term implications of TEVAR in patients under 45 years old.
  /="/">Methods:This is a retrospective, single-institution study of electronic medical records for all patients under age 45 years treated with TEVAR from July 2006 to December 2022. Data collected included demographics, comorbidities, and 30-day and long term outcomes, including medical and aortic-related complications.
  /="/">Results:The study cohort consisted of 30 patients, mean age 32 years, 22 males (73.3%), 10 (33.3%) with hypertension, and 15 (50%) were smokers. There were 16 (53.3%) traumatic disruptions, 1 (3.3%) aneurysm, 1 (3.3%) penetrating atherosclerotic ulcer, and 12 (40%) dissections (7 Type A and 5 Type B). Three patients died within 30 days of their procedure for a perioperative mortality rate of 10%; the interval from procedure to death was a mean 4.3 days (SD ± 3.8). Twenty-one had at least 1 follow-up visit post-TEVAR and 22 underwent at least one follow-up imaging study. Thirty-day morbidity overall was 50% and included endoleak in 6 (20%), cardiac complications in 5 (16.7%), renal failure in 7 (23.3%), spinal cord ischemia in 1 (3.3%), graft failure in 1 (3.3%), limb ischemia in 3 (10%), and multi-system organ failure in 3 (10%). Of the 22 patients with follow-up imaging, endovascular reinterventions were required in 4 (18.2%), while open surgical reintervention was necessary in 1 (4.5%). Reinterventions occurred at a median of 3.7 months postoperatively (0.7-60.8) and were indicated for 1 expanding aneurysm, 3 endoleaks, and 1 for combined endoleak and expanding aneurysm. There was one late death at 1.1 months (aortic-related) and another deceased patient whose cause and date of death are unknown.
  /="/">Conclusion: Historically, patients that undergo TEVAR for underlying aortic pathologies, especially young patients, are followed long-term to monitor for further aortic degeneration and possible reintervention. In our study, majority of all reinterventions (80%) occurred within 1 year. However, all patients with traumatic aortic disruption who underwent TEVAR did not require any reintervention upon follow-up imaging. These patients may not require surveillance past one year

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  Emergency Department Treatment of Elevated Blood Pressure in the Headache Patient

  Lauren Eberhardt, Michelle Jankowski, and Brett Todd

  Publication Date: 5-2024

  • Headache is an extremely common emergency department (ED) chief complaint, accounting for 1-3% of emergency department (ED) visits per year globally.
  • Headache is often associated with elevated blood pressure and the most frequent clinical manifestation of hypertensive urgency, occurring in 35.9% of patients.5
  • First line treatments used for acute headache management in the ED include intravenous fluid (IVF), anti-dopaminergic agents, aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), and ketorolac.6
  • Rescue analgesia is needed for pain management in 16% to 18.1% of patients.8,9.
  • Rescue analgesia includes: additional doses of first line analgesia or initiation of a second line medication1,6,10,11 such as magnesium sulfate, anti-epileptics, nerve blocks, and ketamine.6
  • It is unclear if the headache is the cause of elevated blood pressure or if elevated blood pressure results in pain and distress.
  • An improved understanding of this relationship could provide guidance to ED physicians managing headache patients with elevated blood pressure.

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  Water-Soluble Contrast Challenge in the Management of Pediatric Adhesive Small Bowel Obstruction: A Systematic Review

  Max Fliegner, Daniel Finn, Spencer Wilhelm, Nathan Novotny, and Anthony Stallion

  Publication Date: 5-2024

  Background: Adhesive small bowel obstruction (ASBO) is a serious complication of intra-abdominal surgery1 Water-soluble contrast (WSC) challenges have been used for medical management in the adult population2,3

  Knowledge Gap: The therapeutic value of water-soluble contrast challenge in the pediatric population with ASBO is under-studied3,4

  Research Question: Does administration of water-soluble contrast challenge reduce the need for surgery in pediatric patients with adhesive small bowel obstruction?

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  Utility of Great Saphenous Vein Mapping in the Detection of Superficial Vein Thrombosis Prior to Infrainguinal Arterial Bypass

  Melissa C. Hetrick, Ashley E. Beale, Graham W. Long, Sarvar Oreizi-Esfahani, Rose E. Callahan, Diane M. Studzinski, and Otto W. Brown

  Publication Date: 3-2024

  OBJECTIVE: The great saphenous vein (GSV) is widely used as a bypass conduit for the treatment of infrainguinal peripheral arterial disease. Preoperative vein mapping assesses both the quality and diameter of the GSV. Ultrasound findings regarded as unfavorable are the presence of superficial vein thrombosis (SVT), ipsilateral deep vein thrombosis (DVT), and small vessel diameter. Identifying a suitable conduit is of utmost importance as GSV bypasses have improved patency compared to alternative conduits. The primary objective of this study was to identify the percentage of patients with ipsilateral SVT as well as patient characteristics associated with SVT and unsuitable GSV.
  /="/">METHODS: Retrospective, single-institution study from March 2013-December 2021. All patients with peripheral arterial disease who underwent outpatient vein mapping were included. Unsuitable GSV was defined by the presence of SVT, DVT, or size < 2.5 mm in any segment (from proximal thigh to distal calf).
  RESULTS: A total of 191 patients met inclusion criteria. Most patients were male (71.7%), Caucasian (69.8%), and the mean(SD) age was 68.6(10.8) years. Ipsilateral SVT was identified in 10.5% of patients. No significant differences in demographics or comorbidities were identified in patients with and without ipsilateral SVT. Less than half (45.8%) of patients had GSV that was greater than 2.5 mm throughout, and only one third (37.4%) had a GSV conduit of adequate size without SVT or ipsilateral DVT. GSV conduits of adequate size and without SVT or ipsilateral DVT were associated with male gender, 86.6% male vs 13.4% female (p=0.001, OR 3.6 (95% CI 1.6-8.2)). After completion of vein mapping, 90 (62.1%) patients underwent infrainguinal bypass and the ipsilateral GSV was used as a conduit in 58.9% of cases.
  /="/">CONCLUSIONS: Our study revealed that 10.5% of patients have SVT identified on preoperative vein mapping. Given these findings, routine preoperative venous duplex should be performed to assess for the presence of SVT, as this finding is difficult to identify intraoperatively and may predict lower patency rates. Veins identified as unsuitable, based on size criteria alone, should still be investigated intraoperatively with ultrasound or direct surgical exploration as vessel diameter, unlike SVT, is a dynamic finding.

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  Comparing Plastic Surgeon Operative Time for Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction

  Christopher J. Issa, Elizabeth M. Boudiab, Jeffrey DeSano, Neil S. Sachanandani, Jeremy Powers, and Kongkrit Chaiyasate

  Publication Date: 5-2024

  The deep inferior epigastric perforator (DIEP) flap has remained the gold standard for perforator flap reconstruction due to its consistent anatomy and low morbidity. Despite higher longterm patient satisfaction in autologous breast reconstruction compared to breast implants,1–3 implant-based reconstruction remains more common due to shorter operative time.

  Several studies have examined the issue of optimizing efficiency of autologous breast reconstruction but were typically performed in the context of immediate reconstruction. In our institution and others, however, two-stage delayed reconstruction is the norm — a tissue expander is placed at the first stage for preservation of the skin envelope; after expansion and any adjuvant therapies are completed, the expanders are removed and replaced with DIEP flaps in a second stage.

  The primary objective of this study was to compare the plastic surgeon’s operative time between DIEP flap reconstruction immediately following mastectomy (single-stage), versus immediate placement of tissue expander(s) followed by delayed DIEP flap reconstruction (two-stage). Secondary objectives included comparing total patient time under anesthesia and overall complications. We hypothesized that the operative time for the plastic surgeon to place tissue expanders and then return at a later date to perform free flap reconstruction would be the same or less than the time required for immediate flap reconstruction at the time of mastectomy.

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  Heart Rate Metrics in Surgical Residents Performing an Educational Task Under Stress

  Harkirat Jawanda, Kathryn K. Howard, and Rose E. Callahan

  Publication Date: 5-2024

  Although a moderate amount of stress can be beneficial for performance, excess stress can lead to a decrease in fine motor skills, focus, decision-making skills, and communication.1-3.

  • These effects can be especially detrimental in the operating room, where a stress-induced lapse in performance can lead to catastrophic outcomes for patients.
  • One unique stressor experienced by surgical residents is observation by an attending surgeon during procedures, which has been shown to lead to an increase in stress related behaviors.4
  • Mimicking the stress of the operating room in simulation environments presents the opportunity for residents to improve their ability to recognize and manage stress.

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  A Penetrating Neck Injury Resulting in Complete Transection of the Ipsilateral Common Carotid Artery, Delayed Contralateral Pneumothorax and Occult Esophageal Injury: A Case Report with a Multidisciplinary Approach to Management

  Michaela Knaggs, Christian Przeslawski, Peter Habib, Ahmed Ghamraoui, Caitlin Wahl, and Jeffrey Gerken

  Publication Date: 5-9-2024

  A 29-year-old male presented a zone one penetrating neck injury. He had a proximal common carotid artery and internal jugular vein injuries which were successfully managed with vessel ligation. Patient also had an occult esophageal injury at the junction of the cervical and thoracic esophagus which was successfully managed with wide drainage of the neck and right chest.

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  Nephrolithiasis Induced Hydronephrosis as an Unusual Pathology of Biliary Obstruction: A Case Report

  Michaela Knaggs, Lianne Strimpel, Christian Przeslawski, Erika Michelin, and Ahmed Tahawi

  Publication Date: 5-9-2024

  We present an interesting case of biliary obstruction secondary to mass effect of hydronephrosis from nephrolithiasis managed jointly between general and urologic surgery.

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  Effectiveness of a Modified Difficult Colonoscopy Score A Retrospective Review of General Surgeon Performed Colonoscopies at a Community Hospital

  Killian Llewellyn, Lianne Caceres, Christian Przeslawsk, Karen Childers, and John Parmely

  Publication Date: 5-9-2024

  Colonoscopy remains the mainstay of screening for colon cancer in the US and an essential operating room skill for general surgeons.

  A quality review was performed of general surgeons at a community hospital.

  Difficult Colonoscopy Score (DCS) was a score created to predict difficulty of colonoscopy which was defined as prolonged intubation time, need for external compression, or increased pain score [1]. We tested the utility in our community and resident-involved endoscopy department.

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  Rare paraneoplastic syndrome associated with colorectal malignancy

  Erika Michelin, Jordan Jay, Craig Gordon, and Cynthia Sandona

  Publication Date: 5-9-2024

  Paraneoplastic hypertrichosis lanuginosa acquisita (PHLA) is a rare paraneoplastic syndrome characterized by the global growth of fine hairs. PHLA’s dermatologic manifestation is similar to languo hair which is thin and unpigmented. Other associated symptoms include glossitis, weight loss and diarrhea. Though PHLA's etiology is unknown, this rare syndrome is strongly associated with malignancy. Specifically, colonic malignancies, especially when it manifests in female patients.

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  Perioperative Antibiotic Use in Neonatal General Surgery: A Survey of APSA Membership

  Samuel K. Osei, Ashley Williams, Diane Studzinski, Patrick Karabon, Begum Akay, and Pavan Brahmamdam

  Publication Date: 5-2024

  • Guidelines for antibiotic prophylaxis for surgical site infection (SSI) are widely used for adult patients.
  • There is limited data on prophylaxis in pediatrics, and there are no standardized guidelines for neonates.
  • Perioperative antibiotic use in neonates based on the surgeon’s preference.

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  Traumatic Thoracostomy Tube Management at a Community Hospital A Retrospective Review

  Christian Przeslawski, Peter Habib, Kita Mack, Vimal Love, Julie George, and Amelia Pasley

  Publication Date: 5-9-2024

  Thoracostomy tubes or chest tubes (CT) have been a mainstay in thoracic trauma treatment since the Vietnam war with their roots dating back to the 5th century. Trauma is the number one cause of death in the world, with chest trauma being the second highest cause of trauma related death. 18% of patients with a blunt thoracic injury require chest tube. Management varies widely and there is no general consensus on management.

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  Aberrant Diagnostic Imaging Resulting in Misdiagnosed Acute Perforated Appendicitis: A Case Report

  Christian , Przeslawski; Leanne Iorio; and Jeffrey Gerken

  Publication Date: 5-9-2024

  300,000 appendectomies are performed every year in the United States with lifetime risk of acute appendicitis in the United States is approximately 9%.

  We present a case where initial diagnostic imaging was consistent with perforated sigmoid diverticulitis with definitive diagnosis at the time of surgery being acute perforated appendicitis

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  Perforated Marginal Ulcer with Whipple History Operative Management

  Tyler Sauerbeck, Erika Michelin, and Logan Smith

  Publication Date: 5-9-2024

  1 day history of abdominal pain and vomiting.

  History of GERD, no active antacid usage.

  Pancreatic cancer history with Whipple 3 years prior.

  Social history of daily cigarette and smokeless. tobacco use, EtOH consumption half pint daily, and cocaine use.

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  Invasive Lobular Carcinoma of the Breast Presenting as Pneumoperitoneum with Omental and Retroperitoneal Metastasis: A Case Report

  Logan Smith, Christian Przeslawsk, Katie Sarraf, Steven Jones, and Raimundo Pastor

  Publication Date: 5-9-2024

  A 65 year old female presenting with abdominal pain and imaging findings of pneumoperitoneum was brought to the operating room and found to have a retroperitoneal mass and omental caking secondary to metastatic breast lobular carcinoma. Intra abdominal metastasis is rare however lobular carcinoma is more likely to spread here than other types of breast cancer. This is the first case of pneumoperitoneum from metastatic lobular carcinoma in the literature.