Shows
Colorectal Surgery ReviewLarge Bowel ObstructionA crucial review of Large Bowel Obstruction (LBO), emphasizing the foundational physiology of the closed-loop obstruction caused by a competent ileocecal valve, leading to imminent perforation risk dictated by the Law of Laplace (highest risk at the cecum). CT is the definitive modality for locating the transition point. Management of malignant LBO is highly sensitive; emergency right colectomy is associated with 10% mortality and 14% leak rate. While Subtotal Colectomy (STC) avoids a high-risk anastomosis, it carries a high functional cost (41% of patients report high bowel frequency). For Sigmoid Volvulus, initial endoscopic detorsion must be followed by mandatory elective resection due...
2026-01-2937 min
The Jewish Journey: The People, The Land, The EvidenceBronze & Bondage: The Imperial Cost of Solomon’s JerusalemHow did a tribal federation become a global superpower, and what was the true price of that glory? In this forensic episode of The Jewish Journey, we analyze the high-stakes political and economic engineering that defined the reign of King Solomon.In this episode, we unpack:The Military-Industrial Machine: Moving beyond the "wise king" image to see Solomon as a shrewd operative who turned Israel into a regional hub for trade and advanced military technology.Building the Temple: A look at the unprecedented scale of Solomon’s construction projects. We examine the logistics of...
2026-01-2929 minColorectal Surgery ReviewDiverticulosisThis episode reviews the significant evolution in the management of colonic diverticular disease, moving past old dogmas like the "second episode rule" and simple fiber deficiency hypothesis. Level 1 trials (Diabolo/AVOD) definitively show that antibiotics are not mandatory for stable, uncomplicated diverticulitis. The current indication for elective surgery is now based solely on symptom burden and reduced quality of life (QOL). For Hinchey III (purulent peritonitis), Laparoscopic Lavage (LL) is a valid, evidence-based option, as the increased initial risk of reintervention is balanced by a profoundly reduced rate of long-term stoma formation. For emergency resection in Hinchey IV, primary...
2026-01-2636 minColorectal Surgery ReviewMinimally Invasive SurgeryComprehensive review of Minimally Invasive Surgery (MIS) for colorectal cancer, distinguishing the settled science of laparoscopic colon resection from the ongoing controversy of rectal resection. The episode details how pivotal trials (ACOSOG, ALaCaRT) failed to prove non-inferiority for laparoscopic proctectomy, primarily due to higher rates of compromised Circumferential Radial Margin (CRM) in the deep pelvis. Technical solutions like the Reverse Smile technique for anastmosis are discussed to mitigate weak spots from stapler limitations. The RoLAR trial demonstrated that robotics is not clinically superior to standard laparoscopy but is significantly more costly. Transanal Total Mesorectal Excision (TaTME) is presented as...
2026-01-2241 minThe Jewish Journey: The People, The Land, The EvidenceThe Iron Crown: Anarchy, Technology, and the Rise of the Israeli StateHow did a loose federation of twelve tribes survive the transition from the Bronze Age to the Iron Age? In this pivotal episode of The Jewish Journey, we investigate the brutal geopolitical realities that forced ancient Israel to trade its direct "God-people alliance" for the centralized power of a human king.In this episode, we unpack:The Failure of Tribal Anarchy: Why the 300-year "Era of the Judges" collapsed into a cycle of internal corruption and civil war, proving that a decentralized theocracy couldn't hold under pressure.The Philistine Technological Monopoly: A forensic...
2026-01-2234 minThe Jewish Journey: The People, The Land, The EvidenceThe Iron Crown: The Rise of the Israeli EmpireHow did a band of tribal refugees become the dominant superpower of the ancient Near East? In this deep dive of The Jewish Journey, we analyze the high-stakes political and military engineering that birthed the United Monarchy of Israel.In this episode, we unpack:David the Pragmatist: Moving beyond the "shepherd king" myth to examine David as a shrewd military operative who learned the secrets of Iron Age warfare while in exile among the Philistines.The Neutral Capital: Why David chose the non-Hebrew city of Jebus (Jerusalem) as his capital—a masterstroke of "fe...
2026-01-2028 minColorectal Surgery ReviewCytoreduction and HIPECExplores Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Colorectal Peritoneal Metastases (CPM). Success relies entirely on meticulous patient selection and achieving complete macroscopic cytoreduction (CC0). The episode details the Peritoneal Cancer Index (PCI) for staging and emphasizes that for aggressive CPM, CC1 is essentially a failure to cure, whereas it may be acceptable for less aggressive PMP. The landmark Verwall trial proved a survival benefit for CRS + Mitomycin C HIPEC. However, the PRODIGE 7 trial introduced controversy by showing no survival benefit when using Oxaliplatin HIPEC after successful CRS alone, suggesting the choice of agent is critical. Current...
2026-01-1538 minThe Jewish Journey: The People, The Land, The EvidenceThe Lost Timeline: Forensically Solving the Exodus DateNote: This is a special one-off episode produced out of our regular chronological order in direct response to listener feedback and requests for a deep dive into the dating of the Exodus.For decades, the standard scholarly view has been that the Exodus never happened because the evidence doesn't exist in the time of Ramses II. But what if we've simply been looking at the wrong century? In this investigative special of The Jewish Journey, we apply a forensic lens to ancient chronologies to recover the "lost" timeline of the Israelites.In this episode, we...
2026-01-1538 minThe Jewish Journey: The People, The Land, The EvidenceAnarchy & Iron: The Brutal Birth of the Israeli Monarchy"In those days there was no king in Israel; every man did that which was right in his own eyes." In this gritty episode of The Jewish Journey, we investigate the 300-year collapse of the tribal theocracy and the high-stakes trade-off that led to the birth of the Israeli Kingdom.In this episode, we unpack:The Failed Theocracy: Why the idealistic "God-people alliance" established at Sinai devolved into a cycle of corruption, tribal isolation, and the devastating Civil War against Benjamin.The Philistine Iron Monopoly: A look at the ancient arms race. We...
2026-01-1332 minColorectal Surgery ReviewGIST, Neuroendocrine Tumors and LymphomaFocuses on three complex non-epithelial entities that demand specialized algorithms. For GIST, diagnosis is based on CD117 (KIT) and DOG1, and management hinges on molecular genetics (Exon 11 is favorable; Exon 9 requires higher imatinib dosing). Rectal GIST presents a core dilemma, as local excision carries a strikingly high local recurrence rate (up to 77%); neo-adjuvant imatinib is used to downsize tumors and facilitate sphincter preservation. Adjuvant imatinib must be given for a minimum of 3 years for high-risk disease. For Neuroendocrine Tumors (NETs), management is anatomical and metric: Rectal NETs < > 2 cm require radical resection. For Colorectal Lymphoma, localized DLBCL is unique among...
2026-01-1243 minColorectal Surgery ReviewAppendiceal NeoplasmsA detailed analysis of appendiceal neoplasms, highlighting how management is strictly driven by histology and classification. For invasive adenocarcinoma, a formal right hemicolectomy (RHC) is the standard due to the high risk of nodal metastasis (up to 30%). For mucinous neoplasms (LAMN/HAMN), the management pivots away from RHC to aggressive surveillance, driven by the critical distinction between high-risk cellular mucin versus low-risk acellular mucin found outside the appendix. For Neuroendocrine Tumors (ANENs), RHC is mandatory for lesions > 2 cm, or those 1-2 cm with high-risk features like lymphovascular invasion or involvement of the base. Finally, the episode stresses the fundamental...
2026-01-0836 minThe Jewish Journey: The People, The Land, The EvidenceAnarchy & Iron: The Brutal Trade for Israel’s First KingIn those days there was no king in Israel; every man did that which was right in his own eyes." In this gripping episode of The Jewish Journey, we investigate the high-stakes evolution of a nation as it abandons a failed theocracy for the safety of a crown.In this episode, we unpack:The failure of the "God-People Alliance": How the visionary tribal system established at Sinai collapsed into a 300-year cycle of internal corruption and foreign invasion.The Philistine Iron Curtain: A look at the technological arms race of the ancient world...
2026-01-0825 minThe Jewish Journey: The People, The Land, The EvidenceAnarchy & Iron: The Violent Birth of the Israeli Monarchy"In those days there was no king in Israel; every man did that which was right in his own eyes." In this gritty episode of The Jewish Journey, we investigate the brutal 300-year period known as the Era of the Judges—a time of internal collapse, foreign invasion, and the desperate search for a national identity.In this episode, we unpack:The Failure of the Theocracy: Why the idealistic "God-people alliance" established at Sinai devolved into a cycle of corruption, civil war, and tribal isolation.The Philistine Iron Curtain: Examining the technological gap be...
2026-01-0625 minColorectal Surgery ReviewRectal Cancer - Local RecurrenceThis episode tackles the highly complex and morbid radical management of Locally Recurrent Rectal Cancer (LRC), a disease defined as extra-TME pathology, operating in dense, irradiated, fibrotic tissue. Achieving an R0 resection is the single biggest determinant of cure (40-50% 5-year OS). Planning requires mandatory Multidisciplinary Team (MDT) input and combined PTCT/MRI, recognizing the limitations of MRI in delineating small pelvic sidewall structures. The modern radical approach often necessitates major structural sacrifice, including internal iliac vascular resection and careful management of the sciatic nerve. A critical academic point discussed is the evolving R0 margin controversy, suggesting that margins...
2026-01-0546 minColorectal Surgery ReviewManagement of Colorectal MetastasesA deep dive into the aggressive, curative-intent management of stage IV colorectal cancer with distant metastasis, fueled by an average 40% 5-year overall survival rate for resectable liver metastases. The discussion centers on critical decision points, including sequencing for resectable synchronous metastases (neo-adjuvant chemo is preferred for high-volume disease to assess tumor biology). For liver lesions, modern resectability hinges on achieving R0 clearance and preserving an adequate Future Liver Remnant (FLR). Techniques like ALPPS (Associating Liver Partition and Portal vein Ligation for Staged hepatectomy) are shown to provide a massive 20-month survival advantage over conventional staging. Also reviewed is the...
2026-01-0130 minThe Jewish Journey: The People, The Land, The EvidenceThe Exodus Part 6: Jericho’s Falling Walls: The Forensic Proof of the ConquestDid the walls of Jericho truly come tumbling down? In this forensic episode of The Jewish Journey, we move beyond the sunday school story to examine the hard archaeological evidence that supports the biblical account of the city’s destruction.In this episode, we unpack:The Chronological Anchor: Why the year 1406 B.C. is the non-negotiable date for the conquest, backed by ancient Jewish sources and the urgent pleas found in the Amarna Letters from Canaanite kings.Forensics of a Collapse: Examining the physical layout of Jericho’s double-wall system and the archaeological find...
2025-12-3125 minThe Jewish Journey: The People, The Land, The EvidenceThe National Witness: A Conspiracy of MillionsCan a religion be forensically proven? In this episode of The Jewish Journey, we dissect the "Sinai Standard"—the radical historical claim that the foundation of Jewish faith rests on a public, collective experience rather than a solitary visionary.In this episode, we unpack:The Evolution of Covenant: Tracing the journey from Adam’s dawn of moral consciousness to the individual "pilot programs" of Noah and Abraham, leading to the massive national scale-up at Sinai.The Anti-Conspiracy Logic: Why the decision to reveal the law to millions at once was a deliberate move to p...
2025-12-3131 minThe Jewish Journey: The People, The Land, The EvidenceThe Exodus Part 4: Deep Sea Detectives: The Forensics of the Red Sea CrossingIn this episode, we move beyond the cinematic imagery of Hollywood to conduct a rigorous forensic investigation into the most famous escape in history: the crossing of the Red Sea. By re-examining ancient cartography and original Hebrew texts, we uncover a "blind spot" that has misled scholars for centuries and point toward a startlingly different location for this monumental event.In this episode, we unpack:The Cartographic Blind Spot: How early AD maps often omitted the Gulf of Aqaba, leading generations of scholars to wrongly focus on the shallow marshes of the Gulf of Suez.
2025-12-3029 minThe Jewish Journey: The People, The Land, The EvidenceThe Exodus Part 5: Will the Real Mount Sinai Please Stand Up?This episode serves as a geographical and theological detective story, concluding that the traditional location of Mount Sinai in the Egyptian Sinai Peninsula is incorrect based on cartography, politics, and geology.The Map Error: For nearly 2,000 years, tradition has placed Mount Sinai at Jebel Musa (St. Catherine’s). However, the hosts explain that early geographers didn't recognize the Gulf of Aqaba as a distinct body of water. Once you acknowledge that "finger" of the sea, the "wilderness beyond the sea" is clearly modern-day Saudi Arabia, not the Sinai Peninsula.The Political Reality: The Sinai Peninsula wa...
2025-12-3023 minThe Jewish Journey: The People, The Land, The EvidenceWords vs. Idols: The Birth of a New CovenantIn this episode, we explore the radical sociological and theological transformation of the Israelites as they transition from property in Egypt to a self-governing nation defined by an invisible God and abstract ethics. We dissect the tension between the comforting immediacy of visible idols and the difficult demands of a religion rooted in the "Word."In this episode, we unpack:A Revolutionary Constitution: How the Mosaic Law provided a revolutionary break from ancient codes like Hammurabi’s by establishing class equality and prioritizing human life over material property.The Crisis of the Golden Ca...
2025-12-3028 minThe Jewish Journey: The People, The Land, The EvidenceThe Exodus Part 3: The Plagues - How?In this deep dive, we conduct a "forensic analytical investigation" into the Ten Plagues of Egypt. Moving beyond simple storytelling, we explore the research of physicists like Colin Humphreys and theologians like Brian Godawa to see if these events follow a logical, catastrophic ecological chain reaction.In this episode, we break down:The Biological Domino Effect: How a toxic red algae bloom in the Nile could have triggered a mass exodus of frogs, leading to an explosion of disease-carrying insects.The Meteorological Mystery: How an early spring hail storm—precisely dated by ancient ag...
2025-12-3018 minThe Jewish Journey: The People, The Land, The EvidenceThe Exodus Part 2: The Empty Tomb and the 20,000: Digging for Joseph in AvarisDid Joseph really wear a coat of many colors? In this episode, we uncover the "smoking gun" of Jewish history at Avaris. We explore the excavation of a Semitic palace with 12 tombs and a statue of a red-haired ruler in a multicolored coat—but the tomb was meticulously cleaned out. We solve the "Numbers Problem" using the research of Colin Humphreys, decoding the word Eleph to reveal a historically plausible Exodus of 20,000 people. From the Brooklyn Papyrus to mass burial pits, we find the physical anchors of the great departure.
2025-12-3023 minThe Jewish Journey: The People, The Land, The EvidenceThe Exodus Part 1: Solving the "Cold Case"If you dig for Moses in 1250 BC, the ground is empty. Scholars call the Exodus a myth—but are they looking in the wrong time? In this episode, we confront the "crisis of history" by shifting the timeline to the Middle Kingdom. Following scholars like Timothy Mahoney and Collin Humphreys , we uncover startling forensic markers: Hebrew slave names on the Brooklyn Papyrus, mass graves at Avaris, and the Ipuwer Papyrus—an Egyptian account of the Nile turning to blood. Discover the "smoking gun" that proves the Exodus isn't a myth, just misplaced in time.
2025-12-2913 minColorectal Surgery ReviewAdjuvant Therapy for Colorectal CancerA high-yield review of the post-operative management of resected stage II and III colorectal cancer. Key topics include the non-negotiable need for adjuvant chemotherapy (chemo) in stage III patients, leveraging landmark trials like MOSAIC. The episode details the paradigm shift in duration: 3 months of CAPOX is now the standard for low-risk stage III disease following the IDEA collaboration, reducing debilitating oxaliplatin toxicity. For stage II, management relies heavily on risk stratification (e.g., T4 tumors, less than 12 nodes harvested) and molecular analysis (MSI/MMR, BRAF status). Also covered are the benefits of Total Neo-adjuvant Therapy (TNT) for rectal cancer...
2025-12-2928 minThe Jewish Journey: The People, The Land, The EvidenceThe Pharaoh’s Vizier: Forensic Economics and the Bar YussefHow did a Hebrew slave fundamentally restructure the Egyptian Empire? In this episode, we investigate the "forensic" evidence behind Joseph’s rise to power. We explore the 20-shekel price tag—a precise economic "carbon date" for the 18th century BCE—and the "Dream Manuals" that Joseph’s divine intuition defied. We also examine the Bar Yussef, a massive Middle Kingdom engineering feat that still bears his name today. Discover how a 20% tax and a national famine consolidated Pharaoh’s power and changed the course of history forever.
2025-12-2929 minThe Jewish Journey: The People, The Land, The EvidenceJacob: The Wrestler and the Slave: Evidence from the Middle Bronze AgeWas Jacob’s life a simple family drama or a high-stakes legal battle? In this episode, we use the Nuzi Tablets to decode the ancient laws of adoption and inheritance that fueled the conflict between Jacob and Laban. We investigate Rachel’s theft of the household idols—not as a religious act, but as a bold grab for a legal title deed. Finally, we examine the sale of Joseph for 20 shekels, a precise economic "time stamp" that matches the market rate of the 18th century BCE. Join us as we trace the birth of a nation forged in struggle.
2025-12-2921 minThe Jewish Journey: The People, The Land, The EvidenceThe Patriarchal Bridge: Isaac and the Irrevocable ContractIn the grand saga of Jewish history, Isaac often stands in the shadow of his visionary father, Abraham, and his transformative son, Jacob. But was Isaac’s "quiet" life actually the most critical period of all?In this episode of The Jewish Journey, we investigate the life of the second patriarch not as a passive figure, but as the quintessential administrator who secured the future of a nation. We move beyond the Sunday School stories to examine the high-stakes legal world of the Middle Bronze Age. By comparing the biblical text to archaeological discoveries from Nuzi, Mari, an...
2025-12-2920 minThe Jewish Journey: The People, The Land, The EvidenceThe Call of Abraham: From Ur to the Cave of MachpelahWe begin our 4,000-year investigation not with a myth, but with a man. Was Abraham merely a primitive nomad wandering the desert, or was he a wealthy chieftain leaving behind the sophisticated metropolis of Ur to reinvent himself?In this premiere episode of The Jewish Journey, we explore the radical transformation of the "First Jew." Drawing on the works of Paul Johnson and Rufus Learsi, we challenge the Sunday School image of the Patriarchs. We investigate Abraham as a warrior-prince in the "War of the Kings," analyze the terrifying moral crisis of the Binding of Isaac (the...
2025-12-2928 minColorectal Surgery ReviewRectal Cancer - ProctectomyThis episode reviews the technical and academic principles governing Proctectomy for Rectal Cancer, highlighting that the foundation of modern care is Total Mesorectal Excision (TME). We emphasize the consequences of surgical failure, noting that a Circumferential Resection Margin (CRM) of less than 1 mm carries a local recurrence rate greater than 50%.The episode details the meticulous anatomy required for nerve sparing, focusing on maintaining the Holy Plane during posterior dissection. Violation of this plane risks severe consequences, including catastrophic bleeding from the pre-sacral venous plexus and autonomic nerve injury (leading to sexual dysfunction and urinary retention). Pre-operative best...
2025-12-0842 minColorectal Surgery ReviewRectal Cancer - Non-operative ManagementThis episode details the revolutionary Watch and Wait (WW) strategy, the most significant paradigm shift in modern rectal cancer care. We distinguish PCR (Pathological Complete Response, post-surgical) from CCR (Clinical Complete Response, the goal for organ preservation), and discuss how Total Neoadjuvant Therapy (TNT) maximizes the CCR rate. The primary motivation for WW is avoiding the guaranteed morbidity of proctectomy, particularly the debilitating effects of Low Anterior Resection Syndrome (LARS).WW safety hinges on strict adherence to a triodality assessment (DR, endoscopy, and MRI). CCR status requires MRI to show a low signal scar (MRTG1) with a...
2025-12-0426 minColorectal Surgery ReviewRectal Cancer - Local ExcisionThis deep dive focuses on the high-stakes risk-benefit analysis of Local Excision (LE) for rectal cancer, balancing the functional benefits of organ preservation against the critical risk of missing occult lymph node metastases. We trace the technical path from conventional surgery to the modern standard of TAMIS (Transanal Minimally Invasive Surgery), emphasizing that oncologic LE requires an en block, full thickness resection.The core discussion centers on the histological predictors that mandate completion surgery following LE. These powerful predictors include deep invasion (Kikuchi SM3 has up to 23% nodal risk), Poor Differentiation (PD), and critically, Lymphovascular Invasion (LVI...
2025-12-0143 minColorectal Surgery ReviewRectal Cancer - Neoadjuvant Therapy in 2025This episode explores the evolution of rectal cancer management to Total Neoadjuvant Therapy (TNT), driven by the failure of traditional trimodal approaches to address the high (30–40%) risk of distant recurrence. We review the foundational role of Total Mesorectal Excision (TME) and high-resolution MRI staging, which identifies a threatened Circumferential Resection Margin (
2025-11-2740 minColorectal Surgery ReviewColorectal Cancer - Operative PrinciplesThis academic review details the foundational principles and technical specifics of colectomy for colon cancer, emphasizing the oncologic triad of achieving negative circumferential margins, removing the entire mesentery, and accurate staging. We confirm the mandatory margin requirement is a minimum of 5 cm proximally and distally. We address localization challenges, detailing the critical technique for endoscopic tattooing using a saline bleb (0.5–1.0 ml) to contain the India ink and ensure strictly submucosal placement.The episode provides a deep dive into Complete Mesocolic Excision (CME), the standard requiring central vascular ligation and removal of the mesocolon within its intact envelope. CM...
2025-11-2444 minColorectal Surgery ReviewPreop Planning and Staging of Colorectal CancerThis episode provides a comprehensive review of pre-operative evaluation and staging for colorectal cancer, emphasizing the shift toward highly reproducible imaging and personalized risk stratification. We detail screening methods and clarify when pre-operative biopsy is mandatory (absolutely required for rectal tumors to obtain immediate MMR testing). We establish the modern definition of the rectum using fixed MRI bony landmarks (sacral promontory to symphysis pubis), superseding the variable 12 cm rule.A major focus is placed on using high-resolution MRI to assess the Circumferential Resection Margin (CRM) and detect Extramural Vascular Invasion (EMVI), the single most critical predictors of...
2025-11-2049 minColorectal Surgery ReviewMalignant Polyps - What to do?This deep dive tackles the challenging management of the malignant polyp (early T1 colorectal cancer), focusing on the pivotal decision point: endoscopic cure versus formal surgical resection. We review key precursor lesions (adenomas, sessile serrated lesions or SSLs) and the critical anatomical distinction of invasion beyond the muscularis mucosa.A major focus is on predicting invasion depth using enhanced endoscopic criteria, including Paris morphology (depressed lesions, e.g., 0-III, are high risk) and advanced imaging patterns (Kudo V/Vn and NICE Type 3 suggest deep invasion). The episode mandates interpreting quantitative pathology, including the critical depth thresholds: less...
2025-11-1730 minColorectal Surgery ReviewColorectal Cancer - Sporadic vs. InheritedThis episode of Colorectal Surgery Review provides a focused, deep dive into the absolute current state-of-the-art management of Colorectal Cancer (CRC). Targeted specifically toward practicing clinicians and academic colorectal surgeons, the discussion dissects the fundamental molecular biology, changing epidemiology, screening variance, and the critical nuances in surgical and medical treatment guidelines for both sporadic and inherited forms of the disease.Key Topics Covered in this Deep Dive:Molecular Foundation and Drivers: The episode anchors the discussion on the fundamental concept that CRC is a disease of progressive accumulation of genetic alterations, starting with the classic...
2025-11-1446 minColorectal Surgery ReviewPresacral TumorsThe Deep Dive: Presacral Tumors – The Deep Dive on Anatomy, Nerve Preservation, & Oncologic StrategyThis episode tackles the incredibly rare but complex topic of presacral tumors. Though they are rarely encountered, maybe appearing in only one in 40,000 hospital admissions, they present high stakes due to their location near critical nerves and vessels, requiring a solid, almost academic understanding for effective management.What We Cover:Anatomic Foundation & Function: We break down the boundaries of the presacral space and stress the critical importance of the sacral nerve roots (S2 through S5). Learn the fundamental findings fr...
2025-10-2232 minColorectal Surgery ReviewAnal CancerThis episode of Colorectal Surgery Review provides a comprehensive deep dive into the evolving management of anal cancer, focusing on key clinical updates and the minutiae essential for effective practice.Key Discussion Points:The Paradigm Shift: The episode explores the foundational change in treatment from radical surgery to definitive chemoradiation (CRT) as the standard of care for most anal canal Squamous Cell Carcinoma of the Anus (SCA). This shift is based on the Nigro Paradigm, which demonstrated that CRT alone could achieve a complete histologic response.Epidemiology and Diagnosis: The incidence of SCA...
2025-10-2033 minColorectal Surgery ReviewAnal DysplasiaThis episode offers a rigorous academic deep dive into Anal Intraepithelial Neoplasia (AIN), a critical premalignant condition driven overwhelmingly by the Human Papilloma Virus (HPV). Essential for practicing and board-certified colon and rectal surgeons, this review tackles the nuances, fundamental changes in nomenclature, and evidence-based management of this disease.Nomenclature Standardization (The LAST Project): We clarify the mandatory shift from the outdated three-tiered system (AIN 1, 2, 3) to the modern, unified, two-tiered terminology: Low-grade Squamous Intraepithelial Lesion (LSIL) and the critically important High-grade Squamous Intraepithelial Lesion (HSIL).High-Risk Screening: We define the specific populations where screening is...
2025-10-1732 minColorectal Surgery ReviewSexually Transmitted DiseasesThis crucial episode delivers a deep dive into an essential, rapidly evolving, and clinically critical domain for practicing surgeons and clinicians. We tackle the surge in sexually transmitted infections (STIs)—including Chlamydia, Gonorrhea, Syphilis, and HPV—and focus on their rising prevalence within the anorectum.STIs in this region are often "diagnostic masquerades," mimicking common surgical issues like fissures, bad hemorrhoids, or even inflammatory bowel disease (IBD). Learn how to maintain a high index of suspicion and recognize infectious proctitis, especially when patients fail to respond to standard therapy.The Critical Swab Rule: A non-negotiable proc...
2025-10-1535 minColorectal Surgery ReviewPruritis AniPruritus ani—chronic itching around the anus—is one of the most common yet frustrating conditions in colorectal practice. Often dismissed as a minor problem, it can severely impact quality of life and frequently overlaps with dermatologic disease. In this episode, we bring dermatology and colorectal care together to explore the full spectrum of causes, evaluation strategies, and treatment options for pruritus ani.We begin by defining pruritus ani and breaking down its prevalence, common risk factors, and why it remains underdiagnosed. From there, we explore the wide range of underlying causes—ranging from local irritants and infect...
2025-10-0638 minColorectal Surgery ReviewPilonidal Disease & Hidradenitis SupporativaPilonidal disease and hidradenitis suppurativa are two chronic, often misunderstood conditions that significantly impact quality of life. Though different in origin, they share common themes of recurrent infection, inflammation, and the need for thoughtful long-term management. In this episode, we take a deep dive into both conditions, outlining their anatomy, causes, diagnostic challenges, and modern treatment strategies.We begin with pilonidal disease—a condition commonly affecting young adults, caused by hair and debris becoming trapped in the natal cleft. We explore how pilonidal disease develops, the range of clinical presentations from simple pits to complex abscesses, and wh...
2025-10-0346 minColorectal Surgery ReviewRectovaginal FistulasRectovaginal fistulas are among the most difficult and emotionally impactful conditions in colorectal surgery. In this episode, we explore the causes, diagnosis, and management of rectovaginal fistulas with a focus on both the surgical and human aspects of care.We begin by breaking down the anatomy and mechanisms that lead to fistula formation, including obstetric injury, surgical complications, inflammatory bowel disease, and radiation. Listeners will gain an understanding of how these pathways differ and why the underlying cause strongly influences treatment decisions.The conversation then shifts to diagnosis, highlighting the importance of history, physical examination...
2025-10-0133 minColorectal Surgery ReviewRectourethral and Complex FistulasRectourethral and complex fistulas represent some of the most challenging conditions in colorectal and urologic surgery. In this episode, we take a structured deep dive into the anatomy, causes, diagnostic pathways, and management strategies for these rare but highly impactful problems.The discussion begins with the basics—how rectourethral fistulas form, whether from surgical complications, radiation, trauma, or inflammatory disease. We then move into clinical presentation, highlighting the key symptoms that can guide early recognition and prevent delayed diagnosis.Diagnostic strategies are explored in detail, from physical examination to advanced imaging and endoscopic evaluation. Listeners wi...
2025-09-2958 minColorectal Surgery ReviewAnorectal Abscesses and FistulasAnorectal abscesses and fistulas are among the most complex and misunderstood conditions in colorectal disease. In this in-depth episode, we take a clear, step-by-step journey into the anatomy, pathophysiology, diagnosis, and treatment strategies surrounding cryptoglandular disease. Whether you are a medical trainee, a healthcare professional, or a patient seeking to understand your own condition, this episode is designed to provide both clarity and depth on a topic that too often remains shrouded in confusion.We begin with the fundamentals: what an anorectal abscess is, how it forms, and why the anal glands play such a central role...
2025-09-251h 07Colorectal Surgery ReviewAnal Fissures and Anal StenosisIn this episode, we take a comprehensive look at two challenging colorectal conditions: anal fissures and anal stenosis. Listeners will learn how to differentiate between them, understand the underlying anatomy and causes, and explore both conservative and surgical treatment strategies. With a clear, physician-led breakdown, this discussion blends clinical expertise with practical insights for patients, trainees, and professionals seeking deeper knowledge in colorectal care.
2025-09-2244 minColorectal Surgery ReviewEndoscopic Management of PolypsThis "Colorectal Surgery Review" episode provides a deep dive into the rapidly evolving field of advanced endoscopy, framing it as a new surgical frontier called "endoluminal surgery." The discussion is aimed at colorectal surgeons and trainees, highlighting critical techniques, evolving evidence, and key nuances for board exams and clinical practice.Key topics covered in the episode include:Historical Context and Evolution: The episode begins by drawing a parallel between the initial skepticism surrounding the adoption of colonoscopy in the 1970s and the current challenges and learning curves associated with advanced techniques like Endoscopic Submucosal Dissection...
2025-09-1549 minColorectal Surgery ReviewHemorrhoidsThis episode of "Colorectal Surgery Review" provides a comprehensive guide to hemorrhoidal disease for clinicians, with a focus on details relevant for board exams and clinical practice. The hosts emphasize that hemorrhoids are normal anatomical structures (vascular cushions) and only require treatment when they become symptomatic.Key topics covered in the episode include:Anatomy and Classification: The podcast stresses the critical distinction between internal and external hemorrhoids based on their position relative to the dentate line.Internal hemorrhoids are proximal to the line, have visceral innervation (making them insensitive to pain), and are...
2025-09-1224 minColorectal Surgery ReviewFecal Incontinence - Evaluation & TreatmentKey topics covered in the episode include:Definition and Physiology: Fecal incontinence is defined as the uncontrolled passage of stool or gas for at least one month in a person who had previously achieved continence. Continence relies on a complex interplay of five factors: stool consistency, anal sphincter function, rectal compliance (the rectum's ability to store stool), neurologic function, and pelvic floor coordination.Evaluation: A thorough evaluation begins with a detailed patient history and the use of scoring systems like the Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) to quantify severity. This is followed by...
2025-09-1042 minColorectal Surgery ReviewColonosocopiesIn this episode, we review the principles and practice of endoscopy in colorectal surgery. Topics include indications for diagnostic and therapeutic endoscopy, scope design and function, and the essential steps for safe technique. We cover screening colonoscopy, polypectomy, management of bleeding, and evaluation of inflammatory bowel disease, as well as the role of endoscopy in cancer detection and surveillance. Clinical pearls and common pitfalls are highlighted to guide fellows and practicing surgeons in applying endoscopy effectively and safely in daily practice.
2025-09-0417 minColorectal Surgery ReviewThe Physiology of the Anus & RectumThis episode reviews the physiology of the anorectum, focusing on the mechanisms of continence and defecation. We cover the anatomy and function of the internal and external anal sphincters, the puborectalis muscle, and the rectoanal inhibitory reflex. Sensory pathways, autonomic and somatic innervation, and the role of the pelvic floor are explained in detail, along with the coordination required for continence and evacuation. Clinical correlations include constipation, fecal incontinence, and functional anorectal disorders, with attention to how physiology guides surgical decision-making.
2025-09-0423 minColorectal Surgery ReviewColonic PhysiologyIn this episode, we explore the physiology of the colon — a vital but often misunderstood organ. Beginning with embryology, we review how the colon and rectum develop from the primitive gut, including the rotations of the midgut and the complex differentiation of the cloaca. These processes explain congenital anomalies such as malrotation, Hirschsprung’s disease, and anorectal malformations.We then move to anatomy and function. The colonic wall contains four distinct layers — mucosa, submucosa, muscularis propria, and serosa — with specialized epithelial cells including enterocytes, goblet cells, and neuroendocrine cells. Stem cells at the crypt base continually regenerate the muco...
2025-09-041h 15Colorectal Surgery ReviewAnatomy & Embryology of the Colon, Rectum & AnusWe begin with the anal canal and pelvic floor. In colorectal surgery, it’s important to distinguish between the anatomic anal canal and the surgical anal canal. Continence depends on a coordinated set of muscles: the internal and external anal sphincters, and the puborectalis. The canal is lined by different epithelial types, with the dentate line as the critical landmark. That line separates endoderm from ectoderm, and it also marks a division in nerve supply, blood supply, and lymphatic drainage.Moving proximally, we examine the rectum. Its divisions, its blood supply from the superior, middle, and inferior re...
2025-09-0455 min
The House of SurgeryTransitioning from Training to Practice - What Don't I KnowGraduating from residency or fellowship to attending is a pivotal moment for surgeons in training. Jyoti D. Chouhan, DO, PharmD, MBA, FACS, from Oregon Health and Science University in Portland, talks with three of her colleagues about mentorship, tips to prepare for surgery, managing complications, work-life integration, and other advice to make the transition as smooth as possible.
Presented by the ACS Women in Surgery Committee, guests include:
Tiffany Sinclair, MD, FACS
Cheyenne Sonntag, MD, MS
Irlna Trantchou, MD, FACS, FASCRS
Talk about the podcast on...
2025-03-1458 minThe House of SurgeryTransitioning from Training to Practice - What Don't I KnowGraduating from residency or fellowship to attending is a pivotal moment for surgeons in training. Jyoti D. Chouhan, DO, PharmD, MBA, FACS, from Oregon Health and Science University in Portland, talks with three of her colleagues about mentorship, tips to prepare for surgery, managing complications, work-life integration, and other advice to make the transition as smooth as possible.
Presented by the ACS Women in Surgery Committee, guests include:
Tiffany Sinclair, MD, FACS
Cheyenne Sonntag, MD, MS
Irlna Trantchou, MD, FACS, FASCRS
Talk about the podcast on...
2025-03-1458 minThe House of SurgeryPower of QualityThis episode features the audio from a press conference that the ACS held in Washington, DC, on April 14 to officially kick off the Power of Quality Campaign. Following opening remarks from ACS Executive Director and CEO Dr. Patricia Turner, panelists discuss the importance of quality care for all surgical patients and expanding the reach of ACS Quality Programs into more hospitals.
This episode features:
PATRICIA L. TURNER, MD, MBA, FACS
ACS Executive Director & CEO
TANISHA CARINO, PHD
Moderator
J. STEPHEN JONES, MD, FACS
President and CEO, Inova Health S...
2023-04-211h 04The House of SurgeryPower of QualityThis episode features the audio from a press conference that the ACS held in Washington, DC, on April 14 to officially kick off the Power of Quality Campaign. Following opening remarks from ACS Executive Director and CEO Dr. Patricia Turner, panelists discuss the importance of quality care for all surgical patients and expanding the reach of ACS Quality Programs into more hospitals.
This episode features:
PATRICIA L. TURNER, MD, MBA, FACS
ACS Executive Director & CEO
TANISHA CARINO, PHD
Moderator
J. STEPHEN JONES, MD, FACS
President and CEO, Inova Health S...
2023-04-211h 04
Gut CheckA Conversation with Dr. Scott SteeleAfter growing up in Northern Wisconsin raised by a single mom and riding his snowmobile to school during harsh Winters, Dr. Scott Steele found his medical calling at West Point Academy and developed his passion for colorectal surgery over multiple combat tours in Iraq and Afghanistan. Join Alex, Avery, Biddy, and Jon for a special conversation with Dr. Scott Steele to hear more about his life and career journey. OUR GUEST Scott R. Steele, MD, MBA, FACS, FASCRS, FPSCRS (Hon) is the Rupert B. Turnbull MD Endowed Chair in Colorectal Surgery...
2022-11-2130 min