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Wiemann B, Kamya C, Auyang E. Laparoscopic Revision of Nissen to Partial Fundoplication 20 Years After Initial Surgery as an Infant. CRSLS 2021; 8:CRSLS.2021.00002. [PMID: 36016771 PMCID: PMC9387396 DOI: 10.4293/crsls.2021.00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report a case of a 21-year-old male who presented with adult-onset dysphagia after previous Nissen fundoplication initially created at age 10.5 months. The patient first presented one year ago to a different hospital, where he underwent extensive workup for his symptomatology. Physiologic tests performed were esophagogastroduodenoscopy (EGD), abdominal ultrasound, hepatobiliary iminodiacetic acid scan, esophageal manometry, and lactulose breath test. The EGD identified stricture at the level of the gastroesophageal junction. The other studies did not reveal other physiologic causes for his symptoms. The patient then presented to our institution, at which time a repeat EGD showed evidence of tight Nissen fundoplication. The patient subsequently underwent laparoscopic exploration, which revealed that the fundoplication had was partially disrupted, herniated, and twisted causing a long-segment distal stricture. To alleviate the patient’s presenting symptom of dysphagia as well as prevent possible future reflux, it was decided to convert repair the hernia and revise the Nissen into a partial fundoplication. This was successfully accomplished laparoscopically with subsequent resolution of the patient’s symptoms.
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Affiliation(s)
- Brianne Wiemann
- Department of Surgery, University of New Mexico Hospital, Albuquerque, NM
| | - Cyril Kamya
- Department of Surgery, University of New Mexico Hospital, Albuquerque, NM
| | - Edward Auyang
- Department of Surgery, University of New Mexico Hospital, Albuquerque, NM
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Romanelli J, Gee D, Mellinger JD, Alseidi A, Bittner JG, Auyang E, Asbun H, Feldman LS. The COVID-19 reset: lessons from the pandemic on Burnout and the Practice of Surgery. Surg Endosc 2020; 34:5201-5207. [PMID: 33051763 PMCID: PMC7552950 DOI: 10.1007/s00464-020-08072-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Abstract
Background Burnout among physicians is an increasing concern, and surgeons are not immune to this threat. The ongoing COVID-19 pandemic has caused dramatic changes to surgeon workflow, often leading to redeployment to other clinical areas, slowdown and shutdown of elective surgery practices, and an uncertain future of surgical practice in the post-pandemic setting. Paradoxically, for many surgeons who had to prepare for but not immediately care for a major surge, the crisis did allow for reflective opportunities and a resetting of priorities that could serve to mitigate chronic patterns contributory to Burnout. Methods SAGES Reimagining the Practice of Surgery task force convened a webinar to discuss lessons learned from the COVID pandemic that may address burnout. Results Burnout is multifactorial and may vary in cause among different generation/experience groups. Those that report burnout symptoms often complain of lacking purpose or meaning in their work. Although many mechanisms to address Burnout are from a defensive standpoint—including coping mechanisms, problem solving, and identification of a physician having wellness difficulties—offensive mechanisms such as pursuing purpose and meaning and finding joy in one's work can serve as reset points that promote thriving and fulfillment. Understanding what motivates physicians will help physician leaders to develop and sustain effective teams. Reinvigorating the surgical workforce around themes of meaning and joy in the service rendered via our surgical skills may diminish Burnout through generative and aspirational strategies, as opposed to merely reactive ones. Fostering an educational environment free of discriminatory or demeaning behavior may produce a new workforce conducive to enhanced and resilient wellbeing at the start of careers. Conclusion Surgeon wellness and self-care must be considered an important factor in the future of all healthcare delivery systems, a need reaffirmed by the COVID-19 pandemic.
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Affiliation(s)
- John Romanelli
- University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA, USA
| | - Denise Gee
- Massachusetts General Hospital, Boston, MA, USA
| | - John D Mellinger
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Adnan Alseidi
- San Francisco School of Medicine, University of California, San Francisco, CA, USA
| | - James G Bittner
- University of Connecticut School of Medicine and Quinnipiac University Frank H Netter MD School of Medicine, Saint Francis Hospital, Hartford, CT, USA
| | - Edward Auyang
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Horacio Asbun
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Liane S Feldman
- McGill University Health Centre, 1650 Cedar Avenue D6-156, Montreal, QC, H3G 1A4, Canada.
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Meyerson SL, Odell DD, Zwischenberger JB, Schuller M, Williams RG, Bohnen JD, Dunnington GL, Torbeck L, Mullen JT, Mandell SP, Choti MA, Foley E, Are C, Auyang E, Chipman J, Choi J, Meier AH, Smink DS, Terhune KP, Wise PE, Soper N, Lillemoe K, Fryer JP, George BC. The effect of gender on operative autonomy in general surgery residents. Surgery 2019; 166:738-743. [PMID: 31326184 PMCID: PMC7382913 DOI: 10.1016/j.surg.2019.06.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/02/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite an increasing number of women in the field of surgery, bias regarding cognitive or technical ability may continue to affect the experience of female trainees differently than their male counterparts. This study examines the differences in the degree of operative autonomy given to female compared with male general surgery trainees. METHODS A smartphone app was used to collect evaluations of operative autonomy measured using the 4-point Zwisch scale, which describes defined steps in the progression from novice ("show and tell") to autonomous surgeon ("supervision only"). Differences in autonomy between male and female residents were compared using hierarchical logistic regression analysis. RESULTS A total of 412 residents and 524 faculty from 14 general surgery training programs evaluated 8,900 cases over a 9-month period. Female residents received less autonomy from faculty than did male residents overall (P < .001). Resident level of training and case complexity were the strongest predictors of autonomy. Even after controlling for potential confounding factors, including level of training, intrinsic procedural difficulty, patient-related case complexity, faculty sex, and training program environment, female residents still received less operative autonomy than their male counterparts. The greatest discrepancy was in the fourth year of training. CONCLUSION There is a sex-based difference in the autonomy granted to general surgery trainees. This gender gap may affect female residents' experience in training and possibly their preparation for practice. Strategies need to be developed to help faculty and residents work together to overcome this gender gap.
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Affiliation(s)
| | - David D Odell
- Department of Surgery, Northwestern University, Chicago, IL
| | | | - Mary Schuller
- Department of Surgery, Northwestern University, Chicago, IL
| | | | - Jordan D Bohnen
- Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Laura Torbeck
- Department of Surgery, Indiana University, Indianapolis
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Michael A Choti
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Eugene Foley
- Department of Surgery, University of Wisconsin, Madison, WI
| | | | - Edward Auyang
- Department of Surgery, University of New Mexico, Albuquerque
| | | | - Jennifer Choi
- Department of Surgery, Indiana University, Indianapolis
| | - Andreas H Meier
- Department of Surgery, State University of New York Upstate Medical University, Syracuse
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Kyla P Terhune
- Department of Surgery, Vanderbilt University, Nashville, TN
| | - Paul E Wise
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Keith Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor
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Williams RG, George BC, Meyerson SL, Bohnen JD, Dunnington GL, Schuller MC, Torbeck L, Mullen JT, Auyang E, Chipman JG, Choi J, Choti M, Endean E, Foley EF, Mandell S, Meier A, Smink DS, Terhune KP, Wise P, DaRosa D, Soper N, Zwischenberger JB, Lillemoe KD, Fryer JP. What factors influence attending surgeon decisions about resident autonomy in the operating room? Surgery 2017; 162:1314-1319. [PMID: 28950992 DOI: 10.1016/j.surg.2017.07.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/10/2017] [Accepted: 07/29/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. METHODS We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. RESULTS Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74). CONCLUSION Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors.
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Affiliation(s)
- Reed G Williams
- Department of Surgery, Indiana University, Indianapolis, IN.
| | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Jordan D Bohnen
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | - Laura Torbeck
- Department of Surgery, Indiana University, Indianapolis, IN
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Edward Auyang
- Department of Surgery, University of New Mexico, Albuquerque, NM
| | | | - Jennifer Choi
- Department of Surgery, Indiana University, Indianapolis, IN
| | - Michael Choti
- Department of Surgery, University of Texas Southwestern, Surgery, Dallas, TX
| | - Eric Endean
- Department of Surgery, University of Kentucky, Lexington, KY
| | - Eugene F Foley
- Department of Surgery, University Of Wisconsin, Madison, WI
| | - Samuel Mandell
- Department of Surgery, University of Washington, Surgery, Seattle, WA
| | - Andreas Meier
- Department of Surgery, State University of New York, Surgery, Syracuse, NY
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Surgery, Boston, MA
| | - Kyla P Terhune
- Department of Surgery, Vanderbilt University Medical Center, Surgery, Nashville, TN
| | - Paul Wise
- Department of Surgery, Washington University, Surgery, St. Louis, MO
| | - Debra DaRosa
- Department of Surgery, Northwestern University, Chicago, IL
| | | | | | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA
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Greenbaum A, Parasher G, Demarest G, Auyang E. Oesophageal stent placement to treat a massive iatrogenic duodenal defect after laparoscopic cholecystectomy. BMJ Case Rep 2017; 2017:bcr-2016-218895. [PMID: 28476904 DOI: 10.1136/bcr-2016-218895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Iatrogenic duodenal injury occurring during laparoscopic cholecystectomy (LC) is managed surgically, though rarely a large, persistent fistula is refractory to surgical interventions. We present the case of a 40-year-old woman transferred to our centre following elective LC for a reported perforated duodenal ulcer. An uncontained leak was found to originate from a 1.5 cm duodenal defect, with no evidence of ulceration. A duodenostomy tube was placed. One month after abdominal closure, the patient continued to have a persistent, large duodenal fistula. A through-the-scope covered oesophageal stent was placed under endoscopic and fluoroscopic guidance. Five weeks later, it was successfully retrieved and no subsequent extravasation of contrast from the duodenum was noted. Unrecognised iatrogenic duodenal injuries sustained during LC can be catastrophic. In cases of massive duodenal defects and high-output biliary fistula uncontrolled after surgical intervention, endoscopic-guided and fluoroscopic-guided placement of a fully covered oesophageal stent may be lifesaving.
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Affiliation(s)
- Alissa Greenbaum
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Gulshan Parasher
- Division of Gastroenterology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Gerald Demarest
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Edward Auyang
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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