Beyond race: social vulnerability and access to metabolic and bariatric surgery.

Background: Metabolic and bariatric surgery (MBS) is under-accessed by non-White patients, who are disproportionately affected by obesity. We hypothesized that unique barriers experienced by socially vulnerable patients drive disparate MBS utilization.

Objectives: To determine whether socially vulnerable patients experience greater attrition and face more insurance-mandated medical weight management (MWM) requirements.

IDEAL Phase 2a Results: Posterior Rectus Sheath Flap for Hiatal Augmentation in Complex Paraesophageal Hernias.

Objective: To report the developmental phase results of posterior rectus sheath hiatal flap augmentation (PoRSHA), a promising surgical innovation for large and recurrent paraesophageal hernias.

Background: Durable hernia repair for large paraesophageal hernias continues to be a surgical challenge. PoRSHA addresses the challenges of current and historical approaches to complex paraesophageal hernias and demonstrates significant promise as a successful alternative approach.

Supervised weight loss requirements disproportionately affect Black patients seeking weight loss surgery.

Background: We use our high-volume institutional experience with a majority Black population to examine the role of supervised weight loss (SWL) requirements perpetuating disparities in bariatric surgery.

Objective: To determine if there are racial disparities in the required amount of supervised weight loss prior to approval for bariatric surgery.

Setting: University hospital.

Autologous Posterior Rectus Sheath as a Vascularized Onlay Flap: a Novel Approach to Hiatal Hernia Repair.

Introduction: Complex and recurrent paraesophageal hernia repairs are a challenge for surgeons due to their high recurrence rates despite the use of various prosthetic and suturing techniques.

Methods: Here we describe the use of vascularized fascia harvested from the posterior rectus sheath with peritoneum during robotic hiatal hernia repair in two patients with large complex diaphragmatic defects.

Results: Successful harvesting and onlay of the right posterior rectus sheath based on a falciform vascular pedicle was achieved robotically by rotating and securing the flap to the diaphragmatic hiatus as an onlay flap following cruroplasty of the hiatal defect.

What Is the Appropriate Use of Laparoscopy over Open Procedures in the Current COVID-19 Climate?

Introduction: Among surgeons worldwide, a concern with the use of minimally invasive techniques has been raised due to a proposed risk of viral transmission of the coronavirus disease of 2019 (COVID-19) with the creation of pneumoperitoneum. Due to this proposed concern, we sought to collect the available data and evaluate the use of laparoscopy and the risk of COVID-19 transmission.

Methods: A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID-19 virus was performed.

Weight loss and co-morbidity resolution between different races and ethnicities after gastric bypass.

Background: Several studies have demonstrated that minorities and Hispanic ethnicities have disproportionally greater burden of morbid obesity in the United States. However, the majority of bariatric procedures are performed in the non-Hispanic white population.

Objectives: The objective of this study was to investigate the weight loss and remission of obesity-related co-morbidities based on race and ethnicity.

Assessment of Routine Esophagram for Detecting Anastomotic Leak After Esophagectomy.

This study assesses the value of routine esophagrams in detecting anastomotic leaks after esophagectomy.

Laparoscopic procedures in patients with cardiac ventricular assist devices.

Background: Cardiac left ventricular assist device (LVAD) placement is a common therapy for heart failure. Non-cardiac surgical care of these patients can be complex given the need for anticoagulation, perioperative monitoring, comorbidities, and anatomical considerations due to the device itself. There are no guidelines or significant patient series reported to date for laparoscopic procedures in this population.

Video review program enhances resident training in laparoscopic inguinal hernia: a randomized blinded controlled trial.

Background: The purpose was to determine if a standardized video review program for residents improves operative performance.

Methods: Participation was offered to surgical residents rotating on a minimally invasive service. Residents were randomized to either the video review group or no video review group.

Outcomes in patients with over 1-year follow-up after peroral endoscopic myotomy (POEM).

Background: Peroral endoscopic myotomy (POEM) is a promising therapy in the treatment of achalasia. The study was designed to report outcomes, including quality of life, in patients with at least 1-year follow-up.

Methods: Patients from an institutional review board-approved protocol underwent POEM and were followed prospectively.

Laparoscopic Antireflux Surgery: Importance of Patient's Selection and Preoperative Workup.

Background: Laparoscopic antireflux surgery (LARS) is an excellent option for patients with symptoms refractory to medical treatment, for patients who have complications secondary to the use of proton pump inhibitors, and for those who do not want to take medications for a long period of time.

Hypothesis: We hypothesized that (1) LARS has excellent outcomes if a complete preoperative workup and proper patient selection are performed and (2) recurrent symptoms often are not due to failure of the fundoplication to control the pathologic reflux.

Patients And Methods: Every patient referred for antireflux surgery underwent a detailed symptomatic evaluation, barium swallow, esophagogastroduodenoscopy (EGD), high-resolution manometry (HRM), and pH monitoring.

Importance of esophageal manometry and pH monitoring for the evaluation of otorhinolaryngologic (ENT) manifestations of GERD. A multicenter study.

Background/aims: Patients with otorhinolaryngologic (ear, nose, and throat-ENT) symptoms attributed to gastroesophageal reflux disease (GERD) are usually treated with medication based on the findings of nasal endoscopy and laryngoscopy only. This study aims to determine sensitivity and specificity of symptoms, nasal endoscopy, and laryngoscopy for the diagnosis of GERD as compared to pH monitoring.

Methods: We studied 79 patients (mean age 53 years, 38 % males) in whom ENT symptoms were assumed to be secondary to GERD.

This paper is the winner of an SFB Award in the Hospital Intern, Residency category: Peptide biomaterials raising adaptive immune responses in wound healing contexts.

Biomaterials used in the context of tissue engineering or wound repair are commonly designed to be "nonimmunogenic." However, previously it has been observed that self-assembled peptide nanofiber materials are noninflammatory despite their immunogenicity, suggesting that they may be appropriate for use in wound-healing contexts. To test this hypothesis, mice were immunized with epitope-containing peptide self-assemblies until they maintained high antibody titers against the material, then gels of the same peptide assemblies were applied within full-thickness dermal wounds.

Peroral endoscopic myotomy: An emerging minimally invasive procedure for achalasia.

Peroral endoscopic myotomy (POEM) is an emerging minimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding.

Elderly and octogenarian cohort: Comparable outcomes with nonelderly cohort after open or laparoscopic inguinal hernia repairs.

Purpose: To understand whether the elderly (>65 years of age) or octogenarian cohort is at greater risk for poor clinical outcomes after open or laparoscopic inguinal hernia repairs.

Methods: Beginning in June 2009, all patients presenting to our institution for inguinal hernia repair were asked to participate in a prospective database. Demographics, presenting symptoms, preoperative findings on examination, intraoperative variables, postoperative outcomes, and readmission data were collected.

Educating surgeons may allow for reduced intraoperative costs for inguinal herniorrhaphy.

Background: Our aim was to determine the impact of surgeon education regarding disposable supply costs to reduce intraoperative costs for a common procedure such as inguinal hernia repair.

Study Design: At the end of the 2013 fiscal year (FY 13), surgeons in our department were provided with information about the cost of disposable equipment and implants used in common general surgery operations. Surgeons who historically had lower supply costs demonstrated individual techniques to their colleagues.

Evaluation of Vessel Sealing Performance Among Ultrasonic Devices in a Porcine Model.

Background: As new technologies emerge, it is imperative to define which new devices are most likely to provide a reproducible, effective result for the patient and surgeon. The purpose of our study was to analyze 3 commercially available ultrasonic energy devices; the Sonicision (SC), the Harmonic ACE (HA), and the THUNDERBEAT (TB).

Material And Methods: Eight female Yorkshire pigs were used for data collection and vessel harvest.

Educating surgeons on intraoperative disposable supply costs during laparoscopic cholecystectomy: a regional health system's experience.

Background: Surgeons play a crucial role in the cost efficiency of the operating room through total operative time, use of supplies, and patient outcomes. This study aimed to examine the effect of surgeon education on disposable supply usage during laparoscopic cholecystectomy.

Methods: Surgeons were educated about the cost of disposable equipments without incentives for achieved cost reductions.

Laparoscopy has a superior diagnostic yield than percutaneous image-guided biopsy for suspected intra-abdominal lymphoma.

Introduction: To date, no study has compared laparoscopy (LB) to percutaneous (PB) biopsy for the diagnosis of abdominal lymphoma. The objective of this study is to compare the success rate and safety profile of laparoscopic lymph node biopsy to the percutaneous approach in patients with intra-abdominal lymphadenopathy concerning for lymphoma.

Materials And Methods: We performed a multi-institution, retrospective review of patients undergoing lymph node biopsy for suspected intra-abdominal lymphoma between 2005 and 2013.

Quality of life assessment after peroral endoscopic myotomy.

Background: Peroral Endoscopic Myotomy (POEM) is a promising treatment option for motor disorders of the esophagus. The purpose of this study was to assess quality of life (QOL) postoperatively.

Methods: All patients who presented to our institution for surgical treatment of achalasia after 2011 were asked to complete QOL (SF-36), dysphagia, reflux severity index, and GERD questionnaires in clinic preoperatively and postoperatively at approximately 3 weeks, 6 months, and 1 year.

Peroral endoscopic myotomy (POEM): feasible as reoperation following Heller myotomy.

Purpose: The purpose of this study was to demonstrate the feasibility of performing peroral endoscopic myotomy (POEM) in the management of recurrent achalasia after failed myotomy.

Methods: Eight patients presented to our institution between October 2010 and June 2013 with recurrent/persistent symptoms after prior laparoscopic Heller myotomy. Three patients underwent redo laparoscopic Heller myotomy, and five patients consented to redo myotomy with POEM.

NBME subject examination in surgery scores correlate with surgery clerkship clinical experience.

Objective: Most medical schools in the United States use the National Board of Medical Examiners Subject Examinations as a method of at least partial assessment of student performance, yet there is still uncertainty of how well these examination scores correlate with clinical proficiency. Thus, we investigated which factors in a surgery clerkship curriculum have a positive effect on academic achievement on the National Board of Medical Examiners Subject Examination in Surgery.

Design: A retrospective analysis of 83 third-year medical students at our institution with 4 unique clinical experiences on the general surgery clerkship for the 2007-2008 academic year was conducted.

Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma.

Background: Malignant pleural mesothelioma is an aggressive malignancy in which radical surgical treatment appears to improve survival. It is unknown, however, if radical surgical treatment affects quality of life (QoL) adversely. Our objective was to assess patient-reported symptoms of health-related QoL after radical pleurectomy decortication (PD).