Kfir Ben-David

Operative Treatments for Reflux After Bariatric Surgery: Current and Emerging Management Options.

Gastroesophageal reflux disease (GERD) is a common disorder that has a well-established connection with obesity. To ameliorate the morbidity associated with obesity, bariatric procedures have become an established pathway to accomplish sustained weight loss. In some procedures, such as with the Roux-en-Y gastric bypass surgery, weight loss is also accompanied by the resolution of GERD symptoms. However, other popular bariatric surgeries, such as the sleeve gastrectomy, have a controversial impact on their effect on reflux. Consequently, increased attention has been given to the development of strategies for the management of de novo or recurrent reflux after bariatric surgery. This article aims to discuss medical and surgical strategies for reflux after bariatric surgery, and their outcomes.

Preoperative enteral access is not necessary prior to multimodality treatment of esophageal cancer

Background. Surgical enteral access prior to multimodality treatment for esophageal cancer is controversial as dysphagia is often used for feeding tube referral. We hypothesized that enteral access before neoadjuvant chemoradiation for esophageal cancer provides no benefit compared to that placed during definitive esophagectomy. Methods. Patients undergoing esophagectomy for esophageal malignancy from 2007 − 2014 were retrospectively identified. Clinicopathologic factors were recorded including preoperative enteral access, weight change, nutritional laboratory works, and perioperative complications. Results. Of 156 identified patients, 99 (63.5%) received neoadjuvant chemoradiation and comprised the study cohort. Fifty (50.5%) underwent enteral access (gastrostomy [14], jejunostomy [32], other [4]; “Access Group”) prior to chemoradiation followed by esophagectomy and were compared to 49 “No‐Access” patients who underwent enteral access during esophagectomy. Clinicopathologic variables were similar between cohorts. The Access and No‐Access cohorts had similar reported dysphagia (86% vs 75.5%, respectively; P = .2) and mean preesophagectomy serum albumin (3.9 vs 4 gm/dL, respectively; P = .2). Weight loss ± 6‐month periesophagectomy was similar between access versus No‐Access cohorts (−11.2% vs −15.4%, respectively; P = .1). Weight loss during this period was likewise similar for patients with dysphagia in the Access (−11%) versus No‐Access group (−15.2%, P = .1). No difference in complication rates was noted between Access (64%) and No‐Access groups (51%, P = .2). Conclusion. Despite healthcare provider bias, there seems to be no nutritional or perioperative benefit for enteral access before neoadjuvant chemoradiation for esophageal malignancy. Patients with esophageal malignancy should therefore proceed to appropriate neoadjuvant and surgical therapy with enteral access performed during definitive resection or reserved for those with frank obstruction on endoscopy.

Minimally Invasive Esophagectomy for Benign Disease

This chapter focuses on the history of esopagectomies from open procedures to the pioneers of minimally invasive techniques who have standardized the use of laparoscopic surgical options for benign esophageal diseases. At present there are two widely accepted techniques for the treatment of esophageal diseases, two site Ivor-Lewis and three site McKeown procedures. Each with slightly different applications, goals, and surgical steps which are highlighted in detail with step-by-step instructions. Postoperative goals and pitfalls are also discussed.

Fundamentals of Basic Laparoscopic Setup

The advent of laparoscopic surgery has revolutionized the field of general surgery. This chapter will cover the basic setup laparoscopic surgery, ranging from equipment and setup to troubleshooting as well as reviewing a variety of common laparoscopic surgical approaches. While each patient and each surgery are unique, a working knowledge of the common features will help ensure the safest possible outcome for the patient.

Laparoscopic proximal gastrectomy for gastric neoplasms: KUKAR et al.

For cancers of the distal gastroesophageal junction or the proximal stomach, proximal gastrectomy can be performed. It is associated with several perioperative benefits compared with total gastrectomy. The use of laparoscopic proximal gastrectomy (LPG) has become an increasingly popular approach for select tumors.

Esophagectomy for Failed Anti-reflux Therapy: Indications, Techniques, and Outcomes

Weekly reflux symptoms occur in approximately 20–30% of the United States population [1, 2]. The standard surgical management of reflux is laparoscopic fundoplication, with 43% of patients continuing anti-reflux medication use after surgery, and 3–18% of patients requiring reoperation, most commonly for reflux and dysphagia [3–5]. In addition to intractable recurrent symptoms, other complications after anti-reflux surgery include severe dysphagia and strictures. Thus, long term outcomes are not ideal in either medically or surgically treated patients with gastroesophageal reflux disease (GERD).

Technical Surgical Failures: Presentation, Etiology, and Evaluation

Esophagectomies have come a long way since first being described more than 100 years ago. However, they remain a very challenging procedure that can come with significant morbidity and mortality. The most recent major advance in this field is the advent of minimally invasive esophagectomies. While there are many different methods for performing the surgery and minimally invasive techniques seem to have further reduced some of the associated morbidity and mortality, however, most of the pitfalls remain the same. This chapter is dedicated to the surgical failures that may present during and following a minimally invasive esophagectomy (MIE) including presentation and evaluation.

Comparative Effectiveness of Preoperative Treatment Regimens in Patients With Potentially Resectable Esophageal Cancer.

Comparative Effectiveness of Preoperative Treatment Regimens in Patients With Potentially Resectable Esophageal Cancer Despite potentially curative surgery, the 5-year survival rate for patients with esophageal cancer (EC) is approximately 25%, and thus, additional therapies have been explored to improve outcomes.1 Randomized trials have demonstrated improved recurrence-free survival (RFS) and overall survival (OS) in patients with EC treated with preoperative chemoradiation vs surgery alone.2,3 Historically, cisplatin-based regimens demonstrate higher tumor response rates but exhibit increased toxic effects compared with carboplatin-based regimens, which have become an attractive alternative.2-4 While preoperative chemoradiation with cisplatin and fluorouracil (cis/5FU) or carboplatin and paclitaxel (carbo/pac) have been studied individually in EC, comparative randomized trials are lacking. Given the cis/5FU and carbo/pac usage during 2 time periods (2005-2012 and 2011-present, respectively) at our institution, we hypothesized that despite concerns of toxic effects there would be no difference in treatment completion be-