scholarly journals Outcomes of primary versus revisional robotically assisted laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of ten-year experience

2020 ◽  
Author(s):  
Pouya Iranmanesh ◽  
John Fam ◽  
Thomas Nguyen ◽  
David Talarico ◽  
Kavita D. Chandwani ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Medical Center ◽  
Intraoperative Complications ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Laparoscopic Bariatric Surgery ◽  
Complication Rates ◽  
Specific Complication ◽  
Multicenter Analysis

Abstract Background Postoperative morbidity after laparoscopic bariatric surgery is considered higher for patients undergoing revisional versus primary procedures. The objective of this retrospective cohort study was to compare outcomes between patients undergoing primary versus revisional robotically assisted laparoscopic (RAL) Roux-en-Y gastric bypass (RYGB). Methods Data of all patients who underwent RAL primary and revisional RYGB between 2009 and 2019 at two accredited, high-volume bariatric surgery centers—the Memorial Hermann – Texas Medical Center, Houston, TX, and the Tower Health, Reading Hospital, Reading, PA, were analyzed. Primary outcomes were early (< 30 days) and overall postoperative complications. Secondary outcomes included intraoperative complications, operative times, conversions to laparotomy, length of hospital stay, early (< 30 days) postoperative readmissions and deaths. Results Data of 1072 patients were analyzed, including 806 primary and 266 revisional RAL RYGB procedures. Longer operative times (203 versus 154 min, P < 0.001), increased number of readmissions for oral intolerance (10.5% versus 6.7%, P = 0.046) and higher rate of gastrojejunal stricture (6.4% versus 2.7%, P = 0.013) were found in the revisional group. Gastrointestinal leak rates were 0.2% for the primary versus 1.1% for the revisional group (P = 0.101). Early (< 30 days) reoperations rates were 2.2% for the primary versus 1.1% for the revisional group (P = 0.318). There were no statistically significant differences between groups in overall and severe complication rates. Conclusion Patients undergoing RAL primary and revisional RYGB had comparable overall outcomes, with a non-significant higher early complication rate in the revisional group. Despite the study being underpowered to detect differences in specific complication rates, the morbidity seen in the revisional RYGB group remains markedly below literature reports of revisional laparoscopic RYGB and might suggest a benefit of robotic assistance. Further prospective studies are needed to confirm these results.

scholarly journals ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP): ANALYSIS OF THE EFFECTIVENESS AND SAFETY OF THE PROCEDURE IN THE PATIENT WITH ROUX-EN-Y GASTRIC BYPASS

2019 ◽  
Vol 32 (2) ◽  
Author(s):  
Flávio Heuta IVANO ◽  
Bruno Jeronimo PONTE ◽  
Thais Caroline DUBIK ◽  
Victor Kenzo IVANO ◽  
Vitória Luiza Locatelli WINKELER ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Intraoperative Complications ◽  
Length Of Hospital Stay ◽  
Endoscopic Procedure ◽  
Endoscopic Retrograde ◽  
Therapeutic Success

ABSTRACT Background: Obesity can be treated with bariatric surgery; but, excessive weight loss may lead to diseases of the bile duct such as cholelithiasis and choledocholithiasis. Endoscopic retrograde cholangiopancreatography is a diagnostic and therapeutic procedure for these conditions, and may be hampered by the anatomical changes after surgery. Aim: Report the efficacy and the safety of videolaparoscopy-assisted endoscopic retrograde cholangiopancreatography technique in patients after bariatric surgery with Roux-en-Y gastric bypass. Method: Retrospective study performed between 2007 and 2017. Data collected were: age, gender, surgical indication, length of hospital stay, etiological diagnosis, rate of therapeutic success, intra and postoperative complications. Results: Seven patients had choledocholithiasis confirmed by image exam, mainly in women. The interval between gastric bypass and endoscopic procedure ranged from 1 to 144 months. There were no intraoperative complications. The rate of duodenal papillary cannulation was 100%. Regarding complications, the majority of cases were related to gastrostomy, and rarely to endoscopic procedure. There were two postoperative complications, a case of chest-abdominal pain refractory to high doses of morphine on the same day of the procedure, and a laboratory diagnosis of acute pancreatitis after the procedure in an asymptomatic patient. The maximum hospital stay was four days. Conclusion: The experience with endoscopic retrograde cholangiopancreatography through laparoscopic gastrostomy is a safe and effective procedure, since most complications are related to the it and did not altered the sequence to perform the conventional cholangiopancreatography.

Activity Tracking After Surgery: Does It Correlate With Postoperative Complications?

2021 ◽  
pp. 000313482098881
Author(s):  
Yehonatan Nevo ◽  
Tali Shaltiel ◽  
Naama Constantini ◽  
Danny Rosin ◽  
Mordechai Gutman ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Inverse Correlation ◽  
Complication Rates ◽  
Activity Tracking ◽  
Primary Endpoints ◽  
Specific Complication ◽  
Secondary Endpoints ◽  
Enhanced Recovery Programs

Background Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. Methods Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. Results 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission ( P < .05). POD2 step count was an independent risk factor for severe complications ( P = .026). Discussion Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.

scholarly journals Global Benchmark Values for Laparoscopic Roux-en-Y-Gastric Bypass: a Potential New Indicator of the Surgical Learning Curve

2020 ◽  
Author(s):  
Guillaume Giudicelli ◽  
Michele Diana ◽  
Mickael Chevallay ◽  
Benjamin Blaser ◽  
Chloé Darbellay ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Learning Curve ◽  
Operative Time ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Morbidity Rate ◽  
Bariatric Surgeon ◽  
Senior Surgeon ◽  
Surgical Learning

Abstract Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a technically demanding procedure. The learning curve of LRYGB is challenging and potentially associated with increased morbidity. This study evaluates whether a general laparoscopic surgeon can be safely trained in performing LRYGB in a peripheral setting, by comparing perioperative outcomes to global benchmarks and to those of a senior surgeon. Methods All consecutive patients undergoing primary LRYGB between January 2014 and December 2017 were operated on by a senior (A) or a trainee (B) bariatric surgeon and were prospectively included. The main outcome of interest was all-cause morbidity at 90 days. Perioperative outcomes were compared with global benchmarks pooled from 19 international high-volume centers and between surgeons A and B for their first and last 30 procedures. Results The 213 included patients had a mean all-cause morbidity rate at 90 days of 8% (17/213). 95.3% (203/213) of the patients were uneventfully discharged after surgery. Perioperative outcomes of surgeon B were all within the global benchmark cutoffs. Mean operative time for the first 30 procedures was significantly shorter for surgeon A compared with surgeon B, with 108.6 min (± 21.7) and 135.1 min (± 28.1) respectively and decreased significantly for the last 30 procedures to 95 min (± 33.7) and 88.8 min (± 26.9) for surgeons A and B respectively. Conclusion Training of a new bariatric surgeon did not increase morbidity and operative time improved for both surgeons. Perioperative outcomes within global benchmarks suggest that it may be safe to teach bariatric surgery in peripheral setting.

Reduction of Costs for Pelvic Exenteration Performed by High Volume Surgeons: Analysis of the Maryland Health Service Cost Review Commission Database

2016 ◽  
Vol 82 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Azah A. Althumairi ◽  
Joseph K. Canner ◽  
Michael A. Gorin ◽  
Sandy H. Fang ◽  
Susan L. Gearhart ◽  
...  
Keyword(s):  
Pelvic Exenteration ◽  
Quality Care ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Complication Rates ◽  
Health Service Cost ◽  
Total Cost ◽  
Icu Stay ◽  
Lower Complication ◽  
The Impact

High volume hospitals (HVHs) and high volume surgeons (HVSs) have better outcomes after complex procedures, but the association between surgeon and hospital volumes and patient outcomes is not completely understood. Our aim was to evaluate the impact of surgeon and hospital volumes, and their interaction, on postoperative outcomes and costs in patients undergoing pelvic exenteration (PE) in the state of Maryland. A review of the Maryland Health Services Cost Review Commission database between 2000 and 2011 was performed. Patients were compared for demographics and clinical variables. The differences in length of hospital stay, length of intensive care unit (ICU) stay, operating room (OR) cost, and total cost were compared for surgeon volume and hospital volume controlling for all other factors. Surgery performed by HVS at HVH had the shortest ICU stay and lowest OR cost. When PE was performed by a low volume surgeon at an HVH, the OR cost and total cost were the highest and increased by $2,683 ( P < 0.0001) and $16,076 ( P < 0.0001), respectively. OR costs reduced when surgery was performed by an HVS at an HVH ($-1632, P = 0.008). PE performed by HVS at HVH is significantly associated with lower OR costs and ICU stay. We feel this is indicative of lower complication rates and higher quality care.

scholarly journals Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions

2021 ◽  
Vol 10 (5) ◽  
pp. 1016
Author(s):  
Paul I. Heidekrueger ◽  
Nicholas Moellhoff ◽  
Raymund E. Horch ◽  
Jörn A. Lohmeyer ◽  
Mario Marx ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Revision Surgery ◽  
National Level ◽  
Length Of Hospital Stay ◽  
High Standard ◽  
High Volume ◽  
National Registry ◽  
Wound Complications ◽  
Diep Flap ◽  
Complication Rates

While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps performed by 22 centers were included in this study. Demographics, patient characteristics, perioperative details and postoperative outcomes were accounted for. Centers performing < Ø 40 (low-volume (LV)) vs. ≥ Ø 40 (high-volume (HV)) annual DIEP flaps were analyzed separately. Overall, total and partial flap loss rates were as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery was performed in 4.3% of cases. Revision surgery due to wound complications was conducted in 8.3% of all cases. Mean operative time and length of hospital stay was significantly shorter in the HV group (LV: 385.82 min vs. HV: 287.14 min; LV: 9.04 (18.87) days vs. HV: 8.21 (5.04) days; both p < 0.05). The outcome and complication rates deduced from the national registry underline the high standard of microsurgical breast reconstruction on a national level in Germany.

scholarly journals Pancreaticoduodenectomy: Volume is not Associated with Outcome within an Academic Health Care System

HPB Surgery ◽  
2008 ◽  
Vol 2008 ◽  
pp. 1-6 ◽  
Author(s):  
Micheal T. Schell ◽  
Anthony Barcia ◽  
Austin L. Spitzer ◽  
Hobart W. Harris
Keyword(s):  
Health Care ◽  
San Francisco ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Survival Rates ◽  
High Volume ◽  
Care Pathways ◽  
Complication Rates ◽  
Significant Difference

Hypothesis. Smaller and lower-volume hospitals can attain surgical outcomes similar to high-volume centers if they incorporate the expertise and health care pathways of high-volume centers. Setting. The academic tertiary care center, Moffit-Long Hospital (ML); the community-based Mount Zion Hospital (ZION); the San Francisco County General Hospital (SFGH); and the Veterans Affairs Medical Center of San Francisco (VAMC). Patients. 369 patients who underwent pancreaticoduodenectomy between October 1989 and June 2003 at the University of California, San Francisco (UCSF) affiliated hospitals. Interventions. Pancreaticoduodenectomy. Design. Retrospective chart review. To correct for the potentially confounding effect of small case volumes and event rates, data for SFGH, VAMC, and ZION was combined (Small Volume Hospital Group; SVHG) and compared against data for ML. Main Outcome Measures. Complication rates; three-year and five-year survival rates. Results. The average patient age and health, as determined by ASA score, were similar between ML and the SVHG. The postoperative complication rate did not differ significantly between ML and the SVGH (58.8% versus 63.1%). Patients that experienced a complication averaged 2.5 complications in both groups. The perioperative mortality rate was 4% for patients undergoing pancreaticoduodenectomy at either ML or the SVGH. Although the 3-year survival rate for patients with adenocarcinoma of the pancreas was nearly twice as high at ML (31.2% versus 18.3% at SVHG), there was no significant difference in the 5-year survival rates (19% at ML versus 18.3% at SVHG). Conclusions. Low-volume hospitals can achieve similar outcomes to high-volume tertiary care centers provided they import the expertise and care pathways necessary for improved results.

Sign in / Sign up

Export Citation Format

Share Document