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Behind The Knife: The Surgery Podcast

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  • Summary

  • Behind the Knife is the world’s #1 surgery podcast. From high-yield educational topics to interviews with leaders in the field, Behind the Knife delivers the information you need to know. Tune in for timely, relevant, and engaging content designed to help you DOMINATE THE DAY! Behind the Knife is more than a podcast. Visit http://www.behindtheknife.org to learn more.
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Episodes
  • So, You Want to be a Cardiac Surgeon?: Training Paradigms

    So, You Want to be a Cardiac Surgeon?: Training Paradigms
    Jun 3 2024
    Interested in cardiac surgery? The training paradigm for cardiac surgery has changed significantly over the past decade and we know may students often struggle when deciding what pathway is best for them. For this episode, we assembled a robust team of attendings, fellows, and residents to discuss their journey as well as some of the research that has been conducted about these different pathways to help guide students navigating this decision.

    Hosts:
    - Jessica Millar, MD- PGY-5 General Surgery Resident, University of Michigan, @Jess_Millar15

    Guests:
    - Nick Teman, MD- Assistant Professor of Thoracic and Cardiovascular Surgery, University of Virginia, @nickteman

    - Jolian Dahl, MD, MSc- Integrated Thoracic Surgery Resident (PGY-6), University of Virginia, @JolianDahl

    - Lyndsey Wessels, MD- Traditional Thoracic Surgery Resident (CT-1), University of Virginia, @LyndseyWessels

    Articles Referenced:

    - Pathways to Certification: https://www.abts.org/ABTS/CertificationWebPages/Pathways%20to%20Certification.aspx

    - Narahari AK, Patel PD, Chandrabhatla AS, Wolverton J, Lantieri MA, Sarkar A, Mehaffey JH, Wagner CM, Ailawadi G, Pagani FD, Likosky DS. A Nationwide Evaluation of Cardiothoracic Resident Research Productivity. Ann Thorac Surg. 2024 Feb;117(2):449-455. doi: 10.1016/j.athoracsur.2023.08.011. Epub 2023 Aug 26. PMID: 37640148; PMCID: PMC10842395
    https://pubmed.ncbi.nlm.nih.gov/37640148/

    - Bougioukas L, Heiser A, Berg A, Polomsky M, Rokkas C, Hirashima F. Integrated cardiothoracic surgery match: Trends among applicants compared with other surgical subspecialties. J Thorac Cardiovasc Surg. 2023 Sep;166(3):904-914. doi: 10.1016/j.jtcvs.2021.11.112. Epub 2022 Mar 22. PMID: 35461707.
    https://pubmed.ncbi.nlm.nih.gov/35461707/

    For episode ideas/suggestions/feedback feel free to email Jessica Millar at: millarje@med.umich.edu

    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
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    35 mins
  • Journal Review in Bariatric Surgery: Are Less Anastomoses Better?

    Journal Review in Bariatric Surgery: Are Less Anastomoses Better?
    May 30 2024
    Bariatric surgery is an evolving field with new procedures, or variations of old ones, being developed to meet the needs of patients with obesity. The single anastomosis duodenoileal bypass (SADI) and one anastomosis gastric bypass (OAGB) are two such procedures which have recently entered the mainstream conversation. In this episode we will give a brief overview of the SADI and OAGB, go over some short and long term studies evaluating safety and efficacy, and discuss current sentiments about these options and how they may fit into bariatric practice. Show Hosts: Matthew Martin, MD Adrian Dan, MD Crystal Johnson-Mann, MD Paul Wisniowski, MD Article #1: Chao 2024 - Outcomes of SADI and OAGB Compared to RYGB from the Metabolic and Bariatric Surgery Quality Improvement Program: The North American Experience Roux-en-Y gastric bypass (RYGB) and duodenal switch are well described procedure for weight loss; however, associated postoperative complications have led to the development of simpler techniquesSingle anastomosis duodenoileal bypass (SADI) - modification of the duodenal switch where by a loop of ileum of the bilopancreatic limb approximately 200-300cm from the ileal cecal valve is anastomosed to the distal duodenal cuff of a tubularized stomachOne anastomosis gastric bypass (OAGB) – modification of the RYGB where a loop of jejunum of the bilopancreatic limb approximately 150-200cm from the ligament of treitz is anastomosed to the distal end of a gastric pouch. There is increasing interest in these procedures given the perceived reduced risk reduction associated with one fewer anastomosisCurrently, there is insufficient data on the safety of these procedures compared to the established RYGB. The article utilizes the MBSAQIP database to evaluate each procedure against the RYGB Matched groups: SADI vs RYGB and OAGB vs RYGB Matched against age, sex, BMI, operative time, and ASA classification30-day outcomes included complications and health care utilizationResults were analyzed with univariate comparative analysis, and significant outcomes were examined with logistic regressionSADI vs RYGB: SADI independently associated INCREASED odds with staple line leak, sepsis, organ space infection, and pneumonia. OAGB vs RYGB: OAGB independently associated with REDUCED odds of SSI, transfusion requirement/GI bleed, ICU admission, bowel obstruction, and healthcare utilization (reoperation, readmissions, and reinterventions)No significant differences in mortality Limitation: Article generally reviews technical complications of procedures. Unable to address significant bariatric outcomes such as weight loss and metabolic profile, as well as long term outcomes. https://pubmed.ncbi.nlm.nih.gov/38170422/ Article #2: Maud 2019 - Efficacy and safety of OAGB vs RYGB for obesity (YOMEGA trial): A multicentre, randomized, open label, non-inferiority trial Limited long-term evidence on OAGBMostly arising from retrospective analyses and one meta-analysisTwo randomized clinical trials but with poor power and questionable methodology. This is a randomized non-inferiority trial of in patients undergoing bariatric surgery Randomized into 2 groups: OAGB vs RYGB with 117 patients per groupPatients were followed for 2 years with a loss to follow up of 21% in OAGB and 24% in RYGB cohortsThe primary outcome was weight loss with a noninferiority threshold of 7% assuming 60% weight loss at 2 years. Secondary outcomes included complications and metabolic outcomesGroups were compared with Student’s T and Wilcoxon tests for quantitative data, and chi-squared and Fischer’s exact for qualitative endpoints. Cohorts were analyzed with the intention to treat, and missing data on the primary endpoint was imputed with prediction-based modeling. Highlighted OutcomesMean percent excess BMI loss of 87.9% in OAGB group compared to 85.8% in RYGB group demonstrating non-inferiority in terms of weight lossIncreased number of serious adverse events (SAE) in the OAGB group, but no difference in the proportion of patients with at least 1 SAEOAGB demonstrated 70% complete or partial remission of diabetes compared to 44% in RYGB but underpowered to demonstrate significant difference. Equal rates of gastritis and esophagitis based on endoscopic biopsy results at 2 years.There were increased nutritional complications in the OAGB groups with 21% vs 0% in RYGB and high rates of diarrhea/anal fissures 14% vs 0%, respectively. This suggests a greater malabsorptive effect of OAGB. There was equal satisfaction in quality of life between RYGB and OAGB on two validated surveys with >80% satisfaction rates. LimitationsData was imputed for the primary end pointHigh rates of loss to follow up in both cohortsUse of “severe adverse events” instead of Clavien-Dindo classificationComparison of specific institutional/surgeon technique of OAGB vs RYGB https://pubmed.ncbi.nlm.nih.gov/30851879/ Please visit https://behindtheknife.org to access ...
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    32 mins
  • Are we failing our patients? Ventral hernia recurrence with Drs. Todd Heniford and Michael Rosen

    Are we failing our patients? Ventral hernia recurrence with Drs. Todd Heniford and Michael Rosen
    May 27 2024
    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/

    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
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    1 hr and 10 mins
Physical Illness & Disease Hygiene & Healthy Living Science
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