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Item Hiatal Hernia Repair with Novel Biological Graft Reinforcement(Journal- Society of Laparoendoscopic Surgeons, 2016) Sasse, Kent C.; Warner, David L.; Ackerman, Ellen; Brandt, JaredHiatal hernias are repaired laparoscopically with increasing use of reinforcement material. Both synthetic and biologically derived materials reduce the recurrence rate compared to primary crural repair. Synthetic mesh introduces complications, such as mesh erosion, fibrosis, and infection. Urinary bladder matrix (UBM) represents a biologically derived material for use in hiatal hernia repair reinforcement with the potential to improve durability of repair without incurring the risks of other reinforcement materials. Methods: The 15 cases presented involved hiatal hernia repair with primary crural repair with UBM reinforcement and fundoplication. Patients were followed for an average of 3 years, and were assessed with upper gastrointestinal (GI) series, endoscopy, and assessments of subjective symptoms of gastroesophageal reflux disease (GERD). Results: Hernia diameters averaged 6 cm. Each repair was successful and completed laparoscopically. UBM exhibited favorable handling characteristics when placed as a horseshoe-type graft sutured to the crura. One patient underwent endoscopic balloon dilatation of a mild postoperative stenosis that resolved. No other complications occurred. In more than 3 years of follow-up, there have been no recurrences or long-term complications. GERD-health-related quality of life (HRQL) scores averaged 6 (range, 0-12, of a possible 50), indicating little reflux symptomatology. Follow-up upper GI series were obtained in 9 cases and showed intact repairs. An upper endoscopy was performed in 8 patients and showed no recurrences. Conclusion: Surgeons may safely use laparoscopic fundoplication with UBM reinforcement for successful repair of hiatal hernias. In this series, repairs with UBM grafts have been durable at 3 years of follow-up and may serve as an alternative to synthetic mesh reinforcement of hiatal hernia repairs.Item Ectopic Papillary Carcinoma in the Midline Neck Accompanied by a Benign Thyroid Gland(Case Reports in Otolaryngology, 2019) Evans, Lauran; Park, SeHoon; Elliott, Christie; Garrett, CourtneyEctopic thyroid tissue can deposit anywhere in the body. There are several cases reporting papillary thyroid carcinoma (PTC) arising from ectopic tissues||however, these cases largely presented with primary PTC within the native thyroid gland as well. Alternatively, some cases report of PTC found solely in an ectopic thyroglossal duct cyst, but reports of isolated malignancy in other types of ectopic thyroid tissue with normal native tissue are sparse throughout the literature. Here, we present an unusual case of PTC in the midline anterior neck that does not appear to be consistent with a thyroglossal duct cyst, accompanied by a completely benign native thyroid gland, of which only few cases have been reported.Item Penile squamous cell carcinoma: a review of the literature and case report treated with Mohs micrographic surgery(Anais Brasileiros de Dermatologia, 2017) Marchionne, Elizabeth; Perez, Caroline; Hui, Andrea; Khachemoune, AmorThe majority of penile carcinoma is squamous cell carcinoma. Although uncommon in the United States, it represents a larger proportion of cancers in the underdeveloped world. Invasive squamous cell carcinoma may arise from precursor lesions or de novo, and has been associated with lack of circumcision and HPV infection. Early diagnosis is imperative as lymphatic spread is associated with a poor prognosis. Radical surgical treatment is no longer the mainstay, and penile sparing treatments now are often used, including Mohs micrographic surgery. Therapeutic decisions should be made with regard to the size and location of the tumor, as well as the functional desires of the patient. It is critical for the dermatologist to be familiar with the evaluation, grading/staging, and treatment advances of penile squamous cell carcinoma. Herein, we present a review of the literature regarding penile squamous cell carcinoma, as well as a case report of invasive squamous cell carcinoma treated with Mohs micrographic surgery.Item Technical Details of Laparoscopic Sleeve Gastrectomy Leading to Lowered Leak Rate: Discussion of 1070 Consecutive Cases(Minimally Invasive Surgery, 2017) Warner, David L.; Sasse, Kent C.Laparoscopic sleeve gastrectomy is a widely utilized and effective surgical procedure for dramatic weight loss in obese patients. Leak at the sleeve staple line is the most serious complication of this procedure, occurring in 1-3% of cases. Techniques to minimize the risk of sleeve gastrectomy leaks have been published although no universally agreed upon set of techniques exists. This report describes a single-surgeon experience with an approach to sleeve leak prevention resulting in a progressive decrease in leak rate over 5 years. Methods. 1070 consecutive sleeve gastrectomy cases between 2012 and 2016 were reviewed retrospectively. Patient characteristics, sleeve leaks, and percent body weight loss at 6 months were reported for each year. Conceptual and technical changes aimed towards leak reduction are presented. Results. With the implementation of the described techniques of the sleeve gastrectomy, the rate of sleeve leaks fell from 4% in 2012 to 0% in 2015 and 2016 without a significant change in weight loss, as depicted by 6-month change in body weight and percent excess BMI lost. Conclusion. In this single-surgeon experience, sleeve gastrectomy leak rate has fallen to 0% since the implementation of specific technical modifications in the procedure.Item Accuracy of Alcon WaveLight EX500 optical pachymetry during LASIK(Clinical Ophthalmology, 2017) Mifflin, Mark D.; Mortensen, Xavier M.; Betts, Brent S.; Gross, Cole; Zaugg, BrianTo study the accuracy and reliability of optical pachymetry using the Alcon WaveLight FX500 during laser-assisted in situ her atomileusis (LASIK) I K). Materials and methods: This was a retrospective chart review of 90 eyes from 45 patients who had undergone LASIK (mean age 35.2 8.2 years||19 males, 26 females). The WaveLight ES200 lemtosecond laser was programmed to cut LASIK flaps at a desired depth of 120 pm. Optical low-coherence reflectometry (Wave Light KX500) was used to measure central corneal thickness prior to lifting the flap, and the residual stromal bed immediately after excimer ablation. Flap thickness (FT) was calculated using simple subtraction. Optical coherence tomography (OCT) was used to measure central corneal thickness, flap thickness, and residual stromal bed M the postoperative period and the results compared to intraoperative measurements. Results: Mean programmed FS200 FT Was 119 pm. Mean FT using EX500 optical pachymetry was 109 pm. The difference between FS200-programmed and EX500-measured FT was 9 pm (P<0.001). There was also a significant difference between the EX500 and OCT FT (109 p.m vs 119 pm, respectively||P<(1.001). Conclusion: FT values calculated tsing intraoperative FX500 optical pachymetry were significantly lower than programmed FS200 values or OCT measurements.