Jeffrey Ponsky

100 timestamped statements across 4 collections — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Colorectal / ARM & Hirschsprung · episode host Inguinal Hernia · episode host Low Cardiac Output · episode host Sarcoma (Ewing/Rhabdo) · episode host Soft Tissue Sarcoma (lymph nodes) · episode host

Featured diaries

▶ Ep 11 · 20:30
If you have a patient that you did a lap choleon, and they call you because they're having pain, something's wrong. Lap choleys don't have pain if everything went well. Now, I may be wrong in 1% of cases, but not many. The patient calls you, the mother calls you, or anybody calls you, says, you know, he's a little nausea, he's not eating well, a little bloated, and he's having pain. It's three days later. Come into the emergency room. Stat. Because in my mind, that's a bile leak, and even, God forbid, a common duct injury until proven otherwise.
quote · Pancreatitis
▶ Ep 11 · 20:30
If you have a patient that you did a lap choleon, and they call you because they're having pain, something's wrong. Lap choleys don't have pain if everything went well. Now, I may be wrong in 1% of cases, but not many. The patient calls you, the mother calls you, or anybody calls you, says, you know, he's a little nausea, he's not eating well, a little bloated, and he's having pain. It's three days later. Come into the emergency room. Stat. Because in my mind, that's a bile leak, and even, God forbid, a common duct injury until proven otherwise.
quote · Pancreatitis
▶ Ep 6 · 0:54
I say the word simple because it's anything but simple. This is a topic which has challenged surgeons for a century, and every generation really believes that they have the correct answer to hernia repair.
quote · Inguinal Hernia
▶ Ep 6 · 0:54
I say the word simple because it's anything but simple. This is a topic which has challenged surgeons for a century, and every generation really believes that they have the correct answer to hernia repair.
quote · Inguinal Hernia
▶ Ep 1 · 0:54
I say the word simple because it's anything but simple. This is a topic which has challenged surgeons for a century, and every generation really believes that they have the correct answer to hernia repair.
quote · Low Cardiac Output
▶ Ep 1 · 0:54
I say the word simple because it's anything but simple. This is a topic which has challenged surgeons for a century, and every generation really believes that they have the correct answer to hernia repair.
quote · Low Cardiac Output

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Inguinal Hernia 2 entries

Inguinal Hernia: Adult

▶ Ep 6 · 0:54
quote I say the word simple because it's anything but simple. This is a topic which has challenged surgeons for a century, and every generation really believes that they have the correct answer to hernia repair. ↗
▶ Ep 6 · 0:54
quote I say the word simple because it's anything but simple. This is a topic which has challenged surgeons for a century, and every generation really believes that they have the correct answer to hernia repair. ↗
Low Cardiac Output 2 entries

Inguinal Hernia: Adult

▶ Ep 1 · 0:54
quote I say the word simple because it's anything but simple. This is a topic which has challenged surgeons for a century, and every generation really believes that they have the correct answer to hernia repair. ↗
▶ Ep 1 · 0:54
quote I say the word simple because it's anything but simple. This is a topic which has challenged surgeons for a century, and every generation really believes that they have the correct answer to hernia repair. ↗
Pancreatitis 94 entries

Gallstone Disease

▶ Ep 11 · 1:53
clinical Biliary dyskinesia is diagnosed with a HIDA scan showing ejection fraction less than 35% after CCK administration, when all other tests are negative. ↗
▶ Ep 11 · 1:53
clinical Biliary dyskinesia is diagnosed with a HIDA scan showing ejection fraction less than 35% after CCK administration, when all other tests are negative. ↗
▶ Ep 11 · 5:00
clinical Modern practice favors early cholecystectomy within the first week for acute cholecystitis, rather than the older approach of cooling down for six weeks. ↗
▶ Ep 11 · 5:00
clinical Modern practice favors early cholecystectomy within the first week for acute cholecystitis, rather than the older approach of cooling down for six weeks. ↗
▶ Ep 11 · 5:40
clinical For stable acute cholecystitis without peritonitis, it is reasonable to wait until the next operating day (e.g., Monday if presenting Saturday) rather than operating emergently. ↗
▶ Ep 11 · 5:40
clinical For stable acute cholecystitis without peritonitis, it is reasonable to wait until the next operating day (e.g., Monday if presenting Saturday) rather than operating emergently. ↗
▶ Ep 11 · 6:10
clinical There is no evidence that prophylactic antibiotics help in acute cholecystitis management. ↗
▶ Ep 11 · 6:10
clinical There is no evidence that prophylactic antibiotics help in acute cholecystitis management. ↗
▶ Ep 11 · 12:12
clinical The sucker is a great tool for blunt dissection during difficult cholecystectomy; hydrodissection (injecting water between tissue planes) helps in tough areas. ↗
▶ Ep 11 · 12:12
clinical The sucker is a great tool for blunt dissection during difficult cholecystectomy; hydrodissection (injecting water between tissue planes) helps in tough areas. ↗
▶ Ep 11 · 12:40
clinical After isolating the cystic duct-gallbladder junction, turning the hook cautery toward the gallbladder and lifting while cauterizing gains an additional half-centimeter of cystic duct length. ↗
▶ Ep 11 · 12:40
clinical After isolating the cystic duct-gallbladder junction, turning the hook cautery toward the gallbladder and lifting while cauterizing gains an additional half-centimeter of cystic duct length. ↗
▶ Ep 11 · 13:02
opinion Easy gallbladders are dangerous because surgeons become complacent; accessory cystic ducts and vascular variants can be missed. ↗
▶ Ep 11 · 13:02
quote Easy gallbladders are the ones where you can make the bad mistakes. There can be accessory cystic ducts, there can be problems with the cystic artery that you didn't realize, an anterior and posterior one, and you have to be careful. So it's real easy, make yourself slow down. You know you're going to go slow on a hard one. Go slow on an easy one. ↗
▶ Ep 11 · 13:02
quote Easy gallbladders are the ones where you can make the bad mistakes. There can be accessory cystic ducts, there can be problems with the cystic artery that you didn't realize, an anterior and posterior one, and you have to be careful. So it's real easy, make yourself slow down. You know you're going to go slow on a hard one. Go slow on an easy one. ↗
▶ Ep 11 · 13:02
opinion Easy gallbladders are dangerous because surgeons become complacent; accessory cystic ducts and vascular variants can be missed. ↗
▶ Ep 11 · 14:50
clinical Routine intraoperative cholangiography is debated; some institutions do it in every case for teaching and to improve transcystic exploration skills, while selective use based on risk factors (pancreatitis history, jaundice, dilated duct) is also acceptable. ↗
▶ Ep 11 · 14:50
clinical Routine intraoperative cholangiography is debated; some institutions do it in every case for teaching and to improve transcystic exploration skills, while selective use based on risk factors (pancreatitis history, jaundice, dilated duct) is also acceptable. ↗
▶ Ep 11 · 18:33
clinical When contrast on cholangiogram flows only distally into the duodenum, pressing on the papilla with the laparoscope under fluoroscopy forces contrast proximally, avoiding the need for morphine to induce sphincter spasm (technique taught by Michelle Gagné). ↗
▶ Ep 11 · 18:33
clinical When contrast on cholangiogram flows only distally into the duodenum, pressing on the papilla with the laparoscope under fluoroscopy forces contrast proximally, avoiding the need for morphine to induce sphincter spasm (technique taught by Michelle Gagné). ↗
▶ Ep 11 · 19:00
clinical Intraoperative administration of 30mg Toradol (age-adjusted in children) before the patient wakes facilitates same-day discharge after cholecystectomy. ↗
▶ Ep 11 · 19:00
clinical Intraoperative administration of 30mg Toradol (age-adjusted in children) before the patient wakes facilitates same-day discharge after cholecystectomy. ↗
▶ Ep 11 · 20:30
clinical Any patient with pain 3-5 days after laparoscopic cholecystectomy should be assumed to have a bile leak or bile duct injury until proven otherwise; laparoscopic cholecystectomies do not cause pain if everything went well. ↗
▶ Ep 11 · 20:30
clinical Any patient with pain 3-5 days after laparoscopic cholecystectomy should be assumed to have a bile leak or bile duct injury until proven otherwise; laparoscopic cholecystectomies do not cause pain if everything went well. ↗
▶ Ep 11 · 20:30
quote If you have a patient that you did a lap choleon, and they call you because they're having pain, something's wrong. Lap choleys don't have pain if everything went well. Now, I may be wrong in 1% of cases, but not many. The patient calls you, the mother calls you, or anybody calls you, says, you know, he's a little nausea, he's not eating well, a little bloated, and he's having pain. It's three days later. Come into the emergency room. Stat. Because in my mind, that's a bile leak, and even, God forbid, a common duct injury until proven otherwise. ↗
▶ Ep 11 · 20:30
quote If you have a patient that you did a lap choleon, and they call you because they're having pain, something's wrong. Lap choleys don't have pain if everything went well. Now, I may be wrong in 1% of cases, but not many. The patient calls you, the mother calls you, or anybody calls you, says, you know, he's a little nausea, he's not eating well, a little bloated, and he's having pain. It's three days later. Come into the emergency room. Stat. Because in my mind, that's a bile leak, and even, God forbid, a common duct injury until proven otherwise. ↗
▶ Ep 11 · 21:11
clinical For suspected postoperative bile leak, obtain CT or ultrasound to identify fluid collections; if present, aspirate immediately—if bile is present, proceed to ERCP. ↗
▶ Ep 11 · 21:11
clinical For suspected postoperative bile leak, obtain CT or ultrasound to identify fluid collections; if present, aspirate immediately—if bile is present, proceed to ERCP. ↗
▶ Ep 11 · 21:32
opinion HIDA scans are useful to confirm normal biliary drainage when postoperative pain occurs without fluid collection, but are less useful than CT for detecting bile leaks. ↗
▶ Ep 11 · 21:32
opinion HIDA scans are useful to confirm normal biliary drainage when postoperative pain occurs without fluid collection, but are less useful than CT for detecting bile leaks. ↗
▶ Ep 11 · 22:37
clinical For bile leaks (typically cystic duct), ERCP with sphincterotomy and short stent (10 French, 5cm) decompresses the biliary system and stops drainage; stent is removed at 3-6 weeks. ↗
▶ Ep 11 · 22:37
clinical For bile leaks (typically cystic duct), ERCP with sphincterotomy and short stent (10 French, 5cm) decompresses the biliary system and stops drainage; stent is removed at 3-6 weeks. ↗
▶ Ep 11 · 23:41
clinical Biliary dyskinesia with ejection fraction less than 35% is an indication for cholecystectomy when all other GI workup is negative. ↗
▶ Ep 11 · 23:41
clinical Biliary dyskinesia with ejection fraction less than 35% is an indication for cholecystectomy when all other GI workup is negative. ↗
▶ Ep 11 · 24:11
clinical Gallstone pancreatitis is caused by small stones creating transient obstruction of both bile and pancreatic ducts while passing through the papilla. ↗
▶ Ep 11 · 24:11
clinical Gallstone pancreatitis is caused by small stones creating transient obstruction of both bile and pancreatic ducts while passing through the papilla. ↗
▶ Ep 11 · 24:40
clinical In the old practice, all patients with gallstone pancreatitis received ERCP on presentation, but two-thirds had normal ERCPs because the stone had already passed. ↗
▶ Ep 11 · 24:40
quote The rule is, in the old days, everybody got ERCP the day they came in. Hydrate them, make them NPO, watch them in the hospital, and don't get the ERCP on the first day because when we did that, we found that two-thirds of the patients that we did the ERCPs on had normal ERCPs. ↗
▶ Ep 11 · 24:40
quote The rule is, in the old days, everybody got ERCP the day they came in. Hydrate them, make them NPO, watch them in the hospital, and don't get the ERCP on the first day because when we did that, we found that two-thirds of the patients that we did the ERCPs on had normal ERCPs. ↗
▶ Ep 11 · 24:40
clinical In the old practice, all patients with gallstone pancreatitis received ERCP on presentation, but two-thirds had normal ERCPs because the stone had already passed. ↗
▶ Ep 11 · 25:10
clinical Current management of gallstone pancreatitis: admit, hydrate, NPO, observe overnight and check amylase/lipase trend. If improving, proceed to cholecystectomy during that admission. If worsening or jaundice persists, perform ERCP with sphincterotomy. ↗
▶ Ep 11 · 25:10
clinical Current management of gallstone pancreatitis: admit, hydrate, NPO, observe overnight and check amylase/lipase trend. If improving, proceed to cholecystectomy during that admission. If worsening or jaundice persists, perform ERCP with sphincterotomy. ↗
▶ Ep 11 · 26:27
opinion The choice between preoperative ERCP versus intraoperative common duct exploration depends on local resources, surgeon comfort with laparoscopic ductal techniques, and availability of fluoroscopy and choledocoscopy. ↗
▶ Ep 11 · 26:27
opinion The choice between preoperative ERCP versus intraoperative common duct exploration depends on local resources, surgeon comfort with laparoscopic ductal techniques, and availability of fluoroscopy and choledocoscopy. ↗
▶ Ep 11 · 28:33
clinical Some experts (George Bursey, Joe Peatland) advocate taking patients with persistent common duct stones directly to the operating room for intraoperative cholangiogram and transcystic or laparoscopic common duct exploration, with postoperative ERCP only if unsuccessful. ↗
▶ Ep 11 · 28:33
host_summary Some experts (George Bursey, Joe Peatland) advocate taking patients with persistent common duct stones directly to the operating room for intraoperative cholangiogram and transcystic or laparoscopic common duct exploration, with postoperative ERCP only if unsuccessful. ↗
▶ Ep 11 · 30:14
clinical For intraoperative common duct stone clearance, after cholangiogram shows a stone (meniscus sign), give 1 amp (1mg) glucagon IV, wait 1-2 minutes, flush with saline, and repeat cholangiogram. ↗
▶ Ep 11 · 30:14
clinical For intraoperative common duct stone clearance, after cholangiogram shows a stone (meniscus sign), give 1 amp (1mg) glucagon IV, wait 1-2 minutes, flush with saline, and repeat cholangiogram. ↗
▶ Ep 11 · 30:56
clinical If glucagon fails to clear the stone, pass a soft-tip wire through the cystic duct under fluoroscopy into the duodenum to attempt to dislodge it; never push against resistance. ↗
▶ Ep 11 · 30:56
clinical If glucagon fails to clear the stone, pass a soft-tip wire through the cystic duct under fluoroscopy into the duodenum to attempt to dislodge it; never push against resistance. ↗
▶ Ep 11 · 31:35
clinical A Dormia basket can be passed closed into the duodenum under fluoroscopy, opened slightly, and pulled back with jiggling to catch stones; alternatively, a #5 Fogarty catheter (vascular Fogarty works) can be inflated in the duodenum, pulled to the papilla, deflated slightly, re-inflated and pulled back. ↗
▶ Ep 11 · 31:35
clinical A Dormia basket can be passed closed into the duodenum under fluoroscopy, opened slightly, and pulled back with jiggling to catch stones; alternatively, a #5 Fogarty catheter (vascular Fogarty works) can be inflated in the duodenum, pulled to the papilla, deflated slightly, re-inflated and pulled back. ↗
▶ Ep 11 · 32:44
clinical Modern choledocoscopes are less than 3mm diameter and can be passed through the cystic duct (sometimes requiring balloon dilation) for direct stone visualization and extraction with Dormia basket or balloon. ↗
▶ Ep 11 · 32:44
clinical Modern choledocoscopes are less than 3mm diameter and can be passed through the cystic duct (sometimes requiring balloon dilation) for direct stone visualization and extraction with Dormia basket or balloon. ↗
▶ Ep 11 · 33:27
clinical After transcystic common duct exploration, place endoloops on the cystic duct stump because prolonged obstruction can blow off simple ties. ↗
▶ Ep 11 · 33:27
clinical After transcystic common duct exploration, place endoloops on the cystic duct stump because prolonged obstruction can blow off simple ties. ↗
▶ Ep 11 · 34:56
clinical Laparoscopic common bile duct exploration via choledocotomy should only be performed in dilated ducts (>1-1.5cm, ideally 2cm) to avoid stricture risk; small-caliber ducts with stones should be managed with ERCP. ↗
▶ Ep 11 · 34:56
clinical Laparoscopic common bile duct exploration via choledocotomy should only be performed in dilated ducts (>1-1.5cm, ideally 2cm) to avoid stricture risk; small-caliber ducts with stones should be managed with ERCP. ↗
▶ Ep 11 · 35:30
clinical For laparoscopic choledocotomy, do not divide the cystic duct—use the gallbladder for lateral retraction while dissecting down to expose the anterior common duct surface. ↗
▶ Ep 11 · 35:30
clinical For laparoscopic choledocotomy, do not divide the cystic duct—use the gallbladder for lateral retraction while dissecting down to expose the anterior common duct surface. ↗
▶ Ep 11 · 37:40
clinical T-tube preparation for choledocotomy closure: cut to 1 inch on each side of the T, bevel the edges, remove half the back wall to facilitate insertion and later removal. ↗
▶ Ep 11 · 37:40
clinical T-tube preparation for choledocotomy closure: cut to 1 inch on each side of the T, bevel the edges, remove half the back wall to facilitate insertion and later removal. ↗
▶ Ep 11 · 38:50
clinical T-tube cholangiogram is performed at 10 days post-choledocotomy; if clear, the T-tube is removed at 2 weeks. ↗
▶ Ep 11 · 38:50
clinical T-tube cholangiogram is performed at 10 days post-choledocotomy; if clear, the T-tube is removed at 2 weeks. ↗
▶ Ep 11 · 39:27
clinical For severe pancreatitis with large phlegmon in the pancreatic head, obtain CT and consider waiting 6 weeks before cholecystectomy to allow inflammation to resolve. ↗
▶ Ep 11 · 39:27
clinical For severe pancreatitis with large phlegmon in the pancreatic head, obtain CT and consider waiting 6 weeks before cholecystectomy to allow inflammation to resolve. ↗
▶ Ep 11 · 40:00
clinical For patients with multiple stones extending up both hepatic ducts in a very dilated common duct, or stone-formers like sickle cell patients, consider choledochoduodenostomy (2cm anastomosis) as a drainage procedure to allow future stones to pass. ↗
▶ Ep 11 · 40:00
clinical For patients with multiple stones extending up both hepatic ducts in a very dilated common duct, or stone-formers like sickle cell patients, consider choledochoduodenostomy (2cm anastomosis) as a drainage procedure to allow future stones to pass. ↗
▶ Ep 11 · 41:04
clinical Percutaneous cholecystostomy can temporize severe acute cholecystitis in high-risk patients or those with large phlegmon, allowing interval cholecystectomy at 6 weeks, but requires normal clotting studies. ↗
▶ Ep 11 · 41:04
clinical Percutaneous cholecystostomy can temporize severe acute cholecystitis in high-risk patients or those with large phlegmon, allowing interval cholecystectomy at 6 weeks, but requires normal clotting studies. ↗
▶ Ep 11 · 41:47
clinical In cases where anatomy is unrecognizable intraoperatively, subtotal cholecystectomy is acceptable: remove the anterior wall or fundus, cauterize the remaining mucosa on the back wall with bovie to prevent mucocele, place drains, and accept a controlled leak. ↗
▶ Ep 11 · 41:47
clinical In cases where anatomy is unrecognizable intraoperatively, subtotal cholecystectomy is acceptable: remove the anterior wall or fundus, cauterize the remaining mucosa on the back wall with bovie to prevent mucocele, place drains, and accept a controlled leak. ↗
▶ Ep 11 · 42:29
clinical Common bile duct injuries typically occur during 'easy' cases when surgeons become complacent and fail to maintain vigilance. ↗
▶ Ep 11 · 42:29
clinical Common bile duct injuries typically occur during 'easy' cases when surgeons become complacent and fail to maintain vigilance. ↗
▶ Ep 11 · 43:00
clinical The common duct can come up to the gallbladder and take a bend like a knee, appearing identical to the cystic duct; only continued dissection reveals the true 2-3mm cystic duct coming off the 'knee.' ↗
▶ Ep 11 · 43:00
clinical The common duct can come up to the gallbladder and take a bend like a knee, appearing identical to the cystic duct; only continued dissection reveals the true 2-3mm cystic duct coming off the 'knee.' ↗
▶ Ep 11 · 43:29
clinical Being able to pass an instrument around a structure does not prove it is the cystic duct—the common bile duct can be encircled and mistakenly used for retraction. ↗
▶ Ep 11 · 43:29
clinical Being able to pass an instrument around a structure does not prove it is the cystic duct—the common bile duct can be encircled and mistakenly used for retraction. ↗
▶ Ep 11 · 44:00
quote If you're going to do biliary surgery, this could happen to anyone. Know that. It's not an incrimination of you. Stop. Suck it out. Take a few breaths and if you have another partner, call them in. ↗
▶ Ep 11 · 44:00
quote If you're going to do biliary surgery, this could happen to anyone. Know that. It's not an incrimination of you. Stop. Suck it out. Take a few breaths and if you have another partner, call them in. ↗
▶ Ep 11 · 44:00
clinical If common bile duct injury is recognized intraoperatively: STOP immediately, call for help, and assess. If shaken or inexperienced with hepaticojejunostomy, do not attempt repair. ↗
▶ Ep 11 · 44:00
clinical If common bile duct injury is recognized intraoperatively: STOP immediately, call for help, and assess. If shaken or inexperienced with hepaticojejunostomy, do not attempt repair. ↗
▶ Ep 11 · 44:20
clinical In most bile duct injury cases, the primary injury is compounded by the attempted repair. ↗
▶ Ep 11 · 44:20
clinical In most bile duct injury cases, the primary injury is compounded by the attempted repair. ↗
▶ Ep 11 · 44:20
quote What happens in most of these cases is the primary injury is compounded by the attempted repair. ↗
▶ Ep 11 · 44:20
quote What happens in most of these cases is the primary injury is compounded by the attempted repair. ↗
▶ Ep 11 · 44:37
quote A primary end-to-end repair of the common bile duct is almost always fraught with failure. Most often, a common duct injury, unless it's just a lateral injury, is best treated with a hepatic oj genostomy. ↗
▶ Ep 11 · 44:37
quote A primary end-to-end repair of the common bile duct is almost always fraught with failure. Most often, a common duct injury, unless it's just a lateral injury, is best treated with a hepatic oj genostomy. ↗
▶ Ep 11 · 44:37
clinical Primary end-to-end repair of transected common bile duct is almost always fraught with failure; most common duct injuries (except small lateral injuries) are best treated with hepaticojejunostomy. ↗
▶ Ep 11 · 44:37
clinical Primary end-to-end repair of transected common bile duct is almost always fraught with failure; most common duct injuries (except small lateral injuries) are best treated with hepaticojejunostomy. ↗
▶ Ep 11 · 44:56
clinical For small lateral common duct injuries, place a small T-tube rather than primary suture closure, as suture alone will leak. ↗
▶ Ep 11 · 44:56
clinical For small lateral common duct injuries, place a small T-tube rather than primary suture closure, as suture alone will leak. ↗
▶ Ep 11 · 45:37
clinical For complete common duct transection, leave everything alone, place multiple drains, do not place ties or tubes that will compromise remaining duct length for the hepatobiliary surgeon, and transfer the patient. ↗
▶ Ep 11 · 45:37
clinical For complete common duct transection, leave everything alone, place multiple drains, do not place ties or tubes that will compromise remaining duct length for the hepatobiliary surgeon, and transfer the patient. ↗
Sarcoma (Ewing/Rhabdo) 2 entries

Inguinal Hernia: Adult

▶ Ep 10 · 0:54
quote I say the word simple because it's anything but simple. This is a topic which has challenged surgeons for a century, and every generation really believes that they have the correct answer to hernia repair. ↗
▶ Ep 10 · 0:54
quote I say the word simple because it's anything but simple. This is a topic which has challenged surgeons for a century, and every generation really believes that they have the correct answer to hernia repair. ↗