Surgery Poster - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1016/thumbnail.jp

Fernandez, Gladys, M.D.

Grant, Heather, MD

Isotti, Joy, MD

Seymour, Neal, MD

Tashjian, David, MD

Theodore, Sheina, MD

English

Scholarly Commons @ Baystate Health

Baystate HealthScholarly Commons @ Baystate HealthResearch and Education Posters Presentations and Posters6-2019Surgery Poster - 2019Gladys Fernandez M.D.Baystate Health, gladys.fernandez@baystatehealth.orgDavid Tashjian MDBaystate Health, david.tashjian@baystatehealth.orgNeal Seymour MDBaystate Health, neal.seymour@baystatehealth.orgSheina Theodore MDBaystate HealthHeather Grant MDBaystate HealthSee next page for additional authorsFollow this and additional works at: https://scholarlycommons.libraryinfo.bhs.org/research_educationPart of the Medicine and Health Sciences CommonsThis Book is brought to you for free and open access by the Presentations and Posters at Scholarly Commons @ Baystate Health. It has been acceptedfor inclusion in Research and Education Posters by an authorized administrator of Scholarly Commons @ Baystate Health.Recommended CitationFernandez, Gladys M.D.; Tashjian, David MD; Seymour, Neal MD; Theodore, Sheina MD; Grant, Heather MD; and Isotti, Joy MD,"Surgery Poster - 2019" (2019). Research and Education Posters. 16.https://scholarlycommons.libraryinfo.bhs.org/research_education/16AuthorsGladys Fernandez M.D., David Tashjian MD, Neal Seymour MD, Sheina Theodore MD, Heather Grant MD,and Joy Isotti MDThis book is available at Scholarly Commons @ Baystate Health: https://scholarlycommons.libraryinfo.bhs.org/research_education/16Boot Camp in a Box: Initial Experience  with Pre-Training Skills Preparation for New Interns Sheina Theodore MD, Heather M. Grant MD, Gladys Fernandez MD, David Tashjian MD, Joy Isotti, Neal E. Seymour MD  Department of Surgery, Baystate Medical Center – University of Massachusetts Medical School, Springfield MA, USA   PURPOSE • To demonstrate the feasibility of implementation of a pre residency skills acquisition program for new interns • Compliance was high: 95% of requested videos submitted • Half of trainees returned second video in response to video feedback • There was a decrement of scores at week 1 of residency compared to week 8 pre-training • Performance improved overall from week 8 pre-training to week 8 of training for all tasks [Table 3 and Figure 2 • Post hoc comparisons showed most significant change was high scores achieved at week 8 of training  METHODS RESULTS • Knot-tying and suture kits, instruments, supplies, [Figure 1 and Table 1] and instructional videos for 4-tasks were sent to newly matched interns (n = 10). Tasks consisted of: • 1- and 2-handed knot tying • Interrupted simple suturing  • Running subcuticular suturing • Trainees practiced all tasks until self-assessed competency then submitted a video of each task 8-weeks prior to start of internship • Assessed videos were annotated and returned to trainees • Tasks were repeated at the start of internship and 8-weeks later (at the end of Surgical PGY1 Boot Camp) CONCLUSION • The consistently lower scores on the tasks at the start of internship (during Bootcamp) may reflect the single-opportunity higher stakes testing conditions of the week 1 assessment • Subsequent achievement of significantly higher performance may have been helped by incentivized pre-training practice • Study of effectiveness of pre-training curriculum and of video feedback is warranted   UMMS-Baystate Research & Education:  Together we advance the state of caring through discovery & innovation Table 1                                          Resident Name: ___________________________     Date:__________________     Examiner: _____                  ITEM NOT DONE or DONE INCORRECTLY (0)   DONE CORRECTLY (1)    *    SIMPLE INTERRUPTED SUTURING    1A           Holds needle driver appropriately >80% of the time (with fingers in place)    2A           Needle loaded appropriately (1/2-2/3 from tip) > 80% of the time    3A         Needle enters skin at right angles (i.e. 90 degrees perpendicular) > 80% of bites    4A Single attempt at needle passage through skin >80% of the time    5A            Follow through on curve of needle on entrance/exit  > 80% of the time    6A Equidistant bites on each side > 80% of the time    7A Uses needle holder or forceps to handle needle    8A  Minimal damage to tissue with forceps (avoids multi-grasping or pulling forcefully)    9A No misalignment of wound closure    10A No over-tightened sutures    11A Square knots with a minimum of 3 throws on knots    12A Instrument tied square knots done appropriately                                                                                                                                                                                                                                     Table 2 Table 3 0204060801008-Weeks Pre-InternshipStart of Internship 8-weeks Post-InternshipSORE (PERCENTAGE) TIME Overall Score Figure 2 Figure 1 PRESENTATIONS • This poster was also presented at the Associate of Program Directors in Surgery conference, Chicago 2019. Incidence and Management of Jejunojejunal Intussusception after Roux-en-Y Gastric Bypass: A Large Case Series Heather M. Grant MD, Parth Sharma MD, Georgios Orthopoulos MD, John R. Romanelli MD FACS Department of Surgery, Baystate Medical Center – UMass Medical School, Springfield, MA   BACKGROUND • Jejunojejunal intussusception is a rare, but potentially catastrophic complication of Roux-en-Y gastric bypass (RYGBP) for morbid obesity  • Reported incidence of < 1% in the literature  • Theories regarding its etiology: • Roux limb dysmotility • Mesenteric thinning after significant weight loss • Postoperative adhesions • Nodal hyperplasia • JJ staple line  • Surgical options include reduction alone, reduction with enteropexy, enteropexy alone, and anastomotic revision • Jejunojejunostomy length greater than 45mm may be associated with the occurrence of intussusception following RYGBP  • This association may explain the increased incidence of post-RYGBP intussusception noted in our case series  • Minimally invasive treatment with laparoscopic reduction and enteropexy may offer effective treatment for most patients  • 575 patients underwent RYGB between January 1, 2008 and June 30, 2018 (Table 1) • Mean age 35.4 + 8.0, mean BMI 47.0 + 13.3             • 34 patients were diagnosed with post-RYGBP jejuno-jejunal intussusception (Table 2) • Mean time to intussusception 66.8 months   HYPOTHESIS RESULTS CONCLUSIONS • Increasing the length of the jejunojejunostomy (> 60mm) results in an anastomosis that becomes patulous over time and increases the risk of post-RYGB intussusception UMMS-Baystate Research & Education:  Together we advance the state of caring through discovery & innovation METHODS • Retrospective chart review of all patients that underwent RYGBP for morbid obesity and subsequently developed jejunojejunal intussusception • January 1, 2008 and June 30, 2018  • Demographics, details of the index procedure (operative approach, construction of roux limb and jejuno-jejunostomy), symptoms and imaging findings at the time of presentation with intussusception, management, and outcomes of operative management were collected  ADDITIONAL RESULTS • Management of intussusception was laparoscopic in the majority of cases and most intussusceptions were retrograde (Table 3) • Surgical management involved reduction with or without enteropexy or jejunojejunostomy revision (Table 3)   

Surgery Poster - 2019

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Surgery Poster - 2019

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