Early morbidity and mortality of laparoscopic sleeve gastrectomy and gastric bypass in the elderly: a NSQIP analysis.

Background: Even though the U.S. population is aging, outcomes of bariatric surgery in the elderly are not well defined.

Laparoscopic paraesophageal hernia repair: advanced age is associated with minor but not major morbidity or mortality.

Background: Large studies have documented the safety of laparoscopic paraesophageal hernia (PEH) repair in the general population. Even though this condition affects primarily the elderly, data on the short-term outcomes of this procedure on the oldest-old are lacking.

Study Design: The NSQIP database was analyzed for all patients undergoing laparoscopic PEH repair in 2010 and 2011.

Laparoscopic adrenalectomy for pheochromocytoma: take the vein last?

Background: Traditionally, the adrenal vein has been ligated early during excision of a pheochromocytoma. Patient anatomy or size of the lesion can sometimes make early vein dissection difficult or unsafe. This study aimed to demonstrate the safety and efficacy of delayed adrenal vein ligation during laparoscopic adrenalectomy for pheochromocytoma.

Biliary dyskinesia.

Functional disorders of the biliary tract include gallbladder dyskinesia (GBD) and sphincter of Oddi dysfunction (SOD). The diagnosis of GBD is made if the gallbladder ejection fraction is less than 35% to 40% using cholecystokinin cholescintigraphy. Despite slightly inferior outcomes compared with calculous disease, patients who have GBD should be treated with cholecystectomy.

Symptoms and treatment burden of gastroesophageal reflux disease: validating the GERD assessment scales.

Background: A comprehensive assessment instrument that measures the burden of both symptoms and treatment is needed to determine the optimal management of gastroesophageal reflux disease (GERD), and we developed such an instrument.

Methods: This validation study included 3 groups: patients with active GERD (n = 193), surgical patients with prior GERD (n = 197), and general medical outpatients (n = 63). All completed an initial survey.

Trends in surgery for gastroesophageal reflux disease: the effect of laparoscopic surgery on utilization.

Background: In addition to substituting for open surgery, minimally invasive surgery may lower thresholds for intervention and thus increase overall utilization rates. The degree to which laparoscopy may have lowered the threshold for elective anti-reflux surgery is unknown.

Methods: Using the Uniform Hospital Discharge Dataset and ICD-9 procedure and diagnosis codes, we identified all laparoscopic and open anti-reflux procedures performed on adults in Massachusetts, New Hampshire, and Vermont for each year from 1993 to 1998.

Determining an appropriate threshold for referral to surgery for gastroesophageal reflux disease.

Background: Persistent symptomatic gastroesophageal reflux disease (GERD) can be treated with medication or surgery. The purposes of this study were (1) to determine how poor the quality of life on medication would need to be to justify assuming the risks of surgery, and (2) to estimate the proportion of patients currently on medication whose quality of life is below this value.

Methods: We developed a Markov decision analysis model to simulate health outcomes (measured in quality adjusted life years [QALY]) over 10 years for medication and surgery in patients with typical GERD symptoms.

Late outcomes after laparoscopic surgery for gastroesophageal reflux.

Hypothesis: Patients still have symptoms following laparoscopic antireflux surgery and require ongoing treatment.

Design: Mailed survey.

Setting: Academic tertiary care center.