Yoav Bichovsky MD, Amit Frenkel MD MHA, Evgeni Brotfain MD, Leonid Koyfman MD, Limor Besser MD, Natan Arotsker MD, Abraham Borer MD, and Moti Klein MD
Sara Dovrat PhD, Ela Kashi-Zagdoun BSc, Zvia Soufiev BSc, Ella Mendelson PhD, and Tzion Schlossberg MD
Background: Infections in neonates with herpes simplex virus 1 (HSV-1) following circumcision due to Metzitzah Be'Peh (MBP) performed by a Mohel occur each year in small numbers. One solution to this problem is the use of a mucus extractor device instead of MBP, which has been authorized by some rabbis. Yet, using a mucus extractor remains controversial among ultra-Orthodox Jews; thus, creating a need for additional solutions.
Objectives: To seek to reduce HSV-1 infection of neonates due to MBP.
Methods: We tested several oral rinse solutions for their ability to destroy virus infectivity following incubation for 30 seconds and using plaque reduction assays.
Results: Corsodyl, Decapinol, and Listerine® all destroyed plaques formation of spiked virus, while Gengigel and Tantum Verde were found to be less effective. We focused specifically on Listerine® due to its efficacy in eliminating contagious HSV-1 from saliva after a 30-second oral rinse. Five different products of Listerine® reduced the infectivity of a spiked virus by more than 4 orders of magnitude in 30 seconds. We also showed that Listerine (up to 7% v/v) can stay in the mouth but did not harm living cells and therefore will not cause any damage to the injured tissue.
Conclusions: Significant reduction in cases of infection with HSV-1 due to MBP can be achieved if Mohalim consistently adopt the practice of careful mouth washing with Listerine® just before performing MBP.
Anton Warshavsky MD, Roni Rosen MD, Uri Neuman MD, Narin Nard-Carmel MD, Udi Shapira MD, Leonor Trejo MD, Dan M. Fliss MD, and Gilad Horowitz MD
Background: Accuracy of the number and location of pathological lymph nodes (LNs) in the pathology report of a neck dissection (ND) is of vital importance.
Objectives: To quantify the error rate in reporting the location and number of pathologic LNs in ND specimens.
Methods: All patients who had undergone a formal ND that included at least neck level 1 for a clinical N1 disease between January 2010 and December 2017 were included in the study. The error rate of the pathology reports was determined by various means: comparing preoperative imaging and pathological report, reporting a disproportionate LN distribution between the different neck levels, and determining an erroneous location of the submandibular gland (SMG) in the pathology report. Since the SMG must be anatomically located in neck level 1, any mistake in reporting it was considered a categorical error.
Results: A total of 227 NDs met the inclusion criteria and were included in the study. The study included 128 patients who had undergone a dissection at levels 1–3, 68 at levels 1–4, and 31 at levels 1–5. The best Kappa score for correlation between preoperative imaging and final pathology was 0.50. There were nine cases (3.9%) of a disproportionate LN distribution in the various levels. The SMG was inaccurately reported outside neck level 1 in 17 cases (7.5%).
Conclusions: At least 7.5% of ND reports were inaccurate in this investigation. The treating physician should be alert to red flags in the pathological report
Moshe Gips MD, Jose Bendahan MD, Shlomo Ayalon MD, Yigal Efrati MD, Moshe Simha MD, and Dov Estlein MD
Background: Pilonidal disease in the natal cleft is treated traditionally by a wide and deep excision of the affected area. There is growing awareness, however, to the advantages of minimally invasive surgeries.
Objectives: To compare the efficacy of wide excision operations and minimal trephine surgery in patients with primary pilonidal disease.
Methods: In this retrospective study we examined surgical and inpatient records of 2039 patients who underwent surgery for primary pilonidal disease in five private hospitals between 2009 and 2012. Most procedures were of lay-open, primary midline closure, and minimal surgery types. Pilonidal recurrence rates were evaluated in a subset of 1260 patients operated by 53 surgeons each performing one type of surgery, regardless of patient characteristics or disease severity.
Results: With a mean follow-up of 7.2 years, 81.5%, 85%, and 88% of patients were disease-free after minimally invasive surgery, wide excision with primary closure, and lay-open surgery, respectively, with no statistically significant difference in recurrence rates. Minimal surgeries were usually performed under local anesthesia and involved lower pain levels, less need for analgesics, and shorter hospital stays than wide excision operations, which were normally performed under general anesthesia. The use of drainage, antibiotics, or methylene blue had no effect on recurrence of pilonidal disease.
Conclusions: Minimally invasive surgeries have the advantage of reducing the extent of surgical injury and preserving patient’s quality of life. They should be the treatment of choice for primary pilonidal disease
Yaron Rudnicki MD, Hagai Soback MD, and Mahajna Ahmad MD
Background: Achieving laparoscopic competency is challenging. Common laparoscopic simulators usually fall short in achieving true simulation.
Objective: To present a live porcine model laparoscopic skills laboratory for training general surgery residents.
Methods: An in vivo porcine laparoscopic model course was developed to simulate seven different laparoscopic procedures and seven laparoscopic skills for trainees under the tutelage of laparoscopic specialists.
Results: A total of 98 surgical trainees from 19 training programs underwent a full-day course from September 2017 to July 2020. Each program consisted of four trainees and two faculty members. In total, 175 laparoscopic procedures were performed. Trainees reported that the course improved their ability to perform in the operating room.
Conclusions: Using a laparoscopic porcine model in a guided didactic course performing complete common laparoscopic procedures in simulated operating room surroundings was beneficial for surgical trainees. The porcine model mimics human abdominal anatomy and allows trainees to increase their comfort level in performing such procedures.
Viacheslav Bard MD, Baruch Brenner MD, and Hanoch Kashtan MD
There has been a general reduction over the last 20 years in the incidence within Israel of gastric cancer (GC). This has particularly been noted in the Jewish population with a slight increase in the incidence of cancer of the gastroesophageal junction among Jews of Sephardi origin. Given the diversity of individual ethnic subpopulations, the effects of GC incidence in second-generation immigrant Jews, particularly from high prevalence regions (e.g., the former Soviet Union, Iraq, and Iran), awaits determination. There are currently no national data on GC-specific mortality. The most recent available cross-correlated Israeli National Cancer Registry (INCR) and International Association for Cancer Research (IARC) incidence data for GC of the body and antrum in Israel are presented. Some of the challenges associated with GC monitoring in the changing Israeli population are discussed. We propose the establishment of a national GC management committee designed to collect demographic and oncological data in operable cases with the aim of recording and improving GC-specific outcomes. We believe that there is value in the development of a national surgical planning program, which oversees training and accreditation in a dynamic environment that favors the wider use of neoadjuvant therapies, minimally invasive surgery and routine extended (D2) lymphadenectomy. These changes should be supported by assessable enhanced recovery programs
Benjamin Gesundheit MD PhD
Aiham Mansour MD, Nir Horesh MD, Mordechai Gutman MD FACS, and Yuri Goldes MD
Itamar Feldman MD, Yigal Frank MD, Ayman Natsheh MD, and Gabriel S. Breuer MD
Yulia Treister-Goltzman MD and Roni Peleg MD