Abhijit Shaligram

Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: Review of the Bariatric Outcomes Longitudinal Database☆

BACKGROUND The prevalence of gastroesophageal reflux disease (GERD) in the morbidly obese population is as high as 45%. The objective of this study was to compare the efficacy of various bariatric procedures in the improvement of GERD. METHODS The Bariatric Outcomes Longitudinal Database is a prospective database of patients who undergo bariatric surgery by a participant in the American Society of Metabolic and Bariatric Surgery Center of Excellence program. GERD is graded on a 6-point scale, from 0 (no history of GERD) to 5 (prior surgery for GERD). Patients with GERD severe enough to require medications (grades 2, 3, and 4) from June 2007 to December 2009 are identified; the resolution of GERD is noted based on 6-month follow-up. RESULTS Of a total of 116,136 patients, 36,938 patients had evidence of GERD preoperatively. After excluding patients undergoing concomitant hiatal hernia repair or fundoplication, there were 22,870 patients with 6-month follow-up. Mean age was 47.6±11.1 years, with an 82% female population. Mean BMI was 46.3±8.0 kg/m(2). Mean preoperative GERD score for patients with Roux-en-Y gastric bypass (RYGB) was 2.80±.56, and mean postoperative score was 1.33±1.41 (P<.0001). Similarly, adjustable gastric banding (AGB, 2.77±.57 to 1.63±1.37, P<.0001) and sleeve gastrectomy (SG, 2.82±.57 to 1.85±1.40, P<.0001) had significant improvement in GERD score. GERD score improvement was best in RYGB patients (56.5%; 7955 of 14,078) followed by AGB (46%; 3773 of 8207) and SG patients (41%; 240 of 585). CONCLUSION All common bariatric procedures improve GERD. Roux-en-Y gastric bypass is superior to adjustable gastric banding and sleeve gastrectomy in improving GERD. Also, the greater the loss in excess weight, the greater the improvement in GERD score.

Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: a national database review of academic medical centers.

Objective:This study aims to examine trends of utilization and rates of conversion to open procedure for patients undergoing laparoscopic colon resections (LCR). Methods:This study is a national database review of academic medical centers and a retrospective analysis utilizing the University HealthSystem Consortium administrative database—an alliance of more than 300 academic and affiliate hospitals. Results:A total of 85,712 patients underwent colon resections between October 2008 and December 2011. LCR was attempted in 36,228 patients (42.2%), with 5751 patients (15.8%) requiring conversion to an open procedure. There was a trend toward increasing utilization of LCR from 37.5% in 2008 to 44.1% in 2011. Attempted laparoscopic transverse colectomy had the highest rate of conversion (20.8%), followed by left (20.7%), right (15.6%), and sigmoid (14.3%) colon resections. The rate of utilization was highest in the Mid-Atlantic region (50.5%) and in medium- to large-sized hospitals (47.0%–49.0%).Multivariate logistic regression has shown that increasing age [odds ratio (OR) = 4.8, 95% confidence interval (CI) = 3.6–6.4], male sex (OR = 1.2, 95% CI = 1.1–1.3), open as compared with laparoscopic approach (OR = 2.6, 95%, CI = 2.3–3.1), and greater severity of illness category (OR = 27.1, 95% CI = 23.0–31.9) were all associated with increased mortality and morbidity and prolonged length of hospital stay. Conclusions:There is a trend of increasing utilization of LCR, with acceptable conversion rates, across hospitals in the United States over the recent years. When feasible, attempted LCR had better outcomes than open colectomy in the immediate perioperative period.

Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study

BACKGROUND Morbidity and mortality are very high for critically ill patients who develop acute acalculous cholecystitis (AAC). The aim of this study was to compare outcomes in extremely ill patients with AAC treated with percutaneous cholecystostomy (PC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC), which were also analyzed together in the LC-plus-OC (LO) group. METHODS Discharge data from the University HealthSystem Consortium database were accessed using International Classification of Diseases codes. The University HealthSystem Consortiums Clinical Data Base/Resource Manager allows member hospitals to compare patient-level, risk-adjusted outcomes. Multivariate regression models for extremely ill patients undergoing PC or LO for the diagnosis of AAC were created and analyzed. RESULTS A total of 1,725 extremely ill patients were diagnosed with AAC between October 2007 and June 2011. Patients undergoing PC (n = 704) compared with the LO group (n = 1,021) showed decreased morbidity (5.0% with PC vs 8.0% with LO, P < .05), fewer intensive care unit admissions (28.1% with PC vs 34.6% with LO, P < .05), decreased length of stay (7 days with PC vs 8 days with LO, P < .05), and lower costs (

Hiatal hernia repair with biologic mesh reinforcement reduces recurrence rate in small hiatal hernias

40,516 with PC vs

Impact on Perioperative Outcomes of Concomitant Hiatal Hernia Repair with Laparoscopic Gastric Bypass

53,011 with LO, P < .05). Although perioperative outcomes of PC compared with LC were statistically similar, PC had lower costs compared with LC (

Do you need a computed tomographic scan to evaluate suspected appendicitis in young men: an administrative database review

40,516 vs 51,596, P < .005). Multivariate regression analysis showed that LC (n = 822), compared with OC (n = 199), had lower mortality (odds ratio [OR], .3; 95% confidence interval [CI], .1 to .6), lower morbidity (OR, .4; 95% CI, .2 to .7), reduced intensive care unit admission (OR, .3; 95% CI, .2 to .5), and similar 30-day readmission rates (OR, 1.0; 95% CI, .6 to 1.5). Also, decreased length of stay (7 days with LC vs 8 days with OC) and costs (

Perioperative outcomes after adrenalectomy for malignant neoplasm in laparoscopic era: A multicenter retrospective study

51,596 with LC vs

Reply to letter: "Author response to the comment on the article about comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis".

61,407 with OC) were observed, with a 26% conversion rate to an open procedure. CONCLUSIONS On the basis of this experience, extremely ill patients with AAC have superior outcomes with PC. LC should be performed in patients in whom the risk for conversion is low and in whom medical conditions allow. These results show PC to be a safe and cost-effective bridge treatment strategy with perioperative outcomes superior to those of OC.

How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia

The utility of mesh reinforcement for small hiatal hernia found especially during antireflux surgery is unknown. Initial reports for the use of biological mesh for crural reinforcement during repair for defects greater than 5 cm have been shown to decrease recurrence rates. This study compares patients with small hiatal hernias who underwent onlay biologic mesh buttress repair versus those with suture cruroplasty alone. This is a single-institution retrospective review of all patients undergoing repair of hiatal hernia measuring 1-5 cm between 2002 and 2009. The patients were evaluated based on surgical repair: one group undergoing crural reinforcement with onlay biologic mesh and other group with suture cruroplasty only. Seventy patients with hiatal hernia measuring 1-5 cm were identified. Thirty-eight patients had hernia repair with biologic mesh, and 32 patients had repair with suture cruroplasty only. Recurrence rate at 1 year was 16% (5/32) in patients who had suture cruroplasty only and 0% (0/38) in the group with crural reinforcement with absorbable mesh (statistically significant, P = 0.017). Suture cruroplasty alone appears to be inadequate for hiatal hernias measuring 1-5 cm with significant recurrence rate and failure of antireflux surgery. Crural reinforcement with absorbable mesh may reduce hiatal hernia recurrence rate in small hiatal hernias.

Trends in adolescent bariatric surgery evaluated by UHC database collection

BackgroundThe role of laparoscopic hiatal hernia repair (LHHR) at the time of laparoscopic Roux-en-y gastric bypass (LRYGB) is still debatable. This study aims to assess the safety of concomitant LHHR with LRYGB.MethodsThis study is a multi-center, retrospective analysis of a large administrative database. The University Health System Consortium (UHC) is a group of 112 academic medical centers and 256 of their affiliated hospitals. The UHC database was queried using International Classification of Diseases—9 codes and main outcome measures were analyzed.ResultsFrom October 2006 to January 2010, we found 33,717 patients who underwent LRYGB and did not have a hiatal hernia. In this same time period, 644 patients underwent concomitant LRYGB and LHHR, while 1,589 patients underwent LRYGB without repair of their hiatal hernias. On comparison of patients undergoing LRYGB with simultaneous LHHR with those who underwent LRYGB without a diagnosis of HH, there was no significant difference in mortality, morbidity, length of stay (LOS), 30-day readmission, or cost shown. On comparison of patients with HH who underwent LRYGB and simultaneous LHHR with those who had LRYGB without LHHR, no significant difference with regards to all the outcome measures was also shown.ConclusionsIn conclusion, concomitant hiatal hernia repair with LRYGB appears to be safe and feasible. These patients did not have any significant differences in morbidity, mortality, LOS, readmission rate, or cost. Randomized controlled studies should further look into the benefit of hiatal hernia repair in regards to reflux symptoms and weight loss for LRYGB patients.