For the 11th time at Clinical Congress, new ACS President E. Christopher Ellison, MD, FACS, MAMSE, and Regent Kenneth W. Sharp, MD, FACS, MAMSE, moderated the wide-ranging, rapid-fire session, Ten Hot Topics in General Surgery.
Daniel Eiferman, MD, MBA, FACS, presented “‘I Hit the Aorta’—The Surgeon as Victim.” He recounted an adverse surgical outcome that led to symptoms of post-traumatic stress disorder for him as the physician, including guilt, anxiety, distress, and feelings of insufficiency.
“I realized that I had been through a decade’s worth of training, and nobody ever talked to me about how to recover when bad things happen,” Dr. Eiferman said. “So, I decided I was going to do everything that I could to come out and talk to different healthcare workers about how to build your resilience and how to bounce back after bad things happen.”
The associate professor of surgery at The Ohio State University emphasized the importance of peer support networks to overcome the trauma of adverse events in the operating room. Dr. Eiferman said that once Dr. Ellison reached out to reassure him that suboptimal outcomes can happen to anyone, he found it much easier to begin recovering from the experience.
Arielle Perez, MD, FACS, presented “Is there an Optimal Treatment for Parastomal Hernia?” Dr. Perez, assistant professor of surgery at the University of North Carolina at Chapel Hill (UNC) and director of the UNC Hernia Center, walked attendees through an array of care strategies for patients dealing with these hernias, but every potential treatment carried risks. Reversing the stoma is generally effective, but not possible for all patients, she said. Stoma relocation can also work, but providers who select this option also create three potential locations for new hernia growth. Ultimately, Dr. Perez concluded there is no single optimal treatment option for parastomal hernias.
Mark D. Iafrati, MD, FACS, discussed “Hyperbaric Oxygen Use: When and Why.” Dr. Iafrati guided attendees through the history of this treatment technique, why it might be helpful for certain types of patients, and the current outlook of data on hyperbaric oxygen treatment.
“One of the ways that Dr. Ellison and I determine topics for us to discuss is we read the ACS communities religiously,” Dr. Sharp said. “This [topic] has been a constant, consistent debate over the years.”
Patients with radiation injuries are one population that can be treated effectively with hyperbarics. With radiation injuries, one of the major issues is microvascular destruction. If treated with routine therapies, it can lead to long-term damage to the patient. That damage could be reduced six-fold by applying oxygen therapy, according to Dr. Iafrati, professor of vascular surgery at Vanderbilt University and director of the Vanderbilt Wound Center.
“Hyperbarics is simply an adjunct therapy that may be useful among many other tools that you have at your exposure to take care of a variety of complicated patients,” Dr. Iafrati said.
Other topics discussed during the session included when to observe or operate on gallbladder polyps, current controversies in clostridium difficile colitis, whole blood use in the trauma setting, ventral hernia repair in a contaminated field, new frontiers in intraoperative nerve monitoring for thyroid operations, and surgical considerations for pancreatic incidentalomas.
For those who were unable to attend Ten Hot Topics in General Surgery, this educational session is available for viewing on demand.