Faculty Bibliography

INTRODUCTION/BACKGROUND:YouTube has become a widely used tool for surgical education, offering open access to procedural videos for trainees and professionals alike. However, the reliability and pedagogical quality of these publicly available resources remain uncertain. In the context of minimally invasive inguinal hernia repair, we hypothesized that robotic (RT) surgery videos provide superior educational value compared with laparoscopic (LAP) ones. This study aimed to systematically evaluate and compare the quality of RT and LAP transabdominal preperitoneal (TAPP) inguinal hernia repair videos available on YouTube. METHODS:. Both assessment tools demonstrated adequate inter-rater agreement and internal consistency, supporting their reliability for evaluating educational video content. RESULTS:= .091). These findings suggest that RT videos present superior adherence to technical and educational standards, respectively. Both assessment tools demonstrated adequate inter-rater agreement and internal consistency, supporting their reliability for evaluating educational video content. CONCLUSION/CONCLUSIONS:YouTube contains a large repository of TAPP repair videos, but quality is inconsistent. The new qualitative tool demonstrated strong reliability and internal consistency, supporting its use for educational video assessment. RT videos showed greater adherence to technical and educational standards compared with LAP. RT videos may therefore offer more structured learning content, but general quality improvements remain necessary across both approaches.

INTRODUCTION/BACKGROUND:Postoperative urinary retention (POUR) is a common complication following inguinal hernia repair (IHR), and it can be influenced by the type of neuromuscular blockade reversal medication used, especially acetylcholinesterase inhibitors. Among the available options for neuromuscular blockade reversal, Sugammadex has gained significant popularity due to its effectiveness, speed, and safety profile. Additionally, some studies suggest that it prevents POUR compared to acetylcholinesterase inhibitors. We aimed to perform a systematic review and meta-analysis to assess the POUR rates with the use of Sugammadex after IHR. METHODS:PubMed, EMBASE, Cochrane, LILACS, and Web of Science databases were systematically searched without date or language restrictions from inception to October 2024. The databases were searched for studies comparing Sugammadex with other medications for neuromuscular blockade reversal after IHR. The primary outcome was POUR. RESULTS:< .001), with a relative risk reduction of 89%. CONCLUSION/CONCLUSIONS:Sugammadex is associated with a significantly lower risk of POUR following IHR when compared to other medications for neuromuscular blockade reversal following IHR. Despite its higher cost and decreased availability in some centers, the use of Sugammadex should be strongly considered as the preferred option to prevent POUR and minimize the need for hospital readmissions.

PURPOSE/OBJECTIVE:The COVID-19 pandemic disrupted health care worldwide. We evaluated telemedicine utilization in a pediatric surgery ambulatory setting before and during the pandemic to assess its impact on surgical access. METHODS:tests, and multivariable logistic regression were performed. RESULTS:< 0.001). CONCLUSIONS:Telemedicine preserved access to pediatric surgical care during the pandemic, with increased use among rural patients. Lower utilization among both higher-income and higher-deprivation groups highlights complex inequities in access.

PURPOSE/OBJECTIVE:During the COVID-19 pandemic, digital encounters became a crucial means of maintaining access to care amid restrictions on in-person interactions. As these limitations ease, it is essential to evaluate the outcomes of telehealth-based consultations. Before the pandemic, telehealth was predominantly used in postoperative care for surgical populations. This study examines the safety and efficacy of telehealth-based consultations compared to traditional in-person preoperative evaluations for small ventral hernia repair, contributing to the understanding of how telemedicine can be effectively integrated into surgical practices. METHODS:We utilized a prospectively maintained single-center database from a tertiary referral hospital with a specialized hernia and abdominal wall reconstruction team to compare preoperative, intraoperative, and postoperative variables between ventral hernia patients who received telehealth-based (phone or video) consultations and those who had any in-person clinic evaluation. RESULTS:A total of 187 patients with small (< 4 cm) ventral hernias were evaluated, with 42 (22%) being evaluated entirely through telemedicine-based consultations prior to their surgery. There were comparable post-operative outcomes for patients evaluated entirely virtually preoperative compared to those evaluated with at least one traditional in-person evaluation. In both cohorts, 52% of patients followed up at one-year through our hernia surveillance program. The unanticipated recurrence rates observed were 0% for digital pre-operative patients, and 2.01% for patients evaluated in person pre-operatively (p = 1). CONCLUSIONS:Based on the data presented here, virtual preoperative encounters are as safe and effective as traditional in-person evaluations for patients with small ventral hernias.

BackgroundLaparoscopic common bile duct exploration (LCBDE) is underutilized by surgeons to treat choledocholithiasis. We hypothesized that fellowship training in acute care surgery (ACS) vs minimally invasive surgery (MIS) results in different LCBDE practices and perceptions, thus producing unique barriers to implementation.MethodsA survey was distributed by email to members of Society of American Gastrointestinal and Endoscopic Surgeons and the American Association for the Surgery of Trauma to assess surgeon demographics, surgeon-specific perceptions, practice patterns, and barriers to LCBDE utilization. Categorical data were compared with Pearson's chi-square, and continuous parametric data were compared with a t test.Results543 US surgeons who perform laparoscopic cholecystectomy completed the survey. Of all, 124 survey respondents were ACS trained and 175 were MIS trained. Similar proportions of MIS and ACS surgeons prefer to manage choledocholithiasis with LCBDE (28% vs 27%, P = 0.79). The most utilized LCBDE technique was choledochoscopy (71% vs 69%, P = 0.17). MIS surgeons more frequently perform intraoperative cholangiogram (IOC) compared to ACS surgeons (P = 0.02). A third of MIS surgeons felt that LCBDE is too time consuming to be of value, vs 25% of ACS surgeons (P = 0.37). When asked if LCBDE is difficult to master, 56% of MIS surgeons agreed compared to 32% of ACS surgeons (P < 0.01).DiscussionBoth MIS and ACS surgeons utilize LCBDE infrequently despite responding that choledocholithiasis should be managed by surgeons. Compared to MIS, fewer ACS surgeons consider time to perform LCBDE and difficulty as barriers. Understanding these barriers can influence education and efforts toward increasing adoption in both groups.

BACKGROUND:The introduction of evidence-based medicine has challenged many concepts. In analyzing comparative study results, it is common to find narratives highlighting favorable outcomes based on a p-value of < 0.05, without understanding the clinical impact of the observed difference. Given the prevalence of this issue in hernia surgery research, we aimed to evaluate the prevalence of studies reporting a cutoff for clinical relevance in published comparisons of open, laparoscopic, and robotic inguinal hernia repair (IHR). METHODS:We searched Hernia, Surgical Endoscopy, Annals of Surgery, Surgery, World Journal of Surgery, and JAMA Surgery for articles comparing open, laparoscopic, and robotic IHR. Our search was performed according to the recent guidelines, comprising articles published since 2018. Articles analyzing non-clinical outcomes, such as cost-effectiveness, were excluded. Two authors independently screened the articles analyzing the presence of a clinical relevance cutoff definition of statistical significance, and if it suggested a superiority of a technique among others based solely on the p-value. RESULTS:The initial search resulted in 62 articles, of which 8 were excluded, resulting in 54 included manuscripts. Among the included studies, 8 (14.8%) were randomized controlled trials (RCTs), while 46 (85.2%) were comparative cohort studies. Surprisingly, none of the studies defined a clinical relevance cutoff for the outcomes analyzed. Furthermore, only 6 (11.1%) studies highlighted that their findings may not be of clinical relevance. However, even among those 6 studies, 3 (50%) suggested a superiority of the approach based solely on the p-value, while the other 3 (50%) studies, despite finding a statistically significant difference, did not make this suggestion. 16 (29.6%) studies showed no statistically significant differences between the groups, but 2 (12.5%) of those still suggested a superiority of one of the surgical approaches. Among the RCTs, only 1 (12.5%) reported that their findings may not be of clinical relevance, while 1 (12.5%) suggested a benefit despite not finding statistically significant results. CONCLUSION/CONCLUSIONS:Our study, encompassing the main journals in the surgical literature, demonstrated that the distinction between statistical and clinical relevance in hernia surgery, even in RCTs, remains inadequately addressed. There is a need for studies to define what difference in association measure is necessary to achieve clinical relevance for key outcomes in hernia surgery, such as recurrence, wound-related morbidity, and postoperative pain.

BACKGROUND:The rapid integration of telemedicine, accelerated by the COVID-19 pandemic, has become an integral part of perioperative care across various surgical specialties. While its role in routine postoperative care is well established, its application in the initial evaluation of complex conditions, such as moderate-to-large ventral hernia, remains unclear. This study investigates the feasibility and outcomes of telemedicine-based preoperative evaluations for patients presenting with ventral hernia measuring more than 4 cm in width. STUDY DESIGN/METHODS:We conducted a single-center, retrospective cohort study comparing patients with moderate-to-large ventral hernia evaluated through telemedicine-based vs traditional in-person encounters. We analyzed demographic, intraoperative, and postoperative factors. The primary goal was to compare perioperative outcomes between patients evaluated entirely virtually preoperatively and patients who had at least 1 in-person encounter. RESULTS:From January 2021 to November 2024, 478 patients underwent ventral hernia repair, of whom 106 (22%) were evaluated entirely virtually before the day of operation. No difference was observed in perioperative outcomes, including complication rates, length of stay, and recurrence rates. One-year surveillance rates were higher in the cohort that was evaluated preoperatively via entirely virtual encounters (62% vs 44%, p = 0.007). CONCLUSIONS:Telemedicine-based preoperative evaluations for moderate-to-large ventral hernia are feasible and safe, with postoperative outcomes comparable with those after traditional in-person new patient consultations. This approach can expand access to specialized care, especially for geographically distant patients. Further prospective studies are needed to refine practices and explore broader applications of telemedicine in complex surgical care.

INTRODUCTION/BACKGROUND:Ventral hernias remain a challenging surgical condition with long-term complications and recurrences. This study evaluates whether standardized telemedicine-based follow-up improves long-term surveillance following ventral hernia repaiI METHODS: A retrospective cohort study compared telemedicine-based surveillance with traditional in-person follow-up for patients undergoing ventral hernia repair at a tertiary hernia center. Follow-up adherence at 6-, 12-, and 24-months were the primary outcomes of interest. RESULTS:Telemedicine-based surveillance significantly improved follow-up adherence; 79 ​% vs. 44 ​% at 6 months, 69 ​% vs 42 ​% at 12 months, and 44 ​% vs 14 ​% at 24 months. There was no significant difference in recurrence rates, but telemedicine helped identify patient concerns (24 ​%) early, leading to select additional interventions such as cross-sectional imaging or supplemental in-person evaluation (10 ​% CONCLUSIONS: Telemedicine improves follow-up adherence and early detection of complications after ventral hernia repair. It offers an affordable solution for long-term patient care, though further research is needed to optimize protocols.

BACKGROUND:With the advent of advanced imaging and endoscopy, we hypothesized that IOC resident training has declined and is currently insufficient. To this end, we evaluated the national general surgery resident experience with laparoscopic cholecystectomy both with and without intraoperative cholangiography. METHODS:The National Accreditation Council for Graduate Medical Education (ACGME) operative logs were evaluated from 2012 to 2023 for general surgery residents. The number of completed laparoscopic cholecystectomy (CCY) operations and CCY with cholangiogram were evaluated and compared by postgraduate year, program (academic, community, hybrid, military), and resident role (first assistant, surgeon junior, and surgeon chief). ANOVA testing was used to analyze the data. RESULTS:The cholecystectomy case volumes of graduating general surgery residents in all cholecystectomies increased between the 2012-2013 and 2022-2023 academic years (123.9 v 143, p < 0.01). The number of performed CCY + IOC declined significantly over this period (25.1 v 21.6, p = 0.02). University-affiliated programs demonstrated statistically lower numbers of IOCs than community-based (19.3 v 34.1, p < 0.01), hybrid (24.0, p < 0.01), or military programs (26.3, p < 0.01). Community-based programs performed more CCY with IOC than any other group (p < 0.01). Despite the number of CCY + IOC declining during the study period, an increasing percentage of the CCY + IOC were performed by chief (PGY5) residents (p < 0.01). CONCLUSION/CONCLUSIONS:Trainee experience with IOC is declining. The decreased rate and number of IOCs performed by residents has correlated with a "seniorization" of resident experience. This change may result in a future general surgeon workforce with inadequate IOC experience and ultimately impact patient safety. To bolster experience with both technique and interpretation, liberal IOC should be advocated for in training environments. A national IOC assessment may be necessary to address this looming deficit.