Ophthalmology, Print Release

PUBLISHED: Lateral Tarsal Strip Procedure for Right Lower Eyelid Ectropion

Lateral Tarsal Strip Procedure for Right Lower Eyelid Ectropion
John Lee, MD
Boston Vision

Ectropion is a common eyelid malposition characterized by outward turning of the eyelid margin, resulting in conjunctival exposure, epiphora, and potential corneal damage. The most common form of ectropion that needs surgical intervention affects elderly patients through horizontal eyelid laxity. This video article demonstrates the lateral tarsal strip (LTS) procedure, which corrects horizontal eyelid laxity by repositioning and reinforcing the lower eyelid, resulting in durable outcomes with minimal postoperative discomfort and low recurrence rates. The LTS procedure stands as the preferred surgical method for treating involutional ectropion because of its straightforward technique and excellent outcomes.

General Surgery, Print Release, Vascular Surgery

PUBLISHED: Conversion of Failed Right Leg Below-Knee Amputation to Above-Knee Amputation for Severe Peripheral Arterial Disease

Conversion of Failed Right Leg Below-Knee Amputation to Above-Knee Amputation for Severe Peripheral Arterial Disease
Faizaan Aziz1; Andrew Shevitz, DO2; Faisal Aziz, MD, MBA, FACS, DFSVS2
1University of Michigan
2Penn State Health Milton S. Hershey Medical Center

Patients with severe peripheral arterial disease and critical limb-threatening ischemia are at high risk for limb loss. This video presents a 76-year-old male with extensive comorbidities who underwent above-knee amputation after failed healing of a below-knee amputation. Despite patent inflow vessels, poor distal perfusion led to non-healing wounds. The patient tolerated the above-knee amputation well, with an uneventful recovery and discharge to rehabilitation on postoperative day five. This case illustrates the role of above-knee amputation in patients with severe peripheral arterial disease and non-healing below-knee amputation, emphasizing technical steps and perioperative management.

Cardiac Surgery, Print Release

PUBLISHED: Combined Replacement of Aortic Valve and Ascending Aorta with Patent Foramen Ovale (PFO) Closure

Combined Replacement of Aortic Valve and Ascending Aorta with Patent Foramen Ovale (PFO) Closure
David W. Miranda, MD, MS; Jordan P. Bloom, MD, MPH
Massachusetts General Hospital

Aortic valve disease in adults has many etiologies and requires careful operative planning when severe enough to require intervention. A common cause of aortic valve dysfunction in adults is a congenitally bicuspid valve that may also be associated with aortic aneurysm. Here, we describe the presentation and management of a middle-aged woman with symptomatic severe aortic stenosis due to a bicuspid aortic valve. She required an aortic valve replacement as well as replacement of an aneurysmal ascending aorta and closure of a patent foramen ovale (PFO).

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General Surgery, Print Release

Laparoscopic-Assisted Takedown of a Gastrocutaneous Fistula

Laparoscopic-Assisted Takedown of a Gastrocutaneous Fistula
Victoria J. Grille, MD1; Eric M. Pauli, MD, FACS, FASGE2
1Jersey Shore University Medical Center
2Penn State Milton S. Hershey Medical Center

A gastrocutaneous fistula is an abnormal connection between the stomach and skin, most commonly occurring after removal of a gastrostomy feeding tube. This video demonstrates the surgical technique of laparoscopic takedown of a gastrocutaneous fistula, performed in conjunction with upper endoscopy. The patient is a pediatric patient with a history of gastrostomy tube placement and Nissen fundoplication for reflux during infancy. Despite removal of the tube, the fistula persisted. Prior endoscopic interventions, including over-the-scope clip placement, were unsuccessful. Due to ongoing drainage and patient preference for definitive closure, surgical intervention was pursued.

General Surgery, Ob/Gyn, Plastic Surgery, Print Release

PUBLISHED: Extralevator Abdominoperineal Resection (APR) for Recurrent Anal Cancer With an En Bloc Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy and Total Vaginectomy With Permanent Colostomy Formation and Pelvic Floor Reconstruction Using a Right Rectus Abdominis Flap

Extralevator Abdominoperineal Resection (APR) for Recurrent Anal Cancer With an En Bloc Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy and Total Vaginectomy With Permanent Colostomy Formation and Pelvic Floor Reconstruction Using a Right Rectus Abdominis Flap
Zoe Garoufalia, MD; Steven D. Wexner, MD, FACS
Cleveland Clinic Florida

This video provides a step-by-step, detailed demonstration of this extensive surgical procedure performed on a 53-year-old female patient with recurrent anal cancer after initial chemoradiotherapy. The surgical technique is thoroughly illustrated, emphasizing the importance of proper anatomical planes, multidisciplinary coordination, and reconstructive considerations.

General Surgery, Print Release

PUBLISHED: Diagnostic Laparoscopy and Small Bowel Resection for a Large Meckel’s Diverticulum in Adult with Persistent GI Bleed

Diagnostic Laparoscopy and Small Bowel Resection for a Large Meckel’s Diverticulum in Adult with Persistent GI Bleed
Julie Thomann, MD; Nicole B. Cherng, MD, FACS, FASMBS
UMass Memorial Medical Center

Symptomatic Meckel’s diverticulum is a diagnosis most commonly associated with male children under two years old. It typically presents with painless hematochezia and is diagnosed with a Meckel’s scan, which uses Technetium-99 to detect ectopic gastric tissue. In an adult with gastrointestinal bleeding, the differential is far broader, including an extensive and at times, inconclusive, work-up. Here, we describe a diagnostic laparoscopy for suspicion of Meckel’s diverticulum in a young adult male whose work-up showed evidence of small bowel bleeding without a definitive source. A large 6.2-cm, broad-based Meckel’s diverticulum was identified about 90 cm proximal to the ileocecal valve and resected via small bowel resection.

General Surgery, Print Release

PUBLISHED: Reversal of a Diversion Loop Ileostomy in a Patient with a Prior Gracilis Transposition Flap for Rectovaginal Fistula Due to Crohn’s Disease

Reversal of a Diversion Loop Ileostomy in a Patient with a Prior Gracilis Transposition Flap for Rectovaginal Fistula Due to Crohn’s Disease
Zoe Garoufalia, MD; Steven D. Wexner, MD, FACS
Cleveland Clinic Florida

This case takes an in-depth look at the reversal of a diverting loop ileostomy performed for a patient who had received a prior gracilis transposition flap for a rectovaginal fistula due to Crohn’s disease. This video provides a detailed step-by-step demonstration of the reversal of this diverting loop ileostomy. It serves as an excellent educational resource for surgeons learning how to close loop ileostomies.

Ophthalmology, Print Release

PUBLISHED: Lacrifill Injection into Punctum for Dry Eyes

Lacrifill Injection into Punctum for Dry Eyes
Alexander Martin, OD
Boston Vision

This detailed demonstration of the Lacrifill injection procedure, from patient preparation through to injection technique and follow-up care, provides valuable information for ophthalmologists, optometrists, and other eye care professionals who treat patients with dry eye disease and are seeking to expand their therapeutic options. As with any interventional procedure, appropriate training and careful patient selection are essential for optimal outcomes.

Print Release, Vascular Surgery

PUBLISHED: Supraceliac Aorta-to-SMA Bypass with Ileocecectomy for Acute-on-Chronic Mesenteric Ischemia Complicated by Bowel Necrosis and Perforation

Supraceliac Aorta-to-SMA Bypass with Ileocecectomy for Acute-on-Chronic Mesenteric Ischemia Complicated by Bowel Necrosis and Perforation
Benjamin J. Pearce, MD
UAB Hospital

This case involved a 63-year-old female with a history of chronic tobacco use, hypertension, and hyperlipidemia, who had undergone aortobifemoral bypass several months earlier at an outside institution. Shortly afterward, she developed progressive postprandial abdominal pain, alternating constipation and diarrhea, unintentional weight loss, and food fear. During a prolonged hospital admission, she underwent upper and lower endoscopy and autoimmune evaluation, none of which yielded a definitive diagnosis. She was dependent on total parenteral nutrition due to intolerance of enteral intake.

On transfer to our facility, she was found to have a high-grade occlusion of the superior mesenteric artery (SMA), beginning approximately 3–4 cm distal to the ostium, caused by a bulky, calcified atherosclerotic plaque. The SMA origin was patent but significantly narrowed, correlating with her chronic symptoms. Given her worsening condition, surgical exploration was undertaken and revealed necrotic terminal ileum, a contained perforation, and localized peritonitis. A supraceliac aorta-to-SMA bypass was performed using a cryopreserved superficial femoral artery (SFA) graft routed through a retropancreatic tunnel, followed by ileocecal resection.

This surgical video demonstrates critical aspects of complex mesenteric revascularization. The technical elements of supraceliac aortic exposure, retropancreatic tunnel creation, and management of bowel complications provide valuable insights for surgeons encountering similar challenging scenarios. This case demonstrates the continued importance of open surgical expertise alongside endovascular techniques.

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