Is Roux-en-Y gastrojejunostomy an adequate anti-reflux operation after esophagogastric myotomy?

Background: Roux-en-Y gastrojejunostomy (RYGJ) is viewed as a salvage operation for fundoplication failure or obesity-related reflux, and we questioned it is long-term effectiveness in patients undergoing esophagogastric myotomy.

Methods: From an operative report database, we identified 37 patients who underwent a combination of Roux-en-Y gastrojejunostomy and esophagogastric myotomy, and retrospective chart review was performed. Dysphagia was the main presenting symptom, reported in 33 patients (89%), followed by regurgitation in 23 patients (62%) and reflux in 16 patients (43%).

Strategies for Resection of Esophageal and Gastroesophageal Junction Submucosal Tumors.

Submucosal tumors (SMT) of the esophagus and gastroesophageal junction (GEJ) are rare entities, which often present a significant challenge to surgeons. Prior studies have reported only single-modality approaches. We report our experience with SMTs using multiple surgical techniques with the intent of margin-negative resection and organ preservation.

Acute cholecystitis treated with urgent cholecystectomy achieves higher rate of critical view of safety when compared to interval cholecystectomy after tube cholecystostomy.

Background: There are few reported outcomes of treatment of acute cholecystitis incorporating current guidelines for gallbladder dissection techniques and use of percutaneous tube cholecystostomy (PCT). The authors hypothesize PCT allows regression of peritoneal inflammation, but infundibular inflammation is increased at interval cholecystectomy, resulting in greater requirement for advanced dissection techniques.

Methods: Between December 2009 and July 2023, 1222 patients were admitted with acute cholecystitis and ultimately underwent cholecystectomy.

Robotic versus laparoscopic revision to Toupet fundoplication for failed Nissen fundoplication: a single-center experience.

Nissen fundoplication (NF) is a common surgical procedure to treat gastroesophageal reflux disease; however, a subset of patients may continue to experience symptoms or develop symptom recurrence despite a successful procedure. This study aims to compare laparoscopic and robotic approaches for treating failed NF and evaluate the outcomes after converting to Toupet fundoplication (TF). We conducted a retrospective analysis of patients who underwent robotic or laparoscopic revision to TF for failed NF between 2016 and 2023.

Can Risk-Based Thromboprophylaxis Practice Guidelines be Safely Used in Esophagectomy Cases? Experience of an Academic Health System.

Background: Venous thromboembolism (VTE) occurs in 3-11% of esophagectomy patients and is associated with increased mortality and morbidity. The use of validated VTE risk assessment tools and compliance with recommended practice guidelines remains unclear. In this study, we seek to determine the use of Caprini guideline indicated VTE prophylaxis and its effect on VTE and bleeding complications following esophagectomy.

Redo fundoplication vs. Roux-en-Y gastric bypass conversion for failed anti-reflux surgery: which is better?

Introduction: Different techniques have been proposed for reoperation after failed anti-reflux surgery. However, there is no consensus on which should be preferred. We aim to report and compare the outcomes of different revisional techniques for failed anti-reflux surgery.

Preoperative high respiratory quotient correlates with lower weight loss after bariatric surgery.

Background: The respiratory coefficient (RQ), as determined by indirect calorimetry (IC), classifies diet as being carbohydrate rich (RQ = 0.7-0.8), fat rich (RQ = 0.

Squamous Cell Carcinoma in Lichen Planus of the Esophagus.

Cancer arising in lichen planus of the esophagus (LPE) is extremely rare. We report 2 elderly female patients with LPE who developed squamous cell carcinoma. Both underwent laparoscopic ischemic gastric preconditioning followed 2 weeks later by 3-field esophagectomy.

Short-Term Outcomes Predict Long-Term Satisfaction in Patients Undergoing Laparoscopic Magnetic Sphincter Augmentation.

Introduction: Laparoscopic magnetic sphincter augmentation (MSA) has been shown to be efficacious therapy for gastroesophageal reflux disease (GERD) refractory to maximal medical management. Herein, we present our experience with this procedure and an analysis of our outcomes.

Materials And Methods: Medical records were retrospectively reviewed of 98 patients who underwent laparoscopic MSA for GERD at a single institution from 2012 to 2016.

Strategies for surgical remediation of the multi-fundoplication failure patient.

Background: Outcomes are not well studied in patients undergoing remediation for multi-fundoplication failure, that is, two or more prior failed fundoplications. Re-operation must balance reflux control and restoration of the ability to eat with the challenge of reconstructing a distorted hiatus and GE junction. The purpose of this study is to present our experience with surgical remediation for multi-fundoplication failure.

The Spectrum of Surgical Remediation of Transoral Incisionless Fundoplication-Related Failures.

Aim: To evaluate outcomes of surgical remediation for symptomatic or anatomic failure after a transoral incisionless fundoplication (TIF).

Methods: This retrospective study was performed on 11 patients who underwent a remedial operation following TIF failure between June 2011 and September 2016 at the Mayo Clinic in Florida for persistent foregut symptoms. Upper gastrointestinal workup characterized 1 patient as having normal post-TIF anatomy and 10 as having anatomic failure.

Correction to: Endoscopic and surgical management of nonampullary duodenal neoplasms.

This article was updated to correct the author listing for Carlos Roberto Simons-Linares.

Endoscopic and surgical management of nonampullary duodenal neoplasms.

Background: Sporadic nonampullary duodenal neoplasms (SNADN) can have malignant potential for which endoscopic and surgical resections are offered. We report combined gastroenterologic and surgical experience for treatment of SNADN, including endoscopic mucosal resection (EMR) and pancreas-preserving partial duodenectomy (PPPD).

Methods: We retrospectively reviewed 121 consecutive patients, who underwent 30 PPPDs and 91 EMRs for mucosal and submucosal SNADN.

The argument for peroral endoscopic myotomy in treatment of achalasia.

Although there has been debate regarding the optimal procedure to palliate dysphagia in patients with achalasia, emerging reports of longer term follow-up of patients after peroral endoscopic myotomy (POEM) suggest that the POEM procedure is efficacious in relief of dysphagia, and that there is infrequent need for subsequent procedures for treatment of failure or reflux. The number of centers in the United States of America performing POEM for esophageal achalasia continues to increase. This report assess the current knowledge of technical issues of POEM, outcomes after POEM and the status of POEM centers in the U.

Guiding Patients Toward the Appropriate Surgical Treatment for Obesity: Should Presurgery Psychological Correlates Influence Choice Between Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy?

Background: Helping patients determine which type of bariatric surgery, Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG), may be the best treatment can be challenging. This study investigated psychological correlates and their influence on weight loss for patients who underwent RYGB or VSG.

Methods: Four hundred twenty-two patients (RYGB = 305; VSG = 117) completed screening questionnaires presurgery and underwent surgery between August 2012 and April 2015.

Laparoscopic repair of giant paraesophageal hernia: are there factors associated with anatomic recurrence?

Background: Repair of giant paraesophageal hernia (PEH) is associated with a favorably high rate of symptom improvement; however, rates of recurrence by objective measures remain high. Herein we analyze our experience with laparoscopic giant PEH repair to determine what factors if any can predict anatomic recurrence.

Methods: We prospectively collected data on PEH characteristics, variations in operative techniques, and surgeon factors for 595 patients undergoing laparoscopic PEH repair from 2008 to 2015.

Revisional surgery after failed esophagogastric myotomy for achalasia: successful esophageal preservation.

Background: Treatment failure with recurrent dysphagia after Heller myotomy occurs in fewer than 10 % of patients, most of whom will seek repeat surgical intervention. These reoperations are technically challenging, and as such, there exist only limited reports of reoperation with esophageal preservation.

Methods: We retrospectively reviewed the records of patients who sought operative intervention from March 1998 to December 2014 for obstructed swallowing after esophagogastric myotomy.

Esophageal motility disorders.

The diagnosis of esophageal motility disorders has been greatly enhanced with the development of high-resolution esophageal manometry studies and the Chicago Classification. Both hypomotility disorders and hypercontractility disorders of the esophagus have new diagnostic criteria. For the foregut surgeon, new diagnostic criteria for esophageal motility disorders have implications for decision-making during fundoplication and may expand the role of surgical therapy for esophageal achalasia by clarifying diagnostic criteria.

Hypometabolizers: characteristics of obese patients with abnormally low resting energy expenditure.

Weight gain or loss is determined by the difference between calorie intake and energy expenditure. The Mifflin metabolic equation most accurately predicts resting energy expenditure (REE) in morbidly obese patients. Hypometabolizers have a measured REE that is much less than predicted and pose the greatest challenge for weight loss induced by restriction of calorie intake.

Prospective evaluation of 24-hour urine profiles following bariatric surgery in a modern comprehensive care bariatric clinic.

Aims: To prospectively examine the effect of modern bariatric surgery on 24-hour urine parameters in a comprehensive care bariatric practice (CCBP).

Materials And Methods: 47 consecutive patients in our CCBP underwent serum and 24-hour urine analysis pre-operatively, and 30 returned at 12 months for repeat testing. Paired comparisons for serum metabolite and 24-hour urine measures were performed using a Wilcoxon signed-rank test for continuous variables and McNemar's test for categorical variables.

"iTrainers"--novel and inexpensive alternatives to traditional laparoscopic box trainers.

Objective: To evaluate the use of 2 inexpensive laparoscopic trainers (iTrainers) constructed of easily attainable materials and portable tablets (iPads).

Methods: Two different laparoscopic trainers were constructed using a cardboard box, thumbtacks, and Velcro tape (box trainer). A separate box was constructed using the same supplies with a 3-ring binder (binder trainer).