Effect of reversible intermittent intra-abdominal vagal nerve blockade on morbid obesity: the ReCharge randomized clinical trial.

Importance: Although conventional bariatric surgery results in weight loss, it does so with potential short-term and long-term morbidity.

Objective: To evaluate the effectiveness and safety of intermittent, reversible vagal nerve blockade therapy for obesity treatment.

Design, Setting, And Participants: A randomized, double-blind, sham-controlled clinical trial involving 239 participants who had a body mass index of 40 to 45 or 35 to 40 and 1 or more obesity-related condition was conducted at 10 sites in the United States and Australia between May and December 2011.

Personalized identification of abdominal wall hernia meshes on computed tomography.

An abdominal wall hernia is a protrusion of the intestine through an opening or area of weakness in the abdominal wall. Correct pre-operative identification of abdominal wall hernia meshes could help surgeons adjust the surgical plan to meet the expected difficulty and morbidity of operating through or removing the previous mesh. First, we present herein for the first time the application of image analysis for automated identification of hernia meshes.

Preoperative risk reduction: strategies to optimize outcomes.

The success of hernia repair is measured by absence of recurrence, appearance of the surgical scar, and perioperative morbidity. Perioperative surgical site occurrence (SSO), defined as infection, seroma, wound ischemia, and dehiscence, increases the risk of recurrent hernia by at least 3-fold. The surgeon should optimize all measures that promote healing, reduce infection, and enhance early postoperative recovery.

Mesh choice in ventral hernia repair: so many choices, so little time.

Background: Currently, >200 meshes are commercially available in the United States. To help guide appropriate mesh selection, the investigators examined the postsurgical experiences of all patients undergoing ventral hernia repair at their facility from 2008 to 2011 with ≥12 months of follow-up.

Methods: A retrospective review of prospectively collected data was conducted.

Distribution of 10-year and lifetime predicted risk for cardiovascular disease prior to surgery in the longitudinal assessment of bariatric surgery-2 study.

Primary prevention guidelines recommend calculation of lifetime cardiovascular disease (CVD) predicted risk in patients who may not meet criteria for high short-term (10-year) Adult Treatment Panel III risk for coronary heart disease (CHD). Extreme obesity and bariatric surgery are more common in women who often have low short-term predicted CHD risk. The distribution and correlates of lifetime CVD predicted risk, however, have not yet been evaluated in bariatric surgical candidates.

Factors in selecting the optimal bariatric procedure for a specific patient and parameters by which to measure appropriate response to surgery.

Bariatric operations are increasingly being used to induce weight loss and ameliorate or cure most of the morbidities that accompany obesity. These procedures not only produce substantial weight loss (>50% body weight), but they cure or ameliorate the comorbidities (diabetes type 2, hypertension, sleep apnea, hyperlipidemia) in the vast majority of patients. These procedures can usually be performed laparoscopically with a mortality of less than 0.

Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States: a plea for outcome-based and not volume-based referral guidelines.

Hypothesis: There is an effect of patient and hospital characteristics on perioperative outcomes for pancreatic resection in the United States.

Design: Retrospective cohort study.

Setting: Academic research.

Reconstruction of complex abdominal wall hernias using acellular human dermal matrix: a single institution experience.

Background: Acellular human dermal matrix (AHDM) has mechanical properties suitable for complex abdominal wall reconstructions and physiologic properties that allow more resistance to infection in contaminated fields. The purpose of this study was to determine which patient and technical factors lead to optimal surgical outcomes.

Methods: A retrospective review was conducted of 144 abdominal wall reconstructions using AHDM over a 33-month period.

Demographic and socioeconomic trends in the use of laparoscopic appendectomy from 1997 to 2003.

Background: Because there is conflicting evidence regarding the benefits of laparoscopic appendectomy, we hypothesized that there would be measurable differences in its use among various socioeconomic groups and geographic areas.

Methods: The Nationwide Inpatient Sample was queried for appendectomies performed between the years of 1997 and 2003. Rates of laparoscopic appendectomy were compared among hospital subtypes and demographic groups.

Revisional bariatric surgery for failed restrictive procedures.

Background: Revisional bariatric surgery is increasing in frequency, but the morbidity and efficacy have not been well defined. The primary aim of this study was to determine the clinical efficacy with respect to weight loss, and associated morbidity, of revisional bariatric surgery in an academic university hospital bariatric surgery program.

Methods: A retrospective review of all patients who underwent revisional bariatric surgery for failed primary restrictive procedures, including gastroplasty and gastric bypass, but not including gastric banding or malabsorptive procedures, during a 10-year period at a single university hospital was performed.

Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing's disease: a 10-year experience.

Objective: To determine long-term quality of life after bilateral adrenalectomy for persistent Cushing's disease after transsphenoidal pituitary tumor resection.

Summary Background Data: Bilateral adrenalectomy for symptomatic relief of persistent hypercortisolism appears to be an effective treatment option. However, few studies have examined long-term outcomes in this patient population.

Aggressive pancreatic resection for primary pancreatic neuroendocrine tumor: is it justifiable?

Background: Benign and malignant pancreatic neuroendocrine tumors (PNETs) are rare, and long-term outcome is generally poor without surgical intervention. The aim of the study was to assess whether aggressive pancreatic resection is justifiable for patients with PNET.

Methods: All consecutive patients who had undergone major pancreatic resection from January 1997 through January 2005 were reviewed and analyzed.

Perioperative morbidity associated with bariatric surgery: an academic center experience.

Hypothesis: As the demand for bariatric surgery increases, it becomes increasingly important to define predictors of morbidity and mortality. We hypothesize that specific clinical variables predict postoperative morbidity after bariatric surgery.

Design, Setting, And Patients: This is a retrospective review of 452 patients undergoing inpatient bariatric surgery at an academic tertiary care institution.

Gastro-gastric fistula in the era of divided Roux-en-Y gastric bypass: strategies for prevention, diagnosis, and management.

Roux-en-Y gastric bypass (RYGBP) is a mainstay of bariatric surgical therapy. Gastro-gastric fistula (GGF) is an infrequent but potentially serious complication of gastric bypass, and diagnosis may be difficult. We report two patients who underwent RYGBP complicated by development of GGF who nevertheless achieved excellent, durable weight loss.

Common channel length predicts outcomes of biliopancreatic diversion alone and with the duodenal switch surgery.

Background: The optimal common channel (CC) length for malabsorptive weight loss surgeries is unknown even though these surgeries were developed in the 1970s (biliopancreatic diversion [BPD]) and the 1990s (biliopancreatic diversion with a duodenal switch [BPD DS]). We hypothesized that the length of the CC correlates with a successful weight loss result.

Methods: We evaluated 3 groups of patients based on the length of the CC whose duration of follow-up evaluation was at least 1 year.

Bismuth subsalicylate increases intracellular Ca2+, MAP-kinase activity, and cell proliferation in normal human gastric mucous epithelial cells.

Clinical and laboratory studies have shown that bismuth subsalicylate (BSS) is helpful in the healing of gastric ulcers because of the bactericidal effects of bismuth (Bi3+) on H. pylori. Bismuth or BSS has also been reported to possess other nonbactericidal or "gastroprotective" effects in the stomach.

Roux-en-Y divided gastric bypass results in the same weight loss as duodenal switch for morbid obesity.

Background: The 2 weight loss procedures most commonly performed in the United States are Roux-en-Y gastric bypass (RYGBP) and lateral gastrectomy with duodenal switch (BPD/DS). RYGB is a restrictive procedure, whereas BPD/DS relies on mild restriction of intake as well as malabsorption. Many physicians believe that weight loss is greater after BPD/DS than after RYGBP.

Delayed celiotomy for the treatment of bile leak, compartment syndrome, and other hazards of nonoperative management of blunt liver injury.

Background: Management of blunt liver injury is predominantly nonoperative. However, complications occur in 10% to 25% of patients, with half taking place more than 24 hours after injury. Few reports have addressed the management of the new pattern of these delayed complications, which is the objective of this study.