Enhanced recovery after surgery for sleeve gastrectomies: improved patient outcomes.

Background: Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care and incorporates patient-centered, evidence-based, and multidisciplinary team-developed pathways for a surgical specialty. ERAS pathways aim to reduce the patient's surgical stress response, optimize their physiologic function, facilitate recovery, and reduce the length of stay. The bariatric program at our institution was previously managed by many surgeons with anecdotal preferences, resulting in increased costs, lengths of stay, and opioid prescribing.

Complex hepatobiliary surgery in the community setting: is it safe and feasible?

Background: Complex hepatobiliary surgical procedures for benign and malignant conditions are regularly performed at tertiary academic referral centers with excellent outcomes, but whether similar surgical outcomes are achievable in community hospitals is not well documented.

Methods: Eighty-four patients underwent complex hepatobiliary surgery between December 2004 and December 2008. Data were prospectively analyzed, including patient demographics, operative procedures, perioperative parameters, pathology, complications up to 30 days postoperatively, and long-term outcomes.

Vascular constraints in laparoscopic renal allograft: comparative analysis of multiple and single renal arteries in 976 laparoscopic donor nephrectomies.

Background: Since the initial description of laparoscopic donor nephrectomy (LDN) in 1995, the field of renal transplantation has continued to evolve. Although the identification of donor kidneys with multiple renal arteries (MRA) was considered a contraindication to LDN, improvement in the surgical technique to surmount the technical challenges of LDN with MRA have been established as the skill and laparoscopic experience of transplant surgeons evolves with time. Consensus regarding LDN with MRA and recipient outcomes is not uniformly documented amongst the transplant community.

Robotic-assisted laparoscopic donor nephrectomies: early experience and review of the literature.

With over 80,000 patients in the United States awaiting kidney transplantation, renal transplant surgery continues to evolve with attractive surgical options for living donation, which include laparoscopic donor nephrectomy (LDN) and robotic-assisted laparoscopic donor nephrectomy (RALDN). LDN is currently accepted as the gold standard procedure for living donor nephrectomy; RALDN is an evolving technique and may emerge as a preferred procedure over time. We present our initial experience with RALDN from December 2007 to August 2008.

Adult Mesenchymal Hamartoma of the Liver: Case Report and Literature Review.

Mesenchymal hamartoma of the liver (MHL) is a rare benign lesion occurring primarily in the pediatric population. While the precise pathogenesis of the tumor is not certain, the most common theory relates to aberrant mesenchyme development in the portal tract likely related to the bile ducts. A 53-year-old female was evaluated for an incidental liver mass.

Complex pancreatic surgery: safety and feasibility in the community setting.

Introduction: Advances in technology, innovative surgical procedures, and enhanced perioperative care have allowed more patients to be considered for complex pancreatic surgery. Published reports on the outcomes of pancreatic surgery performed at high volume tertiary referral centers have yielded excellent results. However, similar outcome and safety data from community hospitals is limited.

Prophylactic mastectomy in high risk patients: a practice-based review of the indications. Do we follow guidelines?

Background: recently, the number of prophylactic mastectomies (PM) in the United States has increased due to a better understanding of the genetic and biological behavior of breast cancer. Consensus guidelines regarding indications for PM are published; however, studies evaluating adherence to published guidelines are lacking. The present study analyzed the indications and possible decision-making process leading to PM among 579 patients who underwent mastectomy.

Bariatric surgery: shedding the monetary weight of prescription costs in the managed care arena.

Background: Prescription costs for treatment of comorbidities associated with morbid obesity is a considerable annual health-care expenditure. This study addressed the effect of Roux-en-Y gastric bypass (RYGBP) on diabetic and anti-hypertensive pharmaceutical utilization and cost savings at our institution.

Methods: Retrospective data from the electronic database of 51 consecutive patients, who underwent RYGBP from March 2001 to May 2002 were studied.