Background
The Hispanic population is the fastest growing ethnic minority in the United States, contributing to nearly half of the population growth over the last decade. Unfortunately, this ...population suffers from lower-than-average health literacy rates, leading to poorer health outcomes. Per the American Medical Association and National Institutes of Health, patient education materials (PEMs) should be written at no higher than a 6th grade reading level. Given that US Hispanic adults have the second-highest obesity prevalence, this study aims to analyze the readability of Spanish-language PEMs regarding bariatric surgery available in US-based academic and medical centers.
Methods
A total of 50 PEMs were found via the query ““cirugía de pérdida de peso” site: (edu OR.org)” on the Google search engine. Thirty-nine sources met the inclusion criteria of belonging to a US-based academic or medical center and containing information regarding the indications for bariatric surgery, descriptions of the types of bariatric surgery, what to expect before and after surgery, or the risks and benefits of bariatric surgery. The excerpts were analyzed according to three readability formulas designed specifically for the Spanish language and evaluated for their reading grade level.
Results
All 39 sources were at the college reading level per the Fry graph corrected for Spanish. Per the Spaulding formula, 37 sources were “Grade 12 + ” and two sources were “Grade 8–10.” Per the Fernandez-Huerta formula, 16 sources were at the 8th/9th grade reading level, 22 sources were at the 7th grade reading level, and one was at the 6th grade reading level.
Conclusion
The Spanish-language bariatric surgery PEMs available online from US-based academic and medical centers are generally above the recommended 6th grade reading level. Failure to meet the recommended sixth-grade reading level decreases health care literacy for Spanish-speaking patients within the United States seeking bariatric surgery.
Background
The open abdomen (OA) is commonly utilized as a technique during damage control laparotomy (DCL). We propose that a selected group of these OA patients can be extubated prior to abdominal ...closure to decrease ventilator days and risk of pneumonia.
Methods
A retrospective chart review was performed at a Level I trauma center on all adult trauma patients with an OA following DCL. Patients were stratified into two groups: extubated prior to (PRE) and extubated after (POST) abdominal closure. Successful extubation in the PRE group was measured by the absence of re-intubation. The two groups were compared using the Mann–Whitney U and Fisher’s exact tests. Multivariate logistic regression identified independent predictors for successful extubation prior to abdominal closure.
Results
Thirty-one patients were in the PRE group, and 59 patients in the POST group. There were no differences between the groups with regard to age, gender, or hours from admission to completion of DCL. The PRE group had a significantly higher incidence of penetrating trauma (77 vs. 53%;
p
= 0.02), a significantly lower number of days from OA to extubation 0.6 (0.2–1.1) vs. 3.4 (2–-8) days;
p
< 0.001, and a significant decrease in pneumonia (10 vs. 31%;
p
= 0.04). Two patients in each group required re-intubation PRE (6%) vs. POST (3%);
p
= 0.61. In a multivariate binominal logistic regression, penetrating trauma (
p
= 0.024), GCS on admission (
p
< 0.0001), and Injury Severity Score (
p
= 0.024) were identified as independent predictors for successful extubation.
Conclusion
Presence of an OA following DCL does not require mechanical ventilation. Extubation of appropriate trauma patients prior to abdominal closure decreases pneumonia and hospital length of stay.
Obesity is known to be epidemiologically associated with malignancy. Although there is an increasing global number of bariatric surgeries, the relationship between bariatric surgery and ...esophagogastric cancers is not well understood. Diagnosis of esophagogastric cancers following bariatric surgery is challenging because the presentation tends to be nonspecific and may be perceived as usual postoperative symptoms in bariatric patients. Therefore, the early diagnosis requires a high index of suspicion. In addition, endoscopic investigation of the excluded stomach after a Roux-en-Y gastric bypass or a one-anastomosis gastric bypass is technically challenging, which further complicates the diagnosis. The aim of this study is to review the current evidence in the literature on esophagogastric cancers following bariatric surgery.
Bleeding and leaks are the most ominous postoperative complications after laparoscopic sleeve gastrectomy (LSG). Various staple line reinforcement (SLR) techniques have been innovated such as ...oversewing/suturing (OS/S), omentopexy/gastropexy, buttressing, and gluing. Currently, no high-quality evidence supports the use of one method over the others or even supports the use of SLR over no SLR. This study aimed to compare postoperative outcomes between LSG with OS/S versus LSG without any SLR.
Background
Despite recent advancements, the advantage of robotic surgery over other traditional modalities still harbors academic inquiries. We seek to take a recently published high-profile ...narrative systematic review regarding robotic surgery and add meta-analytic tools to identify further benefits of robotic surgery.
Methods
Data from the published systematic review were extracted and meta-analysis were performed. A fixed-effect model was used when heterogeneity was not significant (Chi
2
p
≥ 0.05,
I
2
≤ 50%) and a random-effects model was used when heterogeneity was significant (Chi
2
p
< 0.05,
I
2
> 50%). Forest plots were generated using RevMan 5.3 software.
Results
Robotic surgery had comparable overall complications compared to laparoscopic surgery (
p
= 0.85), which was significantly lower compared to open surgery (odds ratio 0.68,
p
= 0.005). Compared to laparoscopic surgery, robotic surgery had fewer open conversions (risk difference − 0.0144,
p
= 0.03), shorter length of stay (mean difference − 0.23 days,
p
= 0.01), but longer operative time (mean difference 27.98 min,
p
< 0.00001). Compared to open surgery, robotic surgery had less estimated blood loss (mean difference − 286.8 mL,
p
= 0.0003) and shorter length of stay (mean difference − 1.69 days,
p
= 0.001) with longer operative time (mean difference 44.05 min,
p
= 0.03). For experienced robotic surgeons, there were less overall intraoperative complications (risk difference − 0.02,
p
= 0.02) and open conversions (risk difference − 0.03,
p
= 0.04), with equivalent operative duration (mean difference 23.32 min,
p
= 0.1) compared to more traditional modalities.
Conclusion
Our study suggests that compared to laparoscopy, robotic surgery may improve hospital length of stay and open conversion rates, with added benefits in experienced robotic surgeons showing lower overall intraoperative complications and comparable operative times.
Various staple line reinforcement (SLR) techniques in sleeve gastrectomy, including oversewing/suturing (OS/S), gluing, and buttressing, have emerged to mitigate postoperative complications such as ...bleeding and leaks. A meta-analysis of randomized controlled trials has demonstrated OS/S as an efficacious strategy for preventing postoperative complications, encompassing leaks, bleeding, and reoperations. Given that OS/S is the sole SLR technique not incurring additional costs during surgery, our study aimed to compare postoperative outcomes associated with OS/S versus alternative SLR methods. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed the literature and conducted fifteen pairwise meta-analyses of comparative studies, each evaluating an outcome between OS/S and another SLR technique. Thirteen of these analyses showed no statistically significant differences, whereas two revealed notable distinctions.
Leaks and bleeding are major acute postoperative complications following laparoscopic sleeve gastrectomy (LSG). Various staple line reinforcement (SLR) methods have been invented such as ...oversewing/suturing (OS/S), omentopexy/gastropexy (OP/GP), gluing, and buttressing. However, many surgeons do not use any type of reinforcement. On the other hand, surgeons who use a reinforcement method are often confused of what kind of reinforcement they should use. No robust and high-quality data supports the use of one reinforcement over the other or even supports the use of reinforcement over no-reinforcement. Therefore, SLR is a controversial topic that is worth our focus. The aim of this study is to compare the outcomes of LSG with versus without Seamguard buttressing of the staple line during LSG.
The optimal distance between the starting point of gastric transection and the pylorus during laparoscopic sleeve gastrectomy (LSG), which can be referred to as the distance from pylorus (DFP), is ...controversial. No consensus exist for what DFP is considered antral preservation, and what DFP is considered antral resection. Some surgeons prefer shorter DFP to maximize excess weight loss percentage (EWL%), while others prefer longer DFP because they believe that it shortens length of stay (LOS) and protects against leaks, prolonged vomiting, and gastroesophageal reflux disease (GERD). We sought to compare 6-cm DFP and 2-cm DFP in postoperative outcomes. In addition, we sought to evaluate the magnitude of any observed benefit through number needed to treat (NNT) analysis.
Intussusception following Roux-en-Y gastric bypass (RYGB) is a rare complication of bariatric surgery with an unclear etiology. The pathogenesis underlying intussusception after gastric bypass is ...likely different from that in the general population. Post-RYGB intussusception might be related to motility issues in the divided small bowel, thinning of the mesentery following rapid weight loss, or anastomotic sutures/staple line acting as the lead point. This condition can cause obstruction with subsequent strangulation and bowel necrosis if not recognized and treated promptly. Clinical presentation is vague and nonspecific, and computerized tomography scan represents the diagnostic test of choice. Surgical treatment consists of reduction with or without anastomosis resection and reconstruction. This literature review provides an extensive overview of this condition, based on multiple studies involving 120 patients.