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Ganam S, Englander K, Paturu T, Sujka J, Velanovich V. Does fixation of the Enterra device to the abdominal fascia cause device flipping inside the pocket? J Gastrointest Surg 2024:S1091-255X(24)00415-3. [PMID: 38641162 DOI: 10.1016/j.gassur.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Samer Ganam
- Morsani College of Medicine, University of South Florida, Tampa, Florida; Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, Florida.
| | | | - Tejasvi Paturu
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Joseph Sujka
- Morsani College of Medicine, University of South Florida, Tampa, Florida; Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, Florida
| | - Vic Velanovich
- Morsani College of Medicine, University of South Florida, Tampa, Florida; Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, Florida
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Sher T, Noom M, Ganam S, Sujka J, Rinde-Hoffman D, DuCoin C. Temporary Mechanical Circulatory Support During Bariatric Surgery: A Novel Bridge to Durable Left Ventricular Assist Device and Cardiac Transplantation. Am Surg 2024:31348241244637. [PMID: 38578069 DOI: 10.1177/00031348241244637] [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] [Indexed: 04/06/2024]
Abstract
Advanced heart failure (HF) with comorbid severe obesity presents a unique surgical dilemma: bariatric surgery may help patients meet cardiac transplantation body mass index (BMI) criteria, but poor cardiac function puts them at increased intraoperative risk. Per International Society for Heart and Lung Transplantation (ISHLT) guidelines BMI > 35 is a contraindication for orthotopic heart transplantation. Temporary mechanical circulatory support (MCS) with Impella 5.5 during bariatric surgery, as presented in this report, may help solve this dilemma for some patients. We present three patients with severe obesity and advanced heart failure (HF) who underwent successful bariatric surgery while supported by Impella 5.5 (Abiomed, Inc., Danvers, MA).
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Affiliation(s)
- Theo Sher
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Madison Noom
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Samer Ganam
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Joseph Sujka
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Debbie Rinde-Hoffman
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Heart Failure Center of Excellence, Heart and Vascular Institute, Tampa General Medical Group/University of South Florida, Tampa, FL, USA
| | - Christopher DuCoin
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Surgery, University of South Florida, Tampa, FL, USA
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Englander K, Ganam S, Paturu T, Sujka J, Velanovich V. Reoperation after gastric neurostimulation device placement: A descriptive study. J Gastrointest Surg 2024:S1091-255X(24)00393-7. [PMID: 38574962 DOI: 10.1016/j.gassur.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/19/2024] [Accepted: 03/30/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Katherine Englander
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Samer Ganam
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Tejasvi Paturu
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Joseph Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Vic Velanovich
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States.
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Calzon ME, Koussayer B, Sujka J. How I do it: robotic hiatal hernia repair with stapled conversion from Nissen to Toupet fundoplication. Updates Surg 2024; 76:719-722. [PMID: 38070073 DOI: 10.1007/s13304-023-01712-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/18/2023] [Indexed: 04/05/2024]
Abstract
The purpose of this paper is to describe a robotic surgical technique for converting a slipped Nissen fundoplication to a Toupet fundoplication. Our technique utilizes four 8 mm robotic ports placed in a horizontal pattern above the umbilicus. The robotic tools we used are a vessel sealer, bipolar forceps, and Cadière forceps. In addition, an esophagogastroduodenoscopy (EGD) is placed through the esophagus into the stomach to be used as a bougie. If a hernia is present, we dissect it from the mediastinum until the posterior confluence is identified. Next sutures from the previous Nissen fundoplication are identified and removed to mobilize the crus. All adhesions around the stomach are removed to mobilize the esophagus, ensuing 3 cm of intraabdominal esophagus is available. Using an EGD as a bougie, we used two interrupted, 0 silk suture over Teflon pledgets placed in a horizontal mattress fashion to close the hiatal defect. Using an endoscope, we identified the previous Nissen fundoplication and used a 60 mm blue load stapler to transect the wrap from the stomach. The 360° Nissen fundoplication had now been converted into a 270° Toupet fundoplication, which is confirmed with the EGD. The functionality of the wrap is confirmed if the "Stack of Coins" sign is present, and the wrap lies tight against the scope. A Nissen-to-Toupet fundoplication conversion using a robotic-assisted surgical technique may be useful in reducing reoperations and complications in patients undergoing fundoplication surgery.
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Affiliation(s)
- Maysen E Calzon
- USF Health Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA.
| | - Bilal Koussayer
- USF Health Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Joseph Sujka
- USF Department of General Surgery 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
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Englander K, Cox K, Smith T, Diab A, Ganam S, Sujka J, DuCoin C. The Financial Implications of a Single-Use Device Reprocessing Program at a Tertiary Referral Center Surgical Department. Am Surg 2024:31348241241679. [PMID: 38561960 DOI: 10.1177/00031348241241679] [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] [Indexed: 04/04/2024]
Abstract
The operating room has been identified as one of the primary contributors to waste and energy expenditure in the health care system. The primary objective of our study was to evaluate the efficacy of single-use device reprocessing and report the cost savings, waste diversion, and reduction in carbon emissions. Data was collected from January 2021 to April 2023. Medline collected the data for analysis and converted it from an Excel file format to SPSS (Version 27) for analysis. Descriptive frequencies were used for data analysis. We found a mean monthly cost savings of $16,051.68 and a mean 700.68 pounds of waste a month diverted, resulting in an estimated yearly saving of $2354.29 in disposal costs and a reduction of 1112.65 CO2e emissions per month. This program has made significant contributions to cost savings and environmental efforts.
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Affiliation(s)
| | - Kaitlyn Cox
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Teagen Smith
- Department of Biostatistics, University of South Florida, Tampa, FL, USA
| | - Adbul Diab
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Samer Ganam
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Joseph Sujka
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Christopher DuCoin
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Ahmed A, Gandhi S, Ganam S, Diab ARF, Mhaskar R, Sujka J, DuCoin C, Docimo S. Ventral hernia repair using bioresorbable poly-4-hydroxybutyrate mesh in clean and contaminated surgical fields: a systematic review and meta-analysis. Hernia 2024; 28:575-584. [PMID: 38345668 DOI: 10.1007/s10029-023-02951-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/16/2023] [Indexed: 04/06/2024]
Abstract
PURPOSE Use of biologic or synthetic mesh in hernia repair shifts is based on evolving evidence. Poly-4-hydroxybutyrate (P4HB) biosynthetic mesh is a potential alternative to biologic and synthetic mesh in ventral hernia repair (VHR). This meta-analysis assesses the efficacy of P4HB mesh in clean and contaminated surgical settings. METHODS Two authors searched literature on PubMed, reviewing titles and abstracts of all articles to determine inclusion eligibility. Post-operative data were compared via transformation method to convert the proportion of patients with the outcome of interest into a suitable quantity for random-effects synthesis using STATA software. RESULTS Initial search yielded 287 citations. Six studies were included and categorized on whether hernia repairs were conducted in clean (CDC class I) or contaminated cases (CDC class II-IV). The pooled proportion of surgical site infection (SSI), surgical site occurrence (SSO), hernia recurrence, total surgical complications, and reoperation were calculated in 391 clean and 81 contaminated cases. For clean vs. contaminated cases, the following pooled proportions were noted: SSI (2% (CI 0-7%) vs 9% (CI 0-025) (p = 0.03), SSO: 14% (CI 5-25%) vs 35% (CI 22-50%) (p = 0.006), hernia recurrence (8% (CI 1-19%) vs 4% (CI 0-12%) (p = 0.769); surgical complications (17% (CI 6-32%) vs 50% (CI 27-72%) (p = 0.009). Reoperation data were available in 298 clean cases across four studies: 5% (CI 0-15%). CONCLUSIONS P4HB biosynthetic mesh may be more effective than previously thought, particularly in clean wounds. P4HB may also be superior to biologic mesh when compared to clinical trial data. Further research is necessary for more direct comparison.
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Affiliation(s)
- A Ahmed
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - S Gandhi
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - S Ganam
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - A-R F Diab
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - R Mhaskar
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - J Sujka
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - C DuCoin
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - S Docimo
- University of South Florida Morsani College of Medicine, Tampa, FL, USA.
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA.
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Sher T, McGee M, DuCoin C, Sujka J, Docimo S. Adjuvant and Neo-Adjuvant Anti-Obesity Medications and Bariatric Surgery: A Scoping Review. Curr Obes Rep 2024:10.1007/s13679-024-00558-z. [PMID: 38507194 DOI: 10.1007/s13679-024-00558-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE OF REVIEW To comprehensively summarize the current body of literature on the topic of adjuvant and neoadjuvant pharmacotherapy used in combination with bariatric surgery. RECENT FINDINGS Anti-obesity medications (AOMs) have been used since the mid-1900s; however, their use in combination with bariatric surgery is a newer area of research that is rapidly growing. Pharmacotherapy may be used before (neoadjuvant) or after (adjuvant) bariatric surgery. Recent literature suggests that adjuvant AOMs may address weight regain and inadequate weight loss following bariatric surgery. Research on neoadjuvant AOM used to optimize weight loss before bariatric surgery is more limited. A literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thirty-four studies were included after screening and exclusion of irrelevant records. Included studies were as follows: seven prospective studies on adjuvant AOM use, 23 retrospective studies on adjuvant AOM use, one prospective study on adjuvant and neoadjuvant AOM use, one retrospective study on adjuvant or neoadjuvant AOM use, one prospective study on neoadjuvant AOM use, and one case series on neoadjuvant AOM use. In the following scoping review, each of these studies is discussed with the goal of presenting a complete synthesis of the current body of literature on AOM use in combination with bariatric surgery.
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Affiliation(s)
- Theo Sher
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA.
| | - Michelle McGee
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Department of Surgery, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Christopher DuCoin
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Department of Surgery, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Joseph Sujka
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Department of Surgery, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Salvatore Docimo
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Department of Surgery, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
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Awshah S, Mhaskar R, Diab ARF, Read M, Coughlin E, Ganam S, Saad AR, Sujka J, DuCoin C. Robotics vs Laparoscopy in Foregut Surgery: Systematic Review and Meta-Analysis Analyzing Hiatal Hernia Repair and Heller Myotomy. J Am Coll Surg 2024:00019464-990000000-00946. [PMID: 38497555 DOI: 10.1097/xcs.0000000000001074] [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: 03/19/2024]
Abstract
BACKGROUND Laparoscopic surgery remains the mainstay of treating foregut pathologies. Several studies have shown improved outcomes with the robotic approach. A systematic review and meta-analysis comparing outcomes of robotic and laparoscopic hiatal hernia repairs (HHR) and Heller myotomy (HM) repairs is needed. STUDY DESIGN PubMed, Embase and Scopus databases were searched for studies published between January 2010 and November 2022. The risk of bias was assessed using the Cochrane ROBINS-I tool. Assessed outcomes included intra- and post-operative outcomes. We pooled the dichotomous data using the Mantel-Haenszel random effects model to report odds ratio (OR) and 95% confidence intervals (95% CIs) and continuous data to report mean difference (MD) and 95% CIs. RESULTS Twenty-two comparative studies enrolling 196,339 patients were included. Thirteen (13,426 robotic, 168,335 laparoscopic patients) studies assessed HHR outcomes, while nine (2,384 robotic, 12,225 laparoscopic patients) assessed HM outcomes. Robotic HHR had a non-significantly shorter length of hospital stay (LOS) [MD -0.41 (95% CI -0.87, -0.05)], fewer conversions to open [OR 0.22 (95% CI 0.03, 1.49)], and lower morbidity rates [OR 0.76 (95% CI 0.47, 1.23)]. Robotic HM led to significantly fewer esophageal perforations [OR 0.36 (95% CI 0.15, 0.83)], reinterventions [OR 0.18 (95% CI 0.07, 0.47)] a non-significantly shorter LOS [MD -0.31 (95% CI -0.62, 0.00)]. Both robotic HM and HHR had significantly longer operative times. CONCLUSIONS Laparoscopic and robotic HHR and HM repairs have similar safety profiles and perioperative outcomes. Randomized controlled trials are warranted to compare the two methods, given the low to moderate quality of included studies.
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Affiliation(s)
- Sabrina Awshah
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Rahul Mhaskar
- University of South Florida Morsani College of Medicine, Tampa, FL
- Department of Medical Education, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Abdul-Rahman Fadi Diab
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Meagan Read
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Emily Coughlin
- University of South Florida Morsani College of Medicine, Tampa, FL
- Department of Medical Education, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Samer Ganam
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Adham R Saad
- University of South Florida Morsani College of Medicine, Tampa, FL
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Joseph Sujka
- University of South Florida Morsani College of Medicine, Tampa, FL
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Christopher DuCoin
- University of South Florida Morsani College of Medicine, Tampa, FL
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
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Sher T, McGee M, DuCoin C, Sujka J, Docimo S. Evaluating the use of adjuvant and neoadjuvant terminology in bariatric surgery: a scoping review. J Gastrointest Surg 2024:S1091-255X(24)00362-7. [PMID: 38523037 DOI: 10.1016/j.gassur.2024.03.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/18/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Weight regain and inadequate weight loss are common after bariatric surgery. Literature is emerging regarding the use of pharmacotherapy with bariatric surgery as a potential solution to these adverse effects. Pharmacotherapy may be used before (neoadjuvant) or after (adjuvant) bariatric surgery, although this terminology has not been standardized. As a rapidly growing area of research, there is opportunity to standardize terminology for future ease of research, data synthesis, and communication. This review aimed to comprehensively evaluate the use of the terms "adjuvant" and "neoadjuvant" to describe pharmacotherapy used in combination with bariatric surgery and propose standardized terminology for future research. METHODS Literature search was conducted systematically and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they were published after 1999; were randomized controlled trials, prospective/retrospective cohort studies, or case series; and used human subjects that were adults at least 18 years of age. The use of the terms "neoadjuvant" and "adjuvant" was analyzed over time. RESULTS Thirty-four publications were included. Thirty-two (94.1%) studied the use of adjuvant pharmacotherapy after bariatric surgery. Four (11.8%) studied the use of pharmacotherapy before bariatric surgery, and 1 used the term "neoadjuvant" to describe medications used before bariatric surgery. Eight publications used the term "adjuvant" to describe medications used after bariatric surgery. CONCLUSION Standardized terminology is needed to ease future understanding, evidence synthesis, and dissemination of work. We propose that the terms "neoadjuvant" and "adjuvant" become the standard terminology to describe pharmacotherapy use before and after bariatric surgery, respectively.
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Affiliation(s)
- Theo Sher
- University of South Florida Morsani College of Medicine, Tampa, Florida, United States.
| | - Michelle McGee
- University of South Florida Morsani College of Medicine, Tampa, Florida, United States; Department of Surgery, University of South Florida, Tampa, Florida, United States
| | - Christopher DuCoin
- University of South Florida Morsani College of Medicine, Tampa, Florida, United States; Department of Surgery, University of South Florida, Tampa, Florida, United States
| | - Joseph Sujka
- University of South Florida Morsani College of Medicine, Tampa, Florida, United States; Department of Surgery, University of South Florida, Tampa, Florida, United States
| | - Salvatore Docimo
- University of South Florida Morsani College of Medicine, Tampa, Florida, United States; Department of Surgery, University of South Florida, Tampa, Florida, United States
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Sujka J, Ahmed A, Kang R, Grimsley EA, Weche M, Janjua H, Mi Z, English D, Martinez C, Velanovich V, Bennett RD, Docimo S, Saad AR, DuCoin C, Kuo PC. Examining surgeon stress in robotic and laparoscopic surgery. J Robot Surg 2024; 18:82. [PMID: 38367193 DOI: 10.1007/s11701-024-01834-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/14/2024] [Indexed: 02/19/2024]
Abstract
Robotic surgery may decrease surgeon stress compared to laparoscopic. To evaluate intraoperative surgeon stress, we measured salivary alpha-amylase and cortisol. We hypothesized robotic elicited lower increases in surgeon salivary amylase and cortisol than laparoscopic. Surgical faculty (n = 7) performing laparoscopic and robotic operations participated. Demographics: age, years in practice, time using laparoscopic vs robotic, comfort level and enthusiasm for each. Operative data included operative time, WRVU (surgical "effort"), resident year. Saliva was collected using passive drool collection system at beginning, middle and end of each case; amylase and cortisol measured using ELISA. Standard values were created using 7-minute exercise (HIIT), collecting saliva pre- and post-workout. Linear regression and Student's t test used for statistical analysis; p values < 0.05 were significant. Ninety-four cases (56 robotic, 38 laparoscopic) were collected (April-October 2022). Standardized change in amylase was 8.4 ± 4.5 (p < 0.001). Among operations, raw maximum amylase change in laparoscopic and robotic was 23.4 ± 11.5 and 22.2 ± 13.4; raw maximum cortisol change was 44.21 ± 46.57 and 53.21 ± 50.36, respectively. Values normalized to individual surgeon HIIT response, WRVU, and operative time, showing 40% decrease in amylase in robotic: 0.095 ± 0.12, vs laparoscopic: 0.164 ± 0.16 (p < 0.02). Normalized change in cortisol was: laparoscopic 0.30 ± 0.44, robotic 0.22 ± 0.4 (p = NS). On linear regression (p < 0.001), surgeons comfortable with complex laparoscopic cases had lower change in normalized amylase (p < 0.01); comfort with complex robotic was not significant. Robotic may be less physiologically stressful, eliciting less increase in salivary amylase than laparoscopic. Comfort with complex laparoscopic decreased stress in robotic, suggesting laparoscopic experience is valuable prior to robotic.
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Affiliation(s)
- Joseph Sujka
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA.
| | - Abrahim Ahmed
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Richard Kang
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Emily A Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Mcwayne Weche
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Haroon Janjua
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Zhiyong Mi
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Diana English
- Department of Gynecologic Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Carolina Martinez
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Vic Velanovich
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Robert D Bennett
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Salvatore Docimo
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Adham R Saad
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Christopher DuCoin
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
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Malaussena Z, Mhaskar R, Richmond N, Diab ARF, Sujka J, DuCoin C, Docimo S. Hernia repair in the bariatric patient: a systematic review and meta-analysis. Surg Obes Relat Dis 2024; 20:184-201. [PMID: 37973424 DOI: 10.1016/j.soard.2023.10.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/03/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Repair options for ventral hernias in bariatric patients include performing a staged approach in which bariatric surgery is performed before definitive hernia repair (BS-first), a staged approach in which hernia repair is performed before bariatric surgery (HR-first), or a concomitant approach. OBJECTIVES This meta-analysis aims to determine which surgical approach is best for bariatric patients with hernias. SETTING PubMed, CENTRAL, and Embase databases. METHODS A comprehensive search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to screen for all studies that focused on outcomes of patients who underwent both hernia repair and bariatric surgery, either simultaneously or separately. Exclusion criteria included hiatal and inguinal hernia studies, case reports, and case series. RESULTS 27 studies fit our inclusion criteria after identifying 1584 studies initially. Seven comparative studies were included, enrolling 8548 staged patients (6458 BS-first) and 3528 concomitant patients. A total of 7 single-arm staged studies and 13 single-arm concomitant studies were also included. Data on hernia recurrence, mesh infection, reoperation, surgical site infections, seroma, bowel complications, and mortality were abstracted. The concomitant approach was associated with decreased odds of experiencing surgical site infections, reoperation, and seromas. The staged approach (BS-first) was associated with decreased odds of mesh infection. The single-arm studies suggest a lower incidence of hernia recurrence in a staged BS-first approach than in a concomitant approach. CONCLUSIONS The data suggest a concomitant approach is appropriate for hernias that the surgeon feels do not require mesh, while the staged (BS-first) approach is more appropriate if the hernia requires mesh placement.
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Affiliation(s)
- Zachary Malaussena
- University of South Florida Morsani College of Medicine, Tampa, Florida.
| | - Rahul Mhaskar
- University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Medical Education, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Noah Richmond
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Abdul-Rahman F Diab
- University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Joseph Sujka
- University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Christopher DuCoin
- University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Salvatore Docimo
- University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
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Kamal AN, Wang CHJ, Triadafilopoulos G, Diehl DL, DuCoin C, Dunst CM, Falk G, Iyer PG, Katzka DA, Konda VJA, Muthusamy R, Otaki F, Pleskow D, Rubenstein JH, Shaheen NJ, Sharma P, Smith MS, Sujka J, Swanstrom LL, Tatum RP, Trindade AJ, Ujiki M, Wani S, Clarke JO. A Delphi Method for Development of a Barrett's Esophagus Question Prompt List as a Communication Tool for Optimal Patient-physician Communication. J Clin Gastroenterol 2024; 58:131-135. [PMID: 36753462 DOI: 10.1097/mcg.0000000000001832] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/02/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND METHODS The question prompt list content was derived through a modified Delphi process consisting of 3 rounds. In round 1, experts provided 5 answers to the prompts "What general questions should patients ask when given a new diagnosis of Barrett's esophagus" and "What questions do I not hear patients asking, but given my expertise, I believe they should be asking?" Questions were reviewed and categorized into themes. In round 2, experts rated questions on a 5-point Likert scale. In round 3, experts rerated questions modified or reduced after the previous rounds. Only questions rated as "essential" or "important" were included in Barrett's esophagus question prompt list (BE-QPL). To improve usability, questions were reduced to minimize redundancy and simplified to use language at an eighth-grade level (Fig. 1). RESULTS Twenty-one esophageal medical and surgical experts participated in both rounds (91% males; median age 52 years). The expert panel comprised of 33% esophagologists, 24% foregut surgeons, and 24% advanced endoscopists, with a median of 15 years in clinical practice. Most (81%), worked in an academic tertiary referral hospital. In this 3-round Delphi technique, 220 questions were proposed in round 1, 122 (55.5%) were accepted into the BE-QPL and reduced down to 76 questions (round 2), and 67 questions (round 3). These 67 questions reached a Flesch Reading Ease of 68.8, interpreted as easily understood by 13 to 15 years olds. CONCLUSIONS With multidisciplinary input, we have developed a physician-derived BE-QPL to optimize patient-physician communication. Future directions will seek patient feedback to distill the questions further to a smaller number and then assess their usability.
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Affiliation(s)
- Afrin N Kamal
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Redwood City
| | - Chih-Hung Jason Wang
- Department of Pediatrics and Department of Health Policy, Stanford University School of Medicine, Stanford
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Redwood City
| | - David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville
| | - Christopher DuCoin
- Department of Surgery, USF Morsani College of Medicine, University of South Florida
| | - Christy M Dunst
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic Center for Advanced Surgery
| | - Gary Falk
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Prasad G Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, MN
| | | | - Vani J A Konda
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor University Medical Center, Dallas, TX
| | - Raman Muthusamy
- Division of Digestive Diseases, Vatche and Tamar Manoukian David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Fouad Otaki
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR
| | - Douglas Pleskow
- Division of Gastroenterology Beth Israel Deaconess Medical Center, Boston, MN
| | - Joel H Rubenstein
- Division of Gastroenterology, Department of Medicine, Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan; Barrett's Esophagus Program, University of Michigan, Ann Arbor, MI
| | - Nicholas J Shaheen
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Veterans Affairs Medical Center, Kansas City, MS
| | - Michael S Smith
- Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai West and Mount Sinai Morningside Hospitals, Icahn School of Medicine at Mount Sinai, New York
| | - Joseph Sujka
- Department of Surgery, Tampa General Hospital, Tampa, FL
| | - Lee L Swanstrom
- Insitute of Image-Guided Surgery, IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, FR
| | - Roger P Tatum
- Department of Surgery, University of Washington School of Medicine and VA Puget Sound Health Care System, Seattle, WA
| | - Arvind J Trindade
- Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY
| | - Michael Ujiki
- Department of Surgery, University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Sachin Wani
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Redwood City
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Sher T, Sujka J. Navigating uncharted waters: long-term implications of GLP-1 agonist use. Surg Obes Relat Dis 2024:S1550-7289(24)00028-5. [PMID: 38368200 DOI: 10.1016/j.soard.2024.01.005] [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] [Received: 01/02/2024] [Accepted: 01/14/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Theo Sher
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Joseph Sujka
- University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Surgery, University of South Florida, Tampa, Florida
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Davis G, Liu L, Bernardi K, Saad AR, Sujka J, Velanovich V. Health services utilization of patients with gastroparesis treated with gastric neurostimulation with and without concomitant pyloroplasty or subsequent pyloromyotomy. J Gastrointest Surg 2024; 28:75-76. [PMID: 38353079 DOI: 10.1016/j.gassur.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Graham Davis
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Langfeier Liu
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Karla Bernardi
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Adham R Saad
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Joseph Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Vic Velanovich
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States.
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15
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Perisetla N, Doyle WN, Ladehoff L, Natarelli N, Nemov V, Pittala K, Sujka J, Saad AR, DuCoin C, Velanovich V. Effects of Spinal Deformities on Hiatal Hernia Occurrence and Recurrence. J Gastrointest Surg 2023; 27:2718-2723. [PMID: 37932593 DOI: 10.1007/s11605-023-05877-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Spinal deformities such as kyphosis, lordosis, and scoliosis have demonstrated a possible association between these deformities. Our hypothesis is that the presence of spinal deformities will increase the risk of hiatal hernia recurrence after repair. METHODS The following data was retrospectively gleaned for patients undergoing hiatal hernia repair (1997-2022): age, sex, date of hiatal hernia repair, presence and type of spinal deformity, Cobb angle, type of hiatal hernia and size, type of hiatal hernia repair, recurrence and size, time to recurrence, reoperation, type of reoperation, and time to reoperation. RESULTS Spinal deformities were present in 15.8% of 546 patients undergoing hiatal hernia repair, with a distribution of 21.8% kyphosis, 2.3% lordosis, 58.6% scoliosis, and 17.2% multiple. There was no difference in sex or age between groups. Spinal deformity patients were more likely to have types III and IV hiatal hernias (52.3% vs. 38.9%, p = 0.02) and larger hernias (median 5 [3-8] vs. 4 [2-6], p = 0.01). There was no difference in access, fundoplication use, or mesh use between groups. However, these patients had a higher recurrence rate (47.7% vs 30.0%, p = 0.001) and a shorter time to recurrence (months) (10.3 [5.6-25.1] vs 19.2 [9.8-51.0], p = 0.02). Cobb angle did not affect recurrence. CONCLUSIONS Spinal deformity patients were more likely to have more complex and larger hiatal hernias. They were at higher risk of hiatal hernia recurrence after repair with shorter times to recurrence. This is a group that requires special attention with additional preoperative counseling and possibly use of surgical adjuncts in repair.
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Affiliation(s)
- Naveen Perisetla
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - William N Doyle
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Lauren Ladehoff
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Nicole Natarelli
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Valerie Nemov
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Karthik Pittala
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Joseph Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Adham R Saad
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Chistopher DuCoin
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Vic Velanovich
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.
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16
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Sujka J, McEwen C, Sandhu M, Sunderland M, Mhaskar R, Mooney A, DuCoin C. Staple Line Bacterial Load May Not Be a Contra-Indication to Magnetic Sphincter Augmentation Placement During Primary Sleeve Gastrectomy. Obes Surg 2023; 33:3703-3705. [PMID: 37792251 DOI: 10.1007/s11695-023-06869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Joseph Sujka
- Department of Surgery, University of South Florida, Tampa, FL, USA.
| | - Courtney McEwen
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Mannat Sandhu
- University of South Florida College of Medicine, Tampa, FL, USA
| | | | - Rahul Mhaskar
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Ashley Mooney
- Department of Surgery, University of South Florida, Tampa, FL, USA
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17
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Bach GH, Crowell W, Griffith J, Rachman B, Bigness A, Reddy N, Sujka J, Mhaskar R, DuCoin C. Peroral Endoscopic Myotomy; Novice Surgeon Learning Curve. Am Surg 2023; 89:4305-4309. [PMID: 35710330 DOI: 10.1177/00031348221109457] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Peroral endoscopic myotomy (POEM) is a novel endoscopic procedure used to treat achalasia and other spastic esophageal disorders that is an alternative to Heller myotomy. We seek to define the learning curve of POEM for a foregut surgeon with no formal endoscopic or POEM training by analyzing different intraoperative factors in a single series. METHODS AND PROCEDURES The first 38 consecutive patients undergoing POEM by a single foregut surgeon were included in this retrospective study. Inverse curve regression models were used to analyze total operative time (TOT) and total operative time per centimeter of myotomy (TOT-CM), in addition to other intraoperative variables. Clinical outcomes were reported as pre- and post-operative Eckardt Scores. RESULTS All patients had type II achalasia with no post-operative complications observed. Eckardt scores improved postoperatively (median (range): 1 (0-4)) compared with the preoperative scores (10 (8-12)) (P < .001). The total operative time (median 76 minutes, range 51-129) decreased significantly over the course of the series (R2 = .38, P < .001), with a learning plateau at 70 minutes and a learning rate of 12 cases. Total operative time per centimeter of myotomy (median 7.08 min/cm, range 4.25 to 15.38) decreased over time (R2 = .45, P < .001), with a learning plateau at 7 minutes/cm and a learning rate of 12 cases. CONCLUSION The number of cases for a foregut surgeon to become proficient in a POEM procedure was found to be 12-14 cases. The learning curve for a POEM in a formally trained foregut surgeon may be comparable to an endoscopically trained interventionist.
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Affiliation(s)
- Gregory H Bach
- Department of General Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Winston Crowell
- Undergraduate Medical Education, Morsani College of Medical Education, University of South Florida, Tampa, FL, USA
| | - Jennifer Griffith
- Undergraduate Medical Education, Morsani College of Medical Education, University of South Florida, Tampa, FL, USA
| | - Ben Rachman
- Department is Undergraduate Medical Education, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Alec Bigness
- Department is Undergraduate Medical Education, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Nikhil Reddy
- Department is Undergraduate Medical Education, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Joseph Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Christopher DuCoin
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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18
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Sher T, Noom M, Diab AR, Sujka J, Rinde-Hoffman D, DuCoin C. Efficacy of bariatric intervention as a bridge to cardiac transplant. Surg Obes Relat Dis 2023; 19:1296-1301. [PMID: 37391350 DOI: 10.1016/j.soard.2023.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/27/2023] [Revised: 04/19/2023] [Accepted: 05/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Many patients with heart failure (HF) are denied cardiac transplants due to inability to meet transplantation body mass index (BMI) criteria. Bariatric intervention, including surgery, medication, and weight loss guidance, may help patients lose weight and become eligible for transplantation. OBJECTIVE We aim to contribute to the literature on the safety and efficacy of bariatric intervention on patients with obesity and HF who are awaiting cardiac transplantation. SETTING University hospital, United States. METHODS This was a mixed retrospective/prospective study. Eighteen patients with HF and BMI >35 kg/m2 were reviewed. Patients were divided based on whether they underwent bariatric surgery or nonsurgical intervention and whether they had left ventricular assist devices or other advanced heart failure therapy including inotropic support, guideline-directed medical therapy, and/or temporary mechanical circulatory support. Weight, BMI, and left ventricular ejection fraction (LVEF) were collected before bariatric intervention and 6 months after bariatric intervention. RESULTS No patients were lost to follow-up. Bariatric surgery led to statistically significant decreases in weight and BMI when compared with nonsurgical patients. At 6 months after intervention, surgical patients lost an average of 18.6 kg and decreased their BMI by 6.4 kg/m2 while nonsurgical patients lost 1.9 kg and decreased their BMI by .7 kg/m2. After bariatric intervention, surgical patients had an average LVEF increase of 5.9% and nonsurgical patients had an average decrease of 5.9%, although these findings lacked statistical significance. CONCLUSION Our study suggests that bariatric intervention among patients with HF and obesity is a safe and effective method of weight and BMI reduction.
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Affiliation(s)
- Theo Sher
- Department of Surgery, University of South Florida, Tampa, Florida.
| | - Madison Noom
- Department of Surgery, University of South Florida, Tampa, Florida
| | | | - Joseph Sujka
- Department of Surgery, University of South Florida, Tampa, Florida
| | - Debbie Rinde-Hoffman
- Department of Surgery, University of South Florida, Tampa, Florida; Heart Failure Center of Excellence, Heart and Vascular Institute, Tampa General Medical Group/University of South Florida, Tampa, Florida
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19
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Shah J, Quesada KG, Sujka J, DuCoin C, Docimo S, Mooney A. Comment on: Obesity, metabolic and bariatric surgery, and cancer prevention: what do we need to learn and how do we get there? Surg Obes Relat Dis 2023; 19:928. [PMID: 37127449 DOI: 10.1016/j.soard.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Jay Shah
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | | | - Joseph Sujka
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Christopher DuCoin
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Salvatore Docimo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Ashley Mooney
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
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20
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Sher T, Diab AR, Mhaskar R, Docimo S, Sujka J, DuCoin C. Evaluating the Spanish readability of American Society for Metabolic and Bariatric Surgery (ASMBS) Centers of Excellence (COE) websites. Surg Endosc 2023:10.1007/s00464-023-09978-9. [PMID: 36914781 PMCID: PMC10010650 DOI: 10.1007/s00464-023-09978-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Healthcare disparities continue to be an ongoing struggle in Bariatrics. Limited availability of Spanish online material may be a correctible barrier for accessibility to Hispanic patients. We sought to evaluate accredited Bariatric Centers of Excellence (COE) for Spanish readability via their websites to determine accessibility for Spanish speakers. METHODS This was an internet research study. 103 COE accredited by American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS) were evaluated and assigned one of five Spanish Visibility Categories. The United States was divided into 4 regions. Regional Spanish visibility was calculated by dividing each category count by the number of institutions in each region. County Spanish-speaking populations were obtained from the US Census Bureau's 2009-2013 American Community Survey. Differences in their distributions across the Spanish Visibility Categories were investigated using the Mann-Whitney U test. RESULTS 25% of websites were translatable to Spanish, and a regional discrepancy was found with 61% translatable in the West, 19% in Northeast, 19% in Midwest, and 15% in South. Median Spanish-speaking population was higher in counties where websites were translatable to Spanish than where websites were not translatable. CONCLUSION Healthcare disparities in Bariatrics continue to be an ongoing struggle. We suggest that Spanish readability for ASMBS ACS COE websites should be improved regardless of geographic differences in Spanish-speaking populations. We believe it would be valuable for these websites to have standards for readability of Spanish and other languages.
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Affiliation(s)
- Theo Sher
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
| | - Abdul-Rahman Diab
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Salvatore Docimo
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Joseph Sujka
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Christopher DuCoin
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
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21
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Liu L, Lewis N, Mhaskar R, Sujka J, DuCoin C. Robotic-assisted foregut surgery is associated with lower rates of complication and shorter post-operative length of stay. Surg Endosc 2022; 37:2800-2805. [PMID: 36477641 DOI: 10.1007/s00464-022-09814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Two of the most common foregut operations are laparoscopic Heller myotomy and laparoscopic Nissen fundoplication. Robotic assistance, compared to standard laparoscopic approach, may potentially grant surgeons advantages such as enhanced visualization and dexterity. This study compares patient outcomes for Heller myotomy (HM) and Nissen fundoplication (NF) when performed laparoscopically versus robotically. METHODS A retrospective review of patients at a single institution who underwent laparoscopic or robotic-assisted HM or NF from January 2019 to July 2022 was conducted. 123 HM (72 laparoscopic, 51 robotic-assisted) and 92 NF (62 laparoscopic, 30 robotic-assisted) were performed by three surgeons. Outcomes investigated were operative time, hospital length of stay, pre- and post-operative imaging, resolution of symptoms at 30 days, resolution of symptoms at 90 days, and complications. RESULTS In the HM cohorts, the average operative time was longer in the robotic cohort (127 min robotic versus 108 min laparoscopic, p < 0.01). However, overall complication rates (p < 0.05) were lower, and hospital length of stay was shorter in the robotic group (1.5 days compared to 2.7 days, p < 0.001). In the NF cohorts, there was no significant difference in operative time. However, hospital length of stay was shorter in the robotic group (1.54 days compared to 2.7 days, p < 0.001) with otherwise similar outcomes. There was no difference in the rate of post-operative resolution of symptoms or need for additional interventions in either HM or NF. CONCLUSION Robotic-assisted HM and NF are associated with shorter hospital stays compared to their respective laparoscopic approaches. Robotic-assisted HM also has a lower rate of complications. Our findings suggest that robotic assistance may be beneficial for shortening hospital length of stay and decreasing complications for certain surgeries specific to Foregut surgery.
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Rogers MP, Janjua H, Fishberger G, Harish A, Sujka J, Toloza EM, DeSantis AJ, Hooker RL, Pietrobon R, Lozonschi L, Kuo PC. A machine learning approach to high-risk cardiac surgery risk scoring. J Card Surg 2022; 37:4612-4620. [PMID: 36345692 DOI: 10.1111/jocs.17110] [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: 06/28/2022] [Revised: 07/26/2022] [Accepted: 10/02/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION In patients undergoing high-risk cardiac surgery, the uncertainty of outcome may complicate the decision process to intervene. To augment decision-making, a machine learning approach was used to determine weighted personalized factors contributing to mortality. METHODS American College of Surgeons National Surgical Quality Improvement Program was queried for cardiac surgery patients with predicted mortality ≥10% between 2012 and 2019. Multiple machine learning models were investigated, with significant predictors ultimately used in gradient boosting machine (GBM) modeling. GBM-trained data were then used for local interpretable model-agnostic explanations (LIME) modeling to provide individual patient-specific mortality prediction. RESULTS A total of 194 patient deaths among 1291 high-risk cardiac surgeries were included. GBM performance was superior to other model approaches. The top five factors contributing to mortality in LIME modeling were preoperative dialysis, emergent cases, Hispanic ethnicity, steroid use, and ventilator dependence. LIME results individualized patient factors with model probability and explanation of fit. CONCLUSIONS The application of machine learning techniques provides individualized predicted mortality and identifies contributing factors in high-risk cardiac surgery. Employment of this modeling to the Society of Thoracic Surgeons database may provide individualized risk factors contributing to mortality.
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Affiliation(s)
- Michael P Rogers
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Haroon Janjua
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Gregory Fishberger
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Abhinav Harish
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Joseph Sujka
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Eric M Toloza
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Anthony J DeSantis
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Robert L Hooker
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona, Tuscon, Arizona, USA
| | | | - Lucian Lozonschi
- Division of Cardiothoracic Surgery and Transplantation, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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23
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DeSantis AJ, Janjua HM, Moiño D, Davis G, Sands V, Weche M, Kuo PC, Sujka J, DuCoin C. Association of individual surgeon volume and postoperative outcome in esophagomyotomy for achalasia. Surg Endosc 2022; 36:8498-8502. [PMID: 35257214 DOI: 10.1007/s00464-022-09169-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/21/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Many surgical disciplines have demonstrated superior outcomes when procedures are performed at "high-volume". Esophagomyotomy is commonly performed for achalasia, however it's unclear what constitutes "high-volume" for this procedure, and if individual procedure volume and outcome are related. We identified physicians performing esophagomyotomy, stratified them by individual case volume, and examined their outcomes with the hypothesis that high-volume surgeons will be associated with improved outcomes as compared to low-volume surgeons. METHODS The 2015-2019 Florida Agency for Health Care Administration (AHCA) inpatient dataset was queried for esophagomyotomy. Surgeons who performed ≥ 10 procedures during the study period were placed into the high-volume cohort, and those performing < 10 into the low-volume cohort. Groups were compared by length of stay, discharge disposition, and postoperative complications. Patient demographics were evaluated using student's t test and chi square test, p < 0.05 considered significant. RESULTS Six hundred and sixty-two procedures performed by 135 surgeons were identified. The mean number of esophagomyotomies per surgeon was 4.9 (Range 1-147). The high-volume group (n = 12) performed 362 of the 662 procedures (55%), while the low-volume group (n = 123) performed the remaining 300 (45%). Patients of high-volume physicians had decreased length of stay (1.4 ± 0.8 days vs 4.9 ± 6.7 days, p = 0.01) and were more likely to be discharged to home following surgery (92.8% vs 86.0, p = 0.04). High volume physicians also had statistically significant differences in rates of urinary tract infection (1.4% vs 4.0%, p = 0.034), postoperative malnutrition (5.8% vs 11.0%, p = 0.015), and postoperative fluid and electrolyte disorders (5.5% vs 13.3%, p < 0.0001). CONCLUSION Surgeons who perform higher volumes of esophagomyotomies are associated with decreased length of stay, higher likelihood of patient discharge to home, and decreased rates of some postoperative complications. This research should prompt further inquiry into defining what constitutes a high-volume center in foregut surgery and their role in improving patient outcomes.
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Affiliation(s)
- Anthony J DeSantis
- Department of Surgery, University of South Florida, Harborside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA.
| | - Haroon M Janjua
- OnetoMap Analytics, University of South Florida, Tampa, FL, USA
| | - Daniela Moiño
- Department of Surgery, University of South Florida, Harborside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Graham Davis
- Department of Surgery, University of South Florida, Harborside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Victoria Sands
- Department of Surgery, University of South Florida, Harborside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - McWayne Weche
- Department of Surgery, University of South Florida, Harborside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Paul C Kuo
- OnetoMap Analytics, University of South Florida, Tampa, FL, USA
| | - Joseph Sujka
- Department of Surgery, University of South Florida, Harborside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Christopher DuCoin
- Department of Surgery, University of South Florida, Harborside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
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Reddy NC, Sujka J, DuCoin C. Magnetic Sphincter Augmentation Algorithm for Post-bariatric Surgery Gastroesophageal Reflux Disease Patients. Obes Surg 2022; 32:3185-3187. [PMID: 35809197 DOI: 10.1007/s11695-022-06168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Nikhil C Reddy
- University of South Florida Morsani College of Medicine, 5 Tampa General Cir, Tampa, FL, 33606, USA.
| | - Joseph Sujka
- Department of Surgery, University of South Florida, Tampa, FL, USA
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25
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DuCoin C, Wasselle J, Kayastha A, Zuercher H, Wilensky A, Sujka J, Mhaskar R, Kuo P, Velanovich V. Massive Paraesophageal Hernia Repair in the Obese Patient Population: Antireflux Gastric Bypass Versus Fundoplication. J Laparoendosc Adv Surg Tech A 2022; 32:1038-1042. [PMID: 35333616 DOI: 10.1089/lap.2022.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/22/2022] Open
Abstract
Introduction: Obesity is a risk factor for gastroesophageal reflux disease (GERD) and hiatal hernia (HH). Fundoplication is the standard operation for GERD with HH. Roux-en-Y gastric bypass (RYGB) is the procedure of choice for obese patients with either GERD or a large HH, but neither are indications for RYGB. To delineate bypass surgery as a treatment option for obese patients with HH and GERD, we propose new terminology, antireflux gastric bypass (ARGB). ARGB differs from RYGB by utilizing varying efferent limb lengths for GERD treatment. We hypothesized that ARGB would have higher GERD resolution, lower HH recurrence, and improves weight loss when compared with fundoplication. Methods: A retrospective cohort study was performed, evaluating patients undergoing repair of large HH (>5 cm) with obesity from January 2013 to February 2021. The primary outcome was GERD resolution, secondary outcomes include HH recurrence and weight loss. Multivariate logistic regression adjusted for age, body mass index (BMI), and hernia size by nonlinear mixed modeling. Results: Forty patients underwent fundoplication, and 16 patients underwent ARGB. Fundoplication patients had a larger mean hernia size (8.7 × 6.3 cm versus 6.6 × 6.4 cm), whereas ARGB patients had a higher BMI (39.2 versus 34.2 kg/m2). Recurrence showed nonstatistically significant lower incidence with ARGB and no significant difference in GERD resolution. Weight (P < .0001) and excess body weight (P < .0001) loss were superior with ARGB. Conclusions: Obese patients with large HHs and GERD treated with ARGB had similar GERD resolution, lower HH recurrence, and improved weight loss when compared with fundoplication. ARGB is an acceptable treatment option for obese patients with a massive paraesophageal hernia in the setting of GERD.
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Affiliation(s)
- Christopher DuCoin
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Joseph Wasselle
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Ahan Kayastha
- University of South Florida Health Morsani College of Medicine, Tampa, Florida, USA
| | - Hannah Zuercher
- University of South Florida Health Morsani College of Medicine, Tampa, Florida, USA
| | - Adam Wilensky
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Joseph Sujka
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Paul Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Vic Velanovich
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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26
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Wang CP, Rogers MP, Bach G, Sujka J, Mhaskar R, DuCoin C. Safety comparison of minimally invasive abdomen-only esophagectomy versus minimally invasive Ivor Lewis esophagectomy: a retrospective cohort study. Surg Endosc 2021; 36:1887-1893. [PMID: 33825009 DOI: 10.1007/s00464-021-08468-0] [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: 12/16/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We report mortality and post-operative complications from esophageal resection in the treatment of gastroesophageal adenocarcinoma or stricture, comparing a minimally invasive abdomen-only esophagectomy (MIAE) approach with a minimally invasive Ivor Lewis esophagectomy (MIILE) approach. METHODS A single-center retrospective cohort study of patients with esophageal adenocarcinoma or stricture treated by either MIAE or MIILE was conducted. MIAE was offered for strictures less than five centimeters or cancers that were American Joint Committee on Cancer (AJCC) Stage ≤ T2 without lymphadenopathy. Patients treated with these surgical techniques were analyzed to assess pre-operative risk, intra and post-operative variables, adverse events, and overall survival. RESULTS This study included 17 patients undergoing MIAE and 32 patients treated with MIILE. There were a fewer median number of lymph nodes resected (p < 0.001) and shorter operative duration (p < 0.001) for MIAE compared to MIILE. MIAE patients also had significantly higher Charlson Comorbidity Index scores and ACS National Surgical Quality Improvement Program (NSQIP) surgical risk values than MIILE patients (p < 0.05). There was no difference in median estimated blood loss, length of stay, pulmonary or cardiac complications between groups. There was no significant difference in 90-day survival. CONCLUSION A minimally invasive abdomen-only approach in a specific patient population is comparable in safety to a minimally invasive Ivor Lewis approach, with associated shorter median operative duration. MIAE patients had significantly greater pre-operative comorbidities and higher calculated peri-operative risk of complication but demonstrated similar post-operative outcomes. This suggests that MIAE may be a suitable surgical approach for treating gastroesophageal adenocarcinoma or stricture in patients deemed unsuitable for MIILE.
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Affiliation(s)
| | - Michael P Rogers
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Gregory Bach
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Joseph Sujka
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Christopher DuCoin
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA.
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Hendrickson RJ, Sujka J, Fischer R, Manalang M, Daniel J, Andrews WS. Indications and efficacy of conversion from tacrolimus- to sirolimus-based immunosuppression in pediatric patients who underwent liver transplantation for unresectable hepatoblastoma. Pediatr Transplant 2019; 23:e13369. [PMID: 30719825 DOI: 10.1111/petr.13369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/19/2018] [Accepted: 12/21/2018] [Indexed: 11/30/2022]
Abstract
SRL-based immunosuppressive strategies in pediatric liver transplantation are not clearly defined, especially within the first year after liver transplant. TAC is the more common, traditional immunosuppressant used. However, SRL may modulate TAC-associated kidney injury and may also have antiproliferative properties that are valuable in the management of patients following liver transplantation for HB. We sought to determine whether early conversion from TAC to SRL was safe, effective, and beneficial in a subset of liver transplant recipients with unresectable HB exposed to CDDP-based chemotherapy. Between 2008 and 2013, six patients were transplanted for unresectable HB. All patients received at least one cycle of CDDP-based chemotherapy prior to transplant. All patients were switched from TAC- to SRL-based immunosuppression within 1 year of transplant. Five patients had improvement in their mGFR, while one patient had a slight decline. The improvement in mGFR was statistically significant. No adverse events were identified. Three patients had BPAR that responded to pulsed steroids. Historical controls showed similar rates of BPAR within the first year after transplant. There were no identified HB recurrences in the follow-up time period. Conversion from TAC to SRL appears to be safe and effective in this selected group of pediatric liver transplant recipients without adverse reaction or HB recurrences.
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Affiliation(s)
| | - Joseph Sujka
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Ryan Fischer
- Department of Gastroenterology and Hepatology, Children's Mercy Hospital, Kansas City, Missouri
| | - Michelle Manalang
- Department of Hematology and Oncology, Children's Mercy Hospital, Kansas City, Missouri
| | - James Daniel
- Department of Gastroenterology and Hepatology, Children's Mercy Hospital, Kansas City, Missouri
| | - Walter S Andrews
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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28
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Sujka J, Alemayehu H, Benedict LA, Sobrino JA, St. Peter SD, Fraser JD. Outcomes of Ostomy Location in Children: Placement of the Ostomy at the Umbilicus. J Laparoendosc Adv Surg Tech A 2019; 29:243-247. [DOI: 10.1089/lap.2018.0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joseph Sujka
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Hanna Alemayehu
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Justin A. Sobrino
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Jason D. Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Abstract
PURPOSE The pain experience is highly variable among patients. Psychological mindsets, in which individuals view a particular characteristic as either fixed or changeable, have been demonstrated to influence people's actions and perceptions in a variety of settings including school, sports, and interpersonal. The purpose of this study was to determine if health mindsets influence the pain scores and immediate outcomes of post-operative surgical patients. METHODS As part of a multi-institutional, prospective, randomized clinical trial involving patients undergoing a minimally invasive pectus excavatum repair of pectus excavatum, patients were surveyed to determine whether they had a fixed or growth health mindset. Their post-operative pain was followed prospectively and scored on a Visual Analog Scale and outcomes were measured according to time to oral pain medication use. RESULTS Fifty patients completed the Health Beliefs survey, 17 had a fixed mindset (8 epidural, 9 PCA) and 33 had a growth mindset (17 epidural, 16 PCA). Patients with a growth mindset had lower post-operative pain scores than patients with a fixed mindset although pain medication use was not different. CONCLUSION This is the first usage of health mindsets as a means to characterize the perception of pain in the post-operative period. Mindset appears to make a difference in how patients perceive and report their pain. Interventions to improve a patient's mindset could be effective in the future to improve pain control and patient satisfaction.
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Affiliation(s)
- Joseph Sujka
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, 64108, USA
| | - Shawn St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, 64108, USA
| | - Claudia M Mueller
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur, Alway M116, Stanford, CA, 94305, USA.
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Sujka J, Weaver KL, Poola AS, Rivard DC, Hendrickson RJ. Percutaneous transhepatic cholecysto-cholangiography (PTCC): An alternative to intraoperative cholangiography in high risk infants suspect for biliary atresia. Journal of Pediatric Surgery Case Reports 2018. [DOI: 10.1016/j.epsc.2018.05.003] [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: 10/16/2022] Open
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Benedict LA, Ha D, Sujka J, Sobrino JA, Oyetunji TA, St Peter SD, Fraser JD. The Laparoscopic Versus Open Approach for Reduction of Intussusception in Infants and Children: An Updated Institutional Experience. J Laparoendosc Adv Surg Tech A 2018; 28:1412-1415. [PMID: 30036131 DOI: 10.1089/lap.2018.0268] [Citation(s) in RCA: 4] [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] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We have previously demonstrated successful laparoscopic management after failed enema reduction of children with intussusception. The purpose of this study is to assess the effectiveness of our mature experience with laparoscopic reduction by evaluating operative success, duration of hospital stay, postoperative complications, and hospital readmission rates. MATERIALS AND METHODS After IRB approval, a retrospective review was conducted on children (age 0-18 years) who failed enema reduction of intussusception between 2008 and 2017. Cases were classified as either open or laparoscopic. Demographic data, incidence of bowel resection, postoperative length of stay, complications, and hospital readmission rates were abstracted from patient medical records. Comparative analysis was performed in STATA with a P value <.05 determined as significant. RESULTS A total of 81 children were included in our study with 63 patients (78%) undergoing a laparoscopic reduction and 18 patients (22%) undergoing an open operation. Laparoscopic reduction carried similar complication rates (11%) when compared with children undergoing an open reduction (11%, P = 1.00). Furthermore, both hospital readmission rates and returns to the operating room were similar between the two groups (P = .345 and P = .672, respectively). The median postoperative length of stay was shorter for patients undergoing a laparoscopic reduction (4 days, interquartile range [IQR], 2-5 days) than for patients undergoing an open reduction (5 days, IQR, 4-6 days, P = .001). Children undergoing a laparoscopic reduction had a decreased rate of bowel resection (43% versus 50%, P = .591) despite similar rate of pathological lead points (21% versus 22%, P = .884). CONCLUSION Laparoscopic management of intussusception after failed radiographic reduction yields a reduced hospital length of stay with no increase in hospital readmission rates and reoperations.
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Affiliation(s)
| | - Derrick Ha
- 2 Kansas City University of Medicine and Biosciences , Kansas City, Missouri
| | - Joseph Sujka
- 1 Department of Surgery, Children's Mercy Hospital , Kansas City, Missouri
| | - Justin A Sobrino
- 1 Department of Surgery, Children's Mercy Hospital , Kansas City, Missouri
| | | | - Shawn D St Peter
- 1 Department of Surgery, Children's Mercy Hospital , Kansas City, Missouri
| | - Jason D Fraser
- 1 Department of Surgery, Children's Mercy Hospital , Kansas City, Missouri
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Sujka J, Sola R, Juang D. Transanal protrusion of subdural peritoneal shunt in the setting of appendicitis. Journal of Pediatric Surgery Case Reports 2018. [DOI: 10.1016/j.epsc.2018.05.001] [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: 10/17/2022] Open
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Sujka J, Benedict LA, Fraser JD, Aguayo P, Millspaugh DL, St Peter SD. Outcomes Using Cryoablation for Postoperative Pain Control in Children Following Minimally Invasive Pectus Excavatum Repair. J Laparoendosc Adv Surg Tech A 2018; 28:1383-1386. [PMID: 29927703 DOI: 10.1089/lap.2018.0111] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 11/12/2022] Open
Abstract
PURPOSE Pain is the main factor that determines the postoperative course for patients undergoing pectus bar placement. Cryoablation of the intercostal nerves has been suggested to mitigate this pain. We instituted a protocol for using intercostal cryoablation and report our early results compared to our immediately previous cohort. MATERIALS AND METHODS A retrospective study was conducted on patients undergoing minimally invasive repair for pectus excavatum between January 1, 2017, and August 21, 2017. Demographic data, anthropometrics, operative times, type and duration of patient analgesia, and postoperative length of stay were collected. Descriptive statistics were performed with all means reported ± standard deviations. Comparisons between groups were analyzed on STATA using T-tests with a P value <.05 determined as significant. RESULTS Twenty-eight patients were treated for pectus excavatum during the study period with 9 (32%) undergoing cryoablation. Mean number of rib spaces ablated was 5 ± 0.53 with no reported intraoperative complications. Mean operative time was 30 minutes longer in the cryoablation group (P = .00). Days to only oral pain medication was shorter in the cryoablation group, (1.22 ± 0.66 day versus 2.63 ± 0.68 day, P = .00). Length of stay, in days, was shorter in the cryoablation group (1.4 ± 0.72 days versus 4.0 ± 1.0 days, P = .00). There were no reported complications from cryoablation or bar placement during the study period. Days to discontinuation of oral narcotics were less in the cryoablation group (8.2 ± 7.0 versus 18.2 ± 10.4, P = .00). CONCLUSION Cryoablation after pectus bar placement dramatically decreases narcotic usage and postoperative length of stay.
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Affiliation(s)
- Joseph Sujka
- 1 Department of Surgery, Children's Mercy Hospital , Kansas City, MO
| | | | - Jason D Fraser
- 1 Department of Surgery, Children's Mercy Hospital , Kansas City, MO
| | - Pablo Aguayo
- 1 Department of Surgery, Children's Mercy Hospital , Kansas City, MO
| | | | - Shawn D St Peter
- 1 Department of Surgery, Children's Mercy Hospital , Kansas City, MO
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Sujka J, Gonzalez KW, Curiel KL, Daniel J, Fischer RT, Andrews WS, Wicklund BM, Hendrickson RJ. The impact of thromboelastography on resuscitation in pediatric liver transplantation. Pediatr Transplant 2018; 22:e13176. [PMID: 29577520 DOI: 10.1111/petr.13176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 12/01/2022]
Abstract
Although TEG directs effective resuscitation in adult surgical patients, pediatric data are lacking. We performed a retrospective comparative review of the effect of TEG on blood product utilization and outcomes following pediatric liver transplantation in 38 patients between 2008 and 2014. Diagnoses, laboratory values, fluid and blood product use, and outcomes were examined. Nineteen patients underwent liver transplantation prior to the implementation of TEG, and 19 had perioperative TEG. The most common indications for transplant were BA (n = 14), HB (n = 7), and metabolic disorders (n = 7). Intraoperative blood loss, urine output, fluid and blood product use were similar between groups. However, the use of fresh frozen plasma decreased significantly in TEG patients within the first 24 hours (29 vs 0 mL/kg, P < .01), and between 24 and 48 hours (12 vs 0 mL/kg, P = .01) post-operatively. The total use of fresh frozen plasma during hospitalization was markedly reduced (111 vs 17 mL/kg, P < .01). Four patients in the TEG group had thromboembolic graft complications, including portal vein or hepatic artery thrombosis, and underwent retransplantation. The decreased use of fresh frozen plasma since implementation of TEG is an important finding for resource utilization and patient safety. However, the increased incidence of thromboembolic complications requires further investigation.
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Affiliation(s)
- Joseph Sujka
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | | | - Kayla L Curiel
- Department of Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA
| | - James Daniel
- Department of Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Ryan T Fischer
- Department of Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Walter S Andrews
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Brian M Wicklund
- Department of Hematology, Children's Mercy Hospital, Kansas City, MO, USA
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Sujka J, Teixeira AF, Jawad MA. Suspected cecal volvulus as a reason for abdominal pain after gastric bypass: a case series. Surg Obes Relat Dis 2015; 11:978-9. [PMID: 26112179 DOI: 10.1016/j.soard.2015.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 04/15/2015] [Accepted: 04/17/2013] [Indexed: 10/23/2022]
Affiliation(s)
- Joseph Sujka
- Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida
| | - Muhammad A Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
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Sujka J, Zeoli T, Ciccone JM. Sacral Neuromodulation for Bladder Atony – A Case Report. Urol Case Rep 2014; 2:27-9. [PMID: 26955538 PMCID: PMC4732992 DOI: 10.1016/j.eucr.2013.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 12/05/2013] [Accepted: 12/06/2013] [Indexed: 11/25/2022] Open
Abstract
In most cases, sacral neuromodulation is used as a treatment for urge incontinence and symptoms of urgency and frequency. It is most used in those who are refractory to traditional management. It is much less common to be used for bladder atony. In this report, we present a case of a 24-year-old woman with a history of urinary retention and bladder atony who failed medical management and subsequently had an InterStim sacral neuromodulator implanted. After implantation, she was able to discontinue intermittent catheterization and had a decrease in her postvoid residual from 848 to 72 mL.
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