Perioperative management of cholelithiasis in patients presenting for laparoscopic Roux-en-Y gastric bypass: have we reached a consensus?

Obesity and rapid weight loss after bariatric surgery is associated with, the development of cholelithiasis and related complications. Several algorithms have been suggested in the management of the asymptomatic gallstones in patients presenting for weight loss surgery (WLS). Charts of patients presenting for laparoscopic Roux-en-Y (LRYGB) were retrospectively reviewed.

Endoscopic retrograde cholangiopancreatography after laparoscopic Roux-en-Y gastric bypass: a case series and review of the literature.

Endoscopic retrograde cholangiopancreatography (ERCP) has become an important tool in the diagnosis and treatment of pancreaticobiliary pathology. ERCP in patients that have undergone Roux-en-Y gastric bypass (RYGB) is particularly challenging because traditional transoral endoscopy may be limited. We present our experience with ERCP after RYGB and review the literature.

Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass.

Background: Early reports described adverse perinatal outcomes of pregnancies after weight loss surgery (WLS), which subsequently raised concerns regarding safety. Our objective was to investigate, in a community-based, academic, tertiary care center, the safety of pregnancies after laparoscopic Roux-en-Y gastric bypass (LRYGB) and its potential effect on obesity-related perinatal complications.

Methods: The pregnancy outcomes of patients delivering infants after LRYGB at our institution were compared with those of control subjects (stratified by body mass index) who had not undergone WLS.

Improvement in infertility and pregnancy outcomes after weight loss surgery.

The majority of bariatric surgical procedures are performed in young women. There is a concern about safety and outcomes of pregnancies after weight loss surgery. Pregnancy after weight loss surgery is not only safe, but is associated with more favorable outcomes in comparison to obese populations who do not undergo weight loss surgery.

Outpatient complications encountered following Roux-en-Y gastric bypass.

Practitioners taking care of postoperative bariatric patients need to keep in mind all of the complications that this population faces to prevent unnecessary morbidity. Bariatric patients presenting postoperatively with abdominal pain, tachycardia, vomiting, tachypnea, and a sense of impending doom should be worked up aggressively to find the cause of their symptoms. Because the incidence of obesity is rising in children and adults, more patients will have surgery to help with their weight loss.

Utility of intraoperative liver ultrasound.

Intraoperative ultrasound has become an essential tool for the surgeon in the field of hepatobiliary surgery. No preoperative study has been able to duplicate the sensitivity and specificity of IOUS in the identification of occult lesions. With recent improvements in technology, IOUS has now become an indispensable means of defining the extent of disease and respectability, and providing a guide to anatomic and nonanatomic hepatic resections and minimally invasive and percutaneous ablative techniques.

Therapeutic efficacy of laparoscopic cholecystectomy in the treatment of biliary dyskinesia.

Background: The outcome of laparoscopic cholecystectomy for patients who present with "classic" biliary colic without evidence of cholelithiasis or acute inflammation (biliary dyskinesia) is not well documented. This study evaluates whether a cholecystokinin dimethyl iminodiacetic acid (CCK-HIDA) scan can predict relief of symptoms in this group of patients.

Methods: Patients who underwent laparoscopic cholecystectomy after a normal ultrasound and with an abnormal dimethyl iminodiacetic acid scan were retrospectively reviewed.

Laparoscopy for diverticulitis.

Although the literature on laparoscopic surgery for diverticulitis includes data on more than 1800 patients, the quality of the studies is insufficient to draw definitive evidence-based conclusions. Nonrandomized evidence suggests that laparoscopic resection for uncomplicated diverticulitis of the sigmoid may fare better than its conventional counterpart not only in short-term outcome (preservation of the abdominal wall, shorter disability), but also in the long term (decreased rates of late symptomatic small bowel obstruction). Five-year recurrence rates show that a laparoscopic or conventional access is unlikely to have an impact, provided that the oral bowel end is anastomosed to the proximal rectum rather than to the distal sigmoid.

The presence of colorectal hepatic metastases does not preclude pulmonary metastasectomy.

Hepatic metastases due to colorectal carcinoma have often been felt to preclude pulmonary metastasectomy. With the recent advances in surgical options, should patients with both liver and lung metastases be considered for surgical resection? The current study reviews the impact of such aggressive management on disease-free and overall survival (OS). The clinical course of 63 patients presenting with colorectal metastasis to the lung alone (group 1, n = 45) or combined hepatic and lung metastases (group 2, n = 18) were reviewed.

Short-term predictors and long-term outcome after ruptured abdominal aortic aneurysm repair.

Few data exist in regard to long-term and functional outcome after ruptured abdominal aortic aneurysm (rAAA) repair. The present study provides such follow-up and defines the impact of variables used to grade resuscitation efforts [base deficit (BD) and core temperature (cT)]. One hundred forty-seven patients presenting with rAAA were retrospectively reviewed.

Technical limitations of sentinel node biopsy in breast cancer: a single surgeon's experience.

Few studies have attempted to critically identify patient- and tumor-related factors that limit sentinel node biopsy (SNB). These studies have been limited by sample size and surgeon variability. The present study attempts to enumerate these limitations in a unique group of patients.