NWSCRS 2017 Saturday

1. Effect of Body Mass Index on Recurrence of Rectal Prolapse After Surgical RepairPresenter: Kristin BuschA 57-year-old female presents to your office for rectal prolapse. Her BMI is 41 kg/m2. She has evidence of full thickness rectal prolapse on exam. How would you counsel the patient regarding her risk of recurrence in regards to her current BMI?

She may have a decreased risk of recurrent rectal prolapse after surgical repair given her current BMI.

Her current BMI will likely have no influence on her risk of recurrent rectal prolapse after surgical repair.

She may have an increased risk of recurrent rectal prolapse after surgical repair given her current BMI.

2. Development of Expert Times for Endoscopy Simulator Tasks in Preparation for the Fundamentals of Endoscopic Surgery ExamPresenter: Heather E Hoops MDSkills required on the FES exam include all of the following EXCEPT:

Navigation

Retroflexion

Loop reduction

Insufflation

3. Resident knowledge of benign anal diseases: how general surgery compares to other disciplinesPresenter: Katherine KelleyA 25-year-old female with chronic constipation presents to clinic with two months of pain with bowel moments and bright red blood seen on toilet paper when wiping. On exam, there is a posterior tear in the anoderm. What initial treatment should be offered?

Fiber supplementation/water

Steroid cream

Excision

Botox

4. Surgical Treatment of Internal Intussusception and Rectal Prolapse: Choosing the Right Operation for the Right PatientPresenter: Liliana Bordeianou89 year old female with significant medical comorbidities and a frozen abdomen presents with rectal prolapse, uterine prolapse and vaginal laxity. She is in lots of pain and is considering surgical options. You review the limited literature and advise considering the following surgery:

Laparoscopic ventral rectopexy and hysteropexy

Perineal proctectomy, vaginal hysterectomy and colpocleisis

Open suture resection rectopexy, hysterectomy

Laparoscopic suture rectopexy and hysterectomy

5. A QUANTITATIVE RISK-BENEFIT ANALYSIS OF PROPHYLACTIC SURGERY PRIOR TO EXTENDED-DURATION SPACEFLIGHTPresenter: Danielle Carroll, MDA 37 year-old astronaut with no significant medical history is preparing for an exploratory mission to Mars. In your office, she inquires as to the current recommendation for undergoing prophylactic appendectomy prior to departing. What do you tell her?

The evidence strongly supports prophylactic appendectomy, but not cholecystectomy, before long-duration missions in austere environments.

The evidence is strongly against any prophylactic surgery whatsoever.

The evidence strongly supports prophylactic cholecystectomy, but not appendectomy, before long-duration missions in austere environments.

6. Searching for Darkness in the Black Hole: Is there a role for high resolution anoscopy surveillance after wide local excision of anal melanoma?Presenter: Ryan ClarkSurgical management of anal melanoma is controversial. What is a proposed method of minimally invasive surgical management?

APR

Wide local transanal excision

Cryoablation

LAR

7. Management of the Difficult StomaPresenter: Beck, David, EAbdominal wall modification

Requires the assistance of a plastic surgeon

Has a low incidence of wound complications

Is helpful in morbidly obese patients

Can not be combined with other procedures

8. 41 yo female presents to your office with report of severe constipation. She has paradoxical EMGs, a small rectocele that does not protrude past the introitus, and intrarectal intussusception on defecography. In addition, defecography shows a small enterocele. You advise:

Biofeedback and medical management

Resection rectopexy (lap or open)

Ventral rectopexy

Stapled transanal rectal resection (STARR)

9. What does the term "therapeutic misconception" mean in reference to the interaction between a patient and a physician scientist?

The patient and the physician are both mistakenly under the assumption that the research study will definitely be therapeutic.

10. What are some of the key elements of being a "Professional" in the context of the history of medical ethics?

Specialized knowledge, Self regulation, Lifelong learning, Honesty

Transparency, Expertise, Respectful of the law, Nonjudgmental

Specialized knowledge, Honesty, Nonjudgmental, Well rounded

Politically active, Respectful of the law, Well – informed, Skillful

11. Can Ethics be Taught in SurgeryPresenter: Piroska KoparWhat does the term "Social Contract" refer to with regard to the relationship between patients and physicians?

The explicit agreement between physicians and members of society that a physician will never practice medicine without full transparency.

The explicit agreement between physicians and members of society that informed consent will always be respected.

12. Reducing Colorectal SSI: Results of an Institution-Wide Standardization ProtocolPresenter: Daniel Herzig, MD The most effective intervention to reduce surgical site infections after colorectal surgery is:

Mechanical and antibiotic bowel prep

Maintaining normothemia

Giving the right antibiotic at the right time

A bundle of interventions standardized for all procedures

13. 54 year old female presents with severe long standing constipation. She is also now noticing new fecal incontinence and a 4 cm full thickness rectal prolapse upon straining. She has had no prior surgeries. Anorectal physiology testing does not show a transit disorder, or obstructed defecation due to paradoxical contractions of puborectalis. She has low normal anal pressures. On defecography, she has a large enterocele that appears to prolapse through the anus. She does not have visible uterine or vaginal prolapse on the physical exam. She tried biofeedback and is still symptomatic. She is looking for the repair that would have the highest chance of fixing her prolapse, constipation and fecal incontinence symptoms.You review the limited literature and advise considering the following surgery:

Laparoscopic suture rectopexy

Laparoscopic resection rectopexy

Laparoscopic ventral rectopexy

Perineal rectal prolapse repair

14. What are the four classic principles of Medical Ethics?

Autonomy, Beneficence, Justice, Paternalism

Autonomy, Non – maleficence, Beneficence, Justice

Autonomy, Non – maleficence, Professionalism, Justice

Beneficence, Non – maleficence, Professionalism, Justice

15. Ventral Mesh Rectopexy: Making the Pelvic Floor Great AgainPresenter: Jill ClarkA 59-year-old woman presents to you for prolapsing hemorrhoids. She mentions that she had radiation for cervical cancer 20 years ago. She reports that with the assistance of laxative teas, she has 2-3 bowel movements weekly that are firm and require som

Recommend that she maintain her current bowel regimen.

Offer her the option of either manually reducing the prolapse as needed versus considering laparoscopic posterior suture rectopexy.

Have her consider evaluation for a pessary as a non-operative treatment option.

16. 62 year old female presents after a failed perineal repair for rectal prolapse (Delorme). She is incontinent, and has a large patulous anus. Her anal sphincter tone is very low. Her defecography suggests a stable anterior compartment. She asks you about the benefit of proceeding with a repeat perineal repair vs. an abdominal operation, with an especial focus on her chance of having improved continence. You summarize the current consensus comparing perineal and abdominal repairs as follows:

Perineal repairs are associated with higher rates of fecal incontinence

Abdominal repairs are associated with higher rates of fecal incontinence

Perineal proctectomy with a levatorplasty offers better continence than a Delorme repair.

17. Colorectal Anastomotic Staplers: Cost vs. EfficacyPresenter: Toby Muniz, MD Which of the following statements regarding bowel anastomotic stapling is correct:

There exists clear data supporting the superiority of one stapling brand over another wtih reference to anastomotic leak rates

Anastomtic leaks are a trivial complication of bowel surgery

Certain technical features of a stapling device may cause a higher or lower risk for anastomotic leak

There are no quantifiable scoring systems to predict anastomotic leak in a patient

Nwscrs 2017 Saturday

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