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Chen SY, Huang R, Kallini J, Wachsman AM, Van Allan RJ, Margulies DR, Phillips EH, Barmparas G. Correction to: Outcomes Following Percutaneous Cholecystostomy Tube Placement for Acalculous Versus Calculous Cholecystitis. World J Surg 2022; 46:2538. [PMID: 35748895 DOI: 10.1007/s00268-022-06632-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Stephanie Y Chen
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 650W, Los Angeles, CA, 90048, USA
| | - Raymond Huang
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 650W, Los Angeles, CA, 90048, USA
| | - Joseph Kallini
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ashley M Wachsman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Richard J Van Allan
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Section of Interventional Radiology, Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel R Margulies
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 650W, Los Angeles, CA, 90048, USA
| | - Edward H Phillips
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 650W, Los Angeles, CA, 90048, USA
| | - Galinos Barmparas
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 650W, Los Angeles, CA, 90048, USA.
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Chen SY, Huang R, Kallini J, Wachsman AM, Van Allan RJ, Margulies DR, Phillips EH, Barmparas G. Outcomes Following Percutaneous Cholecystostomy Tube Placement for Acalculous Versus Calculous Cholecystitis. World J Surg 2022; 46:1886-1895. [DOI: 10.1007/s00268-022-06566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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Huang R, Patel DC, Kallini JR, Wachsman AM, Van Allan RJ, Margulies DR, Phillips EH, Barmparas G. Percutaneous Cholecystostomy Tube for Acute Cholecystitis: Quantifying Outcomes and Prognosis. J Surg Res 2021; 270:405-412. [PMID: 34749121 DOI: 10.1016/j.jss.2021.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/21/2021] [Accepted: 09/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy tubes (PCT) are utilized in the management of acute cholecystitis in patients deemed unsuitable for surgery. However, the drive for these decisions and the outcomes remain understudied. We sought to characterize the practices and utilization of PCT and evaluate associated outcomes at an urban medical center. METHODS Patients undergoing PCT placement over a 12-y study period ending May 2019 were reviewed. Demographics, clinical presentation, labs, imaging studies, and outcomes were abstracted. The primary and secondary outcomes were 30-d mortality and interval cholecystectomy, respectively. RESULTS Two hundred and four patients met inclusion criteria: 59.3% were male with a median age of 67.5 y and a National Surgical Quality Improvement Program (NSQIP) risk of serious complication of 8.0%. Overall, 57.8% of patients were located in an intensive care unit setting. The majority (80.9%) had an ultrasound and 48.5% had a hepatobiliary iminodiacetic acid scan. The overall 30-d mortality was 31.9%: 41.5% for intensive care unit and 18.6% for ward patients (P < 0.01). Of patients surviving beyond 30 d (n = 139), the PCT was removed from 106 (76.3%), and a cholecystectomy was performed in 55 (39.6%) at a median interval of 58.0 d. A forward logistic regression identified total bilirubin (Adjusted Odds Ratio: 1.12, adjusted P < 0.01) and NSQIP risk of serious complication (Adjusted Odds Ratio: 1.16, adjusted P < 0.01) as the only predictors for 30-d mortality. CONCLUSIONS Patients selected for PCT placement have a high mortality risk. Despite subsequent removal of the PCT, the majority of surviving patients did not undergo an interval cholecystectomy. Total bilirubin and NSQIP risk of serious complication are useful adjuncts in predicting 30-d mortality in these patients.
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Affiliation(s)
- Raymond Huang
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Deven C Patel
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joseph R Kallini
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ashley M Wachsman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Daniel R Margulies
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H Phillips
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Galinos Barmparas
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
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Kallini JR, Patel DC, Linaval N, Phillips EH, Van Allan RJ. Comparing clinical outcomes of image-guided percutaneous transperitoneal and transhepatic cholecystostomy for acute cholecystitis. Acta Radiol 2021; 62:1142-1147. [PMID: 32957795 DOI: 10.1177/0284185120959829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Percutaneous cholecystostomy is performed by interventional radiologists for patients with calculous/acalculous cholecystitis who are poor candidates for cholecystectomy. Two anatomical approaches are widely utilized: transperitoneal and transhepatic. PURPOSE To compare the clinical outcomes of transperitoneal and transhepatic approaches to cholecystostomy catheter placement. MATERIAL AND METHODS From December 2007 to August 2015, 165 consecutive patients (97 men, 68 women) underwent either transperitoneal (n = 89) or transhepatic (n = 76) cholecystostomy at a single center. Indications were calculous cholecystitis (n = 21), acalculous cholecystitis (n = 35), hydrops (n = 1), gangrenous cholecystitis (n = 1), and other cholecystitis (n = 107). The most common high-risk co-morbidities were sepsis (n = 53) and cardiac (n = 11). Outcomes were compared using univariate and multivariable analysis. RESULTS Post-procedure outcomes included tube dislodgement (transperitoneal [n = 6] and transhepatic [n = 3], P = 0.44), bile leak (transperitoneal [n = 5], transhepatic [n = 1], P = 0.14), gallbladder hemorrhage (transperitoneal [n = 2]; transhepatic [n = 3], P = 0.52), duodenal fistula (transperitoneal [n = 0], transhepatic [n = 1], P = 0.27), repeat cholecystostomy (transperitoneal [n = 1], transhepatic [n = 3], P = 0.27), and repeat cholecystitis requiring separate admission (transperitoneal [n = 6], transhepatic [n = 10], P = 0.15). All complications were Common Terminology Criteria for Adverse Events grade <3. Twenty transperitoneal patients underwent post-procedure cholecystectomy: 13 laparoscopic, three open, and four unclear/outside records. The mean time from cholecystostomy to operation was 38 days (range 3-211 days). Twenty-three transhepatic patients underwent cholecystectomy: 14 laparoscopic, eight open, and one unclear/outside records, with the mean time from cholecystostomy being 98 days (range 0-1053 days). One transhepatic and three transperitoneal patients died during admission. CONCLUSION There were no significant differences in short-term complications after transperitoneal and transhepatic approaches to percutaneous cholecystostomy catheter placement.
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Affiliation(s)
- Joseph R Kallini
- Department of Imaging, Section of Interventional Radiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Deven C Patel
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nikhil Linaval
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward H Phillips
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Richard J Van Allan
- Department of Imaging, Section of Interventional Radiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Tseng J, DiPeri T, Chen Y, Ben-Shlomo A, Shouhed D, Phillips EH, Burch M, Jain M. Factors Associated With Non-Operative Management of Resectable Adrenocortical Carcinoma. J Surg Res 2021; 267:651-659. [PMID: 34273795 DOI: 10.1016/j.jss.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Surgery is the initial treatment of choice for patients with resectable adrenocortical carcinoma (ACC). We sought to determine factors associated with non-operative management of resectable ACC. METHODS 2004-2016 National Cancer Database (NCDB) was queried to identify patients with AJCC/ENSAT Stage I-III ACC. Patients who underwent surgery (S) were compared to those who did not undergo surgery (NS). Multivariate logistic regression was used to identify factors associated with NS. Kaplan-Meier estimates used to assess survival. RESULTS Two thousand-seventy patients with Stage I-III ACC were identified, of which 17.5% were NS. 85.9% of NS patients were not offered surgery; 69.9% of NS patients did not receive chemotherapy or radiation therapy. NS were older and less likely to receive care at an Academic center or high volume center (≥5 cases during the study period). NS patients were more likely to have advanced T stage and N1 disease. On multivariate regression, factors associated with lower odds of surgery include older age (OR 1.03, 95% CI 1.02-1.06), T4 disease (OR 3.34, 95% CI 1.05-10.68), and treatment at a community center (OR 2.92, 95% CI 1.58-5.40). Overall median survival was significantly poorer for NS patients (50.4 versus 78.4 months, P < 0.01). CONCLUSION Patients with locally advanced ACC are less likely to undergo an operation, while those treated at centers with more operative experience or Academic facilities are more likely to undergo an operation. As the surgery-first approach is the current standard of care for resectable ACC, these patients may be best served at high volume Academic facilities.
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Affiliation(s)
- Joshua Tseng
- Division of Minimally Invasive Surgery and Endocrine Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Timothy DiPeri
- Division of Minimally Invasive Surgery and Endocrine Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yufei Chen
- Division of Minimally Invasive Surgery and Endocrine Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Anat Ben-Shlomo
- Division of Minimally Invasive Surgery and Endocrine Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel Shouhed
- Division of Minimally Invasive Surgery and Endocrine Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H Phillips
- Division of Minimally Invasive Surgery and Endocrine Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Miguel Burch
- Division of Minimally Invasive Surgery and Endocrine Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Monica Jain
- Division of Minimally Invasive Surgery and Endocrine Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
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Shouhed D, Patel DC, Shamash K, Kirillova L, Burch M, Soukiasian HJ, Phillips EH. Patient Expectations After Collis Gastroplasty. JAMA Surg 2020; 155:888-889. [PMID: 32579199 DOI: 10.1001/jamasurg.2020.1762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel Shouhed
- Division of General Surgery, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Deven C Patel
- Division of General Surgery, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Kevin Shamash
- Division of General Surgery, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Lydia Kirillova
- Division of General Surgery, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Miguel Burch
- Division of General Surgery, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Harmik J Soukiasian
- Division of Thoracic Surgery, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Edward H Phillips
- Division of General Surgery, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
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McMillan AK, Phillips EH, Kirkwood AA, Barrans S, Burton C, Rule S, Patmore R, Pettengell R, Ardeshna KM, Lawrie A, Montoto S, Paneesha S, Clifton-Hadley L, Linch DC. Favourable outcomes for high-risk diffuse large B-cell lymphoma (IPI 3-5) treated with front-line R-CODOX-M/R-IVAC chemotherapy: results of a phase 2 UK NCRI trial. Ann Oncol 2020; 31:1251-1259. [PMID: 32464282 PMCID: PMC7487775 DOI: 10.1016/j.annonc.2020.05.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/28/2022] Open
Abstract
Background Outcomes for patients with high-risk diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP chemotherapy are suboptimal but, to date, no alternative regimen has been shown to improve survival rates. This phase 2 trial aimed to assess the efficacy of a Burkitt-like approach for high-risk DLBCL using the dose-intense R-CODOX-M/R-IVAC regimen. Patients and methods Eligible patients were aged 18–65 years with stage II–IV untreated DLBCL and an International Prognostic Index (IPI) score of 3–5. Patients received alternating cycles of CODOX-M (cyclophosphamide, vincristine, doxorubicin and high-dose methotrexate) alternating with IVAC chemotherapy (ifosfamide, etoposide and high-dose cytarabine) plus eight doses of rituximab. Response was assessed by computed tomography after completing all four cycles of chemotherapy. The primary end point was 2-year progression-free survival (PFS). Results A total of 111 eligible patients were registered; median age was 50 years, IPI score was 3 (60.4%) or 4/5 (39.6%), 54% had a performance status ≥2 and 9% had central nervous system involvement. A total of 85 patients (76.6%) completed all four cycles of chemotherapy. There were five treatment-related deaths (4.3%), all in patients with performance status of 3 and aged >50 years. Two-year PFS for the whole cohort was 67.9% [90% confidence interval (CI) 59.9–74.6] and 2-year overall survival was 76.0% (90% CI 68.5–82.0). The ability to tolerate and complete treatment was lower in patients with performance status ≥2 who were aged >50 years, where 2-year PFS was 43.5% (90% CI 27.9–58.0). Conclusions This trial demonstrates that R-CODOX-M/R-IVAC is a feasible and effective regimen for the treatment of younger and/or fit patients with high-risk DLBCL. These encouraging survival rates demonstrate that this regimen warrants further investigation against standard of care. Trial Registration ClinicalTrials.gov (NCT00974792) and EudraCT (2005-003479-19). R-CODOX-M/R-IVAC is an effective regimen for treatment of high-risk DLBCL and high-grade B-cell lymphoma (IPI score 3–5). Treatment was well tolerated in patients aged <50 years, or aged 50–65 with performance status 0 or 1. The 2-year PFS was 67.9% (90% CI: 59.9–74.6) for the whole cohort. This regimen warrants further evaluation against standard of care in high-risk DLBCL.
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Affiliation(s)
- A K McMillan
- Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - E H Phillips
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK; Division of Cancer Sciences, University of Manchester and The Christie Hospital NHS Trust, Manchester, UK
| | - A A Kirkwood
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - S Barrans
- HMDS, St James' University Hospital, Leeds, UK
| | - C Burton
- HMDS, St James' University Hospital, Leeds, UK
| | - S Rule
- Plymouth University Medical School, Plymouth, UK
| | - R Patmore
- Haematology Department, Castle Hill Hospital, Hull, UK
| | - R Pettengell
- Clinical Sciences, St George's University of London, London, UK
| | - K M Ardeshna
- Haematology Department, University College Hospital London, London, UK
| | - A Lawrie
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - S Montoto
- Centre for Haemato-oncology, Barts Health NHS Trust, London, UK
| | - S Paneesha
- Haematology Department, Heart of England NHS Trust, Birmingham, UK
| | - L Clifton-Hadley
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - D C Linch
- Haematology Department, University College Hospital London, London, UK; UCL Cancer Institute, University College London, UK
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Mallipeddi MK, Gillette E, Sekhon HK, Huynh D, Burch MA, Cunneen SA, Phillips EH, Shouhed D. Routine Hiatal Dissection and Repair Does Not Improve Short-Term Reflux After Vertical Sleeve Gastrectomy. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Agapian JV, Herrera AJ, Kriger DI, Ludi DH, Molkara AM, Phillips EH. Optimizing the Critical View of Safety Triangle by Medially Mobilizing the Cystic Artery during Laparoscopic Cholecystectomy. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jain M, Phillips EH, Burch MA, Shouhed D, Alban RF. Laparoscopic and Open Adrenalectomy Performed for Malignant Adrenal Tumors: An Analysis of the American College of Surgeons NSQIP Database. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Barrett AM, Vu KT, Sandhu KK, Phillips EH, Cunneen SA, Burch MA. Primary sleeve gastrectomy compared to sleeve gastrectomy as revisional surgery: weight loss and complications at intermediate follow-up. J Gastrointest Surg 2014; 18:1737-43. [PMID: 25118640 DOI: 10.1007/s11605-014-2592-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/08/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The laparoscopic adjustable gastric band (LAGB) can be revised to sleeve gastrectomy (LSG) for various reasons. Data are limited on the safety and efficacy of single-stage removal of LAGB and creation of LSG. METHODS A retrospective review of cases was performed from 2010 to 2013. From the primary LSG group, a control group was matched in a 2:1 ratio. RESULTS Thirty-two patients underwent single-stage revision from LAGB to LSG, with a control group of 64. The most common indication for revision was insufficient weight loss (62.5%). Operative time for revision and control groups was 134 and 92 min, respectively (p < 0.0001). Hospital stay was 3.22 and 2.59 days, respectively (p = 0.02). Overall, the 30-day complication rate for revision and control patients was 14.71 and 6.25%, respectively (p = 0.20). There were no leaks, one stricture (3.13%) in the revision group, and one reoperation for bleeding in the control group (1.56%). For patients with BMI >30 at surgery, change in BMI at 12 months for revision and control was 8.77 and 11.58, respectively (p = 0.02). CONCLUSION Single-stage revision can be performed safely, with minimal increases in hospital stay and 30-day complications. Weight loss is greater in those who undergo primary LSG compared to those who undergo LSG as revision.
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Affiliation(s)
- Allison M Barrett
- Cedars-Sinai Medical Center, 8635 W 3rd St, Ste 770W, Los Angeles, CA, 90048, USA,
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Barrett AM, Harrison DJ, Phillips EH, Felder SI, Burch MA. Superior mesenteric artery syndrome following sleeve gastrectomy: case report, review of the literature, and video on technique for surgical correction. Surg Endosc 2014; 29:992-4. [PMID: 25115864 DOI: 10.1007/s00464-014-3743-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/07/2014] [Indexed: 11/24/2022]
Abstract
Superior mesenteric artery (SMA) syndrome is a rare condition in which the duodenum is compressed between the SMA and aorta. This often occurs following extreme weight loss and has been reported in the bariatric population. We present the first reported case of SMA syndrome following sleeve gastrectomy. The patient underwent laparoscopic duodenojejunostomy and recovered uneventfully. The following is a review of the literature and detailed operative approach in the attached video.
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Affiliation(s)
- Allison M Barrett
- Department of Surgery, Cedars-Sinai Medical Center, 8635 W 3rd Street 795 W, Los Angeles, CA, 90048, USA,
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13
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Durkan B, Bresee C, Bose S, Phillips EH, Dang CM. Paget's Disease of the Nipple with Parenchymal Ductal Carcinoma in Situ is Associated with Worse Prognosis than Paget's Disease Alone. Am Surg 2013. [DOI: 10.1177/000313481307901011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Paget's disease of the nipple is often found in conjunction with underlying ductal carcinoma in situ (DCIS). In isolation, Paget's disease of the nipple, like DCIS, confers an excellent prognosis for survival. Our objective was to determine if Paget's disease identified with synchronous parenchymal DCIS has as favorable an outcome as Paget's disease alone. We analyzed a prospectively maintained pathology database and medical records to identify all patients diagnosed with Paget's disease of the nipple between June 1996 and December 2011. Overall survival was analyzed using Kaplan-Maier statistics and Cox proportional hazards modeling. Seventy-four patients were identified with Paget's disease: five (6%) with isolated Paget's of the nipple, 22 (30%) associated with parenchymal DCIS, and 47 (64%) associated with invasive cancer (6 DCIS). Unexpectedly, patients with Paget's disease and DCIS had a worse prognosis than those with Paget's disease alone. Survival correlated with pathologic stage at diagnosis. Among the 16 deaths, median survival was 2.8 years (range, 0.1 to 15.2 years). Median follow-up for the entire cohort was 4.2 years (range, 0.1 to 15.2 years). Thus, Paget's disease with parenchymal DCIS may confer worse survival than isolated Paget's disease of the nipple, suggesting the difficulty of identifying invasive carcinoma within a background of DCIS.
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Affiliation(s)
- Brandice Durkan
- Departments of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Catherine Bresee
- Biostatistics and Bioinformatics Core at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Shikha Bose
- Departments of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H. Phillips
- Departments of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Catherine M. Dang
- Departments of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Dang CM, Estrada S, Bresee C, Phillips EH. Exploring Potential Use of Internet, E-mail, and Instant Text Messaging to Promote Breast Health and Mammogram Use among Immigrant Hispanic Women in Los Angeles County. Am Surg 2013. [DOI: 10.1177/000313481307901008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Breast cancer is now the leading cause of death in Hispanic women (HW). Internet, e-mail, and instant text messaging may be cost-effective in educating HW about breast health and in reducing breast cancer mortality. We surveyed 905 HW women attending a free health fair about their technology use, acculturation, insurance status, mammography use, and breast cancer knowledge. Data were analyzed by t test or χ2 tests. Mean age was 51.9 ± 14.2 years (range, 18 to 88 years). Ninety-two per cent were foreign-born. Most had completed some high school (39%) or elementary (38%) education. Most (62%) were uninsured. The majority spoke (67%) and read (66%) only Spanish. Only 60 per cent of HW older than 40 years had a recent mammogram. HW older than 40 years who had not had a recent mammogram were younger (mean 54.9 ± 10.8 vs 58 ± 10.4 years) and less likely to have health insurance (25 vs 44%; P < 0.001). Most HW never use the Internet (58%) or e-mail (64%). However, 70 per cent have mobile phones (66% older than 40 years), and 65 per cent use text messaging daily (58% older than 40 years, P = 0.001). In fact, 45 per cent wish to receive a mammogram reminder by text. Text messaging may be an inexpensive way to promote breast health and screening mammography use among uninsured HW.
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Affiliation(s)
- Catherine M. Dang
- From the Saul & Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sylvia Estrada
- From the Saul & Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Catherine Bresee
- From the Saul & Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H. Phillips
- From the Saul & Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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15
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Durkan B, Bresee C, Bose S, Phillips EH, Dang CM. Paget's disease of the nipple with parenchymal ductal carcinoma in situ is associated with worse prognosis than Paget's disease alone. Am Surg 2013; 79:1009-1012. [PMID: 24160789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Paget's disease of the nipple is often found in conjunction with underlying ductal carcinoma in situ (DCIS). In isolation, Paget's disease of the nipple, like DCIS, confers an excellent prognosis for survival. Our objective was to determine if Paget's disease identified with synchronous parenchymal DCIS has as favorable an outcome as Paget's disease alone. We analyzed a prospectively maintained pathology database and medical records to identify all patients diagnosed with Paget's disease of the nipple between June 1996 and December 2011. Overall survival was analyzed using Kaplan-Maier statistics and Cox proportional hazards modeling. Seventy-four patients were identified with Paget's disease: five (6%) with isolated Paget's of the nipple, 22 (30%) associated with parenchymal DCIS, and 47 (64%) associated with invasive cancer (± DCIS). Unexpectedly, patients with Paget's disease and DCIS had a worse prognosis than those with Paget's disease alone. Survival correlated with pathologic stage at diagnosis. Among the 16 deaths, median survival was 2.8 years (range, 0.1 to 15.2 years). Median follow-up for the entire cohort was 4.2 years (range, 0.1 to 15.2 years). Thus, Paget's disease with parenchymal DCIS may confer worse survival than isolated Paget's disease of the nipple, suggesting the difficulty of identifying invasive carcinoma within a background of DCIS.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnosis
- Breast Neoplasms/mortality
- Breast Neoplasms/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Databases, Factual
- Female
- Follow-Up Studies
- Humans
- Mastectomy
- Middle Aged
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/mortality
- Neoplasms, Multiple Primary/surgery
- Nipples
- Paget's Disease, Mammary/diagnosis
- Paget's Disease, Mammary/mortality
- Paget's Disease, Mammary/surgery
- Prognosis
- Retrospective Studies
- Survival Analysis
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Affiliation(s)
- Brandice Durkan
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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16
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Dang CM, Estrada S, Bresee C, Phillips EH. Exploring potential use of internet, E-mail, and instant text messaging to promote breast health and mammogram use among immigrant Hispanic women in Los Angeles County. Am Surg 2013; 79:997-1000. [PMID: 24160786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Breast cancer is now the leading cause of death in Hispanic women (HW). Internet, e-mail, and instant text messaging may be cost-effective in educating HW about breast health and in reducing breast cancer mortality. We surveyed 905 HW women attending a free health fair about their technology use, acculturation, insurance status, mammography use, and breast cancer knowledge. Data were analyzed by t test or χ(2) tests. Mean age was 51.9 ± 14.2 years (range, 18 to 88 years). Ninety-two per cent were foreign-born. Most had completed some high school (39%) or elementary (38%) education. Most (62%) were uninsured. The majority spoke (67%) and read (66%) only Spanish. Only 60 per cent of HW older than 40 years had a recent mammogram. HW older than 40 years who had not had a recent mammogram were younger (mean 54.9 ± 10.8 vs 58 ± 10.4 years) and less likely to have health insurance (25 vs 44%; P < 0.001). Most HW never use the Internet (58%) or e-mail (64%). However, 70 per cent have mobile phones (66% older than 40 years), and 65 per cent use text messaging daily (58% older than 40 years, P = 0.001). In fact, 45 per cent wish to receive a mammogram reminder by text. Text messaging may be an inexpensive way to promote breast health and screening mammography use among uninsured HW.
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Affiliation(s)
- Catherine M Dang
- Saul & Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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17
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Elazary R, Phillips EH, Cunneen S, Burch MA. Comments on "increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults" (doi:10.1007/s00464-012-2593-9). Surg Endosc 2013; 27:3935-6. [PMID: 23620383 DOI: 10.1007/s00464-013-2974-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/10/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Ram Elazary
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA,
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18
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Durkan B, Amersi F, Phillips EH, Sherman R, Dang CM. Postmastectomy radiation of latissimus dorsi myocutaneous flap reconstruction is well tolerated in women with breast cancer. Am Surg 2012; 78:1122-7. [PMID: 23025955 DOI: 10.1177/000313481207801025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chest wall irradiation decreases locoregional recurrence and breast cancer-related mortality in women at high risk for recurrence after mastectomy. Many women undergoing mastectomy desire immediate breast reconstruction. Postmastectomy radiation therapy (PMRT), however, increases the risk of surgical complications and may adversely affect the reconstructed breast. We compared outcomes of immediate latissimus dorsi myocutaneous flap (Lat Flap) versus tissue expander/implant (EI) reconstruction after mastectomy followed by PMRT in 29 women with invasive breast cancer treated at a single institution between 2009 and 2011. Although patients undergoing EI reconstruction were slightly younger and more frequently underwent bilateral mastectomy, there were no major differences between the groups with respect to patient or tumor characteristics. With a median follow-up of 11 months (Lat Flap) and 13 months (EI) after completion of PMRT, there was a trend toward more wound complications requiring reoperation, including expander/implant loss (n=3), in the EI group. Capsular contracture was the most common sequela of PMRT in the Lat Flap group (67%) but this was easily treated with capsulotomy at the time of nipple-areola reconstruction. Immediate breast reconstruction with a latissimus dorsi myocutaneous flap is a viable option for women undergoing mastectomy who are likely to require chest wall irradiation.
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Affiliation(s)
- Brandice Durkan
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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19
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Vanderwalde LH, Dang CM, Bresee C, Phillips EH. Discordance Between Pathologic and Radiologic Tumor Size on Breast MRI May Contribute to Increased Re-excision Rates. Am Surg 2011. [DOI: 10.1177/000313481107701020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Preoperative breast MRI does not decrease re-excision rates in patients who undergo lumpectomy. We evaluated concordance of tumor size on MRI and pathologic size in patients who underwent re-excision of margins after lumpectomy. A retrospective review of patients at the Cedars-Sinai Breast Center who received breast MRI was performed. We found that MRI was performed before lumpectomy in 136 patients. Mean age was 55.2 years (standard deviation ± 12.6). Re-excision occurred in 34 per cent (n = 46). Of those undergoing re-excision, 35 per cent (16/46) were re-excised for ductal carcinoma in situ (DCIS) at the lumpectomy margin. There was no significant difference between radiologic and pathologic size of the tumor (1.94 vs 2.12 cm; P = 0.159). In those who underwent re-excision, the radiologic size was underestimated compared with the pathologic size (2.01 vs 2.66 cm; P = 0.032). Patients with pure DCIS lesions (n = 9) also had smaller radiologic tumor size compared with pathologic (0.64 vs 2.88 cm; P = 0.039), and this difference trended toward significance in those who underwent re-excision (0.55 vs 3.50 cm; P = 0.059). Discordance between tumor size on MRI and pathologic size may contribute to re-excisions in patients who undergo lumpectomy. The limitations of breast MRI to evaluate the extent of DCIS surrounding many breast cancers, and the impact on re-excision rates, should be further evaluated.
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Affiliation(s)
| | - Catherine M. Dang
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Catherine Bresee
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H. Phillips
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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20
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Vanderwalde LH, Dang CM, Bresee C, Phillips EH. Discordance between pathologic and radiologic tumor size on breast MRI may contribute to increased re-excision rates. Am Surg 2011; 77:1361-1363. [PMID: 22127089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Preoperative breast MRI does not decrease re-excision rates in patients who undergo lumpectomy. We evaluated concordance of tumor size on MRI and pathologic size in patients who underwent re-excision of margins after lumpectomy. A retrospective review of patients at the Cedars-Sinai Breast Center who received breast MRI was performed. We found that MRI was performed before lumpectomy in 136 patients. Mean age was 55.2 years (standard deviation ± 12.6). Re-excision occurred in 34 per cent (n = 46). Of those undergoing re-excision, 35 per cent (16/46) were re-excised for ductal carcinoma in situ (DCIS) at the lumpectomy margin. There was no significant difference between radiologic and pathologic size of the tumor (1.94 vs 2.12 cm; P = 0.159). In those who underwent re-excision, the radiologic size was underestimated compared with the pathologic size (2.01 vs 2.66 cm; P = 0.032). Patients with pure DCIS lesions (n = 9) also had smaller radiologic tumor size compared with pathologic (0.64 vs 2.88 cm; P = 0.039), and this difference trended toward significance in those who underwent re-excision (0.55 vs 3.50 cm; P = 0.059). Discordance between tumor size on MRI and pathologic size may contribute to re-excisions in patients who undergo lumpectomy. The limitations of breast MRI to evaluate the extent of DCIS surrounding many breast cancers, and the impact on re-excision rates, should be further evaluated.
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MESH Headings
- Biopsy, Needle/methods
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Female
- Follow-Up Studies
- Humans
- Magnetic Resonance Imaging/methods
- Mastectomy, Segmental/methods
- Middle Aged
- Neoplasm Invasiveness/pathology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging/methods
- Neoplasm, Residual/pathology
- Neoplasm, Residual/surgery
- Reoperation/trends
- Retrospective Studies
- Time Factors
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Affiliation(s)
- Lindi H Vanderwalde
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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21
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Abstract
Little is known about the use of breast MRI as a diagnostic or surveillance tool in patients after bilateral mastectomy. The objective of this study was to evaluate breast MRI after bilateral mastectomy. Participants consisted of 48 women with prior bilateral mastectomy who underwent breast MRI between 2003 and 2009. Seventy-nine breast MRIs were obtained. The median time between mastectomy and first MRI was 36 months. MRI was ordered most often by a medical oncologist (71%). Median age at bilateral mastectomy was 49 years (range, 33 to 72 years). Reasons for obtaining MRI included surveillance in 60 (76%), mass in eight (10%), lymph nodes in four (5%), pain in three (4%), and abscess in one (1%). Overall, 68 (86%) MRIs showed benign imaging findings only. Within the surveillance group, six patients had MRIs with findings that changed management; four patients had some residual breast tissue, and two patients had findings outside the breast that were better evaluated by CT or bone scan and were ultimately benign. MRI confirmed locoregional recurrence in two patients with highly suspicious physical findings. Overall, postmastectomy breast MRI had limited use, finding no unsuspected recurrences within our study group. Although MRI can be helpful to establish the presence of residual breast tissue after bilateral mastectomy, subsequent routine screening breast MRI should be questioned if no residual breast tissue is identified.
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Affiliation(s)
- Lindi H. Vanderwalde
- Saul and Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Catherine M. Dang
- Saul and Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert Tabrizi
- Saul and Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rola Saouaf
- Saul and Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H. Phillips
- Saul and Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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22
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Vanderwalde LH, Dang CM, Tabrizi R, Saouaf R, Phillips EH. Breast MRI after bilateral mastectomy: is it indicated? Am Surg 2011; 77:180-184. [PMID: 21337876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Little is known about the use of breast MRI as a diagnostic or surveillance tool in patients after bilateral mastectomy. The objective of this study was to evaluate breast MRI after bilateral mastectomy. Participants consisted of 48 women with prior bilateral mastectomy who underwent breast MRI between 2003 and 2009. Seventy-nine breast MRIs were obtained. The median time between mastectomy and first MRI was 36 months. MRI was ordered most often by a medical oncologist (71%). Median age at bilateral mastectomy was 49 years (range, 33 to 72 years). Reasons for obtaining MRI included surveillance in 60 (76%), mass in eight (10%), lymph nodes in four (5%), pain in three (4%), and abscess in one (1%). Overall, 68 (86%) MRIs showed benign imaging findings only. Within the surveillance group, six patients had MRIs with findings that changed management; four patients had some residual breast tissue, and two patients had findings outside the breast that were better evaluated by CT or bone scan and were ultimately benign. MRI confirmed locoregional recurrence in two patients with highly suspicious physical findings. Overall, postmastectomy breast MRI had limited use, finding no unsuspected recurrences within our study group. Although MRI can be helpful to establish the presence of residual breast tissue after bilateral mastectomy, subsequent routine screening breast MRI should be questioned if no residual breast tissue is identified.
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Affiliation(s)
- Lindi H Vanderwalde
- The Saul and Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
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23
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Basseri B, Conklin JL, Pimentel M, Tabrizi R, Phillips EH, Simsir SA, Chaux GE, Falk JA, Ghandehari S, Soukiasian HJ. Esophageal Motor Dysfunction and Gastroesophageal Reflux Are Prevalent in Lung Transplant Candidates. Ann Thorac Surg 2010; 90:1630-6. [DOI: 10.1016/j.athoracsur.2010.06.104] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 06/18/2010] [Accepted: 06/22/2010] [Indexed: 01/24/2023]
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24
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Dang CM, Zaghiyan K, Karlan SR, Phillips EH. Increased use of MRI for breast cancer surveillance and staging is not associated with increased rate of mastectomy. Am Surg 2009; 75:937-940. [PMID: 19886139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The use of MRI in preoperative staging of breast cancer has escalated recently. Breast MRI has greater sensitivity than mammography, ultrasound, and clinical examination in cancer detection. Because of its variable specificity, however, there has been concern that increased MRI use will result in increased rates of mastectomy for early-stage breast cancer. We postulated that mastectomy rates are not affected by trends in MRI use. We performed a retrospective analysis of imaging tests ordered by surgeons at our breast center from 2003 to 2007. We also reviewed all breast cancer cases reported to the National Cancer Database from our institution during the same time period and categorized them as having been treated with mastectomy or breast-conserving surgery. From 2003 to 2007, the number of breast MRIs ordered annually by surgeons increased from 68 to 358. The rate of MRI use increased from 4.1 per every 100 patients seen to 5.7 and from 1.6 per every 100 new patients seen to 2.9. The percentage of women undergoing mastectomy for breast cancer remained unchanged during this 5-year interval. Therefore, although MRI use in breast cancer staging and surveillance has increased, mastectomy rates have not.
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Affiliation(s)
- Catherine M Dang
- Saul & Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
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25
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Dang CM, Zaghiyan K, Karlan SR, Phillips EH. Increased Use of MRI for Breast Cancer Surveillance and Staging is Not Associated with Increased Rate of Mastectomy. Am Surg 2009. [DOI: 10.1177/000313480907501016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of MRI in preoperative staging of breast cancer has escalated recently. Breast MRI has greater sensitivity than mammography, ultrasound, and clinical examination in cancer detection. Because of its variable specificity, however, there has been concern that increased MRI use will result in increased rates of mastectomy for early-stage breast cancer. We postulated that mastectomy rates are not affected by trends in MRI use. We performed a retrospective analysis of imaging tests ordered by surgeons at our breast center from 2003 to 2007. We also reviewed all breast cancer cases reported to the National Cancer Database from our institution during the same time period and categorized them as having been treated with mastectomy or breast-conserving surgery. From 2003 to 2007, the number of breast MRIs ordered annually by surgeons increased from 68 to 358. The rate of MRI use increased from 4.1 per every 100 patients seen to 5.7 and from 1.6 per every 100 new patients seen to 2.9. The percentage of women undergoing mastectomy for breast cancer remained unchanged during this 5-year interval. Therefore, although MRI use in breast cancer staging and surveillance has increased, mastectomy rates have not.
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Affiliation(s)
- Catherine M. Dang
- From the Saul & Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Karen Zaghiyan
- From the Saul & Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Scott R. Karlan
- From the Saul & Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H. Phillips
- From the Saul & Joyce Brandman Breast Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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26
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Sanmiguel CP, Conklin JL, Cunneen SA, Barnett P, Phillips EH, Kipnes M, Pilcher J, Soffer EE. Gastric electrical stimulation with the TANTALUS System in obese type 2 diabetes patients: effect on weight and glycemic control. J Diabetes Sci Technol 2009; 3:964-70. [PMID: 20144347 PMCID: PMC2769967 DOI: 10.1177/193229680900300445] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The TANTALUS System is an investigational device that consists of an implantable pulse generator connected to gastric electrodes. The system is designed to automatically detect when eating starts and only then deliver sessions of gastric electrical stimulation (GES) with electrical pulses that are synchronized to the intrinsic antral slow waves. We report the effect of this type of GES on weight loss and glucose control in overweight/obese subjects with type 2 diabetes mellitus (T2DM). This study was conducted under a Food and Drug Administration/Institutional Review Board-approved investigational device exemption. METHOD Fourteen obese T2DM subjects on oral antidiabetes medication were enrolled and implanted laparoscopically with the TANTALUS System (body mass index 39 +/- 1 kg/m(2), hemoglobin A1c [HbA1c] 8.5 +/- 0.2%).Gastric electrical stimulation was initiated four weeks after implantation. Weight, HbA1c, fasting blood glucose, blood pressure, and lipid levels were assessed during the study period. RESULTS Eleven subjects reached the 6-month treatment period endpoint. Gastric electrical stimulation was well tolerated by all subjects. In those patients completing 6 months of therapy, HbA1c was reduced significantly from 8.5 +/- 0.7% to 7.6 +/- 1%, p < .01. Weight was also significantly reduced from 107.7 +/- 21.1 to 102.4 +/- 20.5 kg, p < .01. The improvement in glucose control did not correlate with weight loss (R(2) = 0.05, p = .44). A significant improvement was noted in blood pressure, triglycerides, and cholesterol (low-density lipoprotein only). CONCLUSIONS Short-term therapy with the TANTALUS System improves glucose control, induces weight loss, and improves blood pressure and lipids in obese T2DM subjects on oral antidiabetes therapy.
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Affiliation(s)
| | | | | | | | | | - Mark Kipnes
- Diabetes and Glandular Disease Research Associates Inc., San Antonio, Texas
| | - John Pilcher
- New Dimension Weight Loss Surgery, San Antonio, Texas
| | - Edy E. Soffer
- Cedars Sinai Medical Center, Los Angeles, California
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27
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Sanmiguel CP, Hagiike M, Mintchev MP, Cruz RD, Phillips EH, Cunneen SA, Conklin JL, Soffer EE. Effect of electrical stimulation of the LES on LES pressure in a canine model. Am J Physiol Gastrointest Liver Physiol 2008; 295:G389-94. [PMID: 18687754 DOI: 10.1152/ajpgi.90201.2008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gastric electrical stimulation modulates lower esophageal sphincter pressure (LESP). High-frequency neural stimulation (NES) can induce gut smooth muscle contractions. To determine whether lower esophageal sphincter (LES) electrical stimulation (ES) can affect LESP, bipolar electrodes were implanted in the LES of four dogs. Esophageal manometry during sham or ES was performed randomly on separate days. Four stimuli were used: 1) low-frequency: 350-ms pulses at 6 cycles/min; 2) high-frequency-1: 1-ms pulses at 50 Hz; 3) high-frequency-2: 1-ms pulses at 20 Hz; and 4) NES: 20-ms bipolar pulses at 50 Hz. Recordings were obtained postprandially. Tests consisted of three 20-min periods: baseline, stimulation/sham, and poststimulation. The effect of NES was tested under anesthesia and following IV administration of l-NAME and atropine. Area under the curve (AUC) and LESP were compared among the three periods, by ANOVA and t-test, P < 0.05. Data are shown as means +/- SD. We found that low-frequency stimulation caused a sustained increase in LESP: 32.1 +/- 12.9 (prestimulation) vs. 43.2 +/- 18.0 (stimulation) vs. 50.1 +/- 23.8 (poststimulation), P < 0.05. AUC significantly increased during and after stimulation. There were no significant changes with other types of ES. With NES, LESP initially rose and then decreased below baseline (LES relaxation). During NES, N(G)-nitro-l-arginine methyl ester increased both resting LESP and the initial rise in LESP and markedly diminished the relaxation. Atropine lowered resting LESP and abolished the initial rise in LESP. In conclusion, low frequency ES of the LES increases LESP in conscious dogs. NES has dual effect on LESP: an initial stimulation, cholinergically mediated, followed by relaxation mediated by nitric oxide.
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Affiliation(s)
- Claudia P Sanmiguel
- Center for Digestive Diseases, GI Motility Program, 8730 Alden Dr., Thalians Bldg., 2nd floor East, Los Angeles, CA 90048, USA
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28
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Phillips EH, Toouli J, Pitt HA, Soper NJ. Treatment of common bile duct stones discovered during cholecystectomy. J Gastrointest Surg 2008; 12:624-8. [PMID: 18176853 DOI: 10.1007/s11605-007-0452-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 11/28/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several techniques of laparoscopic bile duct exploration and intraoperative endoscopic sphincterotomy (ES) have been developed to treat patients with common bile duct (CBD) stones in one session and avoid the complications of ES. With all these options available, very few randomized controlled trials (RCTs) have been undertaken. This review analyzes those studies. METHODS We searched PubMed. Four RCTs and a Cochran Database Systematic Review were found. RESULTS Two RCTs compared preoperative ES and laparoscopic CBD exploration (E) for known CBD stones. Laparoscopic CBDE had shorter length of hospitalization. Two RCTs compared immediate and delayed treatment and found that length of stay was less with laparoscopic CBDE, but clearance rates and morbidity/mortality were similar. CONCLUSIONS Studies suggest that CBD stones discovered at the time of cholecystectomy are best treated during the same operation. The transcystic approach is safest if applicable. Individual surgeons must be aware of their own capabilities and those of the available endoscopists and perform the safest technique.
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Affiliation(s)
- Edward H Phillips
- Department of Surgery, Cedars-Sinai Medical Center, 8635 W. Third St., Suite 795W, Los Angeles, CA 90048, USA.
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29
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Sanmiguel CP, Haddad W, Aviv R, Cunneen SA, Phillips EH, Kapella W, Soffer EE. The TANTALUS system for obesity: effect on gastric emptying of solids and ghrelin plasma levels. Obes Surg 2008; 17:1503-9. [PMID: 18219779 DOI: 10.1007/s11695-008-9430-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gastric electrical stimulation (GES), using the implantable TANTALUS System, is being explored as a treatment for obesity. The system delivers nonstimulatory electrical signals synchronized with gastric slow waves, resulting in stronger contractions. We hypothesized that this GES may enhance gastric emptying and as a result affect plasma ghrelin and insulin homeostasis. The aim was to test the effect of GES on gastric emptying of solids and on ghrelin and insulin blood levels in obese subjects. METHODS The system consists of 3 pairs of gastric electrodes connected to an implantable pulse generator. Gastric emptying test (GE) of solids was performed twice, on separate days, a few weeks after implantation, before and after initiation of stimulation. Blood samples for ghrelin and insulin were taken at baseline and at 15, 30, 60 and 120 min after the test meal. RESULTS There were 11 females, 1 male, mean age 39.1 +/- 8.9 years, mean BMI 41.6 +/- 3.4. Data is available from 11 subjects; GE was normal in 9 subjects and accelerated in 2 subjects. GES significantly accelerated GE compared to control: percent retention at 2 hours 18.7 +/- 12.2 vs 31.9 +/- 16.4, respectively (P < 0.01). Overall, there was no significant change in ghrelin or insulin profile after food intake. Ghrelin levels fell significantly at 60 min compared to baseline during stimulation (P = 0.014) and control (P = 0.046). CONCLUSION GES results in a significant acceleration of gastric emptying of solids in obese subjects. GES did not have a significant effect on postprandial ghrelin levels when compared to control.
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Affiliation(s)
- Claudia P Sanmiguel
- GI Motility Program, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
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Hagiike M, Phillips EH, Berci G. Performance differences in laparoscopic surgical skills between true high-definition and three-chip CCD video systems. Surg Endosc 2007; 21:1849-54. [PMID: 17701251 DOI: 10.1007/s00464-007-9541-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 06/19/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laparoscopic surgery requires surgeons to rely on visual clues for discrimination among differing tissues and for depth of field on a two-dimensional screen. High definition (HD) provides a superior image. If there is a measurable advantage with HD television (TV), the increase in the cost of the technology would be justified. METHODS A digital three-chip CCD camera with a standard monitor (SD system) and a true HD camera (1,080 pixels) with a 16:9-ratio HD monitor (HD system) were compared in clinical and laboratory settings. Three experiments were performed: (1) subjective visual evaluation of the HD and SD systems during actual surgical cases, (2) subjective visual evaluation in a controlled laboratory surgical setting with simultaneous parallel recording, and (3) three laparoscopic surgical task evaluations in a laboratory setting, namely, task A (metric analysis of participants on the surgical simulator), task B (simple eye-hand coordination performance), and task C (knot tying). RESULTS All 53 participants subjectively evaluated HD as superior to SD in the laboratory setting and during actual surgery. In task B, there was no significant difference between SD and HD (dominant hand: p = 0.19; nondominant hand: p = 0.07). In task C, the knot-tying time was significantly less when performed with HD (mean, 173 +/- 84 s vs 214 +/- 107 s; p = 0.003). Most importantly, subjects with less skill (more documented time required in the basic module on a surgical simulator) improved significantly in the knot-tying task with the HD system (R = 0.631; p = 0.005). CONCLUSION All the participants preferred HD to SD. High definition significantly improved laparoscopic knot tying, which requires precise depth perception, proving that HD is more than just a pretty picture.
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Affiliation(s)
- M Hagiike
- Center for Minimally Invasive Surgery, Department of Surgery, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 795 W, Los Angeles, CA 90048, USA
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Chung A, Liou D, Karlan S, Waxman A, Fujimoto K, Hagiike M, Phillips EH. Preoperative FDG-PET for axillary metastases in patients with breast cancer. ACTA ACUST UNITED AC 2006; 141:783-8; discussion 788-9. [PMID: 16924086 DOI: 10.1001/archsurg.141.8.783] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS Fludeoxyglucose F 18 (FDG) positron emission tomography (PET) can be used to predict axillary node metastases. DESIGN Case series. SETTING Comprehensive breast care center. PATIENTS Fifty-one women with 54 biopsy-proven invasive breast cancers. INTERVENTION Whole-body FDG-PET performed before axillary surgery and interpreted blindly. MAIN OUTCOME MEASURES Axillary FDG activity, quantified by standardized uptake value (SUV); axillary metastases, quantified histologically; and tumor characteristics. RESULTS There was PET activity in 32 axillae (59%). The SUVs ranged from 0.7 to 11.0. Twenty tumors had an SUV of 2.3 or greater, and 34 had an SUV of less than 2.3. There were no significant differences between these 2 groups except in axillary metastasis size (SUV </=2.2 vs SUV >/=2.3): mean age, 53 vs 58 years (P = .90); mean modified Bloom-Richardson score, 7.7 vs 7.6 (P = .20); lymphovascular invasion present, 25% vs 36% (P = .40); mean Ki-67 level, 25% vs 32% (P = .20); mean tumor size, 2.9 vs 3.2 cm (P = .05); and axillary metastasis size, 0.9 vs 1.7 (P = .001). By adopting an SUV threshold of 2.3, FDG-PET had a sensitivity of 60%, a specificity of 100%, and a positive predictive value of 100%. CONCLUSIONS Patients with an SUV greater than 2.3 had axillary metastases. This finding obviates the need for sentinel lymph node biopsy or needle biopsy to diagnose axillary involvement. Surgeons can proceed to axillary node dissection to assess the number of nodes involved, eliminate axillary disease, or perhaps provide a survival benefit if preoperative FDG-PET has an SUV greater than 2.3.
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MESH Headings
- Axilla
- Biopsy, Fine-Needle
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/surgery
- Female
- Fluorodeoxyglucose F18
- Follow-Up Studies
- Humans
- Lymphatic Metastasis
- Mastectomy
- Middle Aged
- Positron-Emission Tomography/methods
- Preoperative Care/methods
- Prognosis
- ROC Curve
- Radiopharmaceuticals
- Retrospective Studies
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Affiliation(s)
- Alice Chung
- Saul and Joyce Brandman Breast Center, Cedars-Sinai Medical Center, Los Angeles, Calif, USA
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Abstract
The modern era of common bile duct (CBD) surgery started with Mirizzi, who introduced intraoperative cholangiography in 1932. Intraoperative choledoscopy had been developed as an adjunctive to intraoperative cholangiography, which helped to detect CBD stones in an additional 10% to 15% of instances that otherwise would have been missed. Findings have shown choledochoscopy to be an important technique for efficient and effective management of CBD stones. Efforts to treat patients with common duct stones in one session and to avoid the potential complications of endoscopic sphincterotomy resulted in several laparoscopic transcystic CBD (LTCBDE) techniques. The techniques of transcystic stone extraction include lavage, trolling with wire baskets or biliary balloon catheters, cystic duct dilation, biliary endoscopy, and stone retrieval with wire baskets under direct vision and antegrade sphincterotomy, lithotripsy, and catheter techniques. The indications for LTCBDE are filling or equivocal defects at cholangiography, stones smaller than 10 mm, fewer than 9 stones, and possible tumor. The contraindications are stones larger than 1 cm, stones proximal to the cystic duct entrance into the CBD, small friable cystic duct, and 10 or more stones. Experience with LTCBDE shows that the approach is applicable in more than 85% of cases, with a success rate of 85% to 95%. It also is shown to be more cost effective than postoperative endoscopic retrograde cholangiopancreatography. Recent developments in LTCBDE have focused mainly on implementation of robotically assisted surgery and new imaging methods such as magnetic resonance cholangiopancreatography with three-dimensional virtual cholangioscopy and three-dimensional ultrasound. Further technological advances will facilitate the application of laparoscopic approaches to the common duct, which should become the primary strategy for the great majority of patients.
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Affiliation(s)
- S Lyass
- Cedars Sinai Medical Center, Center for Minimally Invasive Surgery, Los Angeles, CA, USA
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Lyass S, Cunneen SA, Hagiike M, Misra M, Burch M, Khalili TM, Furman G, Phillips EH. Device-Related Reoperations after Laparoscopic Adjustable Gastric Banding. Am Surg 2005. [DOI: 10.1177/000313480507100909] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laparoscopic adjustable gastric banding (LAGB) is considered a relatively safe weight loss procedure with low morbidity. When complications occur, obstruction, erosion, and port malfunction require reoperation. We retrospectively reviewed our experience with 270 consecutive patients who underwent LAGB. Device-related reoperations were performed in 26 (10%) patients. Reoperations were related to the band in 13, to port/tubing in 11, and related to both in 2 patients. Of the 15 band-related problems, it was removed in 5 (2%): slippage (3), intra-abdominal abscess (1), and during emergent operation for bleeding duodenal ulcer (1). Revision or immediate replacement was performed in 10 (4%): slippage (5), obstruction (4), and leak from the reservoir (1). Port/tubing problems were the reason for reoperations in 13 (5%): infection (5), crack at tubing-port connection (6), and port rotation (2). Port removal for infection was followed later by port replacement (average 9 months). Overall, slippage occurred in 8 (3%), obstruction in 4 (1.5%), leak from reservoir in 7 (3%), and infection in 5 (2%) patients. Fifteen device-related problems occurred during our first 100 cases and 12 subsequently ( P = 0.057). Permanent LapBand loss was only 5 per cent, leading to overall rate of 95 per cent of LapBand preservation as a restrictive device.
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Affiliation(s)
- Sergey Lyass
- From the Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Monali Misra
- From the Cedars-Sinai Medical Center, Los Angeles, California
| | - Miguel Burch
- From the Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Gary Furman
- From the Cedars-Sinai Medical Center, Los Angeles, California
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Lyass S, Cunneen SA, Hagiike M, Misra M, Burch M, Khalili TM, Furman G, Phillips EH. Device-related reoperations after laparoscopic adjustable gastric banding. Am Surg 2005; 71:738-43. [PMID: 16468509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Laparoscopic adjustable gastric banding (LAGB) is considered a relatively safe weight loss procedure with low morbidity. When complications occur, obstruction, erosion, and port malfunction require reoperation. We retrospectively reviewed our experience with 270 consecutive patients who underwent LAGB. Device-related reoperations were performed in 26 (10%) patients. Reoperations were related to the band in 13, to port/tubing in 11, and related to both in 2 patients. Of the 15 band-related problems, it was removed in 5 (2%): slippage (3), intra-abdominal abscess (1), and during emergent operation for bleeding duodenal ulcer (1). Revision or immediate replacement was performed in 10 (4%): slippage (5), obstruction (4), and leak from the reservoir (1). Port/tubing problems were the reason for reoperations in 13 (5%): infection (5), crack at tubing-port connection (6), and port rotation (2). Port removal for infection was followed later by port replacement (average 9 months). Overall, slippage occurred in 8 (3%), obstruction in 4 (1.5%), leak from reservoir in 7 (3%), and infection in 5 (2%) patients. Fifteen device-related problems occurred during our first 100 cases and 12 subsequently (P = 0.057). Permanent LapBand loss was only 5 per cent, leading to overall rate of 95 per cent of LapBand preservation as a restrictive device.
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Affiliation(s)
- Sergey Lyass
- Dept. Surgery, Cedars Sinai Medical Center, 8700 Beverly Blvd., Suite 8215, Los Angeles, CA 90048, USA
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Abstract
UNLABELLED Since the advent of laparoscopy and its general acceptance for treating benign diseases, indications for malignant disease have been investigated. Recently, greater evidence shows that laparoscopy for malignant disease is oncologically safe. DESIGN We review a minimally invasive approach to splenic malignancy and the common malignant diseases involving the spleen. We outline our preferred technique for splenectomy in detail. Additionally, the recent literature is reviewed regarding outcome after laparoscopic splenectomy for benign and malignant disease. The data from three studies, containing a total of 327 were analyzed. Complication rates, mortality, and length of stay were compared. RESULTS There was no statistically significant difference identified between those undergoing laparoscopic splenectomy for benign versus malignant disease in terms of length of stay, complication rate or mortality. There were significant differences between the two groups in terms of operative time and spleen weight. DISCUSSION In open splenectomy series for patients with malignant diseases of the spleen, complication and mortality are much higher when compared to those patients undergoing open splenectomy for benign disease. The discussed series show no difference in endpoints when laparoscopy is used. Laparoscopic splenectomy for malignant disease confers significant benefit and rapid recovery for an otherwise at risk population.
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Affiliation(s)
- Miguel Burch
- Department of Minimally Invasive Surgery, Cedars Sinai Medical Center, Los Angeles, California 90048, USA
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Lublin M, Lyass S, Lahmann B, Cunneen SA, Khalili TM, Elashoff JD, Phillips EH. Leveling the learning curve for laparoscopic bariatric surgery. Surg Endosc 2005; 19:845-8. [PMID: 15868262 DOI: 10.1007/s00464-004-8201-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 02/01/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND The learning curve for laparoscopic bariatric surgery is associated with increased morbidity and mortality. METHODS The study included the first 100 patients undergoing laparoscopic Roux-en-Y gastric bypass (LGB) by a designated surgical team. Surgeon A operated as primary surgeon, with surgeon B assisting (Stage 1). Surgeon B learned LGB in stages: exposure and jejunojejunostomy (stage 2), gastric pouch (stage 3), gastrojejunostomy (stage 4), and sequence all steps (stage 5). RESULTS Surgeon A achieved confidence with LGB after 20 cases and surgeon B after 25 cases (stage 2), 18 cases (stage 3), 21 cases (stage 4), and 16 cases (stage 5). Complications (8%) included small bowel obstruction (three); pulmonary embolus (two), and leak, stomal stenosis, and gastrogastric fistula (one each). There was a decreasing trend for operative duration, length of stay, and complications across the five stages (p < 0.05). CONCLUSIONS By transferring skills in stages, a laparoscopic bariatric program can be established with minimal morbidity and mortality.
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Affiliation(s)
- M Lublin
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Lyass S, Burch M, Misra M, Hagiike M, Cunneen SA, Furman G, Phillips EH, Khalili TM. Linear stapler technique for creation of the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass results in minimal rate of anastomotic stricture. Surg Obes Relat Dis 2005. [DOI: 10.1016/j.soard.2005.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khosravi MR, Margulies DR, Alsabeh R, Nissen N, Phillips EH, Morgenstern L. Consider the diagnosis of splenosis for soft tissue masses long after any splenic injury. Am Surg 2004; 70:967-70. [PMID: 15586507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Splenosis represents the autotransplantation of splenic tissue after splenic trauma or surgery. Disruption of the splenic capsule causes fragments of splenic tissue to be seeded mainly throughout the peritoneal cavity, where they are characterized by diffusely scattered bluish implants. Extraperitoneal locations are very rare and mainly include the thoracic cavity after thoracoabdominal trauma with simultaneous splenic rupture and diaphragmatic laceration. We retrospectively identified all patients in the pathology registry with the diagnosis of splenosis between December 1974 and July 2003 at our urban teaching hospital. Data collected included presenting signs and symptoms, history, imaging studies, treatment, pathology, and outcome. Five cases of splenosis were identified and described. Location of the splenosis was intraperitoneal in two and intrahepatic, intrathoracic, and subcutaneous in one each. In these cases, there was an average interval of 29 years between splenic injury and diagnosis, and most were found incidentally. One of the cases was managed entirely laparoscopically and another thoracoscopically.
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Affiliation(s)
- M R Khosravi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Lublin M, Crawford DL, Hiatt JR, Phillips EH. Symptoms before and after Laparoscopic Cholecystectomy for Gallstones. Am Surg 2004. [DOI: 10.1177/000313480407001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Between 1989 and 1995, 1380 patients underwent laparoscopic cholecystectomy for symptomatic cholelithiasis by a single surgical group at a large private teaching hospital. Thirteen hundred surveys were mailed, and 573 (44.3%) were completed at least 6 months postoperatively. Pain and nonpain symptoms were present preoperatively in 432 (75%) and 457 (80%) patients, respectively. Postoperatively, pain and nonpain symptoms were present in 141 (25%) and 247 (43%) patients, respectively ( P < 0.05). All nonpain symptoms were significantly reduced postoperatively except for diarrhea ( P < 0.05). Longer duration of pain, age < 40, frequent episodes of pain, postprandial pain, and increased sites of pain preoperatively were all predictive of a higher incidence of persistent postoperative pain ( P < 0.05). Persistent nonpain symptoms were more likely if diarrhea, fatty food intolerance, age < 40, or both pain and nonpain symptoms were present preoperatively ( P = 0.05) and less likely if only pain symptoms were present preoperatively ( P = 0.0001). This series quantifies symptom-specific outcomes for the surgeon. While most symptoms improve, a significant number of pain and nonpain symptoms persist after laparoscopic cholecystectomy. With these data, surgeons can modulate postoperative expectations and advise on the possible persistence of symptoms.
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Affiliation(s)
- Matthew Lublin
- From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - David L. Crawford
- From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jonathan R. Hiatt
- From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H. Phillips
- From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Lublin M, Crawford DL, Hiatt JR, Phillips EH. Symptoms before and after laparoscopic cholecystectomy for gallstones. Am Surg 2004; 70:863-6. [PMID: 15529838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Between 1989 and 1995, 1380 patients underwent laparoscopic cholecystectomy for symptomatic cholelithiasis by a single surgical group at a large private teaching hospital. Thirteen hundred surveys were mailed, and 573 (44.3%) were completed at least 6 months postoperatively. Pain and nonpain symptoms were present preoperatively in 432 (75%) and 457 (80%) patients, respectively. Postoperatively, pain and nonpain symptoms were present in 141 (25%) and 247 (43%) patients, respectively (P < 0.05). All nonpain symptoms were significantly reduced postoperatively except for diarrhea (P < 0.05). Longer duration of pain, age < 40, frequent episodes of pain, postprandial pain, and increased sites of pain preoperatively were all predictive of a higher incidence of persistent postoperative pain (P < 0.05). Persistent nonpain symptoms were more likely if diarrhea, fatty food intolerance, age < 40, or both pain and nonpain symptoms were present preoperatively (P = 0.05) and less likely if only pain symptoms were present preoperatively (P = 0.0001). This series quantifies symptom-specific outcomes for the surgeon. While most symptoms improve, a significant number of pain and nonpain symptoms persist after laparoscopic cholecystectomy. With these data, surgeons can modulate postoperative expectations and advise on the possible persistence of symptoms.
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Affiliation(s)
- Matthew Lublin
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Lyass S, Khalili TM, Cunneen S, Fujita F, Otsuka K, Chopra R, Lahmann B, Lublin M, Furman G, Phillips EH. Radiological Studies after Laparoscopic Roux-en-Y Gastric Bypass: Routine or Selective? Am Surg 2004. [DOI: 10.1177/000313480407001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Early detection of complications after laparoscopic Roux-en-Y gastric bypass (LRYGB) can be difficult because of the subtle clinical findings in obese patients. Consequently, routine postoperative upper gastrointestinal contrast studies (UGI) have been advocated for detection of leak from the gastrojejunostomy. The medical records of 368 consecutive patients undergoing LRYGB were analyzed to determine the efficacy of selective use of radiological studies after LRYGB. Forty-one patients (11%) developed signs suggestive of complications. Of the 41 symptomatic patients, two were explored urgently, 39 (10%) had radiological studies, and 16 of them (41%) were diagnosed with postoperative complications. Overall morbidity of the series was 4.8 per cent. Four patients (1.1%) developed a leak from the gastrojejunostomy and were correctly diagnosed by computerized tomography (CT). The sensitivity and specificity of CT in determining leak was 100 per cent, with positive and negative predictive value of 100 per cent. The mortality of the series was 0 per cent. No radiologic studies were performed in asymptomatic patients, and no complications developed in these patients. Our results show that selective radiological evaluation in patients with suspected complications after LRYGB is safe. High sensitivity makes CT the test of choice in patients with suspected complication after LRYGB. Routine radiological studies are not warranted.
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Affiliation(s)
- Sergey Lyass
- From the Center for Minimally Invasive Bariatric Surgery, Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Theodore M. Khalili
- From the Center for Minimally Invasive Bariatric Surgery, Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Scott Cunneen
- From the Center for Minimally Invasive Bariatric Surgery, Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Fumihiko Fujita
- From the Center for Minimally Invasive Bariatric Surgery, Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Koji Otsuka
- From the Center for Minimally Invasive Bariatric Surgery, Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ritu Chopra
- From the Center for Minimally Invasive Bariatric Surgery, Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brian Lahmann
- From the Center for Minimally Invasive Bariatric Surgery, Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Matthew Lublin
- From the Center for Minimally Invasive Bariatric Surgery, Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gary Furman
- From the Center for Minimally Invasive Bariatric Surgery, Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H. Phillips
- From the Center for Minimally Invasive Bariatric Surgery, Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Lyass S, Khalili TM, Cunneen S, Fujita F, Otsuka K, Chopra R, Lahmann B, Lublin M, Furman G, Phillips EH. Radiological studies after laparoscopic Roux-en-Y gastric bypass: routine or selective? Am Surg 2004; 70:918-21. [PMID: 15529851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Early detection of complications after laparoscopic Roux-en-Y gastric bypass (LRYGB) can be difficult because of the subtle clinical findings in obese patients. Consequently, routine postoperative upper gastrointestinal contrast studies (UGI) have been advocated for detection of leak from the gastrojejunostomy. The medical records of 368 consecutive patients undergoing LRYGB were analyzed to determine the efficacy of selective use of radiological studies after LRYGB. Forty-one patients (11%) developed signs suggestive of complications. Of the 41 symptomatic patients, two were explored urgently, 39 (10%) had radiological studies, and 16 of them (41%) were diagnosed with postoperative complications. Overall morbidity of the series was 4.8 per cent. Four patients (1.1%) developed a leak from the gastrojejunostomy and were correctly diagnosed by computerized tomography (CT). The sensitivity and specificity of CT in determining leak was 100 per cent, with positive and negative predictive value of 100 per cent. The mortality of the series was 0 per cent. No radiologic studies were performed in asymptomatic patients, and no complications developed in these patients. Our results show that selective radiological evaluation in patients with suspected complications after LRYGB is safe. High sensitivity makes CT the test of choice in patients with suspected complication after LRYGB. Routine radiological studies are not warranted.
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Affiliation(s)
- Sergey Lyass
- Center for Minimally Invasive Bariatric Surgery, Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Fujita F, Lahmann B, Otsuka K, Lyass S, Hiatt JR, Phillips EH. Quantification of Pain and Satisfaction Following Laparoscopic and Open Hernia Repair. ACTA ACUST UNITED AC 2004; 139:596-600; discussion 600-2. [PMID: 15197084 DOI: 10.1001/archsurg.139.6.596] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS Subjective experiences can be quantified by visual analog scale (VAS) scoring to improve comparison of surgical techniques. DESIGN Prospective collection of outcome data by interview of patients at 1 day and 1 week following nonrandomized elective hernia repair by a single surgical group between May 1998 and April 2003. SETTING Cedars-Sinai Medical Center, Los Angeles, Calif. PATIENTS A total of 253 patients (239 men; mean age, 59 years) underwent repair by laparoscopic (n = 110, 105 bilateral, 92 total extraperitoneal, and 18 transabdominal preperitoneal) or tension-free open (n = 143, 133 unilateral) approach. Laparoscopic patients were significantly younger (52.0 vs 63.8 years, P<.001). MAIN OUTCOME MEASURES Subjective measures included VAS scores (1-10, 1 indicates best) for pain at 1 day and 1 week postoperatively and overall satisfaction at 1 week. Objective measures included quantity and days of analgesic use and days before return to regular activities, including work and driving. Results were also compared by patient age (Spearman analysis). RESULTS Satisfaction was high for both procedures; the laparoscopic procedure was superior only for return to work and driving. Spearman analysis showed a significant inverse relation between age and first-day pain (r= -0.15, P=.01), independent of operative approach. Because laparoscopic patients were younger, patients younger than 65 years were analyzed separately; laparoscopic patients had significantly less first-day pain (5.44 vs 6.30, P=.02). CONCLUSIONS Pain following hernia repair was age dependent. Following laparoscopic repair, patients had lower first-day pain scores in younger patients and earlier return to normal activities in all patients. Satisfaction was similar for both approaches. Subjective experiences can be quantified, compared to detect subtle differences in outcome for competing surgical techniques, and used to counsel patients before operation, with the goal of improving satisfaction.
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Affiliation(s)
- Fumihiko Fujita
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif, USA
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Fujita F, Lyass S, Otsuka K, Giordano L, Rosenbaum DL, Khalili TM, Phillips EH. Portal vein thrombosis following splenectomy: identification of risk factors. Am Surg 2003; 69:951-6. [PMID: 14627254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Portal vein thrombosis (PVT) following splenectomy is a potentially life-threatening complication, and the true incidence of PVT in splenectomized patients is unknown. The objective of this study was to determine the incidence of symptomatic PVT after splenectomy. The hospital database was searched to identify cases of PVT associated with splenectomy from January 1990 to May 2002. Six hundred eighty-eight patients underwent splenectomy during this period, 321 of them for hematologic diseases. Eleven of the 688 patients had PVT associated with splenectomy, and the charts of these patients were reviewed. Six patients developed PVT after splenectomy. Five had hematologic diseases. Symptoms were abdominal pain (6), ileus (5), fever (3), or diarrhea (2). Diagnosis was confirmed by computed tomography (CT) (4), duplex ultrasonography (1), and magnetic resonance imaging (1). The indications for splenectomy included hemolytic anemia (3), thalassemia (1), and myelofibrosis (1). One patient had an incidental splenectomy during gastrectomy. There were four laparoscopic and two open splenectomies. The median interval between splenectomy and diagnosis of PVT was 40 days (range, 13-741). One patient died of pulmonary embolism. Five of six patients with postsplenectomy PVT had splenomegaly and hemolysis. We conclude that the risk of PVT is higher in patients with hematologic conditions associated with splenomegaly and hemolysis.
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Affiliation(s)
- Fumihiko Fujita
- Center for Minimally Invasive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Fujita F, Lyass S, Otsuka K, Giordano L, Rosenbaum DL, Khalili TM, Phillips EH. Portal Vein Thrombosis following Splenectomy: Identification of Risk Factors. Am Surg 2003. [DOI: 10.1177/000313480306901107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Portal vein thrombosis (PVT) following splenectomy is a potentially life-threatening complication, and the true incidence of PVT in splenectomized patients is unknown. The objective of this study was to determine the incidence of symptomatic PVT after splenectomy. The hospital database was searched to identify cases of PVT associated with splenectomy from January 1990 to May 2002. Six hundred eighty-eight patients underwent splenectomy during this period, 321 of them for hematologic diseases. Eleven of the 688 patients had PVT associated with splenectomy, and the charts of these patients were reviewed. Six patients developed PVT after splenectomy. Five had hematologic diseases. Symptoms were abdominal pain (6), ileus (5), fever (3), or diarrhea (2). Diagnosis was confirmed by computed tomography (CT) (4), duplex ultrasonography (1), and magnetic resonance imaging (1). The indications for splenectomy included hemolytic anemia (3), thalassemia (1), and myelofibrosis (1). One patient had an incidental splenectomy during gastrectomy. There were four laparoscopic and two open splenectomies. The median interval between splenectomy and diagnosis of PVT was 40 days (range, 13–741). One patient died of pulmonary embolism. Five of six patients with postsplenectomy PVT had splenomegaly and hemolysis. We conclude that the risk of PVT is higher in patients with hematologic conditions associated with splenomegaly and hemolysis.
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Affiliation(s)
- Fumihiko Fujita
- From the Center for Minimally Invasive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sergey Lyass
- From the Center for Minimally Invasive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Koji Otsuka
- From the Center for Minimally Invasive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Luca Giordano
- From the Center for Minimally Invasive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - David L. Rosenbaum
- From the Center for Minimally Invasive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Theodore M. Khalili
- From the Center for Minimally Invasive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H. Phillips
- From the Center for Minimally Invasive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Abstract
BACKGROUND Adult-congenital diaphragmatic hernias and chronic traumatic diaphragmatic hernias are uncommon entities that are often technically challenging to repair. There is growing experience with a minimal access approach to these defects. METHODS We reviewed the English-language literature using a MEDLINE search for "diaphragmatic hernia" and "laparoscopy." RESULTS We found 19 case reports of laparoscopic adult-congenital diaphragmatic hernia repair. Reported complications included two enterotomies, one of which required conversion to laparotomy. We also found 11 case reports of laparoscopic chronic traumatic diaphragmatic hernia repair, with no reported complications or recurrences. Average operative time was 98 min, and average length of stay was 4.5 days. All reports claimed that there was less postoperative pain and an earlier return to full activity with the laparoscopic approach. Herein we discuss anatomy, pathophysiology, diagnosis, method of repair, and recurrence. CONCLUSION Adult-congenital diaphragmatic hernia and chronic traumatic diaphragmatic hernia are amenable to laparoscopic repair. Although experience is still limited, laparoscopic repair appears safe and is associated with a shorter hospital stay.
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Affiliation(s)
- D S Thoman
- Division of Minimally Invasive Surgery, Cedars-Sinai Medical Centre, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
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Abstract
Ventral abdominal wall hernias are a common problem for the general surgeon. Historically, the best results have been obtained with the open Rives-Stoppa approach. This is done by fixing a large piece of prosthetic mesh behind the rectus muscle. Extensive dissection is required and can lead to postoperative pain and wound complications. A laparoscopic approach allows similar mesh placement with minimal dissection. Several small comparative studies have found laparoscopic ventral hernia repair to have fewer complications, a shorter length of stay, and possibly a lower recurrence rate when compared to open mesh repair. Large prospective studies have now confirmed these findings, with recurrence rates below 4%. This is significantly lower than the best reported rates of open mesh repair. Additionally, the morbidity appears to be significantly less. This technique is easily mastered by anyone with basic laparoscopic skills and is briefly presented.
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Affiliation(s)
- D S Thoman
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
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Abstract
In addition to heartburn and regurgitation, cough is a frequent nonspecific complaint of patients with gastroesophageal reflux disease. The incidence of alternative etiologies for patients with chronic cough who are undergoing antireflux surgery is not known. To determine this, and the response of chronic cough to fundoplication, we performed a retrospective review of 129 patients with proven gastroesophageal reflux referred for surgical therapy. Chronic cough was present in 37 (29%) preoperatively. No differences were found in age, sex, or preoperative manometric findings between those with and without chronic cough. Patients with cough had a higher number of lower esophageal reflux events on preoperative 24-hour pH testing, and were more likely to have persistent dysphagia after surgery. Fifty-nine percent of patients with cough had an alternative etiology for cough, compared to 36% of those without cough. Of the common alternative etiologies, only a history of postnasal drip occurred more frequently in those with cough. Complete resolution of cough occurred in 24 patients (64%), with another 10 (27%) reporting significant improvement. The average cough score improved significantly regardless of which coexisting etiology the patients may have had. Additionally, heartburn and regurgitation were improved in 94% of all patients.
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Affiliation(s)
- David S Thoman
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Affiliation(s)
- Mark A Liberman
- Department of General Surgery, Cleveland Clinic Florida, Naples 34119, USA
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