Long-term follow-up after meshectomy with acellular human dermis repair for postherniorrhaphy inguinodynia.

Hypothesis: Direct inguinal hernia repair with acellular human dermis (AHD) may offer greater symptom improvement and lower risk of hernia recurrence than anatomical repair without mesh (AWM) after mesh removal (with or without neurectomy) for postherniorrhaphy inguinodynia.

Design: Retrospective cohort study with long-term follow-up.

Setting: Tertiary referral center for mesh inguinodynia.

Laparoscopic gastric bypass: risks vs. benefits up to two years following surgery in super-super obese patients.

Background: Super-super obesity (body mass index [BMI] >/= 60 kg/m(2)) is thought to be a risk factor for complications and mortality in laparoscopic Roux-en-Y gastric bypass. Excess weight loss has been demonstrated to be diminished compared with less obese patients following surgery. However, we hypothesize that super-super obese patients who undergo laparoscopic gastric bypass can realize major improvements in their health and a good quality of life without a significantly increased risk of complications when compared with less obese patients.

The role of intraoperative parathyroid hormone testing in patients with tertiary hyperparathyroidism after renal transplantation.

Background: Intraoperative parathyroid hormone (PTH) testing has been shown to accurately define adequacy of parathyroid resection in patients with primary hyperparathyroidism (HPT) and alters the operative management in 10% to 15% of cases. However, the benefit of this technique in patients with tertiary HPT after renal transplantation undergoing parathyroidectomy is unclear.

Methods: Intraoperative PTH was measured in 32 consecutive patients undergoing parathyroidectomy for tertiary HPT after renal transplantation between March 2001 and November 2004 by using the Elecsys assay at baseline and, subsequently, 5, 10, and 15 minutes after curative resection.

Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy.

Background: Intraoperative parathyroid hormone (iPTH) testing often is used during minimally invasive parathyroidectomy for primary hyperparathyroidism (1 degrees HPT). However, several investigators report that these assays are not cost effective and do not improve outcomes significantly.

Methods: To determine the impact of iPTH testing on the outcomes of patients with 1 degrees HPT, we reviewed our experience.

A 25-year single institution analysis of health, practice, and fate of general surgeons.

Objective: The objective of this study was to analyze nearly 3 decades of surgical residents from an established training program to carefully define individual outcomes on personal and professional health and practice satisfaction.

Summary Background Data: A paucity of data exists regarding the health and related practice issues of surgeons post-residency training. Despite several studies examining surgeon burnout and alcohol dependency problems, there have been no detailed reports defining health problems in practicing surgeons or preventive health patterns in this physician population.

A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable?

Objective: To determine the utility of several perioperative adjuncts for parathyroid localization during parathyroid surgery, we prospectively compared the accuracy of sestamibi-single photon emission computed tomography (SPECT) scanning, radioguided surgery, and intraoperative parathyroid hormone (ioPTH) testing.

Summary And Background Data: Minimally invasive parathyroidectomy (MIP) is rapidly becoming the procedure of choice in patients with primary hyperparathyroidism (HPT). Several perioperative adjuncts can be used to localize parathyroid adenomas, including sestamibi-SPECT scanning, radioguided surgery, and ioPTH testing.

Changing trends for surgery in elderly patients with hyperparathyroidism at a single institution.

Background: Many elderly patients with primary hyperparathyroidism (1HPT), which increases in incidence with age and is frequently asymptomatic, are often not referred for surgery. However, the development of minimally invasive techniques has facilitated complex operations even in the elderly. Therefore, we sought to delineate the changes in the trends for surgical referral at our institution for patients over 70 years of age with 1HPT.

Laparoscopic gastric bypass results in decreased prescription medication costs within 6 months.

The prevalence of obesity has reached epidemic proportions. The treatment of obesity-related health conditions is costly. Although laparoscopic gastric bypass is expensive, health care costs in obese patients should decrease with subsequent weight loss and overall improved health.

Lessons learned from the first 100 cases in a new minimally invasive bariatric surgery program.

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a technically demanding procedure with a steep learning curve. Experienced laparoscopic surgeons and bariatric surgeons can learn from the outcomes and complications of their initial experience in LRYGBP.

Methods: Between August of 2002 and July of 2003, we performed our first 100 LRYGBPs.

Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism.

Background: To date there have been no reports on the feasibility of radioguided parathyroidectomy (RGP) in patients with secondary and tertiary hyperparathyroidism.

Methods: Twenty-three consecutive patients with secondary (n=5) or tertiary hyperparathyroidism (n=18) underwent RGP. Patients were injected with 10 mCi of technetium 99-sestamibi before surgery.

Radioguided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands.

Objective: To determine the utility of radioguided parathyroidectomy for patients with hyperparathyroidism, we studied the properties of 180 resected, hyperfunctioning parathyroid glands.

Summary And Background Data: Radioguided resection of hyperfunctioning parathyroid glands has been shown to be technically feasible in patients with parathyroid adenomas. Radioguided excision may obviate the need for intraoperative frozen section because excised parathyroid adenomas uniformly have radionuclide ex vivo counts >20% of background.

Long-term follow-up of patients with tertiary hyperparathyroidism treated by resection of a single or double adenoma.

Objective: To determine whether patients with tertiary hyperparathyroidism due to single- or two-gland disease undergoing limited resection have similar long-term outcomes compared with patients with hyperplasia undergoing subtotal or total parathyroidectomy.

Summary Background Data: Tertiary hyperparathyroidism occurs in less than 2% of patients after renal transplantation. Approximately 30% of these cases are caused by one or two hyperfunctioning glands.

Peritoneography (herniography) for detecting occult inguinal hernia in patients with inguinodynia.

Objective: To evaluate the usefulness of peritoneography in patients referred with inguinal pain (inguinodynia) and clinically absent inguinal hernia on physical examination.

Summary Background Data: In patients with chronic groin pain, peritoneography is a seldom-used yet available technique that can detect an occult inguinal hernia. The value of peritoneography in the diagnosis of occult inguinal hernia has been previously shown.