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Foregut surgery

Jordan D Bohnen, Michael N Mavros, Elie P Ramly, Yuchiao Chang, D Dante Yeh, Jarone Lee, Marc de Moya, David R King, Peter J Fagenholz, Kathryn Butler, George C Velmahos, Haytham M A Kaafarani
OBJECTIVE: We sought to assess the impact of intraoperative adverse events (iAEs) on 30-day postoperative mortality, 30-day postoperative morbidity, and postoperative length of stay (LOS) among patients undergoing abdominal surgery. We hypothesized that iAEs would be associated with significant increases in each outcome. SUMMARY OF BACKGROUND DATA: The relationship between iAEs and postoperative clinical outcomes remains largely unknown. METHODS: The 2007 to 2012 institutional ACS-NSQIP and administrative databases for abdominal surgeries were matched then screened for iAEs using the Agency for Healthcare Research and Quality's 15 Patient Safety Indicator, "Accidental Puncture/Laceration"...
November 1, 2016: Annals of Surgery
Ran B Luo, Domingo Montalvo, Toshiaki Suzuki, Bryan J Sandler, Garth R Jacobsen, Santiago Horgan
INTRODUCTION: Laparoscopic foregut surgeries are highly complex procedures that carry a high potential for morbidity and mortality should complications should occur. The robotic-assisted platform offers improved visualization of anatomy, optimal fine motor control, and a higher degree of instrumentation range of motion, which may potentially lead to better outcomes. This paper reviews the risks and benefits of the robotic platform in foregut procedures. EVIDENCE ACQUISITION: A web-based literature search was performed, in August 2016 using Pubmed, EMBASE, and Google Scholar from cited English publications from 1996 to 2016...
October 27, 2016: Minerva Chirurgica
Gabrielle C Colleran, Ciara E Ryan, Edward Y Lee, Brian Sweeney, David Rea, Clare Brenner
BACKGROUND: Esophageal bronchus is a rare form of communicating bronchopulmonary foregut malformation and a rare but important cause of an opaque hemithorax on chest radiography. A higher incidence of esophageal bronchus is associated with esophageal atresia, tracheo-esophageal fistula (TEF) and VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) association. In the presence of these conditions, the pediatric radiologist may be the first to consider the diagnosis of esophageal bronchus or esophageal lung...
October 26, 2016: Pediatric Radiology
Christopher J Berg, Jonathan D Kaunitz
The ability of humans to sense chemical signals in ingested substances is implicit in the ability to detect the five basic tastes; sweet, sour, bitter, salty, and umami. Of these, sweet, bitter, and umami tastes are detected by lingual G-protein-coupled receptors (GPCRs). Recently, these receptors were also localized to the gut mucosa. In this review, we will emphasize recent advances in the understanding of the mechanisms and consequences of foregut luminal chemosensing, with special emphasis on cell surface GPCRs such as the sweet and proteinaceous taste receptors (TASRs), short- and long-chain fatty acid (FA) receptors, and bile acid receptors...
2016: F1000Research
Rodolfo J Oviedo, Jarrod C Robertson, Sharifah Alrajhi
BACKGROUND AND OBJECTIVES: The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. METHODS: Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics...
July 2016: JSLS: Journal of the Society of Laparoendoscopic Surgeons
Whitney D Johnson, M Blair Marshall
Patients with previous foregut surgery who develop additional foregut pathology can be a challenge. Those who have formerly undergone gastric bypass and later develop achalasia are at increased risk related to previous surgery. In this case report, we describe an alternative approach for the Dor fundoplication after laparoscopic Heller myotomy in the setting of the altered anatomy. The technique and advantages of this approach are detailed in the discussion of this patient.
May 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Sonya Sergieva, Bozhil Robev, Milena Dimcheva, Albena Fakirova, Radka Hristoskova
Neuroendocrine tumors (NETs) of the thorax including bronchial and thymic tumors belong to foregut NETs. Limited loco-regional thoracic NETs can be resected with surgery, but in extensive metastatic disease the treatment is mainly palliative. A high incidence and density of somatostatin receptors (SSTR2, SSTR3, and SSTR5) are found in thoracic NETs. The purpose of this study was to evaluate the role of SPECT-CT somatostatin receptor scintigraphy (SRS) with 99mTc-Tektrotyd for imaging, staging and follow up of patients with bronchial and thymic neuroendocrine tumors...
2016: Nuclear Medicine Review. Central & Eastern Europe
Chuong N Lai, Kumar Krishnan, Min P Kim, Brian J Dunkin, Puja Gaur
BACKGROUND: Pseudoachalasia is a rare diagnosis manifested by clinical and physiologic symptoms of achalasia, with alternative etiology for outflow obstruction. While malignancy is a frequent cause of pseudoachalasia, prior surgical intervention especially surgery involving the esophagogastric junction, may result in a misdiagnosis of achalasia. CASE PRESENTATION: We present a case of a 70 year-old male with dysphagia and weight loss after undergoing a Billroth I and Nissen fundoplication several decades ago...
2016: Journal of Cardiothoracic Surgery
Halle B Ellison, David M Parker, Ryan D Horsley, Daaron McField, Michael E Friscia, Anthony T Petrick
INTRODUCTION: More than one third of Americans are obese. Obesity is a risk factor for gastroesophageal reflux disease (GERD) and esophageal adenocarcinoma (EA). The only durable treatment for morbid obesity and its comorbid conditions is bariatric surgery. There is no consensus among bariatric surgeons, however, regarding the role of preoperative screening upper endoscopy in bariatric surgery. PRESENTATION OF CASE: Two cases of incidental EA were identified by completion EGD following laparoscopic Roux-en-Y gastric bypass (LRYGB)...
2016: International Journal of Surgery Case Reports
Julietta Chang, Gautam Sharma, Mena Boules, Stacy Brethauer, John Rodriguez, Matthew D Kroh
BACKGROUND: Anastomotic complications after foregut surgery include leaks, fistulas, and late strictures. The management of these complications can be challenging, and it may be desirable to avoid complex reoperation. OBJECTIVES: We aim to describe the indications and outcomes of the use of esophageal self-expanding metal stents in the management of postoperative anastomotic complications after foregut surgery. SETTING: Tertiary-referral academic medical center...
March 2, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Amir H Aryaie, Jordan L Singer, Mojtaba Fayezizadeh, Jon Lash, Jeffrey M Marks
INTRODUCTION: Anastomotic or staple-line leak after foregut surgery presents a formidable management challenge. In recent years, with advancement of endoscopy, self-expanding covered stents have been gaining popularity. In this study, we aimed to determine the safety and effectiveness of self-expanding covered stents in management of leak after foregut surgery. METHODS: Consecutive patients who received a fully covered self-expandable metal stent (SEMS) due to an anastomotic leak after upper gastrointestinal surgery between 2009 and 2014 were retrospectively reviewed...
June 17, 2016: Surgical Endoscopy
Eugene A Woltering, Anne E Wright, Melissa A Stevens, Yi-Zarn Wang, John P Boudreaux, Gregg Mamikunian, James M Riopelle, Alan D Kaye
STUDY OBJECTIVE: The prophylactic use of a preoperative, intraoperative, and postoperative high-dose continuous octreotide acetate infusion was evaluated for its ability to minimize the incidence of carcinoid crises during neuroendocrine tumor (NET) cytoreductive surgeries. DESIGN: A retrospective study was approved by the institutional review boards at Ochsner Medical Center-Kenner and Louisiana State University Health Sciences Center. SETTING: Ochsner Medical Center-Kenner operating room and multispecialty NET clinic...
August 2016: Journal of Clinical Anesthesia
James Patrick Ryan, Andrew J Borgert, Kara J Kallies, Lea M Carlson, Howard McCollister, Paul A Severson, Shanu N Kothari
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...
September 2016: Journal of Surgical Education
Yan Mei Goh, Zaher Toumi, Ravindra S Date
BACKGROUND: Bariatric surgery results in remission of type 2 diabetes mellitus in a significant proportion of patients. Animal research has proposed the foregut and hindgut hypotheses as possible mechanisms of remission of T2DM independent of weight loss. These hypotheses have formed the basis of investigational procedures designed to treat T2DM in non-obese (in addition to obese) patients. The aim of this study was to review the procedures that utilise the foregut and hindgut hypotheses to treat T2DM in humans...
May 18, 2016: Surgical Endoscopy
Dustin A Carlson, John E Pandolfino
High-resolution manometry (HRM) is the primary method used to evaluate esophageal motor function. Displayed and interpreted by esophageal pressure topography (EPT), HRM/ EPT provides a detailed assessment of esophageal function that is useful in the evaluation of patients with nonobstructive dysphagia and before foregut surgery. Esophageal motility diagnoses are determined systematically by applying objective metrics of esophageal sphincter and peristaltic function to the Chicago Classification of esophageal motility disorders...
June 2015: Gastroenterology & Hepatology
Amilcare Parisi, Stefano Trastulli, Francesco Ricci, Rossana Regina, Roberto Cirocchi, Veronica Grassi, Alessandro Gemini, Daniele Pironi, Vito D'Andrea, Alberto Santoro, Jacopo Desiderio
BACKGROUND: During the last decade, criteria for liver resection were extended thanks to surgical and oncological developments, thus increasing the number of surgeries for non-colorectal liver metastases. However, the real advantages of surgery in this category of patients remain debated, due to the few studies available in the literature. The present study aims to analyze liver surgery performed for metastatic disease at a single referral center, comparing outcomes of patients that underwent resections for colorectal and non-colorectal metastases...
April 14, 2016: International Journal of Surgery
Karen J Dickinson, James B Taswell, Mark S Allen, Shanda H Blackmon, Francis C Nichols, Robert Shen, Dennis A Wigle, Stephen D Cassivi
OBJECTIVES: Length of stay (LOS) is an important measure of quality and healthcare costs. Variation occurs due to individual and institutional practices, case complexity and patient/social factors. Identification of variables affecting LOS may help develop enhanced recovery protocols. This study aims to identify factors influencing LOS following surgery for hiatal hernia, gastro-oesophageal reflux and achalasia. METHODS: We identified all patients who underwent benign foregut surgery between August 2013 and July 2014 inclusive...
July 2016: European Journal of Cardio-thoracic Surgery
Jiangfan Zhu, Radheshyam Gupta, Mahmood Safwa
BACKGROUND: There is growing evidence that bariatric surgery can lead to remission of metabolic syndrome. But the mechanism by which bariatric surgery alleviates metabolic syndrome is unclear. MATERIALS AND METHODS: Several present hypotheses which include decreased caloric intake following the surgeries, foregut and hindgut hypothesis, bile acid and bacterial flora changes, and proposed gastric center hypothesis were discussed. RESULTS: None of the currently available hypotheses is solely capable to lead to a reasonable explanation regarding improvement of metabolic syndrome by various bariatric surgical procedures...
July 2016: Obesity Surgery
Joshua S Winder, Ryan M Juza, Jennifer Sasaki, Ann M Rogers, Eric M Pauli, Randy S Haluck, Stephanie J Estes, Jerome R Lyn-Sue
The robotic surgical platform is being utilized by a growing number of hospitals across the country, including academic medical centers. Training programs are tasked with teaching their residents how to utilize this technology. To this end, we have developed and implemented a robotic surgical curriculum, and share our initial experience here. Our curriculum was implemented for all General Surgical residents for the academic year 2014-2015. The curriculum consisted of online training, readings, bedside training, console simulation, participating in ten cases as bedside first assistant, and operating at the console...
September 2016: Journal of Robotic Surgery
Wendy Jo Svetanoff, Pradeep Pallati, Kalyana Nandipati, Tommy Lee, Sumeet K Mittal
BACKGROUND: The role of fundoplication in addition to hiatal hernia repair has been controversial. The aim of this study was to compare quality of life related to gastroesophageal reflux disease (GERD) in patients who underwent intra-thoracic stomach repair with and without fundoplication. We proposed that the group without a fundoplication would have poorer quality of life due to continued symptoms. METHODS: All patients undergoing foregut surgery at the Creighton University Esophageal Center are entered in a prospectively maintained database...
October 2016: Surgical Endoscopy
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