Publications by authors named "Myron S Powell"

7 Publications

  • Page 1 of 1

Outcomes Following Cholecystectomy on a Service Designed to Maximize Chief Resident Entrustment.

J Surg Res 2021 Apr 12;264:474-480. Epub 2021 Apr 12.

Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC. Electronic address:

Background: The chief resident service provides surgical trainees in their final year of training the opportunity to maximize responsibility, continuity, and decision-making. Although supervised, chief residents operate according to personal preferences instead of adapting to their attendings' preferences. We hypothesized that outcomes following cholecystectomy are equivalent between the chief resident service and standard academic services.

Methods: We matched adults undergoing cholecystectomy from 07/2016-06/2019 on the chief resident service to two standard academic service patients based on operative indication and age. We compared demographics, operative details, and 30-d complications.

Results: This study included 186 patients undergoing cholecystectomy. Body mass index (32.4 versus 32.0, P = 0.49) and Charlson comorbidity index (0.9 versus 1.4, P = 0.16) were similar between chief resident and standard academic services, respectively. Operative approach was similar (95.2% laparoscopic on chief resident service versus 94.4% on standard service), but residents on the chief resident service performed cholangiograms more often (48.4% versus 22.6%, P < 0.01) and averaged longer operative times during laparoscopic cholecystectomy with cholangiogram (146±28 versus 85±22 min, P < 0.01) and without (94±31 versus 76±35 min, P < 0.01) compared with standard academic services, respectively. 30-d complication rates were similar (5.2% chief resident versus 5.0% standard, P = 0.95). No patients suffered bile leak, bile duct injury, or reoperation. Emergency Department visits were similar (12.1% chief resident versus 7.4% standard, P = 0.32); readmissions were less frequent on the chief resident service (0.0% versus 5.0% standard, P = 0.03).

Conclusions: With appropriate supervision, chief residents provide safe care for patients undergoing cholecystectomy while directing medical decisions and practicing according to their preferences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jss.2021.02.042DOI Listing
April 2021

Live Quality Assurance: Using a Multimedia Messaging Service Group Chat to Instantly Grade Intraoperative Images.

J Am Coll Surg 2020 02 11;230(2):200-206. Epub 2019 Nov 11.

Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC; Department of Surgery, WG Bill Hefner VA Medical Center, Salisbury, NC. Electronic address:

Background: The technique for attaining photographic evidence of the critical view of safety (CVS) in laparoscopic cholecystectomy (LC) has previously been defined; however, the consistency, accuracy, and feasibility of CVS in practice is unknown. The aim of this study was to use an already established image sharing and grading system to determine the feasibility of timely feedback after sharing intraoperative images of the CVS and to evaluate if and how cholecystitis affects the ability to attain a CVS.

Study Design: We studied 193 laparoscopic cholecystectomies performed by 14 surgeons between August 2017 and January 2019. Anterior and posterior intraoperative CVS images were shared using a standard multimedia messaging system (MMS). Images were graded remotely by members of the group using an established scoring system, and their times to response and scores were recorded. Response data were analyzed for the ability to attain timely and consistent CVS scores.

Results: There were 74 urgent laparoscopic cholecystectomies for acute cholecystitis and 119 nonurgent cholecystectomies performed during the study period. Scoring of shared images occurred in less than 5 minutes, and peer review (mean 3 responses) showed agreement that was not significantly different. In patients with acute cholecystitis, a small but significant difference was observed between anterior and posterior image scoring agreement.

Conclusions: An established image sharing and grading system for CVS can be used for real-time intraoperative feedback without increasing operative time or compromising private health information. The CVS is almost always attainable; however, decreases in CVS quality and grading agreement are observed in patients with acute cholecystitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jamcollsurg.2019.09.022DOI Listing
February 2020

Laparoscopic Splenectomy for Giant Splenic Cyst.

Am Surg 2015 Nov;81(11):E390-1

Department of General Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
November 2015

Conversion from gastric bypass to sleeve gastrectomy for complications of gastric bypass.

Surg Obes Relat Dis 2016 Mar-Apr;12(3):572-576. Epub 2015 Jul 4.

Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.

Background: Complications after gastric bypass (RYGB) are well documented. Reversal of RYGB is indicated in select cases but can lead to weight gain. Conversion from RYGB to sleeve gastrectomy (SG) has been proposed for correction of complications of RYGB without associated weight gain. However, little is known about outcomes after this procedure.

Objectives: To examine outcomes after conversion from RYGB to SG.

Setting: University hospital.

Methods: A retrospective study of patients who underwent RYGB to SG conversion was undertaken.

Results: Twelve patients underwent RYGB to SG conversion for refractory marginal ulceration, stricture, dumping, gastrogastric fistula, hypoglycemia, and failed weight loss. No deaths occurred. Four patients experienced 7 major complications, including portal vein thrombosis, bleeding, pancreatic leak, pulmonary embolus, seroma, anastomotic leak, and stricture. Two required reoperation, and 6 were readmitted within 30 days. Four required nasoenteric feeding postoperatively because of prolonged nausea. The complication of RYGB resolved in 11 of 12 patients. At 14.7 months, change in body mass index for all patients was a decrease of 2.2 kg/m(2). In 5 patients with morbid obesity at conversion, the change in body mass index was a decrease of 6.4 kg/m(2) at 19 months.

Conclusions: Laparoscopic conversion from RYGB to SG is successful in resolving certain complications of RYGB and does not result in short-term weight gain. However, conversion has a high rate of major complications as well as a high rate of readmission and need for supplemental nutrition. Although conversion to SG may be appropriate in carefully-selected patients, other options for patients with severe chronic complications after RYGB should be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.soard.2015.07.001DOI Listing
October 2017

Atypical ossifying fibromyxoid tumor.

Am Surg 2014 Aug;80(8):E257-8

Minimally Invasive Surgery Division, Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
August 2014

Nonmesenteric defect causing internal hernia after laparoscopic Roux-en-Y gastric bypass.

Am Surg 2013 Aug;79(8):E260-1

Minimally Invasive Surgery Division, Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina 27157, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
August 2013

Surgical treatment for morbid obesity: the laparoscopic Roux-en-Y gastric bypass.

Surg Clin North Am 2011 Dec;91(6):1203-24, viii

Department of General Surgery, Wake Forest University School Of Medicine, Winston-Salem, NC 27157, USA.

Over the past 20 years bariatric surgery proved to be a valid treatment for reduction and elimination of obesity-related diseases and long-term sustainable weight loss. Minimally invasive or laparoscopic techniques such as laparoscopic Roux-en-Y (LRNY) have replaced open procedures. Many factors play important roles in the small intricacies and variations of the procedure, chief of which is the creation and size of the gastrojejunostomy. Regardless of the variations in technique, the LRNY remains the gold standard for the surgical treatment of clinically severe or morbid obesity, with relatively low morbidity and mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.suc.2011.08.013DOI Listing
December 2011