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Behind The Knife: The Surgery Podcast: Daily Summaries Delivered
by Behind The Knife: The Surgery Podcast
Behind the Knife is the world’s #1 surgery podcast. From high-yield educational topics to interviews with leaders in the field, Behind the Knife delivers the information you need to know. Tune in for timely, relevant, and engaging content designed to help you DOMINATE THE DAY!
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- Yesterday35 min
Clinical Informatics for Surgeons, Episode 3: AI in the OR and Beyond; Machines That See, Read, and Act
Picture three machines in your next operation. One watches the laparoscopic feed and flags the zone that is not safe to divide. One reads the chart and has the op note and a plain-language patient summary done before you close. One works quietly in the background and has the ICU bed request queued before anyone asks. Notice that none of them hands you a percentage. In the series finale, Drs. Mason Pearce, Tyler Loftus, and Dan Hashimoto trace surgical AI from the NSQIP risk calculator to computer vision, large language models, and agentic systems: which of these is already in operating rooms, which is arriving fast, which is still mostly promise, and how a surgeon without a machine learning degree stays in control of all three.Hosts: Mason Pearce, MD, General Surgery Resident and Clinical Informatics Fellow, University of South Florida; Behind the Knife Education Fellow Tyler J. Loftus, MD, PhD, Acute Care Surgeon and Associate Professor of Surgery; Program Director, General Surgery Residency, University of Florida; board certified in Clinical Informatics; Past Chair, ACS Health IT Committee Daniel A. Hashimoto, MD, MSTR, Associate Professor of Surgery and Director of Surgical Informatics, Duke University Health System; editor of Artificial Intelligence in Surgery Learning objectives: Distinguish predictive, generative, and agentic AI (models that score, read and write, or act) and give a surgical example of each. Trace surgical risk prediction from the regression-based ACS NSQIP calculator to machine learning models (XGBoost, POTTER, MySurgeryRisk), and explain why external, multicenter validation matters. Describe how computer vision recognizes operative steps and safe versus unsafe dissection zones, and why standardized annotation and real-world video are needed for those models to hold up in practice. Identify the strengths and failure modes of large language models (fluent but wrong output, automation bias) in documentation, perioperative triage, and value-informed proxy decision support. Explain what makes an AI system agentic, how errors can compound across steps, and where human oversight belongs. Apply a practical checklist to any surgical AI tool (data source, validation on patients like yours, drift, explainability, effect on decisions and outcomes) and seek a seat on hospital AI and clinical decision support committees. References: Bilimoria KY, Liu Y, Paruch JL, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217(5):833-842.e1-3. https://pubmed.ncbi.nlm.nih.gov/24055383/ Liu Y, Ko CY, Hall BL, Cohen ME. American College of Surgeons NSQIP risk calculator accuracy using a machine learning algorithm compared with regression. J Am Coll Surg. 2023;236(5):1024-1030. https://pubmed.ncbi.nlm.nih.gov/36728295/ Bertsimas D, Dunn J, Velmahos GC, Kaafarani HMA. Surgical risk is not linear: derivation and validation of a novel, user-friendly, and machine-learning-based Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) calculator. Ann Surg. 2018;268(4):574-583. https://pubmed.ncbi.nlm.nih.gov/30124479/ Bihorac A, Ozrazgat-Baslanti T, Ebadi A, et al. MySurgeryRisk: development and validation of a machine-learning risk algorithm for major complications and death after surgery. Ann Surg. 2019;269(4):652-662. https://pubmed.ncbi.nlm.nih.gov/29489489/ Ren Y, Adiyeke E, Guan Z, et al. MySurgeryRisk model predictions of postoperative complications and mortality. JAMA Surg. 2026;161(6):619-627. MySurgeryRisk Model Predictions of Postoperative Complications and Mortality - PubMed Hashimoto DA, Rosman G, Witkowski ER, et al. Computer vision analysis of intraoperative video: automated recognition of operative steps in laparoscopic sleeve gastrectomy. Ann Surg. 2019;270(3):414-421. https://pubmed.ncbi.nlm.nih.gov/31274652/ Madani A, Namazi B, Altieri MS, et al. Artificial intelligence for intraoperative guidance: using semantic segmentation to identify surgical anatomy during laparoscopic cholecystectomy. Ann Surg. 2022;276(2):363-369. https://pubmed.ncbi.nlm.nih.gov/33196488/ Laplante S, Namazi B, Kiani P, et al. Validation of an artificial intelligence p
- 5 days ago32 min
Clinical Informatics for Surgeons, Episode 2: Legal Discovery and Cybersecurity When a Case Goes Wrong
A case goes wrong. There is a complication, maybe a lawsuit, and suddenly the question is not just what happened in the room. It is what got recorded, who owns it, what a plaintiff's attorney can pull into discovery, and whether that same pile of data is a target for people who want to steal it. Join Drs. Scott Steele, Mason Pearce, and Teodor Grantcharov, the surgeon who built the OR Black Box, as they walk through what an instrumented operating room actually captures, why peer review privilege protects the review and not the facts, how AI outputs create a new evidentiary layer, and why cybersecurity is a patient safety issue. The surprising part: governed recording more often protects surgeons than exposes them.Hosts: Scott Steele, MD, MBA, Colon and Rectal Surgeon; President, Cleveland Clinic Main Campus Mason Pearce, MD, General Surgery Resident and Clinical Informatics Fellow, University of South Florida; Behind the Knife Education Fellow Teodor Grantcharov, MD, PhD, Professor of Surgery, Stanford University; Associate Chief Quality Officer for Innovation and Safety, Stanford Health Care; Founder, Aimbient (formerly Surgical Safety Technologies), the company behind the OR Black Box Linkedin: https://www.linkedin.com/in/teodorgrantcharov/?isSelfProfile=true Aimbient’s: https://www.linkedin.com/company/aimbient/ Disclosure: Dr. Grantcharov is the founder of Aimbient (formerly Surgical Safety Technologies). Platform figures discussed on air (hours of data, number of sites and rooms, data volume per OR-hour, retention period, security record, publication count) are company-reported. Learning objectives: Describe the data an instrumented operating room generates (field and room video, audio, device telemetry, EHR timestamps) and how ownership is layered across the institution, the patient's right of access, and the vendor. Distinguish material that is routinely discoverable (the medical record, operative and anesthesia notes, device logs) from contested material (intraoperative video and quality review analytics). Explain why peer review protections cover the review process rather than the underlying facts, vary by state, and depend on how the institution structures its quality program. Recognize how AI alerts and risk scores add a new evidentiary layer to clinical decisions. Explain why cybersecurity is a patient safety issue, using the 2024 Change Healthcare ransomware attack as an example, and name the security basics (multifactor authentication, least-privilege access, security risk analysis) surgeons should ask about. Apply three practical steps: know who the custodian of your operative data is, insist that recording programs run as governed quality and peer review programs, and ask whether a security risk analysis was done before any new vendor goes live. References: Goldenberg MG, Jung J, Grantcharov TP. Using data to enhance performance and improve quality and safety in surgery. JAMA Surg. 2017;152(10):972-973. https://pubmed.ncbi.nlm.nih.gov/28813552/ Jung JJ, Jüni P, Lebovic G, Grantcharov T. First-year analysis of the operating room black box study. Ann Surg. 2020;271(1):122-127. https://pubmed.ncbi.nlm.nih.gov/29916872/ Prigoff JG, Sherwin M, Divino CM. Ethical recommendations for video recording in the operating room. Ann Surg. 2016;264(1):34-35. https://pubmed.ncbi.nlm.nih.gov/27123809/ Filicori F, Addison P. Intellectual property and data ownership in the age of video recording in the operating room. Surg Endosc. 2022;36(6):3772-3774. https://pubmed.ncbi.nlm.nih.gov/34468846/ van Dalen ASHM, Legemaate J, Schlack WS, Legemate DA, Schijven MP. Legal perspectives on black box recording devices in the operating environment. Br J Surg. 2019;106(11):1433-1441. https://pubmed.ncbi.nlm.nih.gov/31112294/ van de Graaf FW, Lange MM, Spakman JI, et al. Comparison of systematic video documentation with narrative operative report in colorectal cancer surgery. JAMA Surg. 2019;154(5):381-389. https://pubmed.ncbi.nlm.nih.gov/30673072/ Succar B, Vella MA, Holena D, et al. Trauma video review through the legal lens: improving care while minimizing risk. J Trauma Acute Car
- 1 weeks ago29 min
Clinical Informatics for Surgeons, Episode 1: What Is Clinical Informatics, and Why Should Surgeons Care?
You click an order set and ten seconds later the labs, imaging and meds are in. A drug interaction alert fires, and you override it without reading. A sepsis score in the corner of the chart flags your post-op patient. Who built those defaults, who set that alert threshold, and was that score ever validated on surgical patients? Join Drs. Kevin Kniery, Mason Pearce, and Genevieve Melton-Meaux, a practicing colorectal surgeon and the American College of Surgeons' first Chief Health Informatics Officer, as they kick off the Clinical Informatics for Surgeons series. They explain what clinical informatics actually is (hint: not the help desk), how it is already running your operative day, and the few habits that let any surgeon shape the tools everyone else is stuck with.Hosts: Genevieve Melton-Meaux, MD, PhD, Colon and Rectal Surgeon; Senior Associate Dean for Health Informatics and Data Science, University of Minnesota; Chief Health Informatics Officer, American College of Surgeons; Chair, AMIA Board of Directors Kevin Kniery, MD, FACS, Vascular Surgeon, Brooke Army Medical Center Mason Pearce, MD, General Surgery Resident and Clinical Informatics Fellow, University of South Florida; Behind the Knife Education Fellow Learning objectives: Define clinical informatics, distinguish it from information technology, and describe how physicians train and certify in the subspecialty (ACGME-accredited fellowship, ABPM/ABPath board exam). Identify four everyday systems that shape surgical care (order set defaults, medication alerts, embedded risk scores, OR scheduling logic) and recognize them as clinical design decisions. Explain alert fatigue as a patient safety problem and why independent external validation of predictive models matters, using the Epic Sepsis Model as an example. Describe the three core areas of the surgeon informatician: clinical decision-making and care process improvement; health information systems, data and analytics; and leadership and change management. Apply practical habits for informatics literacy: question a risk score's data and validation, report faulty alerts, and join the committees that maintain order sets and decision support. References: Felisberto M, Lima GDS, Celuppi IC, et al. Override rate of drug-drug interaction alerts in clinical decision support systems: a brief systematic review and meta-analysis. Health Informatics J. 2024;30(2):14604582241263242. https://pubmed.ncbi.nlm.nih.gov/38899788/ Ashton M. Getting rid of stupid stuff. N Engl J Med. 2018;379(19):1789-1791. https://pubmed.ncbi.nlm.nih.gov/30403948/ Rajamani G, Diethelm M, Gunderson MA, et al. Crowdsourcing electronic health record improvements at scale across an integrated health care delivery system. Appl Clin Inform. 2023;14(2):356-364. https://pubmed.ncbi.nlm.nih.gov/37164355/ Wong A, Otles E, Donnelly JP, et al. External validation of a widely implemented proprietary sepsis prediction model in hospitalized patients. JAMA Intern Med. 2021;181(8):1065-1070. https://pubmed.ncbi.nlm.nih.gov/34152373/ Osheroff J, Teich J, Levick D, Saldana L, Velasco F, Sittig D, Rogers K, Jenders R. Improving Outcomes with Clinical Decision Support: An Implementer's Guide. 2nd ed. HIMSS Publishing; 2012. ISBN 9780984457731. Book; not indexed in PubMed. Source of the CDS Five Rights framework. https://www.routledge.com/Improving-Outcomes-with-Clinical-Decision-Support-An-Implementers-Guide-S… Gardner RM, Overhage JM, Steen EB, et al. Core content for the subspecialty of clinical informatics. J Am Med Inform Assoc. 2009;16(2):153-157. https://pubmed.ncbi.nlm.nih.gov/19074296/ Zhao J, Forsythe R, Langerman A, Melton GB, Schneider DF, Jackson GP. The value of the surgeon informatician. J Surg Res. 2020;252:264-271. https://pubmed.ncbi.nlm.nih.gov/32402396/ Anderson TN, Jenkins PD, Doberne JW, Mohan V, Thanawala RM. Defining the clinical informatics knowledge gap in general surgery: evaluation of resident experience and perspectives. J Surg Educ. 2025;82(11):103682. https://pubmed.ncbi.nlm.nih.gov/40911943/ Lyu HG, Doherty GM, Landman AB. Surgical informatics: defining the role of informa
- 1 weeks ago42 min
USA vs. UK: ASGBI Ep. 11 - Surgeons Are Human Too- Breaking the Silence on Mental Health
How do we care for ourselves while caring for others?Surgery is a demanding profession that requires resilience, sacrifice, and the ability to navigate high-stakes decisions. However, depression, anxiety, burnout, and the emotional consequences of complications are realities that many surgeons face but often struggle to discuss openly.In this episode of the Behind the Knife/Association of Surgeons of Great Britain and Ireland (ASGBI) collaborative series, our guests share their personal experiences navigating mental health challenges throughout their careers, confronting stigma, finding support, and learning that being a successful surgeon does not require being perfect.Hosts Dr. Agnes Premkumar — Behind the Knife Surgical Education Fellow, General Surgery resident (US) Dr. Gita Lingham — President, Moynihan Academy, trainee association within the Association of Surgeons of Great Britain and Ireland (ASGBI) (UK) Dr. Elizabeth McLennan — Vice President, Moynihan Academy, trainee association within the Association of Surgeons of Great Britain and Ireland (ASGBI) (UK) Guests Dr. Luke Elms — Board-certified general surgeon specializing in abdominal wall reconstruction and hernia surgery; host of The Hernia Gods podcast. Dr. Elizabeth “Liz” Miller — Former neurosurgical trainee and current occupational health physician, mental health advocate, and author of Mood Mapping. Resources MentionedMood Mapping — Dr. Elizabeth “Liz” MillerA practical guide to understanding and managing emotional well-being through mood awareness, self-reflection, and strategies such as exercise, music, spending time outdoors, and connecting with others.The Hernia Gods Podcast — Dr. Luke ElmsA podcast exploring the humanity behind surgery, including imposter syndrome, complications, professional identity, self-doubt, and the shared experiences of surgeons at every career stage.Available on Apple Podcasts, Spotify, and YouTube.Doctors' Support Networkhttps://www.dsn.org.uk/. A peer-support initiative discussed by Dr. Miller, emphasizing compassion, connection, and reducing the stigma associated with mental health challenges among physicians.Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review<
- 2 weeks ago42 min
Demystifying Topical Hemostatic Agents: A Mental Model for Surgeons
The scrub tech holds up two boxes, “SURGICEL or EVARREST?”, and you realize nobody ever taught you the difference. Patrick Georgoff, MD, John McClellan, MD, Kevin Kniery, MD, and Nick Teman, MD, break down topical hemostatic agents, one of the most used and least taught tools in the OR. You’ll get a simple two-question model for picking the right product: can your patient make their own clot, and can a patch reach the bleeding? Through trauma, vascular, and cardiac cases, the team covers when these agents earn their keep and when two minutes of pressure (no peeking!) will do the job. Bottom line: hemostatic agents speed up hemostasis, but they’re a targeted adjunct to good surgical technique, not a substitute for it!Hosts: Patrick Georgoff, MD, Duke Nick Teman, MD, University of Colorado John McCllelan, MD, UNC Kevin Kniery, MD, Madigan Army Medical Center Topical Hemostatic Agent PDF link: https://drive.google.com/file/d/1Qv9V_0l20CTXKQ_83newveIahmxzlpcb/view?usp=sharingPlease visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewABSITE Question Bank: https://behindtheknife.org/premium/absite-question-bankEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
- 2 weeks ago27 min
Journal Review in Surgical Oncology: Gastric Cancer
Join the Behind the Knife Surgical Oncology Team as we discuss the MATTERHORN trial and the addition of perioperative immunotherapy to FLOT for resectable gastric and gastroesophageal junction adenocarcinoma!Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center. Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery and Surgical Oncologist at the University of Tennessee Health Science Center, Chattanooga. Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncologist at Brooke Army Medical Center. Joe (Joseph) Broderick, MD, MA (@joebrod5) is a General Surgery research resident between his second and third year at Brooke Army Medical Center. Galen Gist, MD (@gistgalen) is a third-year General Surgery resident at Brooke Army Medical Center. Learning Objectives:In this episode, we review the evolution of perioperative therapy for resectable gastric and gastroesophageal junction adenocarcinoma, from the MAGIC and FLOT4 trials to the MATTERHORN trial, a phase III randomized controlled trial investigating the addition of perioperative durvalumab to FLOT. We discuss the mechanism of checkpoint inhibition, the trial design, the event-free and overall survival results, the pathologic and nodal response data, and the open questions this trial raises for surgeons.References used in the making of this episode: Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11-20. doi:10.1056/NEJMoa055531 Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948-1957. doi:10.1016/S0140-6736(18)32557-1 Janjigian YY, Al-Batran SE, Wainberg ZA, et al. Perioperative durvalumab in gastric and gastroesophageal junction cancer. N Engl J Med. 2025;393(3):217-230. doi:10.1056/NEJMoa2503701 Tabernero J, Al-Batran SE, Wainberg ZA, et al. Final overall survival and the association of pathological outcomes with event-free survival in MATTERHORN: a randomised, phase III study of durvalumab plus FLOT in resectable gastric/gastroesophageal junction adenocarcinoma. Presented at: European Society for Medical Oncology (ESMO) Congress 2025; October 17, 2025; Berlin, Germany. Abstract LBA81. Shitara K, Rha SY, Wyrwicz L, et al. Pembrolizumab plus chemotherapy versus chemotherapy as perioperative therapy in locally advanced gastric and gastroesophageal junction cancer: final analysis of the randomized, phase III KEYNOTE-585 study. J Clin Oncol. 2025;43(29):3152-3159. doi:10.1200/JCO-25-00486 Kang YK, Terashima M, Kim YW, et al. Adjuvant nivolumab plus chemotherapy versus placebo plus chemotherapy for stage III gastric or gastro-oesophageal junction cancer after gastrectomy with D2 or more extensive lymph-node dissection (ATTRACTION-5): a randomised, multicentre, double-blind, placebo-controlled, phase 3 trial. Lancet Gastroenterol Hepatol. 2024;9(8):705-717. doi:10.1016/S2468-1253(24)00156-0 André T, Tougeron D, Piessen G, et al. Neoadjuvant nivolumab plus ipilimumab and adjuvant nivolumab in localized deficient mismatch repair/microsatellite instability-high gastric or esophagogastric junction adenocarcinoma: the GERCOR NEONIPIGA phase II study. J Clin Oncol. 2023;41(2):255-265. doi:10.1200/JCO.22.00686 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: <a href="https://behindtheknife.org/p
- 3 weeks ago28 min
Building a Career in Global Surgery - Purpose, Mentorship, and Impact
In this episode of the Behind the Knife Global Surgery Series, we explore what it actually takes to build a meaningful career in global surgery. Global surgery is not a single specialty or job title—it is a broad field that intersects with clinical care, education, research, policy, advocacy, implementation science, and health-system strengthening. So how do trainees and early-career surgeons find their place in it?Host Mike M. Mallah is joined by Dr. Barnabas Alayande and Dr. Lacey LaGrone for a candid discussion about the personal and professional paths that brought them into global surgery. Dr. Alayande shares how experiences with limited access to healthcare in Nigeria shaped his decision to pursue medicine and ultimately global surgery, while Dr. LaGrone discusses her focus on translating evidence into clinical practice and building scalable approaches to knowledge dissemination.Together, they discuss why purpose matters, why global surgery should be viewed as a field rather than a job title, and why aspiring global surgeons should first become excellent at something that allows them to add real value. The conversation also examines mentorship, the difference between visibility and impact, the importance of integrity in partnerships, and the personal sacrifices that can accompany a career devoted to this work.For medical students, residents, fellows, and junior faculty interested in global surgery, this episode offers practical advice: develop meaningful expertise, seek mentors who are genuinely invested in your growth, focus less on recognition and more on impact, and keep doing the next right thing—excellently. Hosts/Guests:Mike M. Mallah, MD, FACS, FICSDirector of Global Surgery, Medical University of South Carolina@MikeMMallahMD@MUSCGlobalSurgmallahm@musc.edu Barnabas Alayande, MDChair, Center for Equity and Global SurgeryUniversity of Global Health Equity, RwandaGeneral Surgeon, Surgical Educator, and Global Surgery Leader@DrBarnabasAlay Lacey LaGrone, MDAssociate Director of Research, Medical Center of the RockiesAssociate Clinical Faculty, University of ColoradoCo-Founder, Together MadeAcute Care Surgeon, Surgical Intensivist, and Global Surgery Leader Papers noted:· Abimbola S. The foreign gaze: authorship in academic global health. BMJ Global Health. 2019;4:e002068. https://doi.org/10.1136/bmjgh-2019-002068· Essentialism: The Disciplined Pursuit of Less by Greg McKeown https://gregmckeown.com/books/essentialism/ Topics discussed: Career pathways in global surgery; finding your “why”; global surgery as a field rather than a specialty; developing expertise; implementation science; mentorship; visibility versus impact; ethical partnerships; professional sacrifice; work-life balance; and advice for the next generation of global surgeons.Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course:
- 3 weeks ago40 min
Clinical Challenges in Bariatric Surgery: Marginal Ulcers
Open the capsule, quit the cigarettes, and know when to cut: the essentials of managing marginal ulcers after bypass.Marginal ulcers are among the most common complications after Roux-en-Y gastric bypass, with a pooled prevalence around 4.6%, and they span everything from mild postprandial pain to perforation with peritonitis. In this episode, our expert panel works through three clinical scenarios (an uncomplicated early ulcer, a refractory ulcer with recurrent stricture, and a perforated ulcer with peritonitis) to build a practical framework for prevention, workup, medical therapy, and surgical escalation.Hosts Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio) Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida) Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) Learning objectives1. Identify the established and debated risk factors for marginal ulcers. Recognize smoking, diabetes, NSAIDs, and larger pouch size as key contributors. Appreciate that the role of H. pylori remains unsettled because of heavy heterogeneity across meta-analyses.2. Perform a complete etiologic workup for a new marginal ulcer. Assess NSAID and immunosuppressant use, smoking (including cotinine test), H. pylori status, and visible suture or staple material at the anastomosis, and know that endoscopy, not CT, is the diagnostic tool of choice unless perforation is suspected.3. Optimize first-line medical management. Use PPI therapy with instructions to open the capsules for faster healing, understand the limited evidence for adding sucralfate, confirm healing with repeat endoscopy, and individualize treatment duration, including when lifelong prophylaxis is reasonable.4. Define and evaluate the refractory ulcer. Apply the 6- to 12-month definition of refractory disease, rule out gastrogastric fistula, hypersecretory states (serum gastrin), and PPI rapid metabolism (CYP2C19), and recognize ulcer-related gastrojejunal stricture and the perforation risk of serial dilation.5. Weigh escalation options for refractory disease. Compare endoscopic suturing and stenting, truncal vagotomy, and GJ revision, including their mixed durability data, and address nutritional optimization and remnant access before reoperation.6. Manage a perforated marginal ulcer. Prioritize resuscitation, antibiotics, and IV PPI; take unstable patients straight to the OR, use primary repair with omental patch as the default approach, and reserve revision or damage control for select patients based on physiology, tissue quality, and expertise.7. Counsel patients on long-term recurrence risk. Communicate substantial recurrence rates after both repair and revision and emphasize that quitting smoking early (more than a year before surgery) meaningfully lowers reoperation risk.Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premi
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About Behind The Knife: The Surgery Podcast
Behind the Knife is the world’s #1 surgery podcast. From high-yield educational topics to interviews with leaders in the field, Behind the Knife delivers the information you need to know. Tune in for timely, relevant, and engaging content designed to help you DOMINATE THE DAY!
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Frequently Asked Questions
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It's a free AI-powered email that summarizes new episodes of Behind The Knife: The Surgery Podcast as soon as they're published. You get the key takeaways, notable quotes, and links & mentions — all in a quick read.
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When a new episode drops, our AI transcribes and analyzes it, then generates a personalized summary tailored to your interests and profession. It's delivered to your inbox every morning.
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How often does Behind The Knife: The Surgery Podcast release new episodes?
Behind The Knife: The Surgery Podcast publishes every few days. Our AI generates a summary within hours of each new episode.
What topics does Behind The Knife: The Surgery Podcast cover?
Behind The Knife: The Surgery Podcast covers topics including Science, Education, Medicine, Fitness, Health & Fitness. Our AI identifies the specific themes in each episode and highlights what matters most to you.
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