Behind The Knife: The Surgery Podcast

Strap in and grab your NG tubes, because the EGS team in TIGER Country is taking you on a fast, forceful, and evidence-packed ride through 15 years of global SBO literature. From the OG 2011 Zielinski model to the latest 2025 predictive tools sweeping across Europe and North America, we’re breaking down what matters when the bowel stops behaving and the clock starts ticking.  Join Dr. Rushabh Dev and the Acute Care Surgery crew at the University of Missouri as they tackle the most common EGS consult in America with humor, data, and real-world pearls. Get ready for CT red flags, strangulation scores, Gastrografin truths, and the eternal battle between “operate early” vs. “wait it out.” Whether you’re a med student trying to decode your first CT or a seasoned attending debating the next Gastrografin challenge, this episode delivers the insights you need to Dominate the Day. Participants: Dr. Rushabh Dev FACS (Moderator, Surgical Attending) – Assistant Professor of Surgery, Associate PD ACS & SCCM Fellowship, SICU Medical Director, Lieutenant Commander United States Navy Reserve   Dr. Raymond Okeke; Acute Care Surgery & SCCM Fellow  Dr. Eugene Ismailov, General Surgery Resident; PGY 5 Dr. Brycen Ratcliffe, General Surgery Resident; PGY 4 Dr. Desra Flecher, General Surgery Resident; PGY 3 Objectives: 1. Identify the core clinical and CT predictors of operative need in SBO including mesenteric edema, free fluid, closed-loop obstruction, lack of enhancement, and feces sign absence — and understand how these features have remained consistent across 15 years of research. 2. Compare major international SBO predictive models (Zielinski, Geneva Severity Score, STRISK, and NOFA) and describe how they inform real-time decision-making in North American acute care surgery. 3. Apply evidence-based algorithms, including the 2025 JTACS EGS pathway to structure SBO evaluation, integrate Water-Soluble Contrast studies, and avoid delayed surgery in high-risk patients. 4. Evaluate the long-term impact of operative vs. non-operative management with emphasis on recurrence risk, timing between episodes, and how to incorporate recurrence data into patient counseling. 5. Synthesize 15 years of evolving SBO literature into practical bedside strategies by balancing red-flag findings, risk-model guidance, and individualized clinical judgment to optimize outcomes. STRISK and NOFA Calculator: Prediction Models | Clinical Abdominal Surgery Helsinki References  1. Geneva Clinical Severity Score Wassmer, C. H., Guber, J., Zeindler, J., Meier, R. P. H., Ouaïssi, M., Ris, F., Morel, P., Didier, C., & Gkikas, I. (2023). A new clinical severity score for the management of adhesive small bowel obstruction: A cohort study. International Journal of Surgery, 109, 262–270. https://pubmed.ncbi.nlm.nih.gov/37026805/ 2. STRISK & NOFA Predictive Models Räty, S., Rinta-Kilpinen, E., Eklund, M., Turunen, N., Koskinen, I., Rasilainen, S., Korhonen, T., & Paajanen, H. (2025). Development and external validation of prediction risk models for strangulation or non-operative treatment failure in small bowel obstruction: A multicenter prospective study. Surgery, 178(1), 45–56. Prediction Models | Clinical Abdominal Surgery Helsinki 3. JTACS EGS Algorithm – Evidence-Based, Cost-Effective Management Livingston, D. H., Wolfson, D., Cogbill, T. H., Rice, T. W., Patel, N., et al. (2025). Evidence-based, cost-effective management of small bowel obstruction: An Emergency General Surgery Algorithms Work Group project. Journal of Trauma and Acute Care Surgery, 98(4), 512–528. https://pubmed.ncbi.nlm.nih.gov/40842046/ 4. Tennessee Recurrence Study (Operative vs Non-Operative Management) Medvecz, A. J., Dennis, B. M., Wang, L., Countouris, M. E., Croce, M. A., Sharpe, J. P., Ivanova, A., & Miller, R. S. (2020). Impact of operative management on recurrence of adhesive small bowel obstruction: A longitudinal analysis of a statewide database. Journal of the American College of Surgeons, 230(4), 544–551.e1. https://pubmed.ncbi.nlm.nih.gov/31954815/ 5. Early Predictive SBO Work – Zielinski (2010–2011) Zielinski, M. D., Eiken, P. W., Bannon, M. P., Heller, S. F., Lohse, C. M., & Huebner, M. (2010). Small bowel obstruction—Who needs an operation? A multivariate prediction model. World Journal of Surgery, 34(5), 910–919. https://pubmed.ncbi.nlm.nih.gov/20217412/ 6. Zielinski, M. D., Haddad, N. N., Cullinane, D. C., Eiken, P. W., & Huebner, M. (2011). Prospective, observational validation of a multivariate small bowel obstruction model to predict the need for operative intervention. Journal of the American College of Surgeons, 212(6), 1068–1076. https://pubmed.ncbi.nlm.nih.gov/21458305/ 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/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate 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-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam. Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.  Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/en-us/index.html If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.   Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   Check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate 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-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general

Endocrine Surgery emergencies are rare. However, they can be clinically significant and understanding how to navigate them as a surgeon in timely fashion is critical. Hosts:  Dr. Rebecca Sippel is an endowed professor of surgery and Division Chief of Endocrine Surgery at University of Wisconsin (UW) - Madison, and she is the most recent past president of the American Association of Endocrine Surgeons (AAES).  She is an internationally recognized leader in the field of endocrine surgery with over 250 publications. She was the principal investigator for a hallmark randomized controlled trial which studied the need for prophylactic central neck dissections in thyroid cancer.   Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI. Her clinical interests are in robotic adrenalectomy, benign and malignant thyroid cancer and hyperparathyroidism. Dr. Simon Holoubek is a fellowship trained endocrine surgeon affiliated with UW Health. His primary practice is with UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.  Learning Objectives: 1) Learn about thyroid storm in hyperthyroidism and treatment options. 2) Understand how to treat hypercalcemic crisis due to uncontrolled primary hyperparathyroidism. 3) Describe the modified surgical techniques required for thyroidectomy in patients with Graves’ disease to prevent recurrent laryngeal nerve traction injury. 4) Identify clinical and intraoperative indicators of parathyroid carcinoma and explain the necessity of en bloc resection to prevent parathyromatosis. References: 1 Palit TK, Miller CC 3rd, Miltenburg DM. The efficacy of thyroidectomy for Graves' disease: A meta-analysis. J Surg Res. 2000 May 15;90(2):161-5. doi: 10.1006/jsre.2000.5875. PMID: 10792958. https://pubmed.ncbi.nlm.nih.gov/10792958/ 2 Yoshimura Noh J, Inoue K, Suzuki N, Yoshihara A, Fukushita M, Matsumoto M, Imai H, Hiruma S, Ichikawa M, Koshibu M, Sankoda A, Hirose R, Watanabe N, Sugino K, Ito K. Dose-dependent incidence of agranulocytosis in patients treated with methimazole and propylthiouracil. Endocr J. 2024 Jul 12;71(7):695-703. doi: 10.1507/endocrj.EJ24-0135. Epub 2024 May 3. PMID: 38710619. https://pubmed.ncbi.nlm.nih.gov/38710619/ 3 Christopher L, Mellman M, Buicko JL. Management of Hypercalcemic Crisis due to Primary Hyperparathyroidism During Pregnancy. Am Surg. 2023 Aug;89(8):3638-3640. doi: 10.1177/00031348231162704. Epub 2023 Apr 27. PMID: 37102502. https://pubmed.ncbi.nlm.nih.gov/37102502/ Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only 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/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate 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-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam. Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.  Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/en-us/index.html If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.   Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   Check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate 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-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general

Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam. Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.  Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/en-us/index.html If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.   Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   Check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate 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-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general