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120 Deep Vein Thrombosis
415
For patients with BMI >40, dose should be
7500units q8hr
– Enoxaparin dosing: 40mg qday
For patients with BMI>40, dose should be 40mg
q12hr
• This patient should also have compression stockings or
pneumatic compression if he is unable to ambulate while
he is hospitalized.
• This patient is undergoing an epidural catheter placement,
which is a high-risk procedure for bleeding into the spinal
canal and paralysis; therefore it is appropriate to hold his
DVT prophylaxis.
• For epidural placement, the amount of time you need to
hold DVT prophylaxis will depend on if you gave heparin
or enoxaparin.
– Heparin: Hold dose for 6 h prior to epidural
placement.
– Enoxaparin: If 30 or 40mg daily dose, hold DVT pro-
phylaxis for 12h.
If 1 mg/kg q12 dose, hold DVT prophylaxis for
24h prior to the procedure.
• The timing for restarting DVT prophylaxis is as follows:
– Heparin: can continue after epidural is placed. Hold
for 4 h prior to removal of the epidural. Can restart
2–4h after the epidural is removed.
Bonus Points
Thrombolysis and Surgical Treatment of DVT
• There is limited role for chemical thrombolysis with tissue plasminogen activator in a postoperative patient
because the risk of life-threatening hemorrhage is too
high (Gutt etal. 2005).
• Surgical thrombectomy should be reserved for patients
with massive thrombosis and limb-threatening isch-
emia (phlegmasia cerulea dolens) to avoid venous gangrene (Gutt etal. 2005).
Words ofWisdom
Ensuring appropriate chemical prophylaxis is indicated in
nearly all surgical and trauma patients. Early prophylaxis
can help to prevent morbidity and even mortality in patients
who are at moderate to high risk. Having a heightened awareness of these populations may lead to early detection even in
patients who are on prophylactic dosing to ensure that they
are then receiving therapeutic dosing as needed. Similarly, it
is important to know when alternative measures are necessary for patients with contraindications to chemoprophylaxis
(intracranial hemorrhage, etc.).
Bibliography
Anderson D, Morgano G, etal. American Society of Hematology 2019
guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients.
Blood Adv. 2019;3(23):3898–944.
Gutt MD, Oniu MD, et al. Prophylaxis and treatment of deep vein
thrombosis in general surgery. Am J Surg. 2005;189(1):14–22.
Kearon C, Akl EA. Duration of anticoagulant therapy for
deep vein thrombosis and pulmonary embolism. Blood.
2014;124(12):1794–801. https://doi.org/10.1182/
blood- 2013- 12- 512681.
O’Donnell M, Weitz J.Thromboprophylaxis in surgical patients. Can J
Surg. 2003;46(2):129–35.
Perrotti MD, Sadri MD, etal. One size does not t all: venous throm-
boembolism prophylaxis in colorectal cancer. J Soc Laparosc
Robot Surg. 2020;24(3):e2020.00038. https://doi.org/10.4293/
JSLS.2020.00038.
Rumbaugh K, Schmidt L. Venous thromboembolism prophylaxis
guidelines. Vanderbilt University Medical Center; 2018.
Part XVI
Pediatric
Gastroesophageal Reflux Disease
inPediatric Patients
ErikaB.Lindholm
121
GERD
Scenario
A 2-month-old baby, born prematurely at 29 weeks’ gestation, presents with inability to take adequate PO and has an
NGT placed. You are consulted for a gastrostomy tube and
possible fundoplication. She is currently getting goal feeds,
but they are unable to give bolus feeds because she starts
spitting up. Nurses note that she arches during feeds periodically and has small spit-ups during continuous feeds. She is
otherwise healthy.
• Medications should be reviewed to determine if this infant
has even been on antacid therapy. If she has been treated,
it is important to know if her symptoms have improved.
• Patient has no signs of pulmonary disease, or ATLE.
• After a trial of antacid therapy, the patient fails to improve.
• What additional test would you like to perform?
– Upper gastrointestinal imaging to check for anatomy is
normal.
– Impedance probe is ordered. The patient comes off the
PPI for 1week and then test shows reux at time of
symptoms. After a long discussion about the risks and
benets, the parent opts for fundoplication at the time
of gastrostomy tube.
• Describe laparoscopic Nissen fundoplication.
– Preoperative antibiotics and large OG tube or bougie
are placed by anesthesia.
– Obtain access at umbilicus using a 5 mm port; insuf-
ate to 8mmHg.
– Make a small subxiphoid incision for placement of the
liver retractor. Two additional ports are placed in the
right and left abdomen.
E. B. Lindholm (*)
Division of Pediatric Surgery, Children’s Regional Hospital,
Cooper University, Camden, NJ, USA
e-mail: Lindholm-Erika@cooperhealth.edu
– Minimal dissection has been shown to prevent compli-
cations with wrap migration. The gastric splenic ligament and short gastrics are ligated with LigaSure.
Once the greater curvature is freed, a small window is
made in the gastrohepatic ligament.
– A retrocrural space is dissected bluntly and the fundus
of the stomach pulled through this small window. A
few sutures are then placed to approximate the 360°
wrap.
– Following this gastrostomy tube is placed in the stan-
dard fashion.
• Postoperative management
– Multiple multicenter trials have shown rapid scheduled
feeds should be given via the gastrostomy tube with
patients on full feeds within 24h.
– In patients without feeding tube access, diet is similar
to an adult with liquids for a few days and then solids.
No carbonated beverages, no bread, and no large
pieces of meat.
Clean Kills
• Performing a wrap in patients with oropharyngeal dys-
motility which will make it more difcult for them to
push food down the fundoplication.
• Failure to perform the correct workup on these patients
and failing to have a proper risk discussion with the
family.
Bonus Points
• Literature does not support the use of fundoplication as a
preventive measure in neurologically devastated children.
Unless there are concerning symptoms that are related to
reux, most patients can safely grow out of their
symptoms.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
M. Neff et al. (eds.), Passing the General Surgery Oral Board Exam, https://doi.org/10.1007/978-3-031-78244-2_121
419
420
E. B. Lindholm
Words ofWisdom
• This is a disease that has wide practice variation patterns
in regard to surgical treatment. Some pediatric centers
perform many anti-reux procedures, and some perform
hardly any. The key is that every patient should be evaluated systematically and care taken to ensure that surgery
risks outweigh the benets.
Bibliography
www.surgicalcore.org. SCORE. Gastroesophageal Reux/Barrett’s
Esophagus (Pediatric/Fellowship Level) August 17, 2023.
Townsend JCM, Beauchamp RD, Evers BM, & Mattox KL. (2016).
Sabiston textbook of surgery (20th ed.). Elsevier - Health Sciences
Division.
Holcom and Ashcraft’s Pediatric Surgery (7th ed.). Chapter 73.
Gastroesphageal Reux Disease. Hollwarth M. 2012.
Hypertrophic Pyloric Stenosis
M.VirginiaButchy, JohnWilliamson,
andErikaB.Lindholm
122
Pyloric Stenosis
Scenario
A 3-week-old infant presents to the Emergency Department
with non-bloody, non-bilious vomiting, which happens frequently with every feed. The dad describes vomiting as initially “spit-ups” with every feed but it has progressed to
forceful, projectile vomiting.
• What is the appropriate preoperative patient
assessment?
– Preoperative resuscitation and correction of electrolyte
abnormalities is essential. Failure to establish adequate
resuscitation can lead to postoperative apnea to
increase respiratory carbon dioxide and compensate
for the metabolic alkalosis.
– Anesthesia can allow for placement of a nasogastric or
orogastric tube for gastric decompression and leak test
postoperatively.
• What is your preferred imaging modality?
– Ultrasound is the gold standard for diagnosis: pyloric
muscle thickness of 4mm (3.5in premature infants)
and a length of 16mm or greater.
– Upper gastrointestinal imaging can also be utilized and
can see an elongated pyloric channel; barium should
be seen exiting the stomach to exclude pyloric web or
atresia.
• Describe open vs laparoscopic pyloromyotomy.
– Fredet-Ramstedt pyloromyotomy (open)
M. V. Butchy · J. Williamson
Department of Surgery, Cooper University Hospital,
Camden, NJ, USA
e-mail: butchy-margaret@cooperhealth.edu;
williamson.john@lha6.navy.mil
E. B. Lindholm (
Department of Surgery, Cooper University Hospital,
Camden, NJ, USA
Division of Pediatric Surgery, Children’s Regional Hospital,
Cooper University, Camden, NJ, USA
e-mail: Lindholm-Erika@cooperhealth.edu
*)
Obtain abdominal access, either periumbilical or
right upper quadrant.
Retract liver superiorly and deliver pylorus through
wound.
Open serosa sharply; from proximal to the hypertrophied muscle to proximal to the pyloric vein,
bluntly divide muscle bers to expose the
submucosa.
Check for leak.
– Laparoscopic pyloromyotomy:
Obtain access at the umbilicus using a 5mm port;
insufate to 8mmHg.
Make small abdominal incisions so that the atraumatic grasper and extended cautery blade can enter
the abdomen without port placement.
From proximal to the hypertrophied muscle to
proximal to the pyloric vein, bluntly divide muscle
bers to expose the submucosa.
Conrm that divided pyloric muscle halves move
independently, conrming adequate myotomy.
Perform leak tests using air insufated via OG or
NGT.
– Goal of both procedures is to cut the hypertrophied cir-
cular pyloric muscle without causing mucosal injury.
– Laparoscopic pyloromyotomy is associated with
shorter length of stay and lower surgical site
infection.
– Full thickness mucosal perforation is more common
with laparoscopic approach but incidence is rare
(<1%).
• After completing the pyloromyotomy, you have a positive
leak test; what is the next step?
– Perforation occurs in approximately 1% of patients. If
this is identied intraoperatively, the defect should be
closed with absorbable suture and can be bolstered
with omentum.
– A new myotomy should be made 90–180° from the
original incision.
– Hold feeding for 24h.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
M. Neff et al. (eds.), Passing the General Surgery Oral Board Exam, https://doi.org/10.1007/978-3-031-78244-2_122
421
422
M. V. Butchy et al.
– If there is additional concern, a water-soluble study
can be performed.
• Operative complications: incomplete myotomy, duodenal
or pyloric leak, hernia, wound infection, or dehiscence
– Infants with persistent emesis 7–10 days postopera-
tively should be imaged with a contrast study to evaluate for incomplete myotomy.
– Differential for persistent vomiting: GERD, discoordi-
nation of gastric peristalsis, gastric atony, incomplete
myotomy, and leaks.
Alternate Scenario
A 3-week-old infant presents to the Emergency Department
with non-bloody, non-bilious vomiting and lethargy, which
happen frequently with every feed. The dad describes vomiting as initially “spit-ups” with every feed but it has progressed to forceful, projectile vomiting. Physical exam shows
dry mucous membranes, sunken fontanelle, and limp, lethargic infant.
• What laboratory tests would you order to assess the
patient’s resuscitation status?
– A basic metabolic panel should be ordered. The serum
carbon dioxide (<30mmol/L), chloride (>100mmol/L),
and potassium (4.5–6.5 mmol/L) can help guide
resuscitation.
• What are the electrolyte abnormalities seen in patients
with HPS?
– Characteristic electrolyte abnormalities: hypokalemic,
hypochloremic metabolic alkalosis (elevated bicarbonate). Loss of hydrochloric acid secondary to persistent
emesis leads to dehydration and hypokalemic, hypochloremic metabolic alkalosis.
• How would you resuscitate a neonate with hypokalemic,
hypochloremic metabolic alkalosis?
– Goals of resuscitation: Establish adequate UOP 2.0cc/
kg/hr. and serum bicarbonate of <30mEq/L prior to
surgery.
– Start with a bolus of 20ml/kg bolus of normal saline.
– Additional resuscitation with 5% dextrose, 0.45%
sodium chloride, and 20mEq/L potassium is appropri-
ate, at 1.25–2 times maintenance intravenous uid
resuscitation rate.
– Electrolytes should be checked every 6 h and a new
bolus can be given until labs normalize and the alkalo-
sis resolves.
– Preoperatively resuscitation and correction of electro-
lyte abnormalities is essential. Failure to establish ade-
quate resuscitation can lead to postoperative apnea to
increase respiratory carbon dioxide and compensate
for the metabolic alkalosis.
• Further recommendations
– Infants can start ad lib feeding immediately post-
procedure. Vomiting is common post-procedure; providers are encouraged to “feed through it” and resume
q3 feeds.
– Studies show that ad lib feeding can get the patient to
full feeds faster.
• Long-term follow-up
Clean Kills
• Taking a newborn to the OR prior to adequate resuscitation, continue to bolus until normal electrolytes. May take
a few days for severely dehydrated patients.
• Failure to recognize a delayed perforation in the postoperative setting. A concerning exam, or pain requiring
more than Tylenol, should raise alarm, and the denitive
test would be a UGI to check for leak.
Bonus Points
• Hypokalemic, hypochloremic metabolic alkalosis is on
every test.
• The worse the electrolyte abnormalities, the longer it will
take the baby to resume full feeds as the stomach needs to
relearn how to pass food through the pylorus.
Words ofWisdom
• The key to a safe surgery is ensuring that the baby has
normal electrolytes. In this modern age, most patients
have access to ultrasound for diagnosis and thus present
earlier than previously. Most patients are able to go to the
OR within 24h, and then most are tolerating full feeds at
24h. In the operating room, if the pylorus does not look
enlarged and is not typical of pyloric stenosis, do not proceed with pyloromyotomy as likely this will cause perforation. Caution when extending the incision onto both the
stomach and duodenum is important to prevent perforation which can be deadly if diagnosis is delayed.
Bibliography
www.surgicalcore.org. SCORE. Inguinal Hernia (Pediatric/Fellowship
Level) August 19, 2023.
Townsend, J. C. M., Beauchamp, R. D., Evers, B. M., & Mattox, K. L.
(2016). Sabiston textbook of surgery (20th ed.). Elsevier - Health
Sciences Division.
Holcom and Ashcraft’s Pediatric Surgery (7th ed.). Chapter 50. Inguinal
Hernia. Hollwarth M. 2019.
Pediatric Inguinal Hernia
M.VirginiaButchy, JohnWilliamson,
andErikaB.Lindholm
123
Inguinal Hernia
Scenario
“A 3-month-old male presents with intermittent groin bulge.
The mom reports that she noticed a bulge in the patient’s
scrotum when she was changing his diaper and he was crying. Groin bulge disappears when the baby calms down. No
bulge is present on examination today.”
• How would you assess and diagnose your patient?
– Diagnosis of a hernia is done clinically based on
detailed history and physical exam. Parents, guardians,
and primary care physicians are extremely helpful in
diagnosis.
– Bulging can be intermittent; it’s common to have a
normal exam and a suggestive history.
– Physical exam: Palpate, identify, and document testic-
ular exam in males; palpate the external the ring lateral
to the pubic tubercle; attempt provocative maneuvers
(raising head, blowing through a straw, coughing,
extending hips).
– Transillumination is not helpful in differentiating
hydrocele vs inguinal hernia for pediatric patients
because the bowel wall is so thin.
– Ultrasound can be used but is operator dependent and
unnecessary in the diagnosis of an inguinal hernia.
• Describe open vs laparoscopic inguinal hernia repair.
– Open inguinal hernia repair
M. V. Butchy · J. Williamson
Department of Surgery, Cooper University Hospital,
Camden, NJ, USA
e-mail: butchy-margaret@cooperhealth.edu;
williamson.john@lha6.navy.mil
E. B. Lindholm (
Department of Surgery, Cooper University Hospital,
Camden, NJ, USA
Division of Pediatric Surgery, Children’s Regional Hospital,
Cooper University, Camden, NJ, USA
e-mail: Lindholm-Erika@cooperhealth.edu
*)
Identify the anterior superior iliac spine and the
pubic tubercle by palpation and make an incision in
the skin crease at the midpoint between these
landmarks.
Divide Camper fascia and Scarpa fascia.
External oblique aponeurosis in the direction of the
external ring, taking care to protect the ilioinguinal
nerve that runs beneath (this step is operator dependent and does not have to be done in many
settings).
Identify and isolate the cord; divide cremasteric
bers.
Identify sac (lies anteromedial to cord structures)
and separate sac from vas deferens and vessels
without causing injury.
Dissect hernia sac to the internal ring and ligate the
sac without injury to the cord structures.
A 3 mm laparoscope can be inserted through the
hernia sac and secured with a tie; the peritoneal
cavity can be insufated allowing for visualization
of contralateral internal inguinal ring.
– Laparoscopic inguinal hernia repair
A 5mm laparoscope via the umbilicus.
Females: A grasper inserted via stab incision can be
inserted into the hernia and the hernia grasped and
inverted. An endoloop placed via another stab incision can then be used to ligate the hernia sac. Finally
the endoloop and hernia sac are excised.
Males: There are multiple different approaches to
the hernia repair for males depending on the instrumentation available. The ring is accessed via the
skin overlying the internal ring; saline is injected in
the plane between the peritoneum and vas/vessels.
A suture is then placed circumferentially around the
internal ring making sure to exclude the vas and
vessels. The suture is then tied into the subcutaneous tissues.
• Why would you choose open vs laparoscopic repair?
– Data is limited comparing outcomes from open vs lap-
aroscopic. Both have associated risk of injury to vas
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
M. Neff et al. (eds.), Passing the General Surgery Oral Board Exam, https://doi.org/10.1007/978-3-031-78244-2_123
423
424
M. V. Butchy et al.
deferens, testicular atrophy, surgical site infection, and
recurrence.
• What is the signicance of an absent vas deferens?
– Absence of the vas deferens should prompt evaluation
for cystic brosis or unilateral renal agenesis.
• What is the timing of surgical repair in premature infants?
– Decision to operate should be balanced with the risk of
incarceration and recurrence. Discussion with parents
should include the balance of these risks.
– Patients with post-conceptual age of <60weeks have a
higher risk of postoperative apnea and need to be
observed overnight.
– Premature infants also have a higher risk of recurrence
that is proportional to their age, so some advocate for
later repair if the parents are reliable to bring the baby
back in the case of incarceration.
• What are the most common operative complications?
– Supercial surgical site infection (<1%) and recur-
rence of hernia (1–5%).
– Risk factor recurrence includes increased intra-
abdominal pressure, pre-op incarcerated hernia, prematurity, high ligation, and intraoperative injury to the
inguinal canal oor.
– Most common intraoperative complication is injury to
the spermatic cord which can cause testicular atrophy
(vessel injury) and future reproductivity (vas
deferens).
• How do you differentiate between a hydrocele and a
recurrence?
– Physical exam can be helpful in assessing recurrence
vs uid accumulation postoperatively if you can feel a
fullness in the inguinal canal.
– Ultrasound can be performed.
– Fluid can resolve spontaneously or be aspirated.
Incarcerated Inguinal Hernia
Alternate Scenario
“A 3-month-old male presents with groin bulge and pain.
The mom reports that she noticed a bulge in the patient’s
scrotum when she was changing his diaper and he was crying. Bulge is hard and tender to palpation.”
pressure to the apex of the hernia to reduce contents
through the external ring.
• After successful reduction, what is the appropriate inter-
val to surgical repair?
– Straightforward reduction—no need for urgent repair.
– Difcult reduction—consider repair in 24–72 h after
reduction to allow the edema to subside.
• What if you are unsuccessful in reducing incarcerated
inguinal hernia?
– Proceed directly to the operating room. This patient
population benets from laparoscopic repair because
you can visualize the bowel after reduction and determine the need for small bowel resection.
• What if there are signs of bowel ischemia or necrosis?
– Incisions can be enlarged to assess and run the bowel.
If unable to adequately assess the bowel, laparoscopy
or laparotomy should be performed to adequately
assess the viability of the bowel.
• Long-term follow-up
– Routine follow-up is typically limited to one ofce
visit for a wound check.
Clean Kills
• Failure to take an irreducible, incarcerated hernia to OR
urgently
• Failure to identify signs of bowel strangulation
Bonus Points
• Female inguinal hernias are most commonly incarcerated
with ovary instead of bowel. If suspected and conrmed
on US, the patient with an incarcerated ovary with blood
ow and no external signs of strangulation may be taken
to the OR on a semi-elective basis. This is not a case that
would require emergency surgical intervention in the
middle of the night. If there are signs of strangulation, OR
is necessary, and the ovary should be returned to the abdomen unless frankly necrotic, in which case removal is
necessary.
• How would you attempt to reduce an inguinal hernia?
– Place patient supine in Trendelenburg position. Dim
the lights in the room. Pain control and sedation can
increase the rate of reduction.
– Two-handed technique of taxis: Cranial hand applies
lateral and caudal pressure to the hernia to extend the
aperture of the external ring. Caudal hand applies rm
Words ofWisdom
• Pediatric inguinal hernias can be difcult to diagnose.
The differential diagnosis includes hydrocele, hernia,
lymph nodes, abscess, ectopic testicle, etc. While US can
be helpful in the diagnosis, dilated bowel may be difcult
123 Pediatric Inguinal Hernia
425
to differentiate from hydrocele, and one should always err
on the side of caution proceeding the OR unless very condent in the diagnosis. Reduction is usually successful
but may take time and patience. Lastly, always ensure that
you can feel both testicles and are not missing an alternate
diagnosis.
Bibliography
Holcomb and Ashcraft’s Pediatric Surgery.
Sabiston Textbook of Surgery.
SCORE.
Pediatric Appendicitis
M.VirginiaButchy, JohnWilliamson,
andErikaB.Lindholm
124
Acute Appendicitis
Scenario
“A 10-year-old boy presents to the ED with fever, abdominal
pain, nausea, and vomiting. The mom reports that the patient
was not hungry at breakfast before school. Patient had mild
abdominal pain and stayed home from school. Over the
course of the day, the patient developed nausea and nonbloody, non-bilious vomiting. The pain migrated and localized to the right lower quadrant and became more severe
prompting them to present to the emergency department this
evening.”
• What lab work and imaging would you acquire? How
would this differ in a female patient?
– A complete blood count, a C-reactive protein, and
basic metabolic panel are commonly ordered. Patients
typically have elevated WBC and CRP. Patients also
often have a urinalysis sent to conrm that the urine is
free of bacteria and red and white blood cells. It is not
uncommon to see ketones in urine because patients are
often dehydrated.
– Diagnostic imaging decreases the rate of negative
appendectomies.
Ultrasound utilizes no contrast or radiation. Can
show a uid-lled, non-compressible appendix and
a diameter>6 mm. Can also visualize an appendicolith or periappendiceal or pericecal uid and
inammation. It is very operator dependent.
M. V. Butchy · J. Williamson
Department of Surgery, Cooper University Hospital,
Camden, NJ, USA
e-mail: butchy-margaret@cooperhealth.edu;
williamson.john@lha6.navy.mil
E. B. Lindholm (
Department of Surgery, Cooper University Hospital,
Camden, NJ, USA
Division of Pediatric Surgery, Children’s Regional Hospital,
Cooper University, Camden, NJ, USA
e-mail: Lindholm-Erika@cooperhealth.edu
*)
Computed tomography is accurate and not operator
dependent. Risk of malignancy with ionizing radiation to children. Often CT is utilized if ultrasound
does not provide adequate information and MRI is
unavailable.
MRI is extremely accurate and does not expose
children to radiation. Fast MRI uses two sequences
to get the diagnosis in a short amount of time in the
scanner. Unfortunately it is not always available
and many children require sedation to undergo the
scan.
• What is the role of nonoperative management of acute
appendicitis with antibiotics?
– Few studies in pediatric patients but extensively stud-
ied in adult patients. Shows a relatively high success
rate of initial nonoperative management (75–90%)
with no increased risk of perforation, but recurrence
rate is as high as 14%.
– Presence of appendicolith, abdominal pain >48 h,
WBC >18k, profound bandemia, CRP >4mg/dL, and
signs of bowel obstruction or abscess are all adverse
indicators for nonoperative management.
• How will you prepare the patient for the OR? How quickly
will you take the patient to the OR?
– Intravenous access should be obtained and the patient
should be started on intravenous uids. Patients should
also be started on broad-spectrum antibiotics.
– Patients should be taken to the OR <24 h of initial
diagnosis. Acute, uncomplicated appendicitis is no
longer an indication for emergent surgical intervention. Studies have shown no difference in the rate of
perforation or postoperative abscess with delays of
12–24h.
• What surgery will you choose for this patient and why?
– Laparoscopic appendectomies are associated with
fewer wound infections and fewer small bowel obstructions for adhesive disease.
– Laparoscopic appendectomies can be same-day surgi-
cal procedures.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
M. Neff et al. (eds.), Passing the General Surgery Oral Board Exam, https://doi.org/10.1007/978-3-031-78244-2_124
427