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Use of Preoperative Endoscopic Capsule-Based pH Testing Before Bariatric Surgery. J Am Coll Surg 2024; 238:551-558. [PMID: 38230854 DOI: 10.1097/xcs.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Vertical sleeve gastrectomy is the most performed bariatric operation in the US; however, a significant number of patients suffer from persistent or new-onset reflux. No consensus for objective preoperative evaluation in these patients exists. We compared capsule-based pH testing vs GERD symptom scoring to determine extent of preoperative GERD to aid in procedure selection for bariatric surgery. STUDY DESIGN An IRB-approved retrospective review of consecutive patients at a single institution was performed from April 2021 to December 2022. During initial consultation for bariatric surgery, a validated GERD symptom subjective survey was administered. All patients demonstrating interest in sleeve gastrectomy or had a history of reflux underwent upper endoscopy with capsule-based pH testing. RESULTS Sixty-two patients underwent preoperative endoscopy with capsule-based pH testing and completed GERD symptom assessment survey(s). Median BMI was 43.4 kg/m 2 and 66.1% of patients were not taking a proton-pump inhibitor before performance of pH testing. There was negligible linear association between the objective DeMeester score obtained by capsule-based pH probe and GERD symptom survey scores. Median GERD symptom survey scores did not differ between patients with and without a diagnosis of GERD based on pH testing (all p values >0.11). CONCLUSIONS An objective method for identifying severe GERD in the preoperative assessment may aid in the decision tree for procedure selection and informed consent process. Patients with significant preoperative GERD may be at higher risk for future GERD-related sleeve complications. Capsule-based pH testing may prove to be superior to subjective symptom scoring systems in this patient population.
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Evaluating metabolic and bariatric surgery fellows' attitudes toward their training. Surg Obes Relat Dis 2024; 20:336-339. [PMID: 38103968 DOI: 10.1016/j.soard.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/01/2023] [Accepted: 10/29/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The American Society of Metabolic and Bariatric Surgeons (ASMBS) Leadership Academy is conducted at the ASMBS Weekend to prepare surgeons for practice, while in their fellowship. OBJECTIVES The aim of this analysis is to gather the views of current fellows in training on issues regarding practice patterns and career development. SETTING Survey at ASMBS Fellows Leadership Academy. METHODS An online survey was conducted at the last 2 ASMBS Leadership Academy Meetings at the ASMBS Weekend. There were 14 questions. There were 61 respondents. Twenty-three respondents had incomplete surveys and were not included in the final analysis. There were 24 fellows surveyed at the Leadership Academy in November 2022, in San Antonio, TX and 37 in January 2022, in Las Vegas, NV. RESULTS Fifty-eight percent of attendees were interviewing for employment after their fellowship with 3.64% already employed. Eighteen percent had employment secured upon completion of their fellowship. Of the academic fellows, 29.1% believe that private practice will no longer exist in 2030 and 10.9% of attendees believe that we will have Medicare for all by 2030. Fellows in academic programs ranked their fellowship as either "best decision of my life" or "great" (96.4%) and 3.6% ranked it as "useless (not good/not bad)." Ninety-three percent of attendees said they would do a bariatric fellowship again. Of those that said they would not, all were from a robotic fellowship program. Of those that would do a bariatric fellowship again, 80% stated they would do so at the same institution. CONCLUSIONS The fellows that attended the ASMBS Leadership Academy overall were very pleased with their fellowship experience, and most would choose to do a MIS/bariatric fellowship again.
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Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus. Sci Rep 2024; 14:3445. [PMID: 38341469 PMCID: PMC10858961 DOI: 10.1038/s41598-024-54141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/08/2024] [Indexed: 02/12/2024] Open
Abstract
Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m2. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.
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Reply to "New IFSO/ASMBS Indications for Metabolic and Bariatric Surgery? Yes, After Failure of Best Nonsurgical Therapy". Obes Surg 2023; 33:2594-2595. [PMID: 37308733 DOI: 10.1007/s11695-023-06667-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
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Turnkey algorithmic approach for the evaluation of gastroesophageal reflux disease after bariatric surgery. Gastroenterol Rep (Oxf) 2023; 11:goad028. [PMID: 37304555 PMCID: PMC10256627 DOI: 10.1093/gastro/goad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/12/2022] [Accepted: 02/01/2023] [Indexed: 06/13/2023] Open
Abstract
Bariatric surgeries are often complicated by de-novo gastroesophageal reflux disease (GERD) or worsening of pre-existing GERD. The growing rates of obesity and bariatric surgeries worldwide are paralleled by an increase in the number of patients requiring post-surgical GERD evaluation. However, there is currently no standardized approach for the assessment of GERD in these patients. In this review, we delineate the relationship between GERD and the most common bariatric surgeries: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), with a focus on pathophysiology, objective assessment, and underlying anatomical and motility disturbances. We suggest a stepwise algorithm to help diagnose GERD after SG and RYGB, determine the underlying cause, and guide the management and treatment.
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Insurance-mandated weight management program completion before bariatric surgery provides no long-term clinical benefit. Surg Obes Relat Dis 2023; 19:290-300. [PMID: 36424327 DOI: 10.1016/j.soard.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/02/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is no evidence that insurance-mandated weight loss before bariatric surgery affects outcomes. OBJECTIVE This retrospective study evaluated the relationship between insurance-mandated weight management program (WMP) completion before primary bariatric surgery and postoperative outcomes. SETTING Suburban academic medical center. METHODS Patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 572) or sleeve gastrectomy (SG, n = 484) from 2014 to 2019 were dichotomized to presence (LRYGB n = 431, SG n = 348) or absence (LRYGB n = 141, SG n = 136) of insurance-mandated WMP completion. Primary endpoints included follow-up rate, percent total weight loss (%TWL), and percent excess weight loss (%EWL) through 60 months after surgery. The Mann-Whitney U test compared between-group means with significance at P < .05. RESULTS Follow-up rate, %TWL, and %EWL were not different (P = NS) up to 60 months postoperation between groups for either surgery. Both LRYGB and SG patients without WMP completion maintained greater %TWL (LRYGB: 34.4 ± 11.1% versus 29.8 ± 11.0%, P = .159; SG: 21.4 ± 10.0% versus 18.2 ± 10.5%, P = .456) and %EWL (LRYGB: 71.3 ± 26.3% versus 67.6 ± 26.5%, P = .618; SG: 49.2 ± 18.8% versus 47.5 ± 28.8%, P = .753) at 36 months after surgery. Secondarily, duration of time to get to surgery was significantly greater among yes-WMP patients (LRYGB: 178 days versus 121 days, P < .001; SG: 169 days versus 95 days, P < .001). CONCLUSION Insurance-mandated WMP completion before bariatric surgery delays patient access to surgery without improving postoperative weight loss potential and must be abandoned.
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INTRODUCTION. Surg Obes Relat Dis 2023:S1550-7289(23)00112-0. [PMID: 37037686 DOI: 10.1016/j.soard.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/05/2023] [Indexed: 03/15/2023]
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Reply to Letter to the Editor: Beyond the BMI: a Critical Analysis of the Edmonton Obesity Staging System and the New Guidelines for Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:1279-1280. [PMID: 36809589 DOI: 10.1007/s11695-023-06517-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/20/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
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Updates on Surgical Treatment for Gastroesophageal Reflux Disease. Am Surg 2023:31348231157414. [PMID: 36789472 DOI: 10.1177/00031348231157414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Gastroesophageal reflux disease (GERD) is a common condition that is on the rise. Obesity is one risk factor that has increased in parallel with the rise of GERD. Typical symptoms include heartburn, regurgitation, dysphagia, cough, and chest pain. Patients with typical symptoms are empirically treated with proton pump inhibitors (PPIs). If the diagnosis is not clear, further evaluation is performed with endoscopy, pH monitoring, and esophageal manometry. Untreated GERD increases the risk of esophagitis, esophageal stricture, Barrett's esophagus, and esophageal adenocarcinoma. Treatment begins with lifestyle modification and medical therapy. If these fail, surgical and endoscopic surgical techniques are available, to provide treatment, symptom relief, and reduce long-term PPI use.
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Outcomes of Bariatric Surgery With Concomitant Hiatal Hernia Repair Using an Absorbable Tissue Matrix. Am Surg 2023; 89:293-299. [PMID: 34058829 DOI: 10.1177/00031348211023450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hiatal hernias are a common finding in patients who undergo bariatric surgery with an incidence of about 20% of all bariatric patients. Controversy exists on the utility of a biosynthetic tissue matrix (BTM) usage in combination with crural repair. This study was designed to explore the safety and benefits of the use of a BTM during concomitant hiatal hernia repair with bariatric surgical procedures. METHODS This was a retrospective chart review of bariatric surgical patients who underwent a concomitant hiatal hernia repair at a single practice at a tertiary academic medical center from January 2014 to February 2019. RESULTS A total of 420 patients were reviewed. Hiatal BTM reinforcement, recurrence, and postoperative proton pump inhibitor use were reported by type of operation. Recurrence was higher in gastric bypass patients who underwent hiatal hernia repair with suture cruroplasty alone vs. those who also underwent hiatal BTM reinforcement (7.1% vs. 3.7%, P = .52) and significantly higher in gastric sleeve patients who underwent hiatal hernia repair with suture cruroplasty alone vs. those who also underwent hiatal BTM reinforcement (7.1% vs. .5%, P = .01). No patient required reoperation for hiatal hernia recurrence. DISCUSSION Performing Roux-en-Y gastric bypass or vertical sleeve gastrectomy with concomitant hiatal hernia repair is safe and durable. Employing crural reinforcement with BTM may be of benefit in reducing recurrence rates of hiatal hernia, particularly in sleeve gastrectomy patients.
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Publisher Correction: 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:15-16. [PMID: 36445365 PMCID: PMC9834333 DOI: 10.1007/s11695-022-06369-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:3-14. [PMID: 36336720 PMCID: PMC9834364 DOI: 10.1007/s11695-022-06332-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 113.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
MAJOR UPDATES TO 1991 NATIONAL INSTITUTES OF HEALTH GUIDELINES FOR BARIATRIC SURGERY: Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) >35 kg/m2, regardless of presence, absence, or severity of co-morbidities.MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.BMI thresholds should be adjusted in the Asian population such that a BMI >25 kg/m2 suggests clinical obesity, and individuals with BMI >27.5 kg/m2 should be offered MBS.Long-term results of MBS consistently demonstrate safety and efficacy.Appropriately selected children and adolescents should be considered for MBS.(Surg Obes Relat Dis 2022; https://doi.org/10.1016/j.soard.2022.08.013 ) © 2022 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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I'm Drowning and Need Help:The Value of the Intraoperative Consult. Am J Surg 2022; 224:1346-1348. [PMID: 36155677 DOI: 10.1016/j.amjsurg.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/08/2022] [Indexed: 12/14/2022]
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Can the marshmallow esophagram replace high-resolution manometry as an appropriate screening for esophageal motility prior to anti-reflux surgery? Am J Surg 2022; 224:1366-1369. [PMID: 36372582 DOI: 10.1016/j.amjsurg.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGOUND The purpose of our study was to evaluate the use of minimally invasive Marshmallow Swallow Study (MSS) as a preoperative screening technique for patients and correlate marshmallow results with High Resolution Manometry (HRM) results and post-operative dysphagia following antireflux surgery. METHODS A retrospective electronic chart review of data on 61 adult patients undergoing MSS was completed. Patients were included if they completed the MSS as well as: HRM and/or antireflux surgery. RESULTS Sixty-one patients completed MSS. Of the 37 patients that completed HRM, 27 had abnormal results. 23 of these 27 patients who had abnormal results also failed MSS. The NPV for a failure on the MSS and abnormal HRM results is 0.767(p-value = 0.360). The PPV for a pass on the MSS and no post-operative dysphagia is 0.833 (p-value = 0.656). CONCLUSIONS MSS is an effective screening tool for ruling out major esophageal motility disorders and can prevent need for invasive HRM.
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Patient characteristics and diagnostic tests associated with syncopal falls: A Southwestern surgical congress multicenter study. Am J Surg 2022; 224:1374-1379. [PMID: 35940931 DOI: 10.1016/j.amjsurg.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients suspected of syncope frequently undergo laboratory and imaging studies to determine the etiology of the syncope. Variability exists in these workups across institutions. The purpose of this study was to evaluate the utilization and diagnostic yield of these workups and the patient characteristics associated with syncopal falls. METHODS A multi-institutional retrospective review was performed on adult patients admitted after a fall between 1/2017-12/2018. Syncopal falls were compared to non-syncopal falls. RESULTS 4478 patients were included. There were 795 (18%) patients with a syncopal fall. Electrocardiogram, troponin, echocardiogram, CT angiography (CTA), and carotid ultrasound were more frequently tested in syncope patients compared to non-syncope patients. Syncope patients had higher rates of positive telemetry/Holter monitoring, CTAs, and electroencephalograms. CONCLUSION Patients who sustain syncopal falls frequently undergo diagnostic testing without a higher yield to determine the etiology of syncope.
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My heart is full: presidential address of the ASMBS 2022 annual meeting. Surg Obes Relat Dis 2022. [DOI: 10.1016/j.soard.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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VTE prevention in bariatric surgery: from where have we come, and how did we get here? Surg Obes Relat Dis 2021; 18:175-176. [PMID: 34920965 DOI: 10.1016/j.soard.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
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Postoperative nausea and vomiting in bariatric surgery: a position statement endorsed by the ASMBS and the ISPCOP. Surg Obes Relat Dis 2021; 17:1829-1833. [PMID: 34462224 DOI: 10.1016/j.soard.2021.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022]
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Shanu N. Kothari, MD, FACS, FASMBS. Obes Surg 2021; 31:1399-1400. [PMID: 33772389 DOI: 10.1007/s11695-021-05273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lack of Correlation Between Subjective and Objective Measures of Gastroesophageal Reflux Disease: Call for a Novel Validated Assessment Tool. Surg Innov 2020; 28:290-294. [PMID: 32867603 DOI: 10.1177/1553350620955031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background. Objective measures including the DeMeester score, lower esophageal sphincter (LES) pressure, acid exposure time, and body mass index (BMI) are used to determine gastroesophageal reflux disease (GERD) severity and eligibility for various antireflux surgical procedures. The GERD Health-Related Quality of Life (GERD-HRQL) survey is widely used to evaluate patients' subjective severity of symptoms and GERD-related quality of life. The purpose of this project was to identify whether or not the subjective measure (GERD-HRQL) correlated with objective measures (DeMeester score, LES, acid exposure time, and BMI) of GERD severity. Methods. A retrospective review of the medical records of patients who underwent antireflux surgery from 2013-2018 was completed. Patients' GERD severity was measured preoperatively and postoperatively using the GERD-HRQL. Statistical analysis included the calculation of Spearman correlation coefficients, Wilcoxon rank sum, sign, and chi-square tests. Results. 151 patients were included in the study; 64% were female. The mean age and BMI were 54.6 ± 14.6 years and 30.1 ± 4.1 kg/m2, respectively. The mean preoperative DeMeester score was 43.1 ± 36.1, LES pressure was 19.9 ± 18.4 mmHg, and acid exposure time was 11.4 ± 9.6. Mean GERD-HRQL scores decreased from 27.3 ± 9.2 preoperative to 5.3 ± 4.5 postoperative; P < .0001. Preoperative GERD-HRQL scores were not correlated with the DeMeester score (r = .11; P = .389), LES pressure (r = -.20; P = .089), acid exposure time (r = .05; P = .755), BMI (r = .10; P = .329), or age (r = -.16; P = .118). Conclusions. Total GERD-HRQL scores significantly decreased from pre- to postoperative. There was no correlation between subjective and objective GERD scoring. These data indicate the need for both physiologic evaluation and subjective assessment of patient symptoms during preoperative workup. There is a need for a contemporary, validated GERD questionnaire that correlates with objective pH testing.
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COVID-19 research priorities in surgery (PRODUCE study): A modified Delphi process. THE BRITISH JOURNAL OF SURGERY 2020; 107:e538-e540. [PMID: 32871017 PMCID: PMC7929143 DOI: 10.1002/bjs.12015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/04/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022]
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Pre-screening for bariatric surgery patients: comparative effectiveness of transnasal endoscopy versus esophagogastroduodenoscopy. Surg Endosc 2020; 35:4153-4159. [PMID: 32797285 DOI: 10.1007/s00464-020-07892-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/05/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Endoscopic evaluation is frequently performed before bariatric surgery to identify foregut pathology that may alter procedure selection. Transnasal endoscopy (TNE) is an alternative to esophagogastroduodenoscopy (EGD). The objective of this study was to compare TNE to EGD. METHODS Patients who underwent TNE or EGD before bariatric surgery from January 2012 through April 2019 were reviewed. Statistical analyses included Chi-square, Wilcoxon two-sample, and Fisher's exact tests. A p value < 0.05 was considered significant. RESULTS Three hundred and forty-five patients underwent preoperative screening (63% EGD, 37% TNE) before bariatric surgery. Mean age and preoperative body mass index in the TNE and EGD groups were 46.2 ± 12.4 vs 45.5 ± 11.6 years (p = 0.58) and 46.5 ± 7.1 vs. 45.5 ± 6.1 kg/m2 (p = 0.25), respectively. Three TNEs were aborted, resulting in a success rate of 98%. Of patients who underwent EGD, 1 (0.5%) visited the emergency department (ED), and 7 (3%) called the nurse with post-procedure concerns. There were no ED visits or nurse calls from patients who underwent TNE. The median total time in the procedure room was 77 (57-97) min for EGD vs. 26 (8-33) min for TNE (p < 0.001). One patient who underwent TNE required subsequent EGD. Mean charge per patient for EGD and TNE was $5034.70 and $1464.00, respectively. CONCLUSIONS TNE was associated with less post-procedure care, shorter procedure time and fewer charges compared to EGD. TNE could be considered an initial screening tool for patients undergoing bariatric surgery, while EGD could be used selectively in patients with abnormal TNE findings.
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Abstract
BACKGROUND Some weight regain is expected after bariatric surgery; however, this concept is not well defined. A favorable weight loss response has commonly been defined as 50% excess weight loss (EWL). The medical literature uses %total weight loss (%TWL), which has recently been adopted in some surgical literature. OBJECTIVE To demonstrate variability in bariatric surgery outcomes based on the definition applied and propose a standardized definition. METHODS A retrospective review of patients who underwent bariatric surgery from 2001 to 2016 with ≥ 1 year follow-up was completed. Several previously proposed definitions of weight regain were analyzed. RESULTS One thousand five hundred seventy-four patients met inclusion criteria. Preoperative mean body mass index (BMI) was 47.6 ± 6.4 kg/m2. Increased preoperative BMI was associated with increased mean %TWL at 2 years postoperative (29.3 ± 9.1% for BMI < 40, vs. 37.5 ± 9.5% for BMI > 60; P < 0.001). Based on %EWL, 93% of patients experienced ≥ 50% EWL by 1-2 years, and 61.8% maintained ≥ 50% EWL through the 10-year follow-up period. Similarly, 97% experienced ≥ 20% TWL by 1-2 years and 70.3% maintained ≥ 20% TWL through the 10-year follow-up period. Over 50% of patients maintained their weight based on several proposed definitions through 5 years follow-up. CONCLUSIONS A high percentage (> 90%) of patients achieve ≥ 20% TWL and ≥ 50% EWL. Increased preoperative BMI was associated with increased %TWL and decreased %EWL at 2 years postoperative. The incidence of weight regain varies depending on the definition. We propose a standardized definition for identifying good responders following bariatric surgery to be ≥ 20% TWL, as this measure is least influenced by preoperative BMI.
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Open letter to insurance companies regarding mandatory in-office visit weight documentation in an era of COVID-19. Surg Obes Relat Dis 2020; 16:1165-1166. [PMID: 32620376 PMCID: PMC7255233 DOI: 10.1016/j.soard.2020.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
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Subjective and Objective Measures of Gastroesophageal Reflux Disease in Patients Undergoing Magnetic Sphincter Augmentation. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Patient perceptions of primary care providers' knowledge of bariatric surgery. Clin Obes 2019; 9:e12297. [PMID: 30708401 DOI: 10.1111/cob.12297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/20/2018] [Accepted: 01/08/2019] [Indexed: 11/28/2022]
Abstract
As the rate of obesity continues to rise, primary care providers (PCPs) must be aware and informed of the treatment options available. Bariatric surgery is the most effective long-term treatment for weight loss and improvement of obesity-related comorbidities. The aim of this study was to assess patients' perception of their PCP's opinion, support and knowledge of bariatric surgery and changes over time. In 2009 and 2015, a 27-question survey was developed and mailed to patients who had undergone laparoscopic Roux-en-Y gastric bypass (LRYGB) at our institution. Statistical analysis included chi-square and Fisher's exact test for associations between categorical variables, Wilcoxon rank sum test for comparison of ordinal or continuous variables and sign test for comparison of paired ordinal variables. There were 680 and 1106 patients who met inclusion criteria and were mailed the 2009 and 2015 survey, respectively. The survey response rate was 47% in 2009 and 35% in 2015; 125 patients completed both surveys. In 2009 and 2015, 78% and 80% of patients described their PCP's opinion of bariatric surgery as "very supportive" (P = 0.64), and 29% and 40% described their PCP as "very knowledgeable" about bariatric surgery (P = 0.02), respectively. Post-operative support from PCPs was described as "very supportive" by 77% and 79% of patients in 2009 and 2015, respectively (P = 0.07). Overall, Ninety-seven percent of patients would repeat their LRYGB experience. The majority of patients perceived their PCP as being supportive of bariatric surgery. Physicians' knowledge of bariatric surgery could be improved by establishing more opportunities for education. While patients' perception of their PCP's knowledge increased, no significant improvements in PCP opinion or support of bariatric surgery were observed over time. Patients' willingness to repeat their experience with bariatric surgery remained high.
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The southwestern surgical congress multi-center trial on suspected common duct stones. Am J Surg 2019; 217:1006-1009. [PMID: 30654919 DOI: 10.1016/j.amjsurg.2018.12.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 10/15/2018] [Accepted: 12/29/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Choledocholithiasis is present in up to 15% of cholecystectomy patients. Treatment can be surgical, endoscopic, or via interventional radiology. We hypothesized significant heterogeneity between hospitals exists in the approach to suspected common duct stones. METHODS A retrospective review of patients that had a preoperative MRCP, endoscopic ultrasound, endoscopic retrograde cholangiopancreatogram (ERCP), or intra-operative cholangiogram was performed. Comparisons were by Wilcoxon-Mann-Whitney tests with significance of p < 0.05 for paired variables and p < 0.017 for multiple comparisons. RESULTS Twelve participating institutions identified 1263 patients (409 men and 854 women) with a median age of 49 years (IQR: 31-94). Liver function tests (LFT's) were elevated in 939 patients (75%), median bilirubin level 1.75 mg/dl (IQ: 0.8-3.7 mg/dl) and median common duct size 7 mm (IQR 5-10 mm). The most common initial procedure was cholecystectomy with IOC at seven institutions, endoscopy at four and MRCP at one. CONCLUSION Significant variation exists within the surgical community regarding suspected common duct stones. These results underscore the need for a protocol for common duct stones to minimize multiple, redundant interventions.
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Non-Alcoholic Steatohepatitis - The Hidden Comorbidity: No Referral for Bariatric Surgery. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Preoperative Weight Loss Medication Use and Postoperative Outcomes. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Roux-en-Y gastric bypass versus sleeve gastrectomy: what factors influence patient preference? Surg Obes Relat Dis 2018; 14:1843-1849. [PMID: 30290991 DOI: 10.1016/j.soard.2018.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/25/2018] [Accepted: 08/22/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed bariatric procedures. RYGB involves altered gastrointestinal anatomy and 2 anastomoses, while SG involves gastric resection. When potential patients view images of the procedures, they may perceive RYGB to involve significant risk compared with SG, in which no significant gastrointestinal alterations are depicted. OBJECTIVE To evaluate preferences for RYGB versus SG. SETTING Survey of U.S. adults. METHODS An electronic survey was distributed to 1000 U.S. adults. Respondents selected either RYGB or SG based on (1) procedural pictures alone, (2) only data on risks and benefits of each procedure, (3) pictures with corresponding risk/benefit profile, and (4) pictures with mismatched information. RESULTS Overall, 999 individuals met inclusion criteria; 66 (7%) had undergone bariatric surgery and were excluded. Mean age and body mass index of respondents was 44.8 ± 14.6 years (n = 922) and 28.7 ± 8.0 kg/m2 (n = 915). A higher proportion of patients preferred RYGB to SG when images only were provided (54% versus 46%), when information only was provided (63% versus 37%), and when correct information with the procedure image was provided (57% versus 43%). When presented with mismatched information and images, 56% preferred RYGB information + SG image versus SG information + RYGB image (44%). CONCLUSIONS Based on this survey, providing evidence-based risks and benefits of a procedure resulted in the majority of respondents choosing RYGB over SG. When procedure images were provided alone, preference for RYGB and SG were similar. There are likely other factors contributing to increasing SG volume aside from patient preference.
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Operating Room Attire: In reply to Fujita. J Am Coll Surg 2018; 227:476-477. [DOI: 10.1016/j.jamcollsurg.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 11/29/2022]
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Bouffant vs Skull Cap and Impact on Surgical Site Infection: Does Operating Room Headwear Really Matter? J Am Coll Surg 2018; 227:198-202. [PMID: 29733905 DOI: 10.1016/j.jamcollsurg.2018.04.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The American College of Surgeons guidelines indicate that skull caps are acceptable, and the Association of Perioperative Registered Nurses recommends bouffant caps. However, no scientific evidence has shown a significant advantage in surgical site infection (SSI) reduction with either cap. The objective of this study was to determine the influence of surgical cap choice on SSIs. STUDY DESIGN Data from a previously published prospective randomized trial on the impact of hair clipping on SSIs were analyzed. Patients were grouped by the attending surgeons' preferred cap choice into either bouffant or skull cap groups. RESULTS Overall, 1,543 patients were included in the trial. Attending surgeons wore bouffant caps in 39% and skull caps in 61% of cases. Prevalence of diabetes and tobacco use were similar between the groups. Bouffant caps were used in 71% of colon/intestinal cases, 42% of hernia/other cases, 40% of biliary cases, and only 1% of foregut cases. Overall, SSIs occurred in 8% and 5% of cases with a bouffant and skull cap, respectively (p = 0.016); with 6% vs 4% classified as superficial (p = 0.041), 0.8% vs 0.2% classified as deep (p = 0.12), and 1% vs 0.9% classified as organ space (p = 0.79); however, when adjusting for the type of operation, no significant differences in SSI rates were observed for skull caps vs bouffant caps. CONCLUSIONS Attending surgeon preference for bouffant vs skull cap does not significantly impact SSI rates after accounting for surgical procedure type. Future guidelines should consider these clinical outcomes data and surgeon preference should dictate operating room headwear.
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Impact of Obesity on Cesarean Delivery Outcomes. WMJ : OFFICIAL PUBLICATION OF THE STATE MEDICAL SOCIETY OF WISCONSIN 2017; 116:206-209. [PMID: 29323807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The rate of cesarean delivery has increased over the last 2 decades. Obesity is a risk factor for complications during pregnancy and cesarean procedures. The objective of this study was to evaluate cesarean delivery outcomes in patients with vs without obesity, and determine the impact of obesity on complications. METHODS The medical records of patients who underwent a cesarean delivery from 2010 to 2014 were reviewed. Patients were grouped by body mass index (BMI) into obese (≥30kg/m²) and non-obese (<30kg/m²) cohorts for comparison. RESULTS Nine hundred seventy-one patients were included; 432 whom had obesity, and 539 did not have obesity. The rate of gestational diabetes was increased among patients with vs without obesity (15.3% vs 5.8%; P<0.001). Obesity was associated with an increased incidence of surgical site infections (8.1% vs 2.4%; P<0.001), yeast infection (2.8% vs 0.2%; P<0.001), and seroma (2.8% vs 0.4%; P=0.002). Obesity was an independent risk factor for surgical site infections, regardless of wound closure technique (adjusted odds ratio=3.24, 95% CI, 1.66-6.32; P<0.001). CONCLUSIONS Obesity is a risk factor for wound infections after a cesarean delivery. As obesity rates increase, it is important to be aware of these risks after performing a cesarean delivery.
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Discussion of: "Southwestern Surgical Congress Jack A. Barney award competition presenters - Where are they now?". Am J Surg 2017; 214:1116-1117. [PMID: 29017730 DOI: 10.1016/j.amjsurg.2017.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bang Your Head–Bouffant vs Skull Caps and Impact on Surgical Site Infections: Does it Really Matter? J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Southwestern Surgical Congress Jack A. Barney award competition presenters - Where are they now? Am J Surg 2017; 214:1112-1115. [PMID: 28958649 DOI: 10.1016/j.amjsurg.2017.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/11/2017] [Accepted: 07/26/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Resident research presentations at surgical conferences may encourage future research endeavors. METHODS 2010-2016 SWSC annual meeting programs were reviewed for presenters eligible for the Jack Barney award. Award recipients from 1987 to 2016 were included. RESULTS There were 100 unique presenters eligible for the Jack Barney award, and 28 unique award recipients. Thirty-six (82%) presenters currently practice in a community setting, 5 (11%) at a university hospital, 2 (5%) internationally, and 1 (2%) in a military hospital. Scholarly articles were published by 41% of presenters. Sixteen of the 28 recipients (57%) practice in community hospitals, and 9 (32%) practice in university settings; 3 are still in training. Twenty recipients (71%) published after residency. Thirty percent and 25% of presenters and recipients are SWSC members, respectively. CONCLUSIONS Peer-reviewed publications were frequent among eligible presenters and award recipients. Encouraging presenters to become SWSC members provides an opportunity for improved retention.
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Trends in the Prevalence of Severe Obesity and Bariatric Surgery Access: A State-Level Analysis from 2011 to 2014. J Laparoendosc Adv Surg Tech A 2017; 27:669-675. [DOI: 10.1089/lap.2017.0157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Benefits of bariatric surgery before elective total joint arthroplasty: is there a role for weight loss optimization? Surg Obes Relat Dis 2017; 13:457-462. [DOI: 10.1016/j.soard.2016.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/01/2016] [Indexed: 11/29/2022]
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Outcome and management of endoscopic retrograde cholangiopancreatography perforations: A community perspective. Am J Surg 2017; 214:69-73. [PMID: 28173939 DOI: 10.1016/j.amjsurg.2017.01.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/20/2017] [Accepted: 01/29/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) carries a small but significant risk of perforation. Recent data suggest that select patients can be managed non-operatively. We sought to evaluate the management of ERCP perforations at our community medical center. METHODS ERCPs performed from 2004 to 2015 were reviewed. RESULTS Twenty-one of 2423 patients who underwent ERCP had a perforation (0.9%). ERCP procedures included balloon sweep with/without sphincterotomy and pancreatic duct stent (71%), common bile duct brushing (10%), and pancreatic duct stenting (5%). Duodenal diverticula were present in 3 (14%), and altered anatomy was present in 6 (29%). Seventeen patients were treated nonoperatively; 3 (14%) underwent percutaneous drain placement. Two patients failed nonoperative treatment and required surgery. Four patients required ICU stay, and median post-ERCP LOS was 5 days. The 30-day mortality rate was 1/21 (4.8%). CONCLUSIONS Perforations remain a rare, but serious, complication of ERCPs. Nonoperative management is highly successful in carefully selected patients. Early recognition with initiation of antibiotics is paramount. Our community-based practice patterns are similar to those previously published for successful nonoperative management of ERCP perforations.
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Obesity and the role of bariatric surgery in the surgical management of osteoarthritis of the hip and knee: a review of the literature. Surg Obes Relat Dis 2017; 13:111-118. [DOI: 10.1016/j.soard.2016.09.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/02/2016] [Accepted: 09/07/2016] [Indexed: 12/14/2022]
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Long-term (>10-year) outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2016; 13:972-978. [PMID: 28223086 DOI: 10.1016/j.soard.2016.12.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/06/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been the "gold standard" for weight loss surgery. Long-term data are limited, and reporting methods for LRYGB outcomes vary in the literature. In addition, follow-up compliance within bariatric centers is poor due to insurance and access to care issues, making long-term follow-up evaluation difficult. OBJECTIVE Evaluate long-term LRYGB outcomes using standard outcome reporting definitions. SETTING Integrated multispecialty health system. METHODS A retrospective review of our institution's prospective bariatric surgery registry and integrated multispecialty electronic medical record system was completed for patients who underwent LRYGB from 2001 to 2015. Data were defined according to the 2015 Standards for Outcome Reporting. RESULTS During the study period, 1402 patients underwent primary LRYGB; mean age and preoperative body mass index were 44.5±10.3 years and 47.5±6.2 kg/m2, respectively. Early complications included anastomotic leak (0.2%), venous thromboembolism (0.6%), surgical site infections (1.4%), and urinary tract infections (1.6%). The 30-day readmission rate was 3.5%. There were no 30-day mortalities. Follow-up weight data were available for>70% of eligible patients through 12 years postoperative. The highest mean percent excess weight loss and lowest body mass index were reached at 18 months postoperative at 79% and 30.1 kg/m2, respectively. Remission of diabetes, dyslipidemia, and hypertension were observed through 8 years postoperatively. CONCLUSION This is the first report of long-term (>10-year) outcomes from a single integrated health system using the 2015 Standards for Outcome Reporting. LRYGB results in significant, sustained weight loss and durable improvement and remission of obesity-related co-morbidities. Integrated healthcare systems provide an optimal environment for data collection and long-term follow-up.
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Utility of MRCP in clinical decision making of suspected choledocholithiasis: An institutional analysis and literature review. Am J Surg 2016; 214:251-255. [PMID: 27986260 DOI: 10.1016/j.amjsurg.2016.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/21/2016] [Accepted: 10/30/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND The ideal treatment algorithm for suspected choledocholithiasis is not yet well defined. Imaging options include magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and intraoperative cholangiogram (IOC). MRCP is diagnostic, while the other two modalities can also be therapeutic. Each of these modalities for diagnosis and treatment carries its own set of risks, benefits, and institutional costs. We hypothesized that there would be a significant difference between the biochemical profiles and characteristics of patients who undergo ERCP vs. MRCP vs. operative intervention as the initial choice of treatment/imaging modality. METHODS We performed a retrospective review of the electronic medical records for all patients with a coded diagnosis of choledocholithiasis from 2011 to 2014. The initial diagnostic modality was assessed for each hospital encounter. The statistical characteristics of MRCP as compared to fluoroscopic imaging of the biliary tree (ERCP, IOC) were analyzed. RESULTS Overall, 527 hospital encounters were identified. Initial intervention included ERCP in 63%, MRCP in 12%, and cholecystectomy in 25% of patients. Patients undergoing cholecystectomy first, compared to MRCP or ERCP, tended to have lower values for alkaline phosphatase (P < 0.001) and AST (P = 0.002) as well as be of younger age (P < 0.0001). Of the patients that underwent MRCP as their initial procedure, 82% subsequently underwent either ERCP or laparoscopic cholecystectomy. In patients who underwent an initial MRCP followed by either ERCP or IOC, the predictive performance of MRCP was as follows: sensitivity = 0.90, specificity = 0.86, positive predictive value = 0.97, negative predictive value = 0.60, agreement (Cohen's Kappa) = 0.64. CONCLUSIONS There is a significant difference in the laboratory evaluation and demographics of patients undergoing ERCP, MRCP, and laparoscopic cholecystectomy. MRCP was followed with a more invasive test a majority of the time. Since MRCP did not change the management of patients with suspected choledocholithiasis, its utility in this patient population should be questioned. Further research is needed to better define the pretest characteristics which would predict which patients do not need further intervention after MRCP as well as defining the most cost-effective strategy.
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Impact of Hair Removal on Surgical Site Infection Rates: A Prospective Randomized Noninferiority Trial. J Am Coll Surg 2016; 223:704-711. [DOI: 10.1016/j.jamcollsurg.2016.03.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 10/20/2022]
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Outcomes of magnetic sphincter augmentation - A community hospital perspective. Am J Surg 2016; 213:1019-1023. [PMID: 27837903 DOI: 10.1016/j.amjsurg.2016.09.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/21/2016] [Accepted: 09/29/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Magnetic sphincter augmentation (MSA) is FDA approved for the surgical treatment of GERD. While multiple reports from academic settings exist, we report the early experience from two community-based health systems. METHODS The first 102 post-trial cases of MSA were reviewed. Outcomes were compared to those in the initial clinical trial. RESULTS Mean follow-up duration was 7.6 months. GERD medication use decreased from 98% preoperative to 8% postoperative (P<0.001). Median GERD health-related quality of life (HRQL) improved from 27 preoperative to 5 postoperative (P<0.001). Patient satisfaction increased from 8% preoperative to 84% postoperative (P<0.001). Results were similar to the trial data. CONCLUSIONS MSA is a safe and effective treatment for GERD, with significant improvement in quality of life. GERD-HRQL, medication reduction, operative times, and dysphagia rates were similar to other reports, demonstrating the reproducibility of MSA. Lower dilation rates may be due to refinements in technique and postoperative dietary management.
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Can Rural Minimally Invasive Surgery Fellowships Provide Operative Experience Similar to Urban Programs? JOURNAL OF SURGICAL EDUCATION 2016; 73:793-798. [PMID: 27211880 DOI: 10.1016/j.jsurg.2016.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/15/2016] [Accepted: 04/13/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Operative experience in rural fellowship programs is largely unknown. The 2 of the most rural minimally invasive surgery (MIS)/bariatric fellowships are located in the upper Midwest. We hypothesized that these 2 programs would offer a similar operative experience to other U.S. programs in more urban locations. DESIGN The 2011 to 2012 and 2012 to 2013 fellowship case logs from 2 rural Midwest programs were compared with case logs from 23 U.S. MIS/bariatric programs. All rural Midwest fellowship graduates completed a survey describing their fellowship experience and current practice. Statistical analysis included Wilcoxon rank-sum test. SETTING Setting included the 2 rural Midwest U.S. MIS/bariatric fellowship programs. PARTICIPANTS Graduates from MIS/bariatric fellowship programs participated in the study. RESULTS Mean volumes for bariatric, foregut, abdominal wall, small intestine, and hepatobiliary cases for rural Midwest fellows vs. other U.S. programs were 123.8 ± 23.7 vs. 150.2 ± 49.2 (p = 0.20); 44.3 ± 19.4 vs. 66.3 ± 35.5 (p = 0.18); 48.3 ± 28.0 vs. 57.9 ± 27.8 (p = 0.58); 11.3 ± 1.9 vs. 12.0 ± 8.7 (p = 0.58); and 55.0 ± 34.8 vs. 48.1 ± 42.6 (p = 0.63), respectively. Mean endoscopy volume was significantly higher among rural Midwest fellows (451.0 ± 395.2 vs. 99.7 ± 83.4; p = 0.05). All rural Midwest fellows reported an adequate number of cases as operating surgeon during fellowship. A total of 60% of fellows currently practice in a rural area. In all, 87% and 13% reported that their fellowship training was extremely or somewhat beneficial to their current practice, respectively. CONCLUSIONS Rural MIS fellowship programs offer a similar operative experience to other U.S. programs. A greater volume of endoscopy cases was observed in rural Midwest fellowships.
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American Society for Metabolic and Bariatric Surgery position statement on accreditation of bariatric surgery centers endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Obes Relat Dis 2016; 12:946-954. [DOI: 10.1016/j.soard.2016.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 01/08/2023]
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Long-term Outcomes of Patients Receiving a Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux. Clin Gastroenterol Hepatol 2016; 14:671-7. [PMID: 26044316 DOI: 10.1016/j.cgh.2015.05.028] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/09/2015] [Accepted: 05/11/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Based on results from year 2 of a 5-year trial, in 2012 the US Food and Drug Administration approved the use of a magnetic device to augment lower esophageal sphincter function in patients with gastroesophageal reflux disease (GERD). We report the final results of 5 years of follow-up evaluation of patients who received this device. METHODS We performed a prospective study of the safety and efficacy of a magnetic device in 100 adults with GERD for 6 months or more, who were partially responsive to daily proton pump inhibitors (PPIs) and had evidence of pathologic esophageal acid exposure, at 14 centers in the United States and The Netherlands. The magnetic device was placed using standard laparoscopic tools and techniques. Eighty-five subjects were followed up for 5 years to evaluate quality of life, reflux control, use of PPIs, and side effects. The GERD-health-related quality of life (GERD-HRQL) questionnaire was administered at baseline to patients on and off PPIs, and after placement of the device; patients served as their own controls. A partial response to PPIs was defined as a GERD-HRQL score of 10 or less on PPIs and a score of 15 or higher off PPIs, or a 6-point or more improvement when scores on vs off PPI were compared. RESULTS Over the follow-up period, no device erosions, migrations, or malfunctions occurred. At baseline, the median GERD-HRQL scores were 27 in patients not taking PPIs and 11 in patients on PPIs; 5 years after device placement this score decreased to 4. All patients used PPIs at baseline; this value decreased to 15.3% at 5 years. Moderate or severe regurgitation occurred in 57% of subjects at baseline, but only 1.2% at 5 years. All patients reported the ability to belch and vomit if needed. Bothersome dysphagia was present in 5% at baseline and in 6% at 5 years. Bothersome gas-bloat was present in 52% at baseline and decreased to 8.3% at 5 years. CONCLUSIONS Augmentation of the lower esophageal sphincter with a magnetic device provides significant and sustained control of reflux, with minimal side effects or complications. No new safety risks emerged over a 5-year follow-up period. These findings validate the long-term safety and efficacy of the magnetic sphincter augmentation device for patients with GERD. ClinicalTrials.gov no: NCT00776997.
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American Society for Metabolic and Bariatric Surgery position statement on vagal blocking therapy for obesity. Surg Obes Relat Dis 2016; 12:460-461. [DOI: 10.1016/j.soard.2015.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 12/20/2022]
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Management of biliary symptoms after bariatric surgery. Am J Surg 2015; 210:1010-6; discussion 1016-7. [DOI: 10.1016/j.amjsurg.2015.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/21/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022]
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