Raquel Gonzalez-Heredia

Sleeve gastrectomy surgery in obese patients post-organ transplantation.

BACKGROUND Among organ transplant recipients, a common side effect of immunosuppressive therapy is the development of obesity, which affects a third of the patients within 3 years after transplantation. Bariatric surgery represents a possible surgical option for weight loss among posttransplant patients. OBJECTIVES The aim of this study was to examine percent excess weight loss (%EWL), and percent weight loss (%WL) and perioperative and postoperative complications in posttransplant obese patients after sleeve gastrectomy (SG) compared with nontransplant patients. We hypothesize that transplant patients who undergo SG will not significantly differ in their perioperative or postoperative complications or in their %EWL and %WL compared with nontransplant patients who undergo SG. The second aim was to evaluate the impact of SG on graft function and immunosuppressive therapy in transplant patients. SETTING University hospital. METHODS Among 500 consecutive patients who underwent SG from January 2008 to June 2014, 10 patients were organ transplant recipients. The following variables were compared between groups: patient demographic characteristics and co-morbidities, type of transplant surgery, date of transplant surgery, pretransplant body mass index (BMI), date of bariatric surgery, prebariatric surgery BMI, operative time, length of hospitalization, postoperative complications, and change in BMI, %EWL, and %WL. Data were also collected on renal, liver, and pancreas graft function parameters and changes in immunosuppressive medications. RESULTS Six patients had a kidney transplant, 2 patients had a liver transplant, and 2 had a pancreas transplant. No significant differences were observed in %EWL or %WL at 6 and 12 months follow-up between transplant and nontransplant patients. No transplant patients were lost to follow-up at 6 and 12 months. Among nontransplant patients, 36.7% and 35.7% were lost to follow-up at 6 and 12 months, respectively. No postoperative complications were registered in the transplant group. SG did not negatively affect the graft function. CONCLUSION Initials results found that there were no significant differences in %EWL or %WL at 6 and 12 months follow-up between transplant and nontransplant patients. There were also no perioperative and postoperative complications among transplant patients after SG.

Effectiveness of gastric neurostimulation in patients with gastroparesis

Background: Patients with gastroparesis have significantly delayed gastric emptying because of impaired nerve function. Gastric neurostimulation from Enterra Therapy provides electrical pulses to the stomach tissue that promotes stimulation of stomach smooth muscle, thereby enhancing gastric emptying. This study evaluates the effectiveness of Enterra Therapy (Medtronic, Minneapolis, Minnesota) in reducing symptoms and improving the quality of life of patients with drug-refractory gastroparesis. Material and Methods: In this study 25 patients underwent minimally invasive, laparoscopic placement of the Enterra Therapy device. Patients were asked to rank their severity of symptoms and quality of life retrospectively by completing the Gastrointestinal Symptoms Rating Scale and Short Form 36 Health Survey with respect to their condition before and 6 months after initiation of Enterra Therapy. Results: Eighteen patients completed the surveys. Patients showed statistically significant improvement in their overall Gastrointestinal Symptoms Rating Scale scores and the mental health component of the Short Form 36 Health Survey. Discussion: Currently, Enterra Therapy has Humanitarian Use Device status, which means that more clinical evidence is needed to prove its effectiveness in gastroparesis. By showing that Enterra Therapy reduces symptoms of gastroparesis and improves patient quality of life, this study contributes to the increasing amount of data supporting its use and potential Food and Drug Administration approval.

Financial Impact of the Robotic Approach in Liver Surgery: A Comparative Study of Clinical Outcomes and Costs Between the Robotic and Open Technique in a Single Institution

Abstract Background: One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution. Methods: Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013. Demographics, perioperative data, and postoperative outcomes were collected and compared between the two groups. An independent company performed the financial analysis. The economic parameters comprised direct variable costs, direct fixed costs, and indirect costs. Results: Mean estimated blood loss was significantly less in the robotic group (438 versus 727.8 mL; P = .038). Overall morbidity was significantly lower in the robotic group (22% versus 40%; P = .047). Clavien III/IV complications were also lower, with 4.4% in the robotic versus 16.3% in the open group (P = .043). The length of stay in the intensive care unit (ICU) was shorter for patients who underwent a robotic procedure (2.1 versus 3.3 days; P = .004). The average total cost, including readmissions, was

Impact of Body Contouring Procedures on Maintenance of Post-Bariatric Weight Loss.

37,518 for robotic surgery and

Comparison of Different Techniques of Pancreatic Stump Management in Robot-Assisted Pancreaticoduodenectomy

41,948 for open technique. Conclusions: Robotic liver resections had less overall morbidity, ICU, and hospital stay. This translates into decreased average costs for robotic surgery. These procedures are financially comparable to open resections and do not represent a financial burden to the hospital.

Impact of Abdominal Lipectomy on Post-Sleeve Gastrectomy Surgery Weight Loss

INTRODUCTION: Morbid obesity has significant impact on patients’ physical and psychosocial conditions. There is negative interference in daily activities, overall quality of life, psychosocial distress and co-morbidities, such as hypertension and diabetes mellitus among others.1-2 Bariatric surgery has evolved as an effective tool to manage weight and associated co-morbidities. Following significant weight loss however, patients often experience residual problems due to the redundant skin with difficulty in maintaining personal hygiene, recurrent infections from friction, or functional impairment leading to physical inactivity.3 Furthermore up to 50% of bariatric patients regain some of the lost weight.4 Several papers have demonstrated the association of improved psychosocial status of bariatric patients after interventions, such as body contouring.5 To the best of our knowledge, no publication has reported an association with weight loss in minimally invasive sleeve gastrectomy patients undergoing body contouring. Our purpose was to examine whether body contouring is associated with improved % Excess Weight Loss (%EWL) specifically in postsleeve gastrectomy patients.

Hand-assisted robotic right donor nephrectomy in patient with total situs inversus: A case report.

Background: Various technical improvements have decreased the morbidity and mortality after pancreaticoduodenectomy. However, postoperative pancreatic fistula (POPF) is the most feared complication, and the ideal technique for pancreatic reconstruction is undetermined. The aim of this study was to identify the risk factors and incidence of POPF with different types of pancreatic stump management after robot-assisted pancreaticoduodenectomy (RAPD). Materials and Methods: This study is a retrospective review of consecutive patients who underwent RAPD at the University of Illinois Hospital and Health Sciences System between September 2007 and January 2016. The cohort was divided based on the type of pancreatic stump management: pancreatic duct occlusion with cyanoacrylate glue (CG), pancreaticojejunostomy (PJ), posterior pancreaticogastrostomy (PPG), and transgastric pancreaticogastrostomy (TPG). Results: The cohort included 69 patients: pancreatic duct occlusion with CG (n = 18), PJ (n = 12), PPG (n = 11), and TPG (n = 28). Pancreatic duct diameter < 3 mm and duct occlusion with CG were identified as risk factors for POPF (p < 0.05). The incidence of POPF was lower when TPG and PJ were performed (p < 0.001). Conclusions: Reconstruction with PJ and TPG had better results compared to pancreatic duct occlusion with CG and PPG. However, TPG was the technique of choice and showed comparable results to PJ.

Surgical management of super–super obese patients: Roux-en-Y gastric bypass versus sleeve gastrectomy

Background Abdominal lipectomy after bariatric surgery is recommended because of residual excess skin resulting in difficulty with maintaining hygiene, recurrent infections, and functional impairment, interfering with daily activities. There is a dearth of literature examining weight loss outcomes in patients undergoing abdominal lipectomy post sleeve gastrectomy (SG). The purpose of this study was to examine whether post-SG patients who received abdominal lipectomy achieved greater percent excess weight loss (%EWL) than post-SG patients who did not receive abdominal lipectomy. Methods Retrospective study of patients who underwent minimally invasive SG at the University of Illinois Hospital and Health Sciences System from March 2008 to June 2015 was conducted. The cohort was divided into 2 groups: patients who underwent abdominal lipectomy after SG (PS-SG) and patients who underwent SG alone (SG). Demographics, comorbidities, and %EWL were examined. Results Twenty-nine patients were included in the PS-SG group versus 287 patients in the SG group. Significant differences were found in %EWL at 24 (P < 0.0001), 36 (P < 0.005), and more than 36 months (P < 0.005) follow-up between groups, with a greater %EWL in patients in the PS-SG group versus the SG group. Conclusions This preliminary study revealed that patients in the PS-SG group achieved greater %EWL than patients with SG alone. Although larger studies are needed, this study supports using abdominal lipectomy as an adjunctive procedure to assist with long-term weight loss as part of the overall treatment of bariatric surgery patients.

Revisions after failed gastric band: sleeve gastrectomy and Roux-en-Y gastric bypass.

Highlights • “Total situs inversus” is an infrequent congenital condition.• The robot has been already proved as a safe and attractive approach for living donor neprectomies.• “Total situs inversus” presents the surgeon with a challenging situation.• In these cases, preoperative planning is essential.• This is the first robotic right donor nephrectomy in a patient with total sinus inversus.