Epigastric hernias, predominantly described in the literature as small defects containing mostly preperitoneal fat, are located in the linea alba between the xiphoid process and the umbilicus. The risk of incarceration in epigastric hernias is influenced by the size of the defect. It has been observed that smaller epigastric hernias, particularly those less than 1 cm in diameter, have a higher risk of incarceration compared to larger ones. Various treatment options are available for epigastric hernias, including laparoscopic and open surgical approaches. This video describes an open epigastric hernia repair without mesh for a 1-cm incarcerated hernia. The technique demonstrated addresses both the correction of the hernia and the prevention of recurrence, which is crucial given the higher incarceration rates associated with smaller hernias. This video demonstration of an open epigastric hernia repair without mesh for a 1-cm incarcerated hernia provides valuable insights for surgical trainees, general surgeons, and hernia specialists. The technique showcased is particularly useful for small epigastric hernias and in cases where a rectus diastasis is present.
Encapsulating peritoneal sclerosis (EPS), also known as encapsulating sclerosing peritonitis is a rare but serious condition that is characterized by the formation of a thick, fibrotic layer encasing the small bowel. The pathophysiology involves an inflammatory process that triggers excessive fibrin deposition and collagen production, resulting in the development of a thick, cocoon-like membrane around the intestines. This video is an in-depth demonstration of a complex surgical case involving a repeat exploratory laparotomy for bowel obstruction, with a focus on careful dissection of adhesions, managing serosal tears, and ensuring hemostasis. It is particularly valuable for surgeons, surgical trainees, and medical professionals specializing in emergency abdominal surgery.
Umbilical hernias are common abdominal wall defects that occur when intra-abdominal contents protrude through the umbilical opening in the abdominal muscles. This article focuses on the detailed surgical technique for open umbilical hernia repair without mesh for a 1-cm hernia, emphasizing both functional and aesthetic outcomes. This video demonstration and accompanying description serve as valuable educational resources for surgical trainees, general surgeons, and plastic surgeons seeking to refine their techniques for small umbilical hernia repairs. The step-by-step approach, rationale for each decision, and emphasis on both functional and cosmetic outcomes provide insights that can help surgeons optimize their results in umbilical hernia repair.
This article presents a case of diffuse large B-cell lymphoma (DLBCL) with skeletal involvement in a geriatric male. Initially presenting with left hip pain, the patient was diagnosed with DLBCL affecting the left acetabulum. Subsequent treatment with systemic and radiation therapy resulted in radiation osteitis, osteoarthritis, and acetabular collapse, necessitating surgical intervention.
The treatment plan involved total hip arthroplasty (THA) with photodynamic intramedullary nails (PDNs) for pelvic stabilization, augmented with tantalum augments for enhanced support. PDNs provided structural stability while minimizing interference with future oncological interventions. The surgical procedure comprised meticulous insertion of PDNs and placement of tantalum augments, achieving optimal stability and alignment of the acetabular component.
This case underscores the strategic use of PDNs and tantalum augments in for treating major acetabular defects in patients with complex pathologies who require THA for pelvic stabilization. These techniques provide advantages in postoperative radiographic disease monitoring and precision in radiation therapy planning. The multidisciplinary approach emphasizes the importance of carefully selecting the appropriate implants to optimize outcomes in orthopaedic oncology.
This video demonstrates a case involving an open complex abdominal wall reconstruction with transversus abdominis release. The case involves an obese patient with a multiply recurrent incarcerated incisional hernia. The CT scan shows a complex defect involving the midline, right linea semilunaris, and inter-rectus hernia. The use of a retromuscular procedure with a posterior component separation will be highlighted and its advantages of allowing wide mesh overlap without creation of subcutaneous tissue flaps to repair defects with these challenging characteristics.
Diagnostic Hip Arthroscopy Jason P. Den Haese Jr., DO1; Scott D. Martin, MD2 1Oklahoma State University Medical Center 2Brigham and Women’s/Mass General Health Care Center
Diagnostic hip arthroscopy is a minimally-invasive surgical technique used to accurately provide intraoperative information and potentially treat certain intra-articular (such as labral tears, chondral defects, and femoroacetabular impingement) and extra-articular (such as capsular tears, ischiofemoral impingement, and pediatric deformities) hip pathologies. The use of this procedure in the United States is becoming more common; annual rates are increasing by as much as 365% since 2004. Within this rapid increase of utilization, the three most common procedures being performed with diagnostic hip arthroscopy are labral repair, femoroplasty, and acetabuloplasty.
In this case, a young female athlete is being assessed for left anterior hip pain recalcitrant to nonoperative management. The patient was placed in a supine position with an anterolateral portal and modified anterior portal being placed into the left hip. A puncture capsulorrhaphy was performed to examine the labrum, femoral head, and transverse ligament. Then, the medial structures and peripheral compartment were visualized. Throughout the procedure, the only treatable hip pathology identified was labral fraying consistent with a minor labral tear. It was determined that the fraying was not significant enough to require surgical repair, so labral debridement was chosen. Other areas of labral fraying and fatty degeneration were identified, but they were not significant enough to be treated intraoperatively. The procedure was completed with no complications.
Left Tube Thoracostomy for Pneumothorax Ryan Boyle1; Elliot Bishop, MD2; Peter Bendix, MD2 1 Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University 2University of Chicago Medicine
The clinical presentation of pneumothorax ranges from no symptoms to life-threatening tension physiology requiring emergent intervention. The thoracic cavity is lined with parietal while the lungs and mediastinal structures are lined with visceral pleura. Normally in apposition, a potential space exists between these two layers where fluid, air, or a combination of the two may accumulate. If this potential space fills with fluid or air, subsequent collapse of the lung tissue causes symptoms such as shortness of breath and tachypnea. If the fluid or air accumulate to the degree that venous cardiac return is impeded, tension physiology ensues with hypotension, tachycardia, and eventual cardiovascular collapse if the pressure is not relieved. Tube thoracostomy remains the treatment of choice for managing pneumothorax. This article presents the management of a traumatic pneumothorax with tube thoracostomy in a 51-year-old male injured in a motor vehicle collision.
Tibial plafond or pilon fractures account for 5 to 10% of all lower extremity fractures and are associated with high energy trauma. These fractures have a high rate of non-union, mal-union, and wound healing issues due to weak metaphyseal bone, a lack of robust soft tissue coverage, and complex intra-articular extension. This manuscript and video demonstrates a tibial pilon fracture managed acutely with a hybrid fixation approach combining internal fixation with external fixation.
Whipple Procedure for Carcinoma of the Pancreas Martin Goodman, MD1; Vahagn G. Hambardzumyan, MD2 1Tufts University School of Medicine 2Yerevan State Medical University, Heratsi Hospital Complex
Pancreatic ductal adenocarcinoma (PDAC) is the ninth most common cancer in the United States, but due to symptoms—such as back pain, jaundice and unexplained weight loss—usually only presenting when the disease has already moved beyond the pancreas, it is highly lethal, representing the fourth most common cause of cancer death. As a result of widespread abdominal imaging, more early stage pancreatic cancers are being diagnosed, and these patients are candidates for a pancreaticoduodenectomy, more commonly known as the Whipple procedure.
The Whipple procedure is used to treat four types of cancer—periampullary, cholangiocarcinoma, duodenal, and pancreatic ductal adenocarcinoma—but is most well known in the setting of PDAC. Although there are only a few basic steps to the procedure—removal of the pancreatic head, distal bile duct, duodenum, and either distal gastrectomy or pyloric preservation. Next is the reconstruction with bringing up the stapled end of jejunum to the pancreas, then the hepatic duct, and lastly to the stomach. The multiple crucial anatomic structures in the same region, as well as the unforgiving nature of the structures involved in the operation itself, lead to high morbidity and necessitate complex postoperative care. Due to this, most Whipple procedures are performed at higher volume centers.
Thoracoabdominal Aortic Aneurysm Repair Andrew Del Re, MD1; Jahan Mohebali, MD, MPH2; Virendra I. Patel, MD, MPH2 1The Warren Alpert Medical School of Brown University 2Massachusetts General Hospital
Thoracoabdominal aortic aneurysms (TAAAs) are generally asymptomatic and are discovered incidentally on thoracic or abdominal imaging. When they are identified, management is often expectant, depending on the size of the aneurysm and its rate of growth. Surgery is indicated for larger aneurysms and those that expand rapidly so as to avoid the catastrophic rupture of the aneurysm.
This article presents the case of a 70-year-old female with a TAAA, whom had been followed with serial computed tomographic angiography scans. The decision to operate was made when the aneurysm began revealing growth in diameter. Her anatomy was not conducive to endovascular treatment; therefore, her aneurysm was repaired using a traditional open approach.
