Use of Bioabsorbable Tissue Reinforcement Reduces Incidence of Internal Hernia in Roux-en-Y Gastric Bypass Patients.

Internal hernias are one of the most devastating late, postsurgical complications associated with laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of this study was to determine whether placement of a bioabsorbable tissue matrix in soft tissue defects after gastric bypass resulted in a lower incidence of internal hernia development. Prospective database was used to identify all patients who underwent LRYGB between January 2002 and January 2016.

Short-Term Preoperative Weight Loss and Postoperative Outcomes in Bariatric Surgery.

Background: Preoperative weight loss is often encouraged before undergoing weight loss surgery. Controversy remains as to its effect on postoperative outcomes. The aim of this study was to determine what impact short-term preoperative excess weight loss (EWL) has on postoperative outcomes in patients undergoing primary vertical sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB).

Assessing the real-world effect of laparoscopic bariatric surgery on the management of obesity-related comorbidities: A retrospective matched cohort study using a US Claims Database.

Aims: To evaluate the real-world effect of laparoscopic bariatric surgery, comprising adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG), on the management of obesity-related comorbidities.

Methods: Patients who underwent laparoscopic bariatric surgeries between 2006 and 2013 were identified from the Optum Clinformatics administrative claims database. Those surgical patients were matched to medically managed patients (controls) on selected patient characteristics.

Cost-effectiveness of Bariatric Surgery: Increasing the Economic Viability of the Most Effective Treatment for Type II Diabetes Mellitus.

There has been considerable debate on the cost-effectiveness of bariatric surgery within larger population groups. Despite the recognition that morbid obesity and its comorbidities are best treated surgically, insurance coverage is not universally available. One of the more costly comorbidities of obesity is Type II diabetes mellitus (T2DM).

The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity.

Background: Saline-filled intragastric balloon devices are reversible endoscopic devices designed to occupy stomach volume and reduce food intake.

Objective: To evaluate the safety and effectiveness of a dual balloon system plus diet and exercise in the treatment of obesity compared to diet and exercise alone.

Setting: Academic and community practice, United States.

Evidence supporting the need for bariatric surgery to address the obesity epidemic in the United States.

Despite aims at prevention, obesity in the United States is now an epidemic. Along with the rise in obesity, the United States has experienced a concomitant rise in obesity-related comorbidities. Furthermore overweight and obesity present a major economic public health challenge.

Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus.

Background: Bariatric surgery (BAR) has been established as an effective treatment for type 2 diabetes mellitus (T2DM) in obese patients. However, few studies have examined the mid- to long-term outcomes of bariatric surgery in diabetic populations. Specifically, no comparative studies have broadly examined major macrovascular and microvascular complications in bariatric surgical patients vs similar, nonbariatric surgery controls.

Incisional hernia risk after hand-assisted laparoscopic surgery.

Hand-assisted laparoscopic surgery (HALS) bridges traditional open surgery and pure laparoscopy. The HALS technique provides the necessary site for organ retrieval, reduces operative time, and realizes the postoperative benefits of laparoscopic techniques. Although the reported rates of incisional hernia should be theoretically low, we sought to determine our incidence of hernia after HALS procedures.

Bariatric surgery is associated with a reduced risk of mortality in morbidly obese patients with a history of major cardiovascular events.

Although the safety of bariatric surgery in patients with established cardiovascular disease has been demonstrated, little is known about the mid- to long-term survival of these patients after surgery. We conducted a retrospective cohort study of bariatric surgical patients (n = 349) compared with morbidly obese surgical controls (n = 903). Data were obtained on all patients 40 to 79 years of age, from 1996 to 2008, with a diagnosis code of morbid obesity, a primary surgical procedure of interest, and a cardiovascular event history.

Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients.

Background: Morbid obesity is associated with the development of cardiovascular and cerebrovascular disease. Several studies have shown that bariatric surgery results in risk factor reduction; however, studies correlating bariatric surgery to the reduced rates of myocardial infarction, stroke, or death have been limited.

Methods: We conducted a large retrospective cohort study of bariatric (BAR) surgical patients (n = 4747) and morbidly obese orthopedic (n = 3066) and gastrointestinal (n = 1327) surgical controls.

Reduction in anastomotic strictures using bioabsorbable circular staple line reinforcement in laparoscopic gastric bypass.

Background: Anastomotic stricture remains the most common complication after laparoscopic gastric bypass with a circular-stapled gastrojejunostomy. The present study examined the effect of the use of bioabsorbable circular staple line reinforcement on the incidence of gastrojejunostomy anastomotic strictures as a complication of laparoscopic Roux-en-Y gastric bypass.

Methods: A retrospective review was performed of 851 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass with circular-stapled gastrojejunostomy.

Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia.

Background: Internal hernia (IH) is one of the more acute and potentially devastating complications after laparoscopic gastric bypass (LGB). Currently, there is no way to predict which patients will develop IH. We propose that patients who undergo periods of rapid excess weight loss (EWL) following LGB are more likely to develop IH.

Management of complications after laparoscopic Roux-en-Y gastric bypass.

Obesity has become an increasing problem in developed countries and laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the leading treatments for this disease. Although studies show that it is effective in reducing weight and lessening comorbidities, both early and late complications can occur. Early complications include venous thromboembolism, anastomotic leak, and hemorrhage.

Clinical results using bioabsorbable staple line reinforcement for circular staplers.

Although linear surgical staple line reinforcement has been shown to increase anastomotic tensile strength in animal models and reduce the incidence of staple line bleeding and anastomotic leaks in colorectal surgery, the benefits of staple line reinforcement on circular stapled anastomoses in bariatric surgery remain unreported in the literature. The purpose if this study was to compare the incidence of anastomotic bleeding, leak, and stricture in patients undergoing laparoscopic gastric bypass with circular staple line reinforcements with those with no circular staple line reinforcements. Since May 2006, 138 consecutive patients (Group B) have undergone laparoscopic Roux-en-Y divided gastric bypass with a 25-mm circular stapled gastrojejunal anastomosis using GORE SEAMGUARD bioabsorbable circular staple line reinforcement (CBSG) with a mean follow up of 9 months.

Acute right-lower-quadrant mass presenting after laparoscopic cholecystectomy.

Hernia formation at trocar sites has been reported following laparoscopic surgical procedures. We present a case, however, of a healthy woman with signs, symptoms, and physical findings consistent with an incarcerated inguinal hernia 3 days after an uneventful laparoscopic cholecystectomy. Exploratory laparotomy revealed a small bile leak from an accessory duct of Luschka but did not identify an intra-abdominal process responsible for the patient's symptoms.

Tumor necrosis factor-alpha-induced apoptosis in hepatocytes in long-term culture.

Apoptosis occurs naturally in the liver and increases in specific pathogenic processes. We previously described the use of a chemically defined medium supplemented with epidermal growth factor and dimethylsulfoxide to maintain rat hepatocytes in a highly differentiated state for more than 30 days (long-term culture). In this study, we showed that hepatocytes in long-term dimethylsulfoxide culture have definite advantages over using cells in short-term culture (cells in culture for 2 to 4 days) to study apoptosis.

Gallstone umbilical sinus tract formation following laparoscopic cholecystectomy.

The use of laparoscopic techniques in general surgical procedures has increased dramatically in the past 6 years. A number of articles in the literature have described a multitude of complications arising from these techniques. We report the development of a draining umbilical sinus tract following laparoscopic cholecystectomy, arising as a result of gallstone fragmentation during gallbladder removal.

Hemodynamic effects of a new right ventricular assist device.

A right ventricular assist device (VAD) based on the principle of counterpulsation has been developed at our institution. The device is a valveless, pneumatically actuated, 40 cc, sac-type pump, with a single inlet-outlet port. For right ventricular support, the "Uniport" pump is anastamosed end-to-side to the pulmonary artery.

Experience with the double lumen Silastic catheter for hemoaccess.

Transvenous access for acute hemodialysis has advanced recently with the introduction of a double lumen Silastic (silicone rubber), Dacron-cuffed (polyester) catheter (Quinton PermCath), which has a better patient acceptance than the stiff Teflon (polytetrafluoroethylene) catheters. We present our experience with 53 PermCath catheters placed in 49 patients (eight to 80 years old). Twenty-two catheters were used for initiation of dialysis, 17 as a bridge to permanent hemoaccess, two as a bridge to peritoneal dialysis and 12 for chronic hemoaccess.