General Surgery, Ob/Gyn, Print Release, Uncategorized

PUBLISHED: Laparoscopic Suture Rectopexy with Culdoplasty, Vaginal Wall Repair, and Perineorrhaphy for Rectal Prolapse

Laparoscopic Suture Rectopexy with Culdoplasty, Vaginal Wall Repair, and Perineorrhaphy for Rectal Prolapse

Marcus V. Ortega, MD;Emily C. Von Bargen, DO; Liliana Bordeianou, MD

Massachusetts General Hospital

This is the case of an 87-year-old female who presented with a history of constipation and bothersome rectal prolapse that required manual rectal prolapse reduction. She had minimal constipation and minimal incontinence, and anorectal manometry revealed low rectal pressures. On exam, she was found to have full-thickness rectal prolapse and stage II posterior vaginal wall pelvic organ prolapse. Gynecological POP-Q exam showed mostly posterior prolapse and some apical prolapse, and urodynamic testing was negative. Defacography revealed an enterocele. Here, Dr. Bordeianou and Dr. Von Bargen at MGH discuss the decision-making process when treating rectal prolapse and perform a laparoscopic suture rectopexy with culdoplasty, vaginal wall repair, and perineorrhaphy with levator plication.

General Surgery, Pediatrics, Plastic Surgery, Print Release

PUBLISHED: Bilateral Dorsal Foot Scar Contracture Release with Split-Thickness Skin Grafts from the Anterior Thigh

Bilateral Dorsal Foot Scar Contracture Release with Split-Thickness Skin Grafts from the Anterior Thigh

Jonah Poster
Shriners Hospitals for Children – Boston

Jonathan Friedstat, MD
Shriners Hospitals for Children – Boston
Massachusetts General Hospital

Burn scar contracture of the dorsal foot causes metatarsophalangeal joint hyperextension and interphalangeal joint hyperextension. In children, these issues only intensify over time as a child grows. Here, Dr. Friedstat at Shriners Hospitals for Children in Boston presents the case of a young boy who suffered a 32% total body surface area flame burn to his lower back, bilateral buttocks, legs, and feet. This patient had previously undergone a bilateral contracture release of the dorsum of the foot. Because the contractures recurred, another bilateral dorsal foot scar contracture release was performed using a split-thickness 1:1 meshed skin graft harvested from the anterior left thigh.

General Surgery, Print Release

PUBLISHED: Peroral Endoscopic Myotomy (POEM) for Achalasia

Peroral Endoscopic Myotomy (POEM) for Achalasia

Daniel Hashimoto; Ozanan R Meireles, MD; David Rattner, MD
Massachusetts General Hospital

Impaired transit of food and liquid from the esophagus to the stomach results in symptoms of dysphagia, regurgitation, retrosternal fullness/pain, and weight loss. Symptoms can be managed with a range of medical or procedural therapy. However, the best results are obtained from surgical management with myotomy. Here, Drs. Rattner, Meireles, and Hashimoto at MGH perform and demonstrate a peroral endoscopic myotomy (POEM), which emerged as a less invasive manner through which to perform a myotomy and provides relief of dysphagia comparable to laparoscopic Heller myotomy – the current standard of surgical therapy for achalasia.

General Surgery, Otolaryngology, Print Release

PUBLISHED: Minimally Invasive Parathyroidectomy Under Local Cervical Block Anesthesia for Primary Hyperparathyroidism and Parathyroid Adenoma

Minimally Invasive Parathyroidectomy Under Local Cervical Block Anesthesia for Primary Hyperparathyroidism and Parathyroid Adenoma

Tobias Carling, MD, PhD, FACS
Yale School of Medicine

With improvement in both preoperative parathyroid tumor identification and the use of intraoperative parathyroid hormone assay, minimally invasive parathyroidectomy (MIP) is now performed more frequently in patients with primary hyperparathyroidism (pHPT). Still, many institutions are not familiar with performing MIP under regional or local anesthesia. Here, Dr. Tobias Carling presents an MIP performed under local cervical block anesthesia on a patient with pHPT and parathryoid adenoma.

Otolaryngology, Print Release

PUBLISHED: Zenker’s Diverticulum: Endoscopic Staple-Assisted Diverticulotomy

Zenker’s Diverticulum: Endoscopic Staple-Assisted Diverticulotomy

Seth M. Cohen, MD, MPH1; David Straka, MD1; Blaine D. Smith, MD1; Douglas O’Connell, MSc2; C. Scott Brown, MD1

1Duke University Medical Center
2College of Osteopathic Medicine, Touro University California

In this case, a patient with a symptomatic Zenker’s diverticulum is treated with an endoscopic staple-assisted diverticulotomy. The clinical presentation, diagnostic criteria, surgical procedure, and postoperative care are highlighted.

General Surgery, Print Release

PUBLISHED: Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy

Naomi Sell, MD, MHS
Massachusetts General Hospital

Denise W. Gee, MD
Operating Surgeon, MGH

The patient in this case is a 32-year-old female with recurrent episodes of biliary colic. An ultrasound revealed numerous gallstones within the gallbladder. Because the patient has had recurrent symptoms for the past six months, surgical removal of her gallbladder was the best option to relieve her recurrent pain and prevent future development of acute cholecystitis. Here, Dr. Denise Gee at Massachusetts General Hospital performs a laparoscopic cholecystectomy to remove the patient’s gallbladder.

Hand Surgery, Orthopedics, Print Release

PUBLISHED: Scaphoid Open Reduction and Internal Fixation Through Dorsal Approach

Scaphoid Open Reduction and Internal Fixation Through Dorsal Approach

M. Grant Liska, BS
University of Central Florida College of Medicine

Asif M. Ilyas, MD, MBA, FACS
Rothman Institute at Thomas Jefferson University

Dr. Asif Ilyas at the Rothman Institute presents the case of a proximal pole scaphoid fracture repaired with ORIF via a dorsal approach. After dissection through the joint capsule and exposure of the base of the scaphoid, a headless compression screw is placed anterograde in line with the thumb in all planes. This procedure provides increased stability and improved rate of the union in correlation with the accuracy of intraoperative reduction, leading to improved outcomes for surgical candidates over more conservative approaches.

Hand Surgery, Orthopedics, Print Release

PUBLISHED: Distal Radius Open Reduction and Internal Fixation

Distal Radius Open Reduction and Internal Fixation

Bradley Richey, MSc
Rothman Institute

Asif M. Ilyas, MD, MBA, FACS
Rothman Institute

In this case, Dr. Asif Ilyas at the Rothman Institute presents the case of an adult female presenting with a dorsally displaced and angulated fracture of the distal radius after a fall on the outstretched hand. The fracture was treated by open reduction and internal fixation with a volar locking plate, and the natural history, preoperative care, intraoperative technique, and postoperative considerations of distal radial fractures are outlined.

Fundamentals, Global Surgery, Print Release

PUBLISHED: Excision of Epidermal Inclusion Cyst

Excision of Epidermal Inclusion Cyst

John Grove
Lincoln Memorial University – DeBusk College of Osteopathic Medicine

Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES
Philippine Children’s Medical Center

Epidermal inclusion cysts, also called keratin or epithelial cysts, are benign lumps that develop beneath the skin. They present as a slow-growing, painless lumps, usually with a punctum in the middle that represents the blockage of keratin excretion. Here, Dr. Lester Suntay with the World Surgical Foundation presents the case of a 64-year-old male with a mass on his upper back. It was noted to be gradually enlarging, and thus excision was performed in order to prevent further growth and infection.

General Surgery, Print Release

PUBLISHED: Ileostomy Reversal for a Two-Stage Laparoscopic Proctocolectomy with Ileoanal J-Pouch for Ulcerative Colitis

Ileostomy Reversal for a Two-Stage Laparoscopic Proctocolectomy with Ileoanal J-Pouch for Ulcerative Colitis

Derek J. Erstad, MD
Massachusetts General Hospital

Richard Hodin, MD
Chief, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital

The patient in this case is a 29-year-old female who had a long history of medically refractory ulcerative colitis. Three months previously, she had undergone a laparoscopic proctocolectomy with ileoanal J-pouch reconstruction and loop ileostomy. Here, Dr. Richard Hodin at MGH reverses the ileostomy.

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