GENERAL SURGERY NEWS The Independent Monthly Newspaper for the General Surgeon
GeneralSurgeryNews.com
January 2022 • Volume 49 • Number 1
Military Surgery: Saving Life, Limb, And Livelihood
The ‘Difficult’ Gallbladder: Approaches to Different Clinical Scenarios
Army Officer Tells Story of How a Forward Surgical Team Saved His Life and Leg
By MONICA J. SMITH
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By CHRISTINA FRANGOU
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ne minute, he was walking toward the governor’s compound in Asadabad, Afghanistan; the next, Col. Daniel Walrath was sprawled on the ground, engulfed in a cloud of dust. He felt a searing pain in his left leg. That morning of Aug. 8, 2012, as Col. Walrath and his colleagues headed to a security meeting with the provincial governor, a Taliban insurgent wearing an explosive vest stepped into their path and detonated his device—killing himself, another member of the Taliban and four Americans. Col. Walrath, who was leading the 2nd Brigade Combat Team of the 101st Airborne Division of the U.S. Army, was knocked to the ground by the blast. Unsure of what might come next, he crawled into a Continued on page 14
Col. Daniel Walrath, seven weeks after being injured by an IED, uses a walker at Walter Reed National Military Medical Center.
aparoscopic cholecystectomy, one of the most commonly performed and straightforward operations for the general surgeon, usually comes off without a hitch. But difficult cases of acute cholecystitis can quickly turn morbid, and management varies dramatically from patient to patient. “Cholecystitis is thought to be a disease process that all general surgeons can take care of—there’s an expectation that it should go well every time,” said Michael Martyak, MD, an assistant professor of surgery at Eastern Virginia Medical School, in Norfolk. “But with the increasing number of patients with comorbidities such as obesity and diabetes, and patients who struggle with access to care who present for evaluation in a delayed fashion, sometimes surgical management can be difficult.” At the 2021 virtual American College of Surgeons Clinical Congress, Dr. Martyak and other experts in the treatment of acute cholecystitis discussed alternative approaches to difficult gallbladders, considerations for the sickest patients, and how to manage the most dreaded complication: common bile duct injury (CBDI). Continued on page 22
Opioid Prescribing for Safe, Mesh Removal: How Effective Postsurgical Pain Much Does Surgical Management Approach Matter?
OPINION
Maybe It’s Cheaper To Pay Your Doctor By P PAULA MU TO, MD, FACS
By KAREN BLUM
By KATE O’ROURKE
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marter prescribing of opioids following surgery can help prevent dependence and overuse of these drugs, panelists said at the 2021 virtual American College of Surgeons Clinical Congress. “As surgeons, it’s important that we understand what our role is in the opioid epidemic,” said Bridget Fahy, MD, FACS, a professor of surgery and the chief of surgical oncology at the
ur health care system is a disaster and getting worse by the day. No one seems to be satisfied, patients complain about the cost, doctors complain about paperwork, employers are tapped out and politicians try to avoid the subject. The only folks who are benefiting from the broken system are the ones in the middle who
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IN THE NEWS
6 Top Surgical Papers of Last Year Reviewed
REPORT
10 Black Women and Breast Cancer L E T TERS TO THE ED I TO R
20 Responses to “The Most Harm” Opinion Article From Last Month
The Landmark Signia™ Stapling System See Insert After Page 15
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oes surgical approach matter for inguinal hernia mesh removal? At the 2021 annual meeting of the Americas Hernia Society (abstract 50176), researchers of a new study sought to answer this question. The study led by Desmond Huynh, MD, a PGY-4 general surgery resident at Cedars Sinai, in Los Angeles, included 113 patients, 39 of whom had open, 23 of whom had laparoscopic and 51 of whom had robotic mesh removal. Approach was based on
