Ventral hernia repair with permanent mesh for non-Hispanic black versus white patients: access and post-operative outcomes in the era of robotic surgery.

Background: Robotic ventral hernia surgery may provide better patient outcomes. Whether it is provided equitably based on race remains unknown.

Methods: We examined whether patients from the Abdominal Core Health Quality Collaborative who were Black had equitable access to robotic surgery for ventral hernia repair with permanent mesh compared to white counterparts from 2013 to 2023.

American society for metabolic and bariatric surgery: intra-operative care pathway for minimally invasive Roux-en-Y gastric bypass.

Background: Clinical care pathways help guide and provide structure to clinicians and providers to improve healthcare delivery and quality. The Quality Improvement and Patient Safety Committee (QIPS) of the American Society for Metabolic and Bariatric Surgery (ASMBS) has previously published care pathways for the performance of laparoscopic sleeve gastrectomy (LSG) and pre-operative care of patients undergoing Roux-en-Y gastric bypass (RYGB).

Objective: This current RYGB care pathway was created to address intraoperative care, defined as care occurring on the day of surgery from the preoperative holding area, through the operating room, and into the postanesthesia care unit (PACU).

Weight Nadir and Long-Term Weight Outcomes After Laparoscopic Sleeve Gastrectomy in a Diverse Cohort of Adolescents and Young Adults.

Introduction: Laparoscopic sleeve gastrectomy (LSG) is currently the most common bariatric procedure performed in adolescents and young adults in the United States (USA), but there are limited data available on long-term postoperative weight outcomes in these patients. This single-institution US study follows longitudinal weight data in a diverse group of patients undergoing LSG at age 25 years or younger.

Methods: We retrospectively reviewed records of all patients 25 years or younger who underwent LSG at our institution between 2013 and 2020.

Collateral Benefit of Systematic Improvement in Bariatric Surgery Outcomes Following a Single Quality Improvement Project for Bleeding.

The study's aim was not only to use quality improvement system techniques to improve patient care specifically for bleeding but also to track other adverse outcomes. Key drivers were identified and mapped to interventions, namely venous thromboembolism prophylaxis, root cause analysis, indications conference, and operative technique standardization. Bleeding was reduced by 88%, and overall postoperative complications also fell by 63%.

Correlating actual one-year weight loss with predicted weight loss by the MBSAQIP: bariatric surgical risk/benefit calculator.

Background: The American Society for Metabolic and Bariatric Surgery has released a Bariatric Surgical Risk/Benefit Calculator, an online tool with which patients and providers can input patient preoperative information and predict their 1-year weight loss. We seek to validate our institutional data with the national database and investigated patient factors that influence lack of treatment effect after bariatric surgery.

Materials And Methods: A retrospective review of all prospectively collected data of bariatric surgeries performed at Yale New Haven Hospital from 2017 to 2018 was conducted.

The omentum of obese girls harbors small adipocytes and browning transcripts.

Severe obesity (SO) affects about 6% of youth in the United States, augmenting the risks for cardiovascular disease and type 2 diabetes. Herein, we obtained paired omental adipose tissue (omVAT) and abdominal subcutaneous adipose tissue (SAT) biopsies from girls with SO undergoing sleeve gastrectomy (SG), to test whether differences in cellular and transcriptomic profiles between omVAT and SAT depots affect insulin sensitivity differently. Following weight loss, these analyses were repeated in a subgroup of subjects having a second SAT biopsy.

Measuring Uncertainty Intolerance in Surgical Residents Using Standardized Assessments.

Background: Physicians are frequently called on to make medical decisions despite being uncertain about the outcomes of these choices. The psychological stress associated with these dilemmas, known as "Uncertainty Intolerance" (UI), can significantly impact the quality of a physician's practice as well as their own mental health. Coping with uncertainty is an important competency that all residents must master, and some residency programs are introducing new education initiatives aimed at improving UI.

Intraoperative Blood Pressure Lability Is Associated with Postoperative Hemorrhage after Uncomplicated Bariatric Surgery.

Background: Postoperative hemorrhage is a rare complication in bariatric surgery. We aim to determine if differences in blood pressure or perioperative medication administration contribute to postoperative bleeding in patients who were hemodynamically stable intraoperatively.

Methods: This was a retrospective case-control study of all bariatric surgery patients from 2014 to 2017 at a high volume academic center.

Technical Feasibility of a Murine Model of Sleeve Gastrectomy with Ileal Transposition.

Background: Sleeve gastrectomy with ileal transposition has been shown to be superior to sleeve gastrectomy alone for promoting weight loss in rat and porcine models. The absence of a mouse model for this procedure has impeded efforts to understand the molecular physiology underlying its efficacy. This study demonstrates the long-term survivability of sleeve gastrectomy with ileal transposition in mice.

Gallbladder Agenesis: A Case Report.

Gallbladder agenesis (GA) is an extremely rare congenital entity. The incidence is around 1 per 6500 live births. The majority of patients, estimated between 50 to 70 percent, remain asymptomatic while those who are symptomatic report symptoms mimicking biliary colic.

Impact of preoperative wait time due to insurance-mandated medically supervised diets on weight loss after sleeve gastrectomy. Are patients losing momentum?

Background: Few studies have examined whether preoperative period length, as defined by the amount of time from enrollment in a surgical weight loss program to the day of surgery, affects postoperative weight loss.

Objectives: To identify associations between preoperative period length and postoperative weight loss.

Setting: Single surgeon at an academic medical center in the United States.

Two-Port Laparoscopic Cholecystectomy: 18 Patients Human Experience Using the Dynamic Laparoscopic NovaTract Retractor.

Objective: The concept of reducing the number of transabdominal access ports has been criticized for violating basic tenets of traditional multiport laparoscopy. Potential benefits of reduced port surgery may include decreased pain, improved cosmesis, less hernia formation, and fewer wound complications. However, technical challenges associated with these access methods have not been adequately addressed by advancement in instrumentations.

Combining disparate surgical residencies into one: lessons learned.

Background: Attitudes, career goals, and educational experiences of general surgery residents are profiled during the acquisition of a community residency program by an academic residency program.

Materials And Methods: The study population included all general surgery residents postgraduate years 2-5 in a tertiary academic medical center divided into community program matriculants (CPM) or academic program matriculants (APM). A survey compared perceptions before and after residency amalgamation in seven training categories as follows: relationships among residents, relationships with faculty, systems interactions, clinical training, surgical training, scholarship, and career plans.

The influence of surgeon personality factors on risk tolerance: a pilot study.

Objective: This study attempts to assess the association between surgeon personality factors (measured by the Myers-Briggs Type Indicator personality inventory (MBTI(®))) and risk tolerance (measured by the Revised Physicians' Reactions to Uncertainty (PRU) and Physician Risk Attitude (PRA) scales).

Design: Instrument assessing surgeon personality profile (MBTI) and 2 questionnaires measuring surgeon risk tolerance and risk aversion (PRU and PRA).

Setting: Saint Raphael campus of Yale New Haven Hospital in New Haven, Connecticut.

Magenstrasse and Mill gastroplasty and sleeve gastrectomy as treatment for morbid obesity.

Background: Laparoscopic nonbanded restrictive procedures are becoming more popular as staging and primary operations in bariatric surgery. The Magenstrasse and Mill (MM) procedure produces a restrictive gastric tubular pouch based along the lesser curvature; for the most part anatomy and physiology are preserved. In Sleeve Gastrectomy (SG), 80% of normal stomach is resected to produce restriction and to decrease ghrelin levels.

The impact of laparoscopy on the volume of open cases in general surgery training.

Objective: The purpose of this study was to evaluate the impact of laparoscopy on the volume of open cases in general surgery residency training over the past 10 years.

Design: The Accreditation Council for Graduate Medical Education (ACGME) database (1999-2008), which records all cases (by Current Procedural Terminology code) performed by graduating general surgery trainees, was retrospectively analyzed.

Setting: ACGME database (1999-2008).

Early postoperative hemorrhage after open and laparoscopic roux-en-y gastric bypass.

Background: Early postoperative hemorrhage is an infrequent complication of both laparoscopic and open Roux-en-Y gastric bypass (RYGBP). The objective of our study is to review the incidence and management of this complication and identify contributing clinical and technical risk factors.

Methods: Over a 3-year period, 1,025 patients underwent RYGBP at our institution.

How do family practitioners perceive surgery for the morbidly obese?

Background: Little is known about the level of knowledge and comfort with bariatric surgery among family practice physicians.

Methods: Surveys were sent to all family practitioners in Connecticut querying the practice type and knowledge of bariatric surgery. The results were analyzed for the prevalence of opinion.

Clinical pulmonary embolus after gastric bypass surgery.

Background: Pulmonary embolus (PE) is one of the most common causes of death for patients undergoing gastric bypass surgery. The risk of developing PE has been associated with increased age, greater body mass index (BMI), and chronic venous stasis disease.

Methods: Between 1998 and 2003, 1225 patients underwent open Roux-en-Y gastric bypass (RYGBP) surgery (258 men and 967 women) for the treatment of morbid obesity and its related disorders.

Totally robotic laparoscopic Roux-en-Y Gastric bypass: results from 75 patients.

Background: A technique for Totally Robotic Laparoscopic Roux-en-y Gastric Bypass (TRL-RYGBP) has been reported previously. In this paper, we report our experience with our first 75 TRLRYGBP operations, including the training of three laparoscopic fellows. We describe changes in technique that have evolved with more experience, lessons learned, and the results from a larger series.

Totally robotic Roux-en-Y gastric bypass.

Hypothesis: We hypothesized that we could develop a safe and effective technique for performing a totally robotic laparoscopic Roux-en-Y gastric bypass procedure using the da Vinci surgical system. We anticipated that the learning curve for this totally robotic procedure could be shorter than the learning curve for standard laparoscopic bariatric surgery.

Design: Retrospective case comparison study.