Ziad Awad, MD, FACS
@ziadtawad
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Proud father, Professor of Surgery, University of Florida, Chief Surgical Oncology, soccer freak, love the slopes, #Chelsea , beach 🏝️ life
Atlantic Beach, FL
Joined July 2014
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Colonic interposition in collaboration with the micro vascular team
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Siewert TYPE III - positive frozen section, re respected margin is good and then this happened 😬
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What is going on?????
@SAGES_Updates
@SSATNews
@JournalofGISurg
@ISDE_net
@ElliotServaisMD
@MagnusNsurgonc
@OGAAudit
@EdLinEmory
@LFerri123
@EwenGriffiths
@sherazmarkar
@AmCollSurgeons
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21 year old female admitted scrim OSH with septic shock after lap chole. Failed ERCP. Robotic washout- cannulation of both visible holes. Contrast images 6 months later. WWYD?
@SAGES_Updates
@SSATNews
@AHPBA
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Enjoying teaching the fellow and residents- YTD 12 times we have done 2 Whipples in one day (1st with PV recon) and done @ 500 pm👏👏.
@UFJaxsurg
@UFMedicineJax
@SSATNews
@SAGES_Updates
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We had an uninvited guest during robo esophagectomy
@LFerri123
@MarkarSheraz
@EwenGriffiths
@ElliotServaisMD
@MagnusNsurgonc
@ISDE_net
@SSATNews
@SAGES_Updates
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Congratulations 👏👏👏to our resident Carolina Garcia for video presentation Tips for creating the gastric conduit for esophagectomy @ the ACS Clinical Congress in San Francisco
@acsJACS
@UFJaxsurg
@UFMedicineJax
@UFHealthJax
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Great Esophageal Oral Presentation Session moderated Dr Qureshi👏👏👏👏
@AliaQureshiMD
@SSATNews
@DDWMeeting
@JournalofGISurg
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29 years old distal adenoca 12 cycles of FOLFOX plus immunotherapy (PDL 1 CPS >10) Excellent response on restaging PET.
Planning LTA + D3 LN dissection
@LFerri123
@ISDE_net
@JournalofGISurg
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Thank you to all members of the surgery team for a great accomplishment
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@SAGES_Updates
@kpather09
@UFJaxsurg
@UFMedicineJax
@UFHealthJax
Congratulations Keouna for podium presentation - well done 👏👏👏
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50 year old male BMI 55, open Ivor Lewis esophagectomy. Ct day 5 showed intercostal lung hernia (asymptomatic).
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Pleural flap is a thing - thanks to our colleagues from Amsterdam 😎
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CT esophagram Day 4 after esophagectomy- anyone still doing conventional upright esophagram?
@LFerri123
@MagnusNsurgonc
@MarkarSheraz
@EwenGriffiths
@ElliotServaisMD
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70 years old female with dysphagia/poor QOL/status post 2 Hellers, 2 POEMS, and many dilations. TBE @ 15 minutes. WWUD?
@LFerri123
@MagnusNsurgonc
@EwenGriffiths
@MarkarSheraz
@ElliotServaisMD
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70 year old female - gastric bypass 20 years ago. Admitted with vague abdominal pain. Diagnostic laparoscopy negative for peritoneal disease. 🔪 Total Gastrectomy Total pancreatectomy-splenectomy, Resection of Roux limb
Recon: esoph J and H J 🤙🏼
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#SAGES2023
Great Esophagectomy Session: Tops and Tricks. World class experts:
Sumeet Mittal
Lorenzo Ferri
Jose Pimiento
Mark Van Berg Henegouwen
Ziad T. Awad
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@TakedaFlavio
@ISDE_net
@Daniela_Molena
@LFerri123
@MagnusNsurgonc
@MarkarSheraz
@JessieAElliott
@DrDavidSLiu
@BrandaliseAndre
@ElliotServaisMD
Construction of the ideal/perfect gastric conduit = most critical part of the technical aspects of the procedure, and the most difficult to teach. Experience comes with time and to know how to pull the conduit taut into the mediastinum to avoid redundancy is another one.
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Appleby plus SMV/PV recon (14 min clamp time) - CT day 5 Left lobe cooked. BTW not🤖😎
@rajibaji1983
@TheNotoriousHPB
@ZhiVenFongMD
@AhmadAbouAbbas8
@JeyarajahRohan
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@SAGES_Updates
@SSATNews
@JournalofGISurg
@ISDE_net
@ElliotServaisMD
@MagnusNsurgonc
@OGAAudit
@EdLinEmory
@LFerri123
@EwenGriffiths
@sherazmarkar
@AmCollSurgeons
EEA anastomosis could be tricky as you go higher in chest. In this particular case, the EEA was straight but was hitting against prominent tracheal rings preventing it from docking. As Elliott mentioned - other scenarios is bad osteophytes (I have seen it).
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Artery 1st approach for locally advanced panc head cancer
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Thoughts on vagus nerve preservation or not during esophagectomy
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@ElliotServaisMD
@MarkarSheraz
@LFerri123
@EwenGriffiths
@MagnusNsurgonc
The issue was not pushing the EEA far enough rather than tension. I opened, dismantled the Orvil from EEA re did the anastomosis. Patient did very well.
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Fixing the conduit in the chest could reduce the incidence of postoperative volvulus
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Congratulations to our team
@UFJaxsurg
@UFMedicineJax
@UFHealthJax
for oral presentation @ Central Surgical Association🙌🙌
@SWexner
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@HalletJulie
@BJSAcademy
@SocSurgErgo
@GeetaLalMD
@jennyshaomd
@andrewswright
@SAGES_Updates
@CAGS_ACCG
Heat Therapy works well
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@CPark_MD
Best thing done @ UF nearly 15 years ago. Eric Frykberg RIP talked to me them saying the ACS model will make your life easier and sure I did ✔️
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@DavidChan023
@maynard_nick
@MarkarSheraz
@LFerri123
@ElliotServaisMD
@ArulImmanuel
@venkarch
@SSGisbertz
@Daniela_Molena
@AlexWPhillips7
@MagnusNsurgonc
@ClaireDonohoe6
@DrDavidSLiu
@oeso
@DOTEsophagus
@ogsurgery
Right VATS/Open abdomen - extended kocherization and narrow conduit to maximize length.
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@rajibaji1983
@MarkarSheraz
@Irena8181
All this talk will be behind us in few years to come as the robot is taking over. Lap Chole for biliary colic in a patient with BMI 45 is madness when you can do it more comfortably using the robot.
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@PhilipMueller_1
@Shrikhande_SV
@HoggNDMD
@Ch_Tschuor
@magpao
@beatpetemueller
@ZhiVenFongMD
@beat
John Stauffer just published PMS of open vs Lap Whipple = worse results with lap Whipple.
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Thoracic duct visualization during IVOR LEWIS ESOPHAGECTOMY
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Proud to have our work using the PINPOINT for esophagectomies accepted @ The American Journal of Surgery
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@nine_degraaf
@LancetRH_Europe
@MarcBesselink
@Abuhilal9Abu
Nice editorial- the big elephant in the room is the 9% Mortality among patients undergoing open PD.
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@AnkitPatelMD
@EricKnauerMD
@SAGES_Updates
@EmorySurgery
@EdLinEmory
@sdavis81
I would rather do robotic Whipple than Laparoscopic CBD exploration. It was painful when I was a resident and I am sure still is.
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Thoughts on Esophageal cancer with RLN paralysis?
70 year old male, mid Esoph adenoca left RLN paralysis- neoadj chemo xrt
Robo Ivor Lewis and Bilateral RLN dissec ypT0N0
@LFerri123
@ISDE_net
@MagnusNsurgonc
@JournalofGISurg
@SSATNews
@EwenGriffiths
@ElliotServaisMD
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Happy to share our work of fixation vs non fixation of the gastric conduit after Ivor Lewis esophagectomy
Does Fixation of the Gastric Conduit Reduce the Incidence of Gastric Volvulus After Esophagectomy?
J Gastrointest Surg. 2023
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@majazkashmiri
@rajibaji1983
@TheNotoriousHPB
@ZhiVenFongMD
@AhmadAbouAbbas8
@JeyarajahRohan
Left PV is patent. We scan all complex HPB cases prior to discharge. It could an over kill but we have an idea of the lay of the land prior to discharge.
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@TheNotoriousHPB
@rajibaji1983
@ZhiVenFongMD
@AhmadAbouAbbas8
@JeyarajahRohan
Agree with you and Raj - could be traction - I use multiple deaver blades so it could be
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66 year old healthy PS 0 male with T1b esophageal adenoca- EMR positive deep margin, positive mucin.
@LFerri123
@EwenGriffiths
@RoosPouw
@SAGES_Updates
@JournalofGISurg
@sherazmarkar
@BrendonStilesMD
@SSATNews
@MagnusNsurgonc
@ElliotServaisMD
Esophagectomy
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Ablation and observation
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Do nothing
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@TheNotoriousHPB
@SyedAAhmad5
@Shrikhande_SV
@Gio_Marchegiani
@chiaro_del
@jhatjhmi1
@FlavioRochaMD
@TsengJennifer
@HoggNDMD
@HalletJulie
Anterior always works for me
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@Dcsy23
@MarkarSheraz
@LFerri123
@EwenGriffiths
@MagnusNsurgonc
Yes I had on few occasions for straight esophago-jejunostomy at the hiatus. The stricture rate is much lower than EEA.
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@rajibaji1983
@OMaxFisher
@Declanfj
@AhmadAbouAbbas8
Nope - too much of a risk for 19 Fr drain JP drain.
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Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: a retrospective cohort study
Proud to be part of this work.
@UFHealth
@UFJaxsurg
@UFJaxsurg
@UFMedicineJax
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@SyedAAhmad5
@SurgJournal
@SWexner
Interesting… they are using EEA 25 mm which equates to 15 mm diameter opening which is relatively small for GJ anastomosis. Linear stapled anastomosis works well in our hands as it wide and easy to teach.
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@EwenGriffiths
@yooeeemd
@AnnalsofSurgery
@roux_group
Ewin - to clarify, Orringer was relating to suturing the conduit to the prevertebral fascia in the neck = increase risk of mediastinitis
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@ElliotServaisMD
@LFerri123
@UGIsurgeon
@DOTEsophagus
Our approach has not changed - chemical pyloroplasty - Nasogastric tube for 48 hours unless there is a reason to leave it longer: on the vent/hemodynamic instability/confusion, etc
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@rajibaji1983
@mstotty88
@LucyLucyHuppler
@bariatricBOMSS
We have 2 carts in my room- staplers/clips/etc. the other cart is sutures that I use. Very helpful
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@maynard_nick
@ISDE_net
@SAGES_Updates
@acsJACS
@SSATNews
@JournalofGISurg
@ogsurgery
@OGAAudit
@LFerri123
@ElliotServaisMD
@EwenGriffiths
@EdLinEmory
In principle yes agree 💯 The reality it was a salvage case for recurrence after definitive chemo XRT (65G). The esophagus was plastered to the trachea and could not be mobilized any further. End product was open thoracotomy and single layer esoph/gastric anastomosis.
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@ElliotServaisMD
@AnkitPatelMD
@rbarbosa91
@SSATNews
@andrewswright
@elliotthaut
@TopKniFe_B
@docmartin22
@SAGES_Updates
@mj_pucci
@NovitskyYuri
@VNikolian
JAMA SURGERY and LANCET are TIK TOKERS.
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@PhilipMueller_1
@Shrikhande_SV
@HoggNDMD
@Ch_Tschuor
@magpao
@beatpetemueller
@ZhiVenFongMD
@beat
Early experience with robotic pancreatoduodenectomy versus open pancreatoduodenectomy: nationwide propensity-score-…
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@Laparoscopes
@SSATNews
@pennsurgery
@shubha_vasisht
@VGershuniMD
@PCASOLab
@DDWMeeting
She did great. Well done and wishing her all the best
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The pancreatic transection line was very very close to the GDA - The vessel was tested 5 times God knows
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@Dcsy23
@MarkarSheraz
@LFerri123
@EwenGriffiths
@MagnusNsurgonc
Did a couple of linear stapled esophago gastric anastomosis during COVID due to shortage of EEA and they were a total nightmare as I usually carry large omental flap and this did not go well when I tried to line up the stomach against the esophagus.
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@TakedaFlavio
@ISDE_net
@Daniela_Molena
@LFerri123
@MagnusNsurgonc
@MarkarSheraz
@JessieAElliott
@DrDavidSLiu
@BrandaliseAndre
@ElliotServaisMD
We will be presenting our video @ the ACS in San Francisco detailing the technical aspects of construction of the gastric conduit.
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@MarkarSheraz
@joostphdrenth
@RoosPouw
@amsterdamumc
@DDWMeeting
@ESGE_news
@ISDE_net
Thankfully it was not SSAT presentation. Not prime time for me- show us more data.
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@DavidChan023
@SAGES_Updates
@SSATNews
@JournalofGISurg
@ISDE_net
@ElliotServaisMD
@MagnusNsurgonc
@OGAAudit
@EdLinEmory
@LFerri123
@EwenGriffiths
@sherazmarkar
@AmCollSurgeons
1. Done it twice but as with anything need to do it consistently to unravel all technical issues and become good at it. You need a good resident/fellow to use the EEA safely, while in the linear stapler you have more control.
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Interesting analysis from our group using the NCDB showing significant increased median time to surgery among African American and Uninsured patients with stage I-III esophageal cancer.
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JSO K-9 ‘all smiles’ as he recovers from gunshot wounds to neck, leg and hind end
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@AnRaFr
congratulations Andres on SSAT abstract acceptance
@ddw
@SSATNews
@UFJaxsurg
@UFMedicineJax
@UFHealthJax
Presentation Title: POSTOPERATIVE
OUTCOMES AFTER MINIMALLY INVASIVE IVOR-LEWIS ESOPHAGECTOMY BASED ON THE ESOPHAGEAL COMPLICATION
CONSENSUS GROUP (ECCG) GUIDELINES
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@EwenGriffiths
@LFerri123
@ElliotServaisMD
@MarkarSheraz
@DavidCookeMD
At the beginning of our MIE experience, we had 2 early post op volvulus and I started placing 2 silk stitches just above the hiatus between the conduit and left edge of mediastinal pleura. Then we decided to study the concept (published in JOGS) and found out no difference.
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@mj_pucci
@SAGES_Updates
@SSATNews
@AHPBA
Yes the washout and drains were placed when I explored her upon transfer from OSH. Contrast imaging done 6 months later
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@SyedAAhmad5
@IHPBA
@AHPBA
@letswinpc
@PanCAN
Agree - the majority of readmissions after total pancreatectomy are due to difficulty in blood sugar control.
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@EwenGriffiths
@acsJACS
@UFJaxsurg
@UFMedicineJax
@UFHealthJax
a. understanding the circumference of the conduit along the greater curvature side of the stomach starting 4 cm proximal to the pylorus.
b. Retraction points used to maximize the length of the conduit.
Other important points: uniform diameter, no step ups and no spiraling effect
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Reoperative Surgery After Minimally Invasive Ivor Lewis Esophagectomy.
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@ElliotServaisMD
@SAGES_Updates
@kpather09
@UFJaxsurg
@UFMedicineJax
@UFHealthJax
Will email the abstract.
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@rajibaji1983
Haha yep - actually the patient was discharged home. No intervention is needed yet.
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@DavidChan023
@MagnusNsurgonc
@SAGES_Updates
@SSATNews
@JournalofGISurg
@ISDE_net
@ElliotServaisMD
@OGAAudit
@EdLinEmory
@LFerri123
@EwenGriffiths
@sherazmarkar
@AmCollSurgeons
Very nice David. Well done. Do you use omental flap? I use the kitchen sink 😆🤪 pleura/omentum
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@MarkarSheraz
@joostphdrenth
@RoosPouw
@amsterdamumc
@DDWMeeting
@ESGE_news
@ISDE_net
Hi Roos - I should have attended but was busy on the SSAT side. I heard from my GI colleagues it was a great presentation. Hopefully we can connect @ ISDE.
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@MarcBesselink
@MarkarSheraz
The pathology is heterogenous - YES. Level of experience of the surgeons performing the procedure? 9% mortality in the open group is unacceptable in the modern era.
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@ElliotServaisMD
@EwenGriffiths
@LFerri123
@MarkarSheraz
@DavidCookeMD
I routinely use omental flap to cover the anastomosis and protect the airway. When I have the robot available- I suture the omental flap in deferent locations to left pleura, top edge of pleura and right edge of Azygos stump.
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@LFerri123
@MagnusNsurgonc
@MarkarSheraz
@EwenGriffiths
@ElliotServaisMD
Dang - glad I asked a question😎 We just finished open Whipple with arterial reconstruction 🤘🏼Good night
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@Gio_Marchegiani
@TheLancet
@LancetGH
@surgery_hps
@markus_diener
@ProfessorMWB
@hpb_so
@hpb_trials
@MarcBesselink
@German_PancClub
@ThomasHankMD
Mortality rate for OPEN PD 9% is unacceptable in this era.
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@MarkarSheraz
@JessieAElliott
@nima_ghadi
@ISDE_net
Also I can Tweet while my fellow is operating 🤙🏼
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