Abstract:

Introduction: Roux-en-Y Gastric Bypass is the gold standard procedure for weight loss surgery and is the most commonly performed bariatric operation in the United States. Laparoscopic gastric bypass (LGBP) has become the predominantly used technique for weight loss surgery since 2004. The aim of this study was to compare surgical outcomes of LGBP versus open gastric bypass (OGBP) for the treatment of morbid obesity. Methods: Using the Nationwide Inpatient Sample database, clinical data of morbidly obese patients who underwent LGBP or OGBP from 2006 to 2008 were analyzed. Outcome measures included patient characteristics, comorbidities, postoperative complications, length of hospital stay (LOS), hospital charges, and in-hospital mortality.Results: A total 226,043 morbidly obese patients underwent gastric bypass during the three-year period (LGBP: 183,452 [81.16%], OGBP: 42,591[18.84%]) . The majority of patients in both groups were female (LGBP: 81.0% vs. OGBP: 78.5%, p < 0.01) and Caucasian (LGBP: 73.9% vs. OGBP: 72.6%, p < 0.01). Most comorbidities were significantly higher in the OGBP group. All specific postoperative complications were significantly higher in the OGBP group (urinary tract infection [UTI], pneumonia, acute renal failure, respiratory failure, myocardial infarction, venous thromboembolism, ileus, gastrointestinal leak, wound infection, and bowel obstruction). LGBP was associated with lower overall postoperative complications (3.5% vs. 10.8%; p < 0.01), shorter LOS (2.4 days vs. 4.2 days; p < 0.01), lower mortality (0.06 vs. 0.52; p < 0.01), and lower hospital costs ($39,570 vs. $45,629; p < 0.01) compared with the OGBP.Conclusion: LGBP was associated with shorter LOS, lower morbidity, lower mortality, and lower hospital costs compared with those of OGBP. The laparoscopic approach to gastric bypass should be considered the gold standard approach for the treatment of morbid obesity.

Authors:

Hossein Masoomi, MD, General Surgery Resident, University of California Irvine Medical Center, Orange, California, Ninh T. Nguyen, MD, FACS, FASMBS, Professor of Surgery, Chief, Division of Gastrointestinal Surgery, University of California Irvine Medical Center, Orange, California, Michael J. Stamos, MD, FACS, Professor and Chair, Department of Surgery, University of California Irvine Medical Center, Orange, California, Brian R. Smith, MD, FACS, FASMBS, Assistant Professor of Surgery & Associate Residency Program Director, University of California Irvine Medical Center, Chief, General Surgery & Resident Director, VA Healthcare System Long Beach, California

PMID: 23065805

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Abstract:

Serious complications after pancreaticoduodenectomy (PD) include pseudoaneurysm formation and rupture accompanying pancreatic fistula, and pancreatojejunostomy leakage, which is commonly associated with mortality or liver failure. We report a case of the successful treatment of pseudoaneurysm rupture after pylorus-preserving pancreaticoduodenectomy (PPPD) by covered stent placement.A 70-year-old man underwent PPPD for ampullary carcinoma. After the procedure, a pancreatic fistula was detected, and suction drainage was continued. The patient was discharged on the twenty-first post-operative day. On the same day, arterial bleeding was detected from the pancreatojejunostomy drain, and emergency abdominal angiography showed a pseudoaneurysm of 3-cm diameter at the proper hepatic artery (PHA). Multiple embolization coils were placed in a pseudoaneurysm. However, bleeding still continued, so hemostasis with coils was considered unfeasible. The next strategy was to place a covered stent, but the PHA was thick; thus, a biliary covered stent was implanted. Angiographic examination subsequently revealed that hepatic arterial flow was maintained, and there were no aneurysms. However, a few days later, a coil that had migrated into a peripheral branch of the right hepatic artery caused multiple hepatic abscesses, and percutaneous transhepatic abscess drainage was performed before the patient was discharged. Although coils were initially sufficient for hemostasis, repeatedly recurrent bleeding led to the consideration of a covered stent.

Authors:

Shunsuke Onizawa, M.D., Assistant Professor , Department of Surgery, Division of Gastroenterological Surgery, Tatsuo Araida, M.D., Ph.D., Professor and Chief , Department of Surgery, Division of Gastroenterological Surgery, Mie Hamano, M.D., Ph.D., Assistant Professor, Department of Surgery, Division of Gastroenterological Surgery, Joe Toda, M.D., Assistant Professor and Chief, Department of Interventional Radiology, Asuka Tsuchiya, M.D., Assistant Professor , Department of Interventional Radiology, Masakazu Yamamoto, M.D., Ph.D., Professor, Department of Gastroenterological Surgery ,Tokyo Women’s Medical University Hospital, Chiba, Japan

PMID: 23065804

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Abstract:

Recently, extensive data has been published about the safety and efficacy of endoscopic radiofrequency ablation (RFA) of Barrett's esophagus (BE) with early cancer and dysplasia as well as without dysplasia. RFA has been shown to be effective and safe. Circumferential RFA is delivered using the HALO360+ Ablation System (Covidien,Inc., Mansfield, MA), which consists of a high-power energy generator, a sizing balloon catheter, and a number of balloon-based ablation catheters with varying outer diameters. Focal RFA is delivered using the HALO90 or HALO60 Ablation Systems (Covidien,Inc., Mansfield, MA), consisting of a radiofrequency energy generator and an endoscope-mounted electrode. Both RFA systems have official approval to be used in the United States, Europe, and other countries for the treatment of BE as well as in patients with gastric antral vascular ectasia and radiation proctopathy. With increasing widespread use of these systems, a full mastery of the equipment and therapeutic technique is essential to maximize eradication rates of BE while maintaining patient safety. The cost-effective patient selection and eradication protocol for RFA are essential to success with this technique in patients with BE. This article will discuss our experience with RFA treatment of BE using the HALO system for effective eradication of Barrett's dysplasia and early Barrett's cancer and available data especially from the U.S. National Registry.

Authors:

David S. Wolf, MD Assistant Professor, University of Texas Medical School, Houston, TX, Brian J. Dunkin, MD, FACS, Professor of Surgery, Weill Cornell Medical College Medical Director, Methodist Institute for Technology, Innovation, and Education The Methodist Hospital Department of Surgery, Houston, TX, Atilla Ertan, MD, FACP, AGAF, MACG Professor of Medicine University of Texas Medical School Medical Director Gastroenterology Center of Excellence, Houston, TX

PMID: 23292670

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