The State of Surgical Task Sharing for Inguinal Hernia Repair in Limited-Resource Countries.

Background: In limited-resource countries, the morbidity and mortality related to inguinal hernias is unacceptably high. This review addresses the issue by identifying capacity-building education of non-surgeons performing inguinal hernia repairs in developing countries and analyzing the outcomes.

Methods: PubMed was searched and included are studies that reported on task sharing and surgical outcomes for inguinal hernia surgery.

Web-Based Video Assessments of Operative Performance for Remote Telementoring.

Introduction: Performance-based feedback is critical to surgical skills acquisition. Barriers of geography and time limit trainees' access to expert mentorship. In this study, we hypothesized that telementoring using an asynchronous, web-based video interface would allow trainees to receive systematic feedback from expert mentors despite these barriers.

Centralized, capacity-building training of Lichtenstein hernioplasty in Brazil.

Background: In Brazil, access to healthcare varies widely by community. Options for repair of surgically correctable conditions, such as inguinal hernias, are limited. A training program was instituted to expand access to Lichtenstein hernioplasty.

Global Outreach Using a Systematic, Competency-Based Training Paradigm for Inguinal Hernioplasty.

Importance: Sustainable, capacity-building educational collaborations are essential to address the global burden of surgical disease.

Objective: To assess an international, competency-based training paradigm for hernia surgery in underserved countries.

Design, Setting, And Participants: In this prospective, observational study performed from November 1, 2013, through October 31, 2015, at 16 hospitals in Brazil, Ecuador, Haiti, Paraguay, and the Dominican Republic, surgeons completed initial training programs in hernia repair, underwent interval proficiency assessments, and were appointed regional trainers.

Wearable Technology for Global Surgical Teleproctoring.

Objective: In underserved communities around the world, inguinal hernias represent a significant burden of surgically-treatable disease. With traditional models of international surgical assistance limited to mission trips, a standardized framework to strengthen local healthcare systems is lacking. We established a surgical education model using web-based tools and wearable technology to allow for long-term proctoring and assessment in a resource-poor setting.

A proposed classification for uniform endoscopic description of surgical fundoplication.

Background: Objective assessment of postfundoplication anatomy is of utmost importance especially if reoperative intervention is being planned. There is a lack of uniformity in the description of endoscopic findings in these patients.The purpose of this study was to propose a classification for standardized endoscopic reporting of postfundoplication anatomy.

Mucosal excision and suturing for obesity and GERD.

Background: Suture and staple-based endoluminal devices for gastroesophageal reflux disease (GERD) and obesity have failed to demonstrate long-term efficacy.

Objective: To demonstrate the feasibility of mucosal excision and full-thickness suture apposition of the excision beds to create sufficient scar tissue formation at the gastroesophageal junction for the intraluminal treatment of GERD or obesity.

Design: Survival animal experiments.

Insights gained from symptom evaluation of esophageal motility disorders: a review of 4,215 patients.

Background/aims: Achalasia (Ach), diffuse esophageal spasm (DES), nutcracker esophagus (NE), and nonspecific motility disorder (NSMD) are described primary esophageal body motility disorders; however, their clinical symptom correlation is poorly understood. The aim of this study is to examine the association between a patient's presenting symptoms and their manometric diagnosis.

Methods: Manometric findings and reported symptoms of all patients undergoing esophageal manometry at the Creighton University Medical Center were prospectively entered in a database.

Endoscopic assessment of failed fundoplication: a case for standardization.

Background: Preoperative endoscopic assessment of the failed fundoplication is instrumental in diagnosis and surgical management. Endoscopy is a routine and essential part of the workup for a failed fundoplication, but no clear guidelines exist for reporting endoscopic findings. This study aimed to compare endoscopic findings reported by community physicians (gastroenterologists and surgeons) with the findings of the authors (esophageal center) for patients who underwent reoperative intervention after a previous antireflux procedure.

Initial experience with Barrett's strip endoscopic mucosal excision: a new Barrett's excision device.

Background: Barrett's mucosa resection techniques are time consuming, often difficult to perform, and used with varying success. This report describes the authors' results with a new device and technique for strip endoscopic mucosal resection (SEMR) using a cold excision blade.

Methods: A retrospective review of ex vivo and in vivo animal and human esophagi experiments was conducted to develop the essential design characteristics of a transoral strip mucosal excision device.

Relationship between manometric findings and reported symptoms in nutcracker esophagus: insights gained from a review of 313 patients.

Background: Nutcracker esophagus (NE) is a well-described esophageal motility disorder often implicated as the cause of chest pain (CP). The aim of this study was to analyze the role of peristaltic amplitude, lower esophageal sphincter (LES) pressure, and 24 h pH scores in patient symptomatology.

Methods: After obtaining Institutional Review Board approval, a retrospective review of manometric data from 1984 to 2008 at the esophageal center was done to identify patients meeting NE criteria (mean distal esophageal body amplitude of >180 mmHg).

Good training allows excellent results for laparoscopic Nissen fundoplication even early in the surgeon's experience.

Background: Laparoscopic antireflux surgery is the gold standard for surgical treatment of gastroesophageal reflux disease (GERD), and a well-defined learning curve for the procedure has been described. This study aimed to assess whether the surgeon's experience has an effect on 1-year symptom scores and patient satisfaction.

Methods: All the patients who underwent antireflux surgery were entered into a prospectively maintained database including 1-year postoperative symptom scores.

Initial experience with new intraluminal devices for GERD, Barrett's esophagus, and obesity.

Background: Transoral intraluminal surgery is less painful. However, endoscopic antireflux procedures have been unsuccessful, endoscopic foregut mucosal excision procedures are often difficult to perform, and endoscopic intra-luminal suturing is both imprecise and too shallow. We have endeavored to correct these deficiencies and report here new devices for GERD, obesity, and Barrett's mucosal excision.

Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series.

Background: Primary laparoscopic hiatal hernia repair is associated with up to a 42% recurrence rate. This has lead to the use of mesh for crural repair, which has resulted in an improved recurrence rate (0-24%). However, mesh complications have been observed.

Preoperative predictability of the short esophagus: endoscopic criteria.

Background: Short esophagus is a common cause of failure of antireflux surgery. Minimally invasive intervention for short esophagus is technically difficult. Reliable predictors of short esophagus would allow appropriate referral and better outcomes.

A study of intragastric and intravesicular pressure changes during rest, coughing, weight lifting, retching, and vomiting.

Background: In patients undergoing a variety of procedures, surgical success is in part dependent on maintaining normal intra-abdominal pressure in the immediate postoperative period. Our objective was to quantify intragastric and intravesicular pressures during activities, through the use of manometry catheters.

Methods: Ten healthy volunteers had a manometry catheter placed transnasally, and a urinary Foley catheter placed.

Anatomy of NOTES gastrotomy in human tissue.

Background: Transoral natural orifice translumenal endoscopic surgery (NOTES) procedural success depends on a secure gastrotomy closure. Balloon gastrotomy is the most common technique to date, but the stomach-layer defect sizes and their relationship in human tissue has not been determined.

Methods: Ten 2-cm diameter controlled radial expansion balloon gastrotomies were performed in ex vivo human tissue.

Use of temporary esophageal stent in management of perforations after benign esophageal surgery.

Successful conservative management in 3 patients with catastrophic postoperative esophageal leak after nonresection surgery is presented. In each case, the placement of removable stent played a significant role. First patient had persistent leak after primary repair of intrathoracic esophageal perforation.

Collagen metabolism and recurrent hiatal hernia: cause and effect?

Hiatus hernia (HH) is a condition characterized by herniation of the intra-abdominal organs into the thorax. Of the several types that have been identified, the most common is type I (sliding) HH. Congenital predisposition and acquired factors, for example trauma and iatrogeny, have been identified as causative factors.

Repair of 104 failed anti-reflux operations.

Objective: To assess whether reoperative surgery for failed Nissen fundoplication is beneficial and to classify all mechanisms of failure recognized.

Summary Background Data: Antireflux surgery is often necessary, but a 10% failure rate is commonplace. We report results for patients undergoing reoperative surgery and present a nomenclature of mechanisms of failure.

Endoscopic therapies of gastroesophageal reflux disease.

The high prevalence of gastroesophageal reflux disease (GERD) in Western societies has accelerated the need for new modalities of treatment. Currently, medical and surgical therapies are widely accepted among patients and physicians. New potent antisecretory drugs and the development of minimally invasive surgery for the management of GERD are at present the pivotal and largely accepted approaches to treatment.

Surgical repair of recurrent hiatal hernia.

The surgical management results of recurrent hiatal hernia repair are unknown in the laparoscopic era. The experience of the senior authors (CJF) and (SKM) is reported herein. From 1993 to 2004, 52 patients underwent re-operative hiatal hernia surgery at our center.

Assessment of diaphragmatic stressors as risk factors for symptomatic failure of laparoscopic nissen fundoplication.

An important limitation of antireflux surgery is a 5%-10% failure rate. We investigated the correlation between various diaphragm stressors and failure of antireflux surgery. Forty-one study cases who underwent a reoperative antireflux operation from 1997 to 2001 and 50 control patients who had undergone a successful laparoscopic Nissen fundoplication during the same period without clinical or symptomatic evidence of failure were randomly selected for comparison.

A long-term comparison of plication configurations for endoluminal gastroplication: circumferential versus helical.

Goals: To determine the long-term efficacy of endoluminal gastroplication (ELGP) and the most effective plication configuration.

Background: Endoluminal gastroplication is an intriguing therapy for gastroesophageal reflux disease. We conducted a retrospective review of a prospective experience of patient cohorts comparing outcomes of the circumferential and helical plication patterns.