Surgical Resection of Gastro-Pleural-Bronchial Fistula after Prolonged Endoscopic Treatments

2021 ◽  
pp. 000313482110488
Author(s):  
Cannon Nelson ◽  
Joseph Suijka ◽  
Christopher DuCoin
Keyword(s):  
United States ◽  
Bariatric Surgery ◽  
Sleeve Gastrectomy ◽  
Surgical Resection ◽  
The United States ◽  
Complication Rates ◽  
Bronchial Fistula ◽  
Subsequent Failure

Sleeve gastrectomy is the most commonly performed bariatric surgery in the United States. While complication rates are typically low, some studies have reported leaks in up to 2.4-5.3% of cases. Here, we examine such a case with subsequent failure of numerous endoscopic interventions ultimately necessitating formal resection of a gastro-Pleural-bronchial fistula.

scholarly journals Trends in Bariatric Surgery Procedures among Patients with ESKD in the United States

2019 ◽  
Vol 14 (8) ◽  
pp. 1193-1199 ◽  
Author(s):  
Kyle H. Sheetz ◽  
Kenneth J. Woodside ◽  
Vahakn B. Shahinian ◽  
Justin B. Dimick ◽  
John R. Montgomery ◽  
...  
Keyword(s):  
United States ◽  
Bariatric Surgery ◽  
Sleeve Gastrectomy ◽  
Confidence Interval ◽  
Practice Patterns ◽  
Surgical Care ◽  
The United States ◽  
Complication Rates ◽  
Linear Regression Models ◽  
Number Of Patients

Background and objectivesDespite the potential for improving health status or increasing access to transplantation, national practice patterns for bariatric surgery in obese patients with ESKD are poorly understood. The purpose of this study was to describe current trends in surgical care for this population.Design, setting, participants, & measurementsUsing 100% Medicare data, we identified all beneficiaries undergoing bariatric surgery in the United States between 2006 and 2016. We evaluated longitudinal practice patterns using linear regression models. We also estimated risk-adjusted complications, readmissions, and length of stay using Poisson regression for patients with and without ESKD.ResultsThe number of patients with ESKD undergoing bariatric surgery increased ninefold between 2006 and 2016. The proportional use of sleeve gastrectomy increased from <1% in 2006 to 84% in 2016. For sleeve gastrectomy, complication rates were similar between patients with and without ESKD (3.4% versus 3.6%, respectively; difference, −0.3%; 95% confidence interval, −1.3% to 0.1%; P=0.57). However, patients with ESKD had more readmissions (8.6% versus 5.4%, respectively; difference, 3.2%; 95% confidence interval, 1.9% to 4.6%; P<0.001) and slightly longer hospitals stays (2.2 versus 1.9 days, respectively; difference, 0.3; 95% confidence interval, 0.1 to 0.4; P<0.001).ConclusionsThis study suggests that laparoscopic sleeve gastrectomy has replaced Roux-en-Y gastric bypass as the most common bariatric surgical procedure in patients with ESKD. The data also demonstrate a favorable complication profile in patients with sleeve gastrectomy.

Bariatric surgery in the treatment of adolescent obesity: current perspectives in the United States

2021 ◽  
pp. 1-12
Author(s):  
Sonali Malhotra ◽  
Kathryn S. Czepiel ◽  
Eftitan Y. Akam ◽  
Ashley Y Shaw ◽  
Ramya Sivasubramanian ◽  
...  
Keyword(s):  
United States ◽  
Bariatric Surgery ◽  
The United States ◽  
Adolescent Obesity

Recent trends in bariatric surgery case volume in the United States

Surgery ◽  
2009 ◽  
Vol 146 (2) ◽  
pp. 375-380 ◽  
Author(s):  
Geoffrey P. Kohn ◽  
Joseph A. Galanko ◽  
D. Wayne Overby ◽  
Timothy M. Farrell
Keyword(s):  
United States ◽  
Bariatric Surgery ◽  
The United States ◽  
Case Volume ◽  
Recent Trends

scholarly journals Fiducial marker placement with electromagnetic navigation bronchoscopy: a subgroup analysis of the prospective, multicenter NAVIGATE study

2019 ◽  
Vol 13 ◽  
pp. 175346661984123 ◽  
Author(s):  
Mark R. Bowling ◽  
Erik E. Folch ◽  
Sandeep J. Khandhar ◽  
Jordan Kazakov ◽  
William S. Krimsky ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Subgroup Analysis ◽  
The United States ◽  
Lung Lesion ◽  
Endobronchial Ultrasound ◽  
Complication Rates ◽  
Electromagnetic Navigation ◽  
Cancer Management ◽  
The Impact

Background: Fiducial markers (FMs) help direct stereotactic body radiation therapy (SBRT) and localization for surgical resection in lung cancer management. We report the safety, accuracy, and practice patterns of FM placement utilizing electromagnetic navigation bronchoscopy (ENB). Methods: NAVIGATE is a global, prospective, multicenter, observational cohort study of ENB using the superDimension™ navigation system. This prospectively collected subgroup analysis presents the patient demographics, procedural characteristics, and 1-month outcomes in patients undergoing ENB-guided FM placement. Follow up through 24 months is ongoing. Results: Two-hundred fifty-eight patients from 21 centers in the United States were included. General anesthesia was used in 68.2%. Lesion location was confirmed by radial endobronchial ultrasound in 34.5% of procedures. The median ENB procedure time was 31.0 min. Concurrent lung lesion biopsy was conducted in 82.6% (213/258) of patients. A mean of 2.2 ± 1.7 FMs (median 1.0 FMs) were placed per patient and 99.2% were accurately positioned based on subjective operator assessment. Follow-up imaging showed that 94.1% (239/254) of markers remained in place. The procedure-related pneumothorax rate was 5.4% (14/258) overall and 3.1% (8/258) grade ⩾ 2 based on the Common Terminology Criteria for Adverse Events scale. The procedure-related grade ⩾ 4 respiratory failure rate was 1.6% (4/258). There were no bronchopulmonary hemorrhages. Conclusion: ENB is an accurate and versatile tool to place FMs for SBRT and localization for surgical resection with low complication rates. The ability to perform a biopsy safely in the same procedure can also increase efficiency. The impact of practice pattern variations on therapeutic effectiveness requires further study. Trial registration: ClinicalTrials.gov identifier: NCT02410837.

scholarly journals The Present Status of Immuno-Oncolytic Viruses in the Treatment of Pancreatic Cancer

Viruses ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 1318
Author(s):  
Scott D. Haller ◽  
Michael L. Monaco ◽  
Karim Essani
Keyword(s):  
United States ◽  
Pancreatic Cancer ◽  
Surgical Resection ◽  
Clinical Investigation ◽  
Treatment Options ◽  
Late Phase ◽  
The United States ◽  
Oncolytic Viruses ◽  
Ductal Adenocarcinoma ◽  
Treatment Regimens

Pancreatic ductal adenocarcinoma (PDAC) is the fifth leading cause of cancer-related death in Western countries. The incidence of PDAC has increased over the last 40 years and is projected to be the second leading cause of cancer death by 2030. Despite aggressive treatment regimens, prognosis for patients diagnosed with PDAC is very poor; PDAC has the lowest 5-year survival rate for any form of cancer in the United States (US). PDAC is very rarely detected in early stages when surgical resection can be performed. Only 20% of cases are suitable for surgical resection; this remains the only curative treatment when combined with adjuvant chemotherapy. Treatment regimens excluding surgical intervention such as chemotherapeutic treatments are associated with adverse effects and genetherapy strategies also struggle with lack of specificity and/or efficacy. The lack of effective treatments for this disease highlights the necessity for innovation in treatment options for patients diagnosed with early- to late-phase PDAC and immuno-oncolytic viruses (OVs) have been of particular interest since 2006 when the first oncolytic virus was approved as a therapy for nasopharyngeal cancers in China. Interest resurged in 2015 when T-Vec, an oncolytic herpes simplex virus, was approved in the United States for treatment of advanced melanoma. While many vectors have been explored, few show promise as treatment for pancreatic cancer, and fewer still have progressed to clinical trial evaluation. This review outlines recent strategies in the development of OVs targeting treatment of PDAC, current state of preclinical and clinical investigation and application.

scholarly journals Total elbow arthroplasty in the United States: evaluation of cost, patient demographics, and complication rates

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Hanbing Zhou ◽  
Nathan D. Orvets ◽  
Gabriel Merlin ◽  
Joshua Shaw ◽  
Joshua S. Dines ◽  
...  
Keyword(s):  
United States ◽  
Direct Cost ◽  
Complication Rate ◽  
Readmission Rate ◽  
The United States ◽  
Total Elbow Arthroplasty ◽  
Complication Rates ◽  
Patient Demographics ◽  
Elbow Arthroplasty ◽  
The Mean

Total elbow arthroplasty (TEA) is utilized in the treatment of rheumatoid and post-traumatic elbow arthritis. TEA is a relatively low volume surgery in comparison to other types of arthroplasty and therefore little is known about current surgical utilization, patient demographics and complication rates in the United States. The purpose of our study is to evaluate the current practice trends and associated inpatient complications of TEA at academic centers in the United States. We queried the University Health Systems Consortium administrative database from 2007 to 2011 for patients who underwent an elective TEA. A descriptive analysis of demographics was performed which included patient age, sex, race, and insurance status. We also evaluated the following patient clinical benchmarks: hospital length of stay (LOS), hospital direct cost, inhospital mortality, complications, and 30-day readmission rates. Our cohort consisted of 3146 adult patients (36.5% male and 63.5% female) with an average age of 58 years who underwent a total elbow arthroplasty (159 academic medical centers) in the United States. The racial demographics included 2334 (74%) Caucasian, 285 (9%) black, 236 (7.5%) Hispanic, 16 (0.5%) Asian, and 283 (9%) other patients. The mean LOS was 4.2±5 days and the mean total direct cost for the hospital was 16,300±4000 US Dollars per case. The overall inpatient complication rate was 3.1% and included mortality &lt;1%, DVT (0.8%), re-operation (0.5%), and infection (0.4%). The 30-day readmission rate was 4.4%. TEA is a relatively uncommon surgery in comparison to other forms of arthroplasty but is associated with low in-patient and 30-day perioperative complication rate. Additionally, the 30-day readmission rate and overall hospital costs are comparable to the traditional total hip and knee arthroplasty surgeries.

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