Surgery Blog for Surgeons

Surgery podcast

Podcasts are regaining attention after the initial hype in the mid 2000s and the subsequent decline of their popularity. I've always thought that podcasts are a great resource for gaining or maintaining knowledge.

Looking for a good surgery podcast, the residents in the center I work in recommended Behind the Knife (BTK). I gave it a try and was pleasantly impressed. It's not ideal but it is very good and well made. In addition, the guys running it, put a great effort in engaging nationwide renown surgeons.

All kind of topics are discussed in BTK incl. ABSITE and Board reviews but also review and analysis of important literature.

I intend to use some of the episodes for complementary information whenever I write about a particular topic.

Here is another list of the episodes and this one offers easier downloads.

Have fun!

How to close a midline laparotomy - The STITCH trial

A lot, maybe even the majority, of things we do in medicine in general and in surgery in particular, are not evidence based. One of those things, no being supported by good data, is one of the most commonly performed procedures in surgery - closing of the abdominal midline incision.

There is some data supporting the 10mm/10mm running closure with PDS 1 suture. However this data is quite weak and now finally somebody decided to challenge that.

Even before this trial, there was evidence that smaller stitches with a more gentle suture would achieve better results in terms of preventing hernias. However, this paper describes the first double-blind, multicentre, randomised controlled trial addressing this question:

Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial, Lancet. 2015 Sep 26;386(10000):1254-1260. doi: 10.1016/S0140-6736(15)60459-7. Epub 2015 Jul 15

Here I'm sharing some thoughts about the trial and its critics.

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Brenner Tumor

In 1907 Fritz Brenner published his thesis "Das Oophoroma folliculare".

F. Brenner: Das Oophoroma folliculare. Frankfurter Zeitschrift für Pathologie, München, 1907, 1: 150-171)

He described what was later called "Brenner Tumor".

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Work load in surgical education - impact on education and healthcare

The introduction of the 80-hours week for the residents in the USA brought a lot of unhappy faces in the faculty members. Ever since then the residents have to listen to even more "what-do-you-know" and "when-I-was-a-resident" stories on a daily basis. The generation conflict is remarkably expressed in these conversations and it is caused solely by the attending physicians. They urge the residents to protest against these rules arguing that working more than 80 hours per week is essential for a sufficient education.

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Happy Holidays!

Everyone who sporadically was or regularly is stopping by, I would like to wish Happy Hanukkah, Merry Christmas or whatever you celebrate these days.

Here is my holiday's gift for you: a very nice surgical story I recently heard.

One of my colleagues told me recently about his father who was a surgeon in the Vietnam War. Back then he (the father) was a youngster and used to work with an elderly surgeon who used to... switched off (!) the lights for 2 minutes before closing the skin. On every case!

The rationale behind this (for us) obviously queer custom was the following.
The postoperative bleedings occur because the vessels start to bleed after the closure of the skin. So, to "trap" them, the old surgeon tried to make them "think" the skin was already closed. After 2 minutes he switched the lights back on and looked for any vessel which might have disclosed itself as a potential troublemaker.

People think about medicine as a science. But there are so many "voodoos" we do.

Being a good surgeon becomes a challenging task if you want to keep up with the recent news in this field and also in the world. Having a "normal" social life is increasingly difficult when you consider the time spent in the OR, taking care of the patients and reading the literature.

This is why I truly appreciate you visiting this blog. Thank you!

Anemia and blood transfusions

Acute anemia is a common reason for transfusion of blood products. The hemoglobin (Hb) threshold for correcting anemia has been a hot topic of discussions for a long time. Here I would like to share my experience and thoughts about this very surgical issue.

About 15 years ago I listened to a talk that was given by a German gastroenterologist who worked at that time in Malawi, a small country in the southern part of Africa. Among other interesting stories, he said that they did not even think about blood transfusion unless there is the number 4 (four!) before the dot/comma in the Hb g/dl level. This was due to a relative lack of blood products but he said also that they never had any problems related to uncorrected acute anemia.
We should assume though, that most of the patients there are generally in a better health that the average patient in the Western world, mostly because of the short life expectancy and very low rate of chronic diseases like Diabetes or Hypertension. Also, as one of my current mentors noted, the rate of patients with sickle cell anemia might be significantly higher there. These patients tend to tolerate much lower Hb levels.

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Michael DeBakey is dead!

Michael DeBakey died at the age of 99.

Michael E. DeBakey, MD

This surgeon published his first invention in 1933 and had an office at the Baylor College in Houston until his death yesterday (In Memoriam, Michael E. DeBakey, MD).

My former chief retired about a year ago and at the same day I left also the Medical Center where he and Dr. Thorsten Morlang made me a surgeon. At a ceremony for his retirement, Prof. Dr. Wolf J. Stelter (a 1994 president of the Michael E. DeBakey International Surgical Society) showed then pictures of his own chiefs through the years in different medical centers in Germany and in the United States. He started talking about them saying that, of all these men, only Michael DeBakey is still alive.
...And I was happy that my chief is alive.

Until some hours ago Michael DeBakey was a living legend... I can't write any more about this.

Rest in peace, Dr. DeBakey!