Teaching endoscopic management of gastrointestinal hemorrhage using a modular simulation curriculum.

Background: As flexible endoscopy is increasingly adopted as a minimally invasive approach to surgical challenges, an efficient curriculum is needed to train surgeons in therapeutic endoscopy. We developed a simulation-based approach to teaching endoscopic management of gastrointestinal hemorrhage as part of a modular curriculum, complete with task performance pre- and post-testing.

Methods: Two sessions of our advanced flexible endoscopy course were taught using ex vivo porcine models to simulate active gastrointestinal hemorrhage and allow for training in hands-on endoscopic management.

A 13-year experience with biologic and biosynthetic absorbable mesh reinforced laparoscopic paraesophageal hernia repair.

Background: Mesh reinforced cruroplasty during laparoscopic paraesophageal hernia repair remains controversial due to wide variation in surgical technique and mesh composition. This study aims to review outcomes and rates of recurrence following laparoscopic paraesophageal hernia repair (LPEHR) with mesh reinforced cruroplasty utilizing absorbable mesh at a single institution.

Methods: A retrospective review of all patients who underwent LPEHR with mesh was performed.

Experience with Impedance Planimetry for Surgical Foregut Disease in 1,097 Cases.

Background: The geometry and compliance of gastrointestinal sphincters may be assessed by impedance planimetry using a functional lumen imaging probe (FLIP). We describe our institutional foregut surgeon experience using FLIP in 1,097 cases, highlighting instances where FLIP changed operative decision making.

Study Design: A retrospective review of an IRB-approved prospective quality database was performed.

Patient-reported outcomes in 645 patients after laparoscopic fundoplication up to 10 years.

Background: Laparoscopic fundoplication is the gold-standard surgical management for gastroesophageal reflux disease. Optimal patient outcomes include resolution of symptoms with minimal postoperative side effects of dysphagia or gas-bloat. This study aims to review outcomes at a single institution up to 10 years after surgery.

Identification of 14 novel susceptibility loci for diaphragmatic hernia development and their biological and clinical implications: results from the UK Biobank.

Introduction: Genetic contributions to hernia development are incompletely understood. This study performed the first comprehensive genome-wide association study (GWAS) for diaphragmatic hernia using a large population-based cohort in the UK Biobank (UKB).

Methods And Procedures: Two-stage GWAS (discovery and confirmation) was performed for diaphragmatic hernia in the UKB.

Impedance Planimetry (Endoflip) and Ideal Distensibility Ranges for Optimal Outcomes after Nissen and Toupet Fundoplication.

Background: Previous research has shown that impedance planimetry-based functional lumen imaging probe (FLIP) measurements are associated with patient-reported outcomes after laparoscopic antireflux surgery. We hypothesize that Nissen and Toupet fundoplications have different ideal FLIP profiles, such as distensibility.

Study Design: A retrospective review of a prospectively maintained quality database was performed.

Esophagogastric junction compliance on impedance planimetry (EndoFLIP™) following peroral endoscopic myotomy (POEM) predicts improvement in postoperative eckardt score.

Background: Peroral endoscopic myotomy (POEM) is a mainstay of treatment for achalasia. Tailored myotomy based on compliance, as measured with impedance planimetry (FLIP), has yet to be described. In this study we describe the associations between Eckardt score, postoperative GERD, and compliance.

"Into the fire" approach to teaching endoscopic foreign body removal using a modular simulation curriculum.

Background: As flexible endoscopy becomes an increasingly valuable minimally invasive approach to surgical challenges, an efficient and comprehensive training curriculum is needed to train surgeons in therapeutic endoscopy. We developed a modular curriculum utilizing a simulation-based, "into the fire" approach to endoscopic foreign body removal for practicing physicians with task performance pre- and post-testing.

Methods: From 2020 to 2021, two sessions of our advanced flexible endoscopy course were taught by two expert surgical endoscopists using ex-vivo porcine models.

Changes in impedance planimetry (EndoFLIP) measurements at follow-up after peroral endoscopic myotomy (POEM).

Background: Numerous studies show changes in functional lumen imaging probe (FLIP) measurements after myotomy during peroral endoscopic myotomy (POEM), but few report on FLIP measurements at follow-up esophagogastroduodenoscopy (EGD). The purpose of this study was to compare perioperative FLIP measurements to those at follow-up EGD.

Methods: Patients who underwent POEM with FLIP in the operating room and POEM patients who had EGD with FLIP at follow-up were included.

Impedance planimetry (EndoFLIP™) after magnetic sphincter augmentation (LINX®) compared to fundoplication.

Introduction: Functional luminal imaging probe (FLIP) use during laparoscopic fundoplication (LF) for gastroesophageal reflux disease is well described. However, there is a lack of data on FLIP measurements during magnetic sphincter augmentation (MSA). This study aims to report our institutional experience in performing FLIP during MSA and to compare these measurements to those obtained during Nissen and Toupet fundoplication.

Patient-reported bowel and bladder function is not adversely impacted by bariatric surgery.

Introduction: This study aims to assess the effect of bariatric surgery on patient-reported outcomes of bowel and bladder function. We hypothesized that bariatric surgery does not worsen bowel and bladder function.

Methods And Procedures: A retrospective review was conducted of a prospectively maintained surgical quality database.

A modular simulation curriculum to teach endoscopic stenting to practicing surgeons: an "Into the fire" approach.

Background: Flexible endoscopy is a valuable tool for the gastrointestinal (GI) surgeon, creating a need for effective and efficient training curricula in therapeutic endoscopic techniques for trainees and practicing providers. Here, we present a simulation-based modular curriculum using an "into the fire" approach with hands-on pre- and post-testing to teach endoscopic stenting to practicing surgeons.

Methods: Three advanced flexible endoscopy courses were taught by expert surgical endoscopists from 2018 to 2019.

Impedance planimetry (EndoFLIP™) reveals changes in gastroesophageal junction compliance during fundoplication.

Introduction: Compliance is the ability of a hollow organ to dilate and increase volume with an increase in pressure, an accurate representation of food bolus transit through the gastroesophageal junction (GEJ). Impedance planimetry system can calculate compliance (change in volume over pressure) and distensibility (cross-sectional area over pressure) of the GEJ. We aim to describe the changes in compliance during anti-reflux surgery and hypothesize that compliance is a better predictor of patient outcomes than distensibility (DI).

Impedance planimetry (EndoFLIP) measurements persist long term after anti-reflux surgery.

Purpose: The functional lumen imaging probe provides objective measurements of the gastroesophageal junction during laparoscopic anti-reflux surgery. There is a lack of data on how functional lumen imaging probe measurements change at follow-up. We aim to describe our institutional experience in performing functional lumen imaging probe during postoperative endoscopy after laparoscopic anti-reflux surgery.

Impedance Planimetry (Endoflip™) Shows That Length of Narrowing After Fundoplication Does Not Impact Dysphagia.

Introduction: A short floppy fundoplication has been the surgical dogma to prevent dysphagia and gas-bloat after laparoscopic fundoplication while adequately addressing gastroesophageal reflux disease. The literature on the ideal length of narrowing (LON) of the gastroesophageal junction after fundoplication is sparse. The functional luminal imaging probe (FLIP) can be used during anti-reflux surgery to produce a visual representation of the LON.

Association of Fundamentals of Laparoscopic Surgery Certification With Outcomes of Laparoscopic Cholecystectomy Performed by Surgical Residents.

This study examines outcomes of laparoscopic cholecystectomies performed by surgical residents before and after mandatory implementation of Fundamentals of Laparoscopic Surgery certification to assess whether certification is associated with residence performance or patient outcome.

A Systematic Review and Meta-Analysis of the Data Behind Current Recommendations for Corticosteroids in Non-HIV-Related PCP: Knowing When You Are on Shaky Foundations.

Background: Randomized trials show a mortality benefit to adjunctive corticosteroids for human immunodeficiency virus (HIV)-related pneumonia (HIV-PCP). Guidelines for non-HIV PCP (NH-PCP) recommend adjunctive corticosteroids based on expert opinion. We conducted a systematic review and meta-analysis characterizing adjunctive corticosteroids for NH-PCP.

Significance of Blunted Venous Waveforms Seen on Upper Extremity Ultrasound.

Background: Current guidelines recommend vascular mapping ultrasound (US) prior to arteriovenous fistula creation. Blunted venous waveforms (BVWs) suggest central venous stenosis; however, this relationship and one between BVWs and the presence of a central venous catheter (CVC) remain unclear.

Methods: All patients who received upper extremity vascular mapping US between January 2013 and October 2014 at a single institution were retrospectively reviewed.

Use of digital health kits to reduce readmission after cardiac surgery.

Background: Unintended rehospitalizations after surgical procedures represent a large percentage of readmissions and have been associated with increased morbidity and cost of care. Beginning in 2017, Medicare will expand diagnostic categories subject to financial penalties for excess postoperative readmissions to include coronary revascularization procedures. Arrhythmias and pulmonary complications comprise the largest categories for readmission after cardiac surgery.

Impact of an Institutional Antimicrobial Stewardship Program on Bacteriology of Surgical Site Infections in Cardiac Surgery.

Background: Surgical site infections (SSIs) occur in 1% to 4% of cardiac surgery patients and are associated with significantly reduced survival. The present study evaluated trends in the incidence and bacteriology of SSIs before and after the implementation of an antimicrobial stewardship program.

Methods: Starting in 2010, our institution utilized a protocol that included daily chlorhexidine baths, and strict cessation of prophylactic antibiotics after 48 hours.