Background
Women surgeons may experience more ergonomic challenges while performing surgery. We aimed to assess ergonomics between men and women surgeons.
Methods
Laparoscopic surgeons from a single ...institution were enrolled. Demographics and intraoperative data were collected. Muscle groups were evaluated objectively using surface electromyography (EMG; TrignoTM, Delsys, Inc., Natick, MA), and comprised upper trapezius (UT), anterior deltoid, flexor carpi radialis (FCR), and extensor digitorum (ED). Comparisons were made between women (W) and men (M) for each muscle group, assessing maximal voluntary contraction (MVC) and median frequency (MDF). The Piper Fatigue Scale-12 (PFS-12) was used to assess self-perceived fatigue. Statistical analyses were performed using SPSS v26.0,
α
= 0.05.
Results
18 surgeries were recorded (W:8, M:10). Women had higher activation of UT (32% vs 23%,
p
< 0.001), FCR (33% vs 16%,
p
< 0.001), and ED (13% vs 10%,
p
< 0.001), and increased effort of ED (90.4 ± 18.13 Hz vs 99.1 ± 17.82 Hz). Comparisons were made between W and M for each muscle group, assessing MVC and MDF.
Conclusions
After controlling for surgeon’s height and duration of surgery, an increase in muscle activation was seen for women laparoscopic surgeons. Since poor ergonomics could be a major cause of work-related injuries, we must understand differences in ergonomics between men and women and evaluate which factors impact these variations.
This study sought to evaluate surgical outcomes, cost, and opiate utilization of patients who underwent laparoscopic (LC) or robotic cholecystectomy (RC).
The Vizient database was queried for ...patients admitted with mild to moderate severity of illness (SOI) scores who underwent LC or RC from January 2015 through December 2017. Rates of overall complications, postoperative infection, mortality, LOS, cost, and opiate utilization were compared between groups using IBM SPSS v.25.0, α = 0.05.
91,849 patients (LC:N = 89,878; RC:N = 1,971) met the inclusion criteria. Robotic approach was associated with more complications (LC:0.9%, RC:1.7%; p < 0.001), postoperative infections (LC:0.2%, RC:0.4%; p = 0.033) and a higher direct cost (LC:$6782 ± 3421, RC:$9354 ± 5497; p < 0.001). Opiates were prescribed more frequently in the laparoscopic group (LC:98.3%, RC:97.2%; p = 0.002).
The direct cost of RC is significantly higher than LC with no added benefit. Routine use of the robotic platform for cholecystectomy should be discouraged until costs are reduced.
•Cost of robotic cholecystectomy remains significantly higher than laparoscopy.•Robotic approach is associated with increased rate of complications and infection.•Use of the robotic platform does not improve outcomes for patients with obesity.
The Vizient database was queried for patients admitted with mild to moderate severity of illness scores who subsequently underwent laparoscopic or robotic cholecystectomy for biliary disease. Robotic approach was associated with a significantly higher direct cost and slightly increased rates of overall complications and postoperative infection.
Internal hernia formation is a feared complication following bariatric surgery. Protrusion of the small bowel through mesenteric defects can result in volvulus presenting with symptoms of bowel ...obstruction. If left untreated, patients may go on to develop bowel ischemia with possible perforation or necrosis necessitating emergent surgical exploration with resection. In severe cases, extensive bowel resection is required, leading to short-gut syndrome, which can have devastating consequences for the already nutritionally vulnerable bariatric patient. This review presents a comprehensive summary of various surgical techniques and technical factors implicated in the formation of internal hernias. The clinical presentation of patients with internal hernias, appropriate diagnostic work-up, and effective management and treatment strategies are discussed based on the established literature.
This study sought to evaluate surgical outcomes, cost, and opiate utilization between patients who underwent either laparoscopic or robotic-assisted bariatric procedures, including sleeve gastrectomy ...(SG) or Roux-en-Y gastric bypass (RYGB).
The Vizient administrative database was queried for patients admitted with mild to moderate severity of illness scores who underwent elective laparoscopic (L) and robotic-assisted (R) SG or RYGB from October 2015 through December 2018. Patients were grouped according to surgical approach for each bariatric procedure. Rates of overall complications, mortality, 30-day readmission, LOS, total direct cost, and opiate utilization were collected. Comparisons were performed within each bariatric procedure, between laparoscopic and robotic approaches, using IBM SPSS v.25.0, α = 0.05.
For SG, a total of 84,034 patients were included (LSG:N = 78,405; RSG:N = 5639). There was no significant difference in rates of overall complications (LSG:0.5%, RSG:0.4%; p = 0.872), mortality (LSG:<0.01%, RSG:<0.01%; p = 0.660), and 30-day readmissions (LSG: 0.5%, RSG:0.5%; p = 0.524). Average LOS was 1.65 ± 1.07 days for LSG and 1.77 ± 1.29 days for RSG (p=<0.001). Robotic approach had a significantly higher direct cost (LSG: $6505 ± 3,200, RSG: $8018 ± 3849; p=<0.001). Rate of opiate use was 97.3% for both groups (p=>0.05). For RYGB, 36,039 patients met the inclusion criteria (LRYGB:N = 33,053; RRYGB:N = 2986). There was no significant difference in rates of overall complications (LRYGB: 1.4%, RRYGB:1.3%; p = 0.414) or mortality (LRGYB:<0.01%, RRYGB: <0.01%; p = 0.646). Robotic approach was associated with a lower 30-day readmission rate (LRYGB: 1.3%, RRYGB:<0.01%; p=<0.001). Average LOS was 2.1 ± 2.18 days for LRYGB and 2.18 ± 3.78 days for RRYGB (p = 0.075). Robotic approach had a significantly higher direct cost (LRYGB:$8564 ± 5,350, RRYGB: $10,325 ± 7689; p=<0.001) and rate of opiate use (LRYG:95.75%, RRYGB:96.85%; p = 0.005).
Our study found the direct cost of RSG to be significantly higher than LSG with no added clinical benefit, therefore, universal use of the robotic platform for routine SG cases remains difficult to justify. While the direct cost of RRYGB was also higher than LRYGB, the significantly lower readmission rate associated with robotic approach may help to offset the financial discrepancy and warrant its use.
•Robotic approach has higher direct cost within minimally invasive bariatric surgery.•Morbidity rate is comparable between laparoscopic and robotic sleeve gastrectomy.•Robotic roux-en-y gastric bypass has lower rates of readmission and GI hemorrhage.
The Vizient database was queried for patients with mild to moderate severity of illness scores who underwent sleeve gastrectomy or roux-en-y gastric bypass via minimally invasive approach. The robotic platform was associated with higher direct cost for both procedures. Robotic roux-en-y bypass had significantly lower readmission rate compared to laparoscopic.
Background
The aim of this study is to identify factors that can predict hiatal hernia recurrence (HHR) in patients after anti-reflux surgery with hiatal hernia (HH) repair.
Methods
A ...single-institution, prospectively collected database was reviewed (January 2002–October 2015) with inclusion criteria of GERD and laparoscopic anti-reflux (AR) surgery with HH repair. Demographics, esophageal symptom scores, and pre- and post-upper gastrointestinal imaging (UGI) were collected. Mesh usage, HH type (sliding, paraesophageal (HH) or type IV), and size were evaluated, and patients who had HHR versus those who did not (NHHR) were compared. Statistical analysis was performed using IBM SPSS v.23.0.0, with
α
= 0.05.
Results
Three hundred twenty-two patients met inclusion criteria. Mean age was 56.9 ± 14.8 years (60.9% female), and mean follow-up was 19.9 ± 23.8 months. 88.2% underwent total fundoplication and 11.8% underwent partial fundoplication. HHR rate was 15.5%. HHR patients had larger HH than the NHHR group. There was no significant difference between groups for age, gender, BMI, race, and mesh usage. Only 3 patients (10.3%) with HHR reported mild-to-moderate heartburn, regurgitation, and solid or liquid dysphagia at 12-month follow-up. Overall reoperation rate was 1% in this population.
Conclusions
HHR is correlated with large hernia size. Mesh use and patient BMI were not predictors, and no correlation was identified between HHR and presence of GERD symptoms. Recurrence after repair is not uncommon, but is asymptomatic in most cases. Reoperation is rare and mesh is not routinely needed. Large asymptomatic HHs in the elderly often do not require intervention.
Background
Considerable weight recurrence (WR) after Roux-en-Y gastric bypass (RYGB) may occur in nearly 20% of patients. While several nonoperative, endoscopic, and surgical interventions exist for ...this population, the optimal approach is unknown. This study reports our initial experience with distal bypass revision (DGB) and provides a comparison with patients after primary RYGB.
Methods
Single-institution, retrospective review was conducted for patients who underwent DGB from 2018 to 2020. A Roux and common channel of 150 cm each were constructed (total alimentary limb 300 cm). A group of primary RYGB patients with similar demographics were selected as controls. Demographics, comorbidity resolution, surgical technique, complications, excess weight loss (EWL), total weight loss (TWL), BMI, and weight change data were compared. Patient postoperative weight loss (WL) was also compared after their primary and DGB operations.
Results
Sixteen DGB patients, all female, were compared with 29 controls. DGB was performed on average 12.3 years after primary RYGB. In the DGB group, mean BMI was 53.7 before primary RYGB, 31.9 at nadir, and 44.1 prior to DGB. Post-DGB, mean BMI was 40.5, 37.4, 34.8, and 34.4, at 3-, 6-, 12-, and 24-months, respectively. Five patients (31.3%) experienced complications and were readmitted within 30 days, with two of them (12.5%) requiring reintervention and one (6.3%) undergoing reoperation. Mean EWL and TWL up to 2 years after DGB were lower than that after the patient’s original RYGB (52.3 ± 18.6 vs. 67.2 ± 33.2;
p
= 0.126 and 19.6 ± 13.3 vs. 29.6 ± 11.8;
p
= 0.027, respectively).
Conclusions
DGB resulted in excellent WL up to 2 years after surgery but was associated with considerable postoperative complication rates. The magnitude of TWL was lower compared with the primary operation. Only a few patients experienced nutritional complications. Results of this study can help counsel patients pursuing DGB for WR or nonresponse to primary RYGB. The comparative effectiveness of this approach to other available options remains to be determined.
Gastrointestinal bleeding following bariatric surgery is a relatively rare adverse event but constitutes a significant cause of morbidity. It requires a high index of suspicion, early diagnosis, and ...prompt management, as it can lead to rapid deterioration and potential mortality. In most cases, GI bleeding is self-limited and does not necessitate emergent reoperation. For some patients, however, control of postoperative hemorrhage may require various procedural-based interventions via surgical, endoscopic, or radiologic approaches. Recent studies suggest that endoscopic therapies to manage intraluminal bleeding post-bariatric surgery are becoming increasingly popular given their high efficacy rate and favorable safety profile. Currently, there is no consensus on the management of early or late GI hemorrhage after metabolic surgery. Therefore, the aim of this review is to summarize the effectiveness of several treatment options and outline management algorithms for this subset of bariatric patients based on the established literature.
Background
Weight regain (WR) post bariatric surgery affects almost 20% of patients. It has been theorized that a complex interplay between physiologic adaptations and epigenetic mechanisms promotes ...WR in obesity, however, reliable predictors have not been identified. Our study examines the relationship between early postoperative weight loss (WL), nadir weight (NW), and WR following laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG).
Methods
A retrospective review of prospectively collected data was conducted for LRYGB or LSG patients from 2012 to 2016. Demographics, preoperative BMI, procedure type, and postoperative weight at 6, 12, 24, 36, and 48 months were recorded. WR was defined as > 20% increase from NW. Univariate and multivariate linear and logistic regression models were used to determine the association between early postoperative WL with NW and WR at 4 years.
Results
Thousand twenty-six adults were included (76.8% female, mean age 44.9 ± 11.9 years, preoperative BMI 46.1 ± 8); 74.6% had LRYGB and 25.3% had LSG. Multivariable linear regression models showed that greater WL was associated with lower NW at 6 months (Coef − 2.16; 95% CI − 2.51, − 1.81), 1 year (Coef − 2.33; 95% CI − 2.58, − 2.08), 2 years (Coef − 2.04; 95% CI − 2.25, − 1.83), 3 years (Coef − 1.95; 95% CI − 2.14, − 1.76), and 4 years (Coef − 1.89; 95% CI − 2.10, − 1.68),
p ≤
0.001. WR was independently associated with increased WL between 6 months and 1 year (Coef 1.59; 95% CI 1.05,2.14;
p
≤ 0.001) and at 1 year (Coef 1.24; 95% CI 0.84,1.63;
p
≤ 0.001) postoperatively. The multivariable logistic regression model showed significantly increased risk of WR at 4 years for patients with greater WL at 6 months (OR 1.20, 95% CI 1.08,1.33;
p
= 0.001) and 1 year (OR 1.14; 95% CI 1.06,1.23;
p
≤ 0.001).
Conclusion
Our findings demonstrate that higher WL at 6 and 12 months post bariatric surgery may be risk factors for WR at 4 years. Surgeons may need to follow patients with high early weight loss more closely and provide additional treatment options to maximize their long-term success.
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