Scholars@Duke
Tamara Noel Fitzgerald

Tamara Noel Fitzgerald

Associate Professor of Surgery
Surgery, Pediatric General Surgery

Selected Publications

Biliary atresia in Uganda: Current ethical challenges and advancement of public policy.

Journal Article World J Surg · October 2024 Biliary atresia is a progressive cholangiopathy in neonates, which often results in liver failure. In high-income countries, initial treatment requires prompt diagnosis followed by Kasai portoenterostomy. For those with a late diagnosis, or those in whom K ... Full text Link to item Cite

Contemporary trends in choledochal cyst excision: An analysis of the pediatric national surgical quality improvement program.

Journal Article World J Surg · April 2024 BACKGROUND: Choledochal cysts are rare congenital anomalies of the biliary tree that may lead to obstruction, chronic inflammation, infection, and malignancy. There is wide variation in the timing of resection, operative approach, and reconstructive techni ... Full text Link to item Cite

Gaps and priorities in innovation for children's surgery.

Journal Article Semin Pediatr Surg · December 2023 Lack of access to pediatric medical devices and innovative technology contributes to global disparities in children's surgical care. There are currently many barriers that prevent access to these technologies in low- and middle-income countries (LMICs). Te ... Full text Link to item Cite

Evaluation of Analgesic Practice Changes Following the Nuss Procedure in Pediatric Patients.

Journal Article J Surg Res · November 2023 INTRODUCTION: Pectus excavatum repair by the Nuss procedure results in severe postoperative pain. Regional blocks and intercostal nerve cryoablation (INC) have emerged as potential strategies to manage analgesia. This study compares pain-related outcomes f ... Full text Link to item Cite

KeyLoop retractor for global gasless laparoscopy: evaluation of safety and feasibility in a porcine model.

Journal Article Surg Endosc · August 2023 BACKGROUND: Many surgeons in low- and middle-income countries have described performing surgery using gasless (lift) laparoscopy due to inaccessibility of carbon dioxide and reliable electricity, but the safety and feasibility of the technique has not been ... Full text Link to item Cite

Met and Unmet Need for Pediatric Surgical Access in Uganda: A Country-Wide Prospective Analysis.

Journal Article J Surg Res · June 2023 INTRODUCTION: Children's surgical access in low and low-middle income countries is severely limited. Investigations detailing met and unmet surgical access are necessary to inform appropriate resource allocation. MATERIALS AND METHODS: Surgical volume, out ... Full text Link to item Cite

Evaluating the status of the Lancet Commission on Global Surgery indicators for India.

Journal Article Lancet Reg Health Southeast Asia · June 2023 For universal surgical, obstetric, trauma, and anesthesia care by 2030, the Lancet Commission on Global Surgery (LCoGS) suggested tracking six indicators. We reviewed academic and policy literature to investigate the current state of LCoGS indicators in In ... Full text Link to item Cite

Low Cost Gastroschisis Silo for Sub-Saharan Africa: Testing in a Porcine Model.

Journal Article World J Surg · February 2023 BACKGROUND: Gastroschisis mortality in sub-Saharan Africa (SSA) remains high at 59-100%. Silo inaccessibility contributes to this disparity. Standard of care (SOC) silos cost $240, while median monthly incomes in SSA are < $200. Our multidisciplinary Ameri ... Full text Link to item Cite

Crucial Business Model Elements for Medical Device Startup Companies in Emerging Markets.

Journal Article Value Health Reg Issues · January 2023 OBJECTIVES: Medical devices that suit the needs and challenges of low- and middle-income countries are desperately needed. To provide sustainable access to such devices, business approaches must be developed to meet the demands of individual economic, heal ... Full text Link to item Cite

With equity in mind: Evaluating an interactive hybrid global surgery course for cross-site interdisciplinary learners.

Journal Article PLOS Glob Public Health · 2023 There is limited understanding of the role of transcultural, cross-site educational partnerships for global surgery training between high- and low- or middle-income country (LMIC) institutions. We describe the development, delivery, and appraisal of a hybr ... Full text Link to item Cite

Prioritization of surgical, obstetric, trauma, and anesthesia care in India over seven decades: A systematic analysis of policy documents.

Journal Article PLOS Glob Public Health · 2023 Improving access to surgical care in India requires policy-level prioritization of surgical, obstetric, trauma, and anesthesia (SOTA) care. We quantified SOTA care prioritization in the last seven decades by analyzing India's national policy and programmat ... Full text Link to item Cite

Social injustice symposium: Urban, rural, and global disparities in access to care.

Journal Article J Pediatr Surg · November 2022 BACKGROUND: Barriers in access to pediatric surgical care are common in low- and middle-income countries (LMICs), but also exist in high-income countries, particularly in urban and rural areas. METHODS: This article describes "Disparities in Access to Care ... Full text Link to item Cite

The Evolving Landscape of Global Surgery: A Qualitative Study of North American Surgeons' Perspectives on Faith-Based and Academic Initiatives.

Journal Article J Relig Health · August 2022 Faith-based missions have played a large role in surgical care delivery in low- and middle-income countries (LMIC). As global surgery is now an academic discipline, this pilot study sought to understand how different faith ideologies influence surgeon moti ... Full text Link to item Cite

KeyLoop: Mechanical Retraction of the Abdominal Wall for Gasless Laparoscopy.

Journal Article Surg Innov · February 2022 Background. Despite favorable outcomes of laparoscopic surgery in high-income countries, its implementation in low- and middle-income countries (LMICs) is challenging given a shortage of consumable supplies, high cost, and risk of power outages. To overcom ... Full text Link to item Cite

Biliary atresia in a neonate with a history of COVID-19: A case report.

Journal Article Int J Surg Case Rep · January 2022 INTRODUCTION AND IMPORTANCE: Biliary Atresia is the progressive destruction of the neonatal intra- and extra- hepatic bile ducts. The novel coronavirus has shown dramatic hepatic tropism, and patients experiencing liver injury appear to have worse outcomes ... Full text Link to item Cite

Finding common ground for the common good: An appeal for innovative collaboration between faith- And non-faith-based organizations

Journal Article Christian Journal for Global Health · January 1, 2022 Both faith-based organizations (FBOs) and non-faith-based organizations (NFBOs) make significant contributions to healthcare in low- and middle-income countries, particularly for patients with fewer economic resources. The perception that FBO and NFBO are ... Full text Cite

Laparoscopic experience and attitudes toward a low-cost laparoscopic system among surgeons in East, Central, and Southern Africa: a survey study.

Journal Article Surg Endosc · December 2021 BACKGROUND: Laparoscopic surgery has become standard of care in high-income countries but is rarely accessible in low- and middle-income countries (LMICs). This study assessed experience with laparoscopy and attitudes toward a low-cost laparoscopic system ... Full text Link to item Cite

Access to pediatric surgery delivered by general surgeons and anesthesia providers in Uganda: Results from 2 rural regional hospitals.

Journal Article Surgery · November 2021 BACKGROUND: Significant limitations in pediatric surgical capacity exist in low- and middle-income countries, especially in rural regions. Recent global children's surgical guidelines suggest training and support of general surgeons in rural regional hospi ... Full text Link to item Cite

Dr. Sr. Mary Margaret Ajiko.

Journal Article World J Surg · October 2021 Full text Link to item Cite

Open versus minimally-invasive surgical techniques in pediatric renal tumors: A population-level analysis of in-hospital outcomes.

Journal Article J Pediatr Urol · August 2021 INTRODUCTION: Minimally-invasive surgery (MIS) has been adopted slowly in pediatric oncology. We attempted to describe contemporary national trends in MIS use; we hypothesized that adolescents (who are more likely to have relatively small renal cell carcin ... Full text Link to item Cite

An Accessible Laparoscope for Surgery in Low- and Middle- Income Countries.

Journal Article Ann Biomed Eng · July 2021 Laparoscopic surgery is the standard of care in high-income countries for many procedures in the chest and abdomen. It avoids large incisions by using a tiny camera and fine instruments manipulated through keyhole incisions, but it is generally unavailable ... Full text Link to item Cite

The first six years of the APSA Travel Fellowship Program: Impact and lessons learned.

Journal Article J Pediatr Surg · May 2021 INTRODUCTION: The American Pediatric Surgical Association (APSA) travel fellowship was established in 2013 to allow pediatric surgeons from low- and middle-income countries to attend the APSA annual meeting. Travel fellows also participated in various clin ... Full text Link to item Cite

Missions, Humanitarianism, and the Evolution of Modern Global Surgery.

Journal Article Am Surg · May 2021 Modern global surgery, which aims to provide improved and equitable surgical care worldwide, is a product of centuries of international care initiatives, some borne out of religious traditions, dating back to the first millennium. The first hospitals (xeno ... Full text Link to item Cite

Development of an Interactive Global Surgery Course for Interdisciplinary Learners.

Journal Article Ann Glob Health · March 31, 2021 INTRODUCTION: Global surgical care is increasingly recognized in the global health agenda and requires multidisciplinary engagement. Despite high interest among medical students, residents and other learners, many surgical faculty and health experts remain ... Full text Open Access Link to item Cite

The Evolving Landscape of Medical Device Regulation in East, Central, and Southern Africa.

Journal Article Glob Health Sci Pract · March 31, 2021 Effective regulatory frameworks, harmonized to international standards, are critical to expanding access to quality medical devices in low- and middle-income countries. This review provides a summary of the state of medical device regulation in the 14 memb ... Full text Link to item Cite

Social and financial barriers may contribute to a "hidden mortality" in Uganda for children with congenital anomalies.

Journal Article Surgery · February 2021 BACKGROUND: The true incidence of congenital anomalies in sub-Saharan Africa is unknown. Owing to complex challenges associated with congenital anomalies, many affected babies may never present to a health facility, resulting in an underestimation of disea ... Full text Link to item Cite

Ugandan Medical Student Career Choices Relate to Foreign Funding Priorities.

Journal Article World J Surg · December 2020 INTRODUCTION: The surgical workforce in sub-Saharan Africa is insufficient to meet population needs. Therefore, medical students should be encouraged to pursue surgical careers and "brain drain" must be minimized. It is unknown to what extent foreign aid p ... Full text Link to item Cite

Multidisciplinary Development of a Low-Cost Gastroschisis Silo for Use in Sub-Saharan Africa.

Journal Article J Surg Res · November 2020 BACKGROUND: Gastroschisis silos are often unavailable in sub-Saharan Africa (SSA), contributing to high mortality. We describe a collaboration between engineers and surgeons in the United States and Uganda to develop a silo from locally available materials ... Full text Link to item Cite

Predictors of Burnout and Depression in Surgeons Practicing in East, Central, and Southern Africa.

Journal Article J Surg Res · November 2020 BACKGROUND: Surgeons are at risk of burnout and depression, which can lead to medical errors, inefficiency, exhaustion, conflicts, and suicide. Significant challenges exist in sub-Saharan Africa that may increase the prevalence of burnout and depression, b ... Full text Link to item Cite

Global Surgery Pro-Con Debate: A Pathway to Bilateral Academic Success or the Bold New Face of Colonialism?

Journal Article J Surg Res · August 2020 Global surgery, especially academic global surgery, is of tremendous interest to many surgeons. Classically, it entails personnel from high-income countries going to low- and middle-income countries and engaging in educational activities as well as procedu ... Full text Link to item Cite

Burden of Surgical Infections in a Tertiary-Care Pediatric Surgery Service in Uganda.

Journal Article Surg Infect (Larchmt) · March 2020 Featured Publication Background: Delayed presentation of surgical disease often leads to infection in low- and middle-income countries (LMICs). In addition, many primary infections require surgical intervention. The burden of infection in children's surgery in LMICs is poorly ... Full text Link to item Cite

Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study.

Journal Article J Surg Res · February 2020 BACKGROUND: Ninety-four percent of congenital anomalies occur in low- and middle-income countries. In Uganda, only three pediatric surgeons and three pediatric anesthesiologists serve more than 20 million children. This study estimates burden, outcomes, co ... Full text Link to item Cite

Comparison of Ugandan and North American Pediatric Surgery Fellows' Operative Experience: Opportunities for Global Training Exchange.

Journal Article J Surg Educ · 2020 Featured Publication OBJECTIVE: North American pediatric surgery training programs vary in exposure to index cases, while controversy exists regarding fellow participation in global surgery rotations. We aimed to compare the case logs of graduating North American pediatric sur ... Full text Link to item Cite

Unifying Children's Surgery and Anesthesia Stakeholders Across Institutions and Clinical Disciplines: Challenges and Solutions from Uganda.

Journal Article World J Surg · June 2019 Featured Publication BACKGROUND: There is a significant unmet need for children's surgical care in low- and middle-income countries (LMICs). Multidisciplinary collaboration is required to advance the surgical and anesthesia care of children's surgical conditions such as congen ... Full text Link to item Cite

Global Initiative for Children's Surgery: A Model of Global Collaboration to Advance the Surgical Care of Children.

Journal Article World J Surg · June 2019 BACKGROUND: Recommendations by the Lancet Commission on Global Surgery regarding surgical care in low- and middle-income countries (LMICs) require development to address the needs of children. The Global Initiative for Children's Surgery (GICS) was founded ... Full text Link to item Cite

Higher mortality in pediatric and adult trauma patients with traumatic coagulopathy, using age-adjusted diagnostic criteria.

Journal Article Surgery · June 2019 BACKGROUND: Acute traumatic coagulopathy has been described in adult trauma patients. Acute traumatic coagulopathy may be associated with higher mortality and morbidity in pediatric trauma patients. We aimed to (1) compare acute traumatic coagulopathy inci ... Full text Link to item Cite

Outcomes of laparoscopic resection of Meckel's diverticulum are equivalent to open laparotomy.

Journal Article J Pediatr Surg · March 2019 PURPOSE: Meckel's diverticulum (MD) is a common congenital anomaly caused by failure of involution of the omphalomesenteric duct. Enthusiasm for minimally invasive surgery (MIS) in children has burgeoned as technologies have advanced, but the outcomes of l ... Full text Link to item Cite

Global Surgery: Building Healthy Surgical Systems.

Journal Article J Pak Med Assoc · February 2019 Global Surgery (GS) is a movement that advocates access of every individual to safe and affordable surgery despite geographic location or socioeconomic status. It has recently received increased attention within the global health arena, but many patients a ... Link to item Cite

Global perspective of paediatric surgery in low and middle income countries.

Journal Article J Pak Med Assoc · February 2019 There is huge burden of paediatric surgical diseases in low and middle income countries. Issues behind such a scenario include lack of trained paediatric surgeons, higher mortality due to infections, and poor postoperative care. The possible solution is im ... Link to item Cite

Teaching patient safety in global health: lessons from the Duke Global Health Patient Safety Fellowship.

Journal Article BMJ Glob Health · 2019 Health systems in low-income and middle-income countries (LMICs) have a high burden of medical errors and complications, and the training of local experts in patient safety is critical to improve the quality of global healthcare. This analysis explores our ... Full text Link to item Cite

Global perspective of paediatric surgery in low and middle income countries

Journal Article JOURNAL OF THE PAKISTAN MEDICAL ASSOCIATION · 2019 Cite

Global Surgery: Building Healthy Surgical Systems

Journal Article JOURNAL OF THE PAKISTAN MEDICAL ASSOCIATION · 2019 Cite

Children with appendicitis on the US-Mexico border have socioeconomic challenges and are best served by a freestanding children's hospital.

Journal Article Pediatr Surg Int · December 2018 INTRODUCTION: The US-Mexico border is medically underserved. Recent political changes may render this population even more vulnerable. We hypothesized that children on the border present with high rates of perforated appendicitis due to socioeconomic barri ... Full text Link to item Cite

Penetrating trauma in children on the United States-Mexico border: Hispanic ethnicity is not a risk factor.

Journal Article Injury · July 2018 INTRODUCTION: The United States-Mexico border is perceived as dangerous by the media and current political leaders. Hispanic ethnicity, low socioeconomic status, male gender and adolescent age have previously been identified as risk factors for penetrating ... Full text Link to item Cite

Papillary cystadenoma of the epididymis in a 12-year-old survivor of stage IV neuroblastoma

Journal Article Journal of Pediatric Surgery Case Reports · April 1, 2018 Papillary cystadenoma of the epididymis (PCE) is the second most common benign neoplasm of the epididymis [1]. It is very uncommon and has never been reported in a prepubertal male. It may occur sporadically, but more often occurs in association with von H ... Full text Cite

The socioeconomic impact of a pediatric ostomy in Uganda: a pilot study.

Journal Article Pediatr Surg Int · April 2018 Featured Publication INTRODUCTION: Multiple pediatric surgical conditions require ostomies in low-middle-income countries. Delayed presentations increase the numbers of ostomies. Patients may live with an ostomy for a prolonged time due to the high backlog of cases with insuff ... Full text Link to item Cite

Transition to Practice: A Global Surgery Approach.

Journal Article J Surg Educ · 2018 OBJECTIVE: To determine the feasibility of a global surgery setting for a transition to practice experience. SETTING: A rural hospital in Malawi, Africa. PARTICIPANTS: A recent graduate of a U.S. general surgery residency program. RESULTS: Fellow performed ... Full text Link to item Cite

Factors Associated With Poor Child Motor Vehicle Restraint on the USA-Mexico Border.

Journal Article J Trauma Nurs · 2018 Motor vehicle collisions (MVCs) are a significant cause of pediatric morbidity, particularly in low- to middle-income countries. We describe car seat use in children on the USA-Mexico border. A retrospective review was conducted for children 0-9 years old, ... Full text Link to item Cite

Surgical volunteerism as a collaborative teaching activity can benefit surgical residents in low-middle income countries.

Journal Article Int J Surg · December 2017 Surgical care is desperately needed in low-middle income countries (LMIC). Due to small numbers of faculty in local training programs, residents have limited exposure to subspecialists. We describe a teaching activity between visiting surgeons from the U.S ... Full text Link to item Cite

Gastroschisis in Uganda: Opportunities for improved survival.

Journal Article J Pediatr Surg · November 2016 PURPOSE: Neonatal mortality from gastroschisis in sub-Saharan Africa is high, while in high-income countries, mortality is less than 5%. The purpose of this study was to describe the maternal and neonatal characteristics of gastroschisis in Uganda, estimat ... Full text Link to item Cite

A practical guide for short-term pediatric surgery global volunteers.

Journal Article J Pediatr Surg · August 2016 INTRODUCTION: The tremendous need for increasing the quantity and quality of global pediatric surgical care in underserved areas has been well documented. Concomitantly there has been a significant increase in interest by pediatric surgeons in helping to r ... Full text Link to item Cite

Colonic polyposis in a 15 year-old boy: Challenges and lessons from a rural resource-poor area.

Journal Article Ann Med Surg (Lond) · May 2016 INTRODUCTION: Colorectal polyps usually present with rectal bleeding and are associated with increased risk of colorectal carcinoma. Evaluation and management in resource-poor areas present unique challenges. PRESENTATION OF CASE: This 15 year-old boy pres ... Full text Open Access Link to item Cite

Case report of migration of 2 ventriculoperitoneal shunt catheters to the scrotum: Use of an inguinal incision for retrieval, diagnostic laparoscopy and hernia repair.

Journal Article Int J Surg Case Rep · 2016 BACKGROUD: Ventriculoperitoneal shunts are commonly used in the treatment of hydrocephalus, and catheter migration to various body sites has been reported. Pediatric and general surgeons are asked on occasion to assist with intraabdominal access for these ... Full text Link to item Cite

Elevated monocytes in patients with critical limb ischemia diminish after bypass surgery.

Journal Article J Surg Res · May 1, 2011 BACKGROUND: Mononuclear cells (MNC) increase neovascularization and ulcer healing after injection into an ischemic extremity. Circulating MNC are composed of lymphocytes (85%), monocytes (15%), and endothelial progenitor cells (EPC; 0.03%). We hypothesized ... Full text Link to item Cite

A unique case of rhabdoid tumor presenting as hemoperitoneum in an infant.

Journal Article J Pediatr Surg · January 2011 We report the first pediatric case of an extrarenal, noncentral nervous system, diffusely metastatic, gastrointestinal rhabdoid tumor in a 106-day-old, previous 25-week preterm infant. The unusual clinical presentation, the diagnosis, and biology of this t ... Full text Link to item Cite

Endovascular aneurysm repair is associated with less malnutrition than open abdominal aortic aneurysm repair.

Journal Article Am J Surg · November 2009 BACKGROUND: Patients undergoing abdominal aortic aneurysm (AAA) repair have high rates of postoperative malnutrition. We examined whether endovascular aneurysm repair (EVAR) is associated with reduced postoperative malnutrition compared with open AAA repai ... Full text Link to item Cite