Laparoscopic Splenectomy for Trauma.

Background And Objectives: The use of laparoscopy in the trauma setting is gaining momentum, with more therapeutic procedures being performed. We evaluated the use of laparoscopic splenectomy among trauma patients with data from the National Trauma Database. We compared outcomes for trauma patients undergoing laparoscopic (LS) versus open splenectomy (OS).

Non-operative management of adhesive small bowel obstruction: Should there be a time limit after which surgery is performed?

The management of adhesive small bowel obstruction (ASBO) has evolved from "the sun should not rise and set on a small bowel obstruction", implying mandatory immediate surgical exploration to selective non-operative management. Not every patient with adhesive small bowel obstruction meets criteria for non-operative management and treating all comers the same way can lead to catastrophic outcomes. Water Soluble Contrast Medium (WSCM) has important diagnostic and therapeutic utility in the management of ASBO and should be employed ab initio.

Laparoscopic Repair of Diaphragmatic Rupture: A Case Report with Radiological and Surgical Correlation.

The leading cause of diaphragmatic rupture is penetrating abdominal trauma, including gunshot- and stab-related wounds; however, diaphragmatic rupture can also result from blunt trauma to the abdomen. The diagnosis can be difficult to make as the physical examination may be unremarkable, and imaging, that is, a conventional chest X-ray and/or CT imaging, may initially fail to reveal the injury. Failure to recognize diaphragmatic rupture can result in a delayed presentation, sometimes years later, with a potential catastrophic outcome.

Percutaneous Gastrostomy Device for the Treatment of Class II and Class III Obesity: Results of a Randomized Controlled Trial.

Objectives: The AspireAssist System (AspireAssist) is an endoscopic weight loss device that is comprised of an endoscopically placed percutaneous gastrostomy tube and an external device to facilitate drainage of about 30% of the calories consumed in a meal, in conjunction with lifestyle (diet and exercise) counseling.

Methods: In this 52-week clinical trial, 207 participants with a body-mass index (BMI) of 35.0-55.

Bariatric surgery outcomes in black patients with super morbid obesity: a 1-year postoperative review.

Background: Super morbid obesity (body mass index [BMI] > 50 kg/m) is associated with significant comorbidities and is disparagingly prevalent among the black population. There is paucity of data regarding bariatric surgery outcomes among super morbid obese (SMO) blacks. Our aim is to evaluate the reduction in weight and resolution of comorbidities after bariatric surgery among SMO black patients at an urban academic institution.

Revision of Roux-En-Y Gastric Bypass for Weight Regain: a Systematic Review of Techniques and Outcomes.

Background: Weight regain has led to an increase in revision of Roux-en-Y gastric bypass (RYGB) surgeries. There is no standardized approach to revisional surgery after failed RYGB. We performed an exhaustive literature search to elucidate surgical revision options.

Race and socioeconomic disparities in national stoma reversal rates.

Background: Many temporary stomas are never reversed leading to significantly worse quality of life. Recent evidence suggests a lower rate of reversal among minority patients. Our study aimed to elucidate disparities in national stoma closure rates by race, medical insurance status, and household income.

Body mass index in blunt trauma patients with hemorrhagic shock: opposite ends of the body mass index spectrum portend poor outcome.

Background: There are controversial data on the relationship between trauma and body mass index. We investigated this relationship in traumatic hemorrhagic shock.

Methods: The "Glue Grant" database was analyzed, stratifying patients into underweight, normal weight (NW), overweight, Class I obesity, Class II obesity, and Class III obesity.

The sleepy surgeon: does night-time surgery for trauma affect mortality outcomes?

Background: Sleepiness and fatigue affect surgical outcomes. We wished to determine the association between time of day and outcomes following surgery for trauma.

Methods: From the National Trauma Data Bank (2007 to 2010), we analyzed all adults who underwent an exploratory laparotomy between midnight and 6 am or between 7 am and 5 pm.

Laparoscopic surgery for trauma: the realm of therapeutic management.

Background: The use of laparoscopy in trauma is, in general, limited for diagnostic purposes. We aim to evaluate the therapeutic role of laparoscopic surgery in trauma patients.

Methods: We analyzed the National Trauma Data Bank (2007 to 2010) for all patients undergoing diagnostic laparoscopy.

Optimal time for early laparoscopic cholecystectomy for acute cholecystitis.

Importance: There is growing evidence in support of performing early laparoscopic cholecystectomy (LC) for acute cholecystitis. However, the definition of early LC varies from 0 through 10 days depending on the research protocol. The optimum time to perform early LC is still unclear.

Late presentation of subcutaneous emphysema and pneumomediastinum following elective tonsillectomy.

Subcutaneous emphysema and pneumomediastinum are rare complications following elective tonsillectomy. Although the mechanism of injury is unclear, air is thought to enter through either the buccopharyngeal mucosa during surgery or via alveolar rupture during positive pressure ventilation. Patients typically present immediately after surgery or upon anesthesia emergence.

Ureteral injury after laparoscopic versus open colectomy.

Background And Objectives: Ureteral injury is an infrequent but potentially lethal complication of colectomy. We aimed to determine the incidence of intraoperative ureteral injury after laparoscopic and open colectomy and to determine the independent morbidity and mortality rates associated with ureteral injury.

Methods: We analyzed data from the National Surgical Quality Improvement Program for the years 2005-2010.

Is laparoscopy a risk factor for bile duct injury during cholecystectomy?

Background And Objectives: Previously, risk factors for bile duct injury have been identified as acute cholecystitis, male gender, older age, aberrant biliary anatomy, and laparoscopic cholecystectomy.

Methods: A retrospective analysis of the Nationwide Inpatient Sample from 1998 to 2006 was performed with an inclusion criterion of cholecystectomy performed on hospital day 0 or 1. Patient- and hospital-level factors potentially associated with bile duct injury were examined by logistic regression.

Open versus laparoscopic hiatal hernia repair.

Background: The literature reports the efficacy of the laparoscopic approach to paraesophageal hiatal hernia repair. However, its adoption as the preferred surgical approach and the risks associated with paraesophageal hiatal hernia repair have not been reviewed in a large database.

Method: The Nationwide Inpatient Sample dataset was queried from 1998 to 2005 for patients who underwent repair of a complicated (the entire stomach moves into the chest cavity) versus uncomplicated (only the upper part of the stomach protrudes into the chest) paraesophageal hiatal hernia via the laparoscopic, open abdominal, or open thoracic approach.

Resolution of Uncontrolled Type 2 Diabetes after Laparoscopic Truncal Vagotomy, Subtotal Gastrectomy, and Roux-en-Y Gastrojejunostomy for a Patient with Intractable Gastric Ulcers.

Background. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been shown to be an effective treatment for type 2 diabetes mellitus (T2DM) in patients with morbid obesity. However, it is unclear just how effective the LRYGB procedure is on T2DM for patients with BMI less than 35 kg/m(2).

Open reduction internal fixation versus hemiarthroplasty versus total hip arthroplasty in the elderly: a review of the National Surgical Quality Improvement Program database.

Background: Total hip arthroplasty (THA), hemiarthroplasty (HA), and open reduction internal fixation (ORIF) are treatment options for femoral neck fractures. However, the optimal surgical treatment remains unclear. The present study aimed to describe the 30-d postoperative outcomes of THA, HA, and ORIF among patients aged ≥65 y with femoral neck fractures within a national surgical database.

Gastric prolapse with pseudocysts following laparoscopic adjustable gastric banding.

Introduction: Laparoscopic adjustable gastric banding (LAGB) is a reversible method of surgical gastric restriction. Following LAGB, the adverse event most commonly necessitating subsequent reoperation is prolapse of the gastric corpus or fundus above the band. A review of the medical literature reveals no reports of nonpancreatic pseudocysts being associated with this adverse event.

Effective weight loss management with endoscopic gastric plication using StomaphyX device: is it achievable?

Background: Despite the effectiveness of Roux-en-Y gastric bypass (RYGB) in promoting excess weight loss, 40% of the patients regain weight. Endoscopic gastric plication (EGP) using the StomaphyX device can serve as a less-invasive procedure for promoting the loss of regained weight. Our objective was to evaluate the effectiveness of the StomaphyX device in sustaining ongoing weight loss in patients who have regained weight after RYGB at the Division of Minimally Invasive and Bariatric Surgery, Howard University Hospital.

Does BMI affect perioperative complications following total knee and hip arthroplasty?

Background: Orthopedic surgeons are reluctant to perform total knee (TKA) or hip (THA) arthroplasty on patients with high body mass index (BMI). Recent studies are conflicting regarding the risk of obesity on perioperative complications. Our study investigates the effect of BMI on perioperative complications in patients undergoing TKA and THA using a national risk-adjusted database.

Axillary sheath hematomas causing neurologic complications following arterial access.

Iatrogenic brachial plexus injuries secondary to expanding hematomas and pseudoaneurysms have been described in limited nature in previously published data. We present the case of a 55-year-old woman who developed neurologic deficits because of a compressive hematoma after axillary arteriography. She underwent emergent exploration of her left arm with decompression of the axillary sheath and brachial artery repair with complete recovery.

Laparoscopic gastric wedge resection for Dieulafoy's disease following preoperative endoscopic localization with India ink and endoscopic clips.

Background: Dieulafoy's lesion is a vascular malformation, usually of the stomach but occasionally of the small or large bowel. It is an uncommon, but clinically significant, source of upper gastrointestinal hemorrhage. Three cases have been reported in the literature of laparoscopic gastric wedge resection of these lesions by using intraoperative endoscopic localization.