Pub Date : 2025-02-01Epub Date: 2025-01-13DOI: 10.1007/s00464-024-11505-3
Hao Chen, Keting Jiang, Xing Li, Qiong Ye, Jie Wang, Songsheng Zhou, Haibiao Wang, Kaijie Qiu
Background: Laparoscopic distal pancreatectomy is a safe and effective surgical method for treating benign and malignant tumors of the pancreatic body and tail. However, laparoscopic surgery requires good intraoperative exposure, and since the pancreas is obstructed by the stomach and duodenum, making surgical operations and the management of intraoperative emergencies challenging. Therefore, gastric traction is crucial in laparoscopic distal pancreatectomy. Common gastric suspension techniques include single and double gastric suspension. Here, we propose a new, simple, and effective gastric suspension method called the triangular gastric suspension.
Methods: We retrospectively analyzed the clinical data of 62 patients who underwent laparoscopic distal pancreatectomy at the Hepatobiliary and Pancreatic Surgery Department, The Affiliated LiHuiLi Hospital of Ningbo University from February 2017 to March 2024. The patients were divided into two groups based on whether triangular gastric suspension with silk sutures was used during surgery: the suspension group (28 cases) and the control group (34 cases). We analyzed various perioperative indicators between the two groups both before and after propensity score matching (PSM).
Results: With or without PSM, there were no statistically significant differences between the two groups in terms of age, gender, body mass index, American Society of Anesthesiologists classification, surgical approach, tumor pathological type and tumor length. Meanwhile, there were no statistically significant differences between the two groups in terms of pancreatic stump anastomosis, intraoperative transfusion, intraoperative R0 rate, postoperative pancreatic fistula grade, postoperative severe hemorrhage, reoperation, and delayed gastric emptying rate. However, the differences in operative time, intraoperative blood loss, and total hospital stay were statistically significant, with the suspension group showing better outcomes.
Conclusion: The triangular gastric suspension method provides significant advantages in reducing intraoperative blood loss and shortening operative time during laparoscopic distal pancreatectomy. It is a new, simple, and effective suspension method.
{"title":"Application and advantage analysis of triangular gastric suspension technique in laparoscopic distal pancreatectomy.","authors":"Hao Chen, Keting Jiang, Xing Li, Qiong Ye, Jie Wang, Songsheng Zhou, Haibiao Wang, Kaijie Qiu","doi":"10.1007/s00464-024-11505-3","DOIUrl":"10.1007/s00464-024-11505-3","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic distal pancreatectomy is a safe and effective surgical method for treating benign and malignant tumors of the pancreatic body and tail. However, laparoscopic surgery requires good intraoperative exposure, and since the pancreas is obstructed by the stomach and duodenum, making surgical operations and the management of intraoperative emergencies challenging. Therefore, gastric traction is crucial in laparoscopic distal pancreatectomy. Common gastric suspension techniques include single and double gastric suspension. Here, we propose a new, simple, and effective gastric suspension method called the triangular gastric suspension.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical data of 62 patients who underwent laparoscopic distal pancreatectomy at the Hepatobiliary and Pancreatic Surgery Department, The Affiliated LiHuiLi Hospital of Ningbo University from February 2017 to March 2024. The patients were divided into two groups based on whether triangular gastric suspension with silk sutures was used during surgery: the suspension group (28 cases) and the control group (34 cases). We analyzed various perioperative indicators between the two groups both before and after propensity score matching (PSM).</p><p><strong>Results: </strong>With or without PSM, there were no statistically significant differences between the two groups in terms of age, gender, body mass index, American Society of Anesthesiologists classification, surgical approach, tumor pathological type and tumor length. Meanwhile, there were no statistically significant differences between the two groups in terms of pancreatic stump anastomosis, intraoperative transfusion, intraoperative R0 rate, postoperative pancreatic fistula grade, postoperative severe hemorrhage, reoperation, and delayed gastric emptying rate. However, the differences in operative time, intraoperative blood loss, and total hospital stay were statistically significant, with the suspension group showing better outcomes.</p><p><strong>Conclusion: </strong>The triangular gastric suspension method provides significant advantages in reducing intraoperative blood loss and shortening operative time during laparoscopic distal pancreatectomy. It is a new, simple, and effective suspension method.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"1372-1378"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-04DOI: 10.1007/s00464-024-11435-0
Kohei Mishima, Marta Goglia, Luca Baratelli, Arturo Pardo, Giorgio Carlino, Riccardo Oliva, Simone Famularo, Ariosto Hernandez-Lara, Elisa Reitano, Pietro Riva, Alfonso Lapergola, Jacques Marescaux, Michel De Mathelin, Eric Felli, Sylvain Gioux, Michele Diana
Background: Identifying liver ischemia is crucial in liver surgery. This study aimed to develop a hemi-hepatic ischemia model for assessing liver ischemia using single snapshot imaging of optical properties (SSOP), a noninvasive optical imaging modality that provides real-time measurements of tissue oxygen saturation (StO2).
Materials and methods: Twelve swine were randomly assigned to two groups: One undergoing total vascular inflow occlusion (TVIO) and the other undergoing hepatic artery occlusion (HAO). Preoperative 3D CT scans were used to locate the left-sided hepatic arteries and portal veins, which were clamped during surgery. Real-time SSOP imaging was conducted to measure StO2 in three lobes-the left lateral lobe (LL), left medial lobe (LM), and right medial lobe (RM)-as well as capillary lactate levels and Doppler blood flow. Measurements were recorded at baseline (T0), during ischemia (T1, 30 min after clamping), and during reperfusion (T2, 30 min after declamping).
Results: In the TVIO group, SSOP imaging revealed a distinct demarcation line on the liver surface. StO2 levels measured by SSOP significantly decreased from T0 to T1, dropping by 29.8% in the LL (46.0 ± 5.1 vs. 16.2 ± 5.1%, p = 0.011) and 36.3% in the LM (42.7 ± 5.9 vs. 6.4 ± 4.0%, p = 0.001). Additionally, capillary lactate levels increased substantially in the LL (1.3 ± 0.4 vs. 8.5 ± 2.4 mmol/L, p = 0.041) and in the LM (1.3 ± 0.4 vs. 8.2 ± 2.1 mmol/L, p = 0.021). In contrast, the HAO group showed a less pronounced reduction in StO2: 13.6% in the LL (32.7 ± 6.4 vs. 19.1 ± 5.4%, p = 0.007) and 19.8% in the LM (35.3 ± 8.2 vs. 15.5 ± 5.8%, p = 0.011), with no significant increase in capillary lactate levels. An inverse correlation was found between StO2 and capillary lactate levels (r = - 0.76, p < 0.001).
Conclusion: SSOP is a real-time, contrast-free imaging technique that effectively evaluates liver ischemia by accurately measuring tissue oxygenation, as validated by perfusion biomarkers.
背景:肝缺血识别在肝脏手术中至关重要。本研究旨在建立一种半肝缺血模型,利用光学特性单快照成像(SSOP)来评估肝脏缺血,SSOP是一种无创光学成像方式,可提供组织氧饱和度(StO2)的实时测量。材料和方法:将12头猪随机分为两组,一组进行全血管流入阻断(TVIO),另一组进行肝动脉阻断(HAO)。术前使用3D CT扫描定位左侧肝动脉和门静脉,术中夹持。实时SSOP成像测量左外侧叶(LL)、左内叶(LM)和右内叶(RM)三个脑叶的StO2以及毛细血管乳酸水平和多普勒血流。记录基线(T0)、缺血(T1,钳位后30分钟)和再灌注(T2,去钳位后30分钟)时的测量。结果:在TVIO组中,SSOP成像显示肝脏表面有明显的分界线。SSOP测定的StO2水平从T0到T1显著下降,其中LL组下降29.8%(46.0±5.1比16.2±5.1%,p = 0.011), LM组下降36.3%(42.7±5.9比6.4±4.0%,p = 0.001)。此外,下肢毛细血管乳酸水平(1.3±0.4 vs. 8.5±2.4 mmol/L, p = 0.041)和下肢毛细血管乳酸水平(1.3±0.4 vs. 8.2±2.1 mmol/L, p = 0.021)显著升高。相比之下,HAO组的StO2降低不太明显:LL组为13.6%(32.7±6.4比19.1±5.4%,p = 0.007), LM组为19.8%(35.3±8.2比15.5±5.8%,p = 0.011),毛细血管乳酸水平无显著升高。StO2与毛细血管乳酸水平呈负相关(r = - 0.76, p)。结论:SSOP是一种实时、无对比的成像技术,可以通过准确测量组织氧合来有效评估肝脏缺血,并得到灌注生物标志物的验证。
{"title":"Quantification of hemi-hepatic ischemia using real-time multispectral oxygenation imaging with single snapshot imaging of optical properties (SSOP).","authors":"Kohei Mishima, Marta Goglia, Luca Baratelli, Arturo Pardo, Giorgio Carlino, Riccardo Oliva, Simone Famularo, Ariosto Hernandez-Lara, Elisa Reitano, Pietro Riva, Alfonso Lapergola, Jacques Marescaux, Michel De Mathelin, Eric Felli, Sylvain Gioux, Michele Diana","doi":"10.1007/s00464-024-11435-0","DOIUrl":"10.1007/s00464-024-11435-0","url":null,"abstract":"<p><strong>Background: </strong>Identifying liver ischemia is crucial in liver surgery. This study aimed to develop a hemi-hepatic ischemia model for assessing liver ischemia using single snapshot imaging of optical properties (SSOP), a noninvasive optical imaging modality that provides real-time measurements of tissue oxygen saturation (StO2).</p><p><strong>Materials and methods: </strong>Twelve swine were randomly assigned to two groups: One undergoing total vascular inflow occlusion (TVIO) and the other undergoing hepatic artery occlusion (HAO). Preoperative 3D CT scans were used to locate the left-sided hepatic arteries and portal veins, which were clamped during surgery. Real-time SSOP imaging was conducted to measure StO<sub>2</sub> in three lobes-the left lateral lobe (LL), left medial lobe (LM), and right medial lobe (RM)-as well as capillary lactate levels and Doppler blood flow. Measurements were recorded at baseline (T0), during ischemia (T1, 30 min after clamping), and during reperfusion (T2, 30 min after declamping).</p><p><strong>Results: </strong>In the TVIO group, SSOP imaging revealed a distinct demarcation line on the liver surface. StO<sub>2</sub> levels measured by SSOP significantly decreased from T0 to T1, dropping by 29.8% in the LL (46.0 ± 5.1 vs. 16.2 ± 5.1%, p = 0.011) and 36.3% in the LM (42.7 ± 5.9 vs. 6.4 ± 4.0%, p = 0.001). Additionally, capillary lactate levels increased substantially in the LL (1.3 ± 0.4 vs. 8.5 ± 2.4 mmol/L, p = 0.041) and in the LM (1.3 ± 0.4 vs. 8.2 ± 2.1 mmol/L, p = 0.021). In contrast, the HAO group showed a less pronounced reduction in StO2: 13.6% in the LL (32.7 ± 6.4 vs. 19.1 ± 5.4%, p = 0.007) and 19.8% in the LM (35.3 ± 8.2 vs. 15.5 ± 5.8%, p = 0.011), with no significant increase in capillary lactate levels. An inverse correlation was found between StO<sub>2</sub> and capillary lactate levels (r = - 0.76, p < 0.001).</p><p><strong>Conclusion: </strong>SSOP is a real-time, contrast-free imaging technique that effectively evaluates liver ischemia by accurately measuring tissue oxygenation, as validated by perfusion biomarkers.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"898-906"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11794345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-03DOI: 10.1007/s00464-024-11418-1
Shuai Xu, Yinlong Xu, Shulin Wang, Qingsen Chu, Huating Zhang, Wei Gong, Yantian Xu, Jun Liu
Background: Overweight is thought to affect the outcome of minimally invasive surgery. There is still a lack of controlled studies of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD) in overweight patients. This study was designed to compare short-term and long-term outcomes in overweight patients treated with LPD and OPD.
Methods: Clinical and follow-up data on overweight patients who received LPD or OPD at Shandong Provincial Hospital from January 2015 to December 2022 were analyzed retrospectively. The bias between groups were balanced by 1:1 propensity score matching (PSM). Kaplan-Meier survival curves described long-term survival outcomes in overweight pancreatic ductal adenocarcinoma (PDAC) patients.
Results: A total of 502 overweight patients were enrolled in the study. There were 276 patients in the LPD group and 226 in the OPD group. After matching, 196 patients were enrolled in each group. Compared with the OPD group, the LPD group had fewer estimated blood loss (EBL) (140 vs. 200 mL, P < 0.001), more lymph node dissection (14 vs. 12, P = 0.010), and shorter postoperative length of stay (LOS) (13 vs. 16 days, P < 0.001). There were no significant differences in severe complications, 90-day readmission and mortality rates (all P > 0.05). The subgroup analysis of obese patients also showed that the LPD group had fewer intraoperative EBL, more lymph node dissection, and shorter LOS. The survival analysis showed that overweight patients with PDAC who underwent LPD or OPD had similar overall survival (OS) (23.8 vs.25.7 months, P = 0.963) after PSM.
Conclusion: It is safe and feasible for overweight patients undergoing LPD to have less EBL, more lymph node harvesting, and a shorter LOS. There was no statistically significant difference in long-term survival outcomes among overweight PDAC patients between the two approaches.
背景:超重被认为会影响微创手术的结果。在超重患者中,腹腔镜胰十二指肠切除术(LPD)与开放式胰十二指肠切除术(OPD)的对照研究仍然缺乏。本研究旨在比较超重患者接受LPD和OPD治疗的短期和长期结果。方法:回顾性分析2015年1月至2022年12月山东省立医院接受LPD或OPD治疗的超重患者的临床及随访资料。组间偏倚采用1:1倾向评分匹配(PSM)进行平衡。Kaplan-Meier生存曲线描述了超重胰腺导管腺癌(PDAC)患者的长期生存结果。结果:共有502名超重患者入组研究。LPD组276例,OPD组226例。配对后,每组入组196例。与OPD组相比,LPD组的估计失血量(EBL)更少(140 mL vs 200 mL, p0.05)。肥胖患者的亚组分析也显示,LPD组术中EBL较少,淋巴结清扫较多,LOS较短。生存分析显示,超重的PDAC患者接受LPD或OPD后,PSM后的总生存期(OS)相似(23.8个月vs.25.7个月,P = 0.963)。结论:超重患者行LPD术后EBL减少、淋巴结清扫增多、LOS缩短是安全可行的。两种方法对超重PDAC患者的长期生存结果无统计学差异。
{"title":"Comparison of short‑ and long‑term outcomes between laparoscopic and open pancreaticoduodenectomy in overweight patients: a propensity score‑matched study.","authors":"Shuai Xu, Yinlong Xu, Shulin Wang, Qingsen Chu, Huating Zhang, Wei Gong, Yantian Xu, Jun Liu","doi":"10.1007/s00464-024-11418-1","DOIUrl":"10.1007/s00464-024-11418-1","url":null,"abstract":"<p><strong>Background: </strong>Overweight is thought to affect the outcome of minimally invasive surgery. There is still a lack of controlled studies of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD) in overweight patients. This study was designed to compare short-term and long-term outcomes in overweight patients treated with LPD and OPD.</p><p><strong>Methods: </strong>Clinical and follow-up data on overweight patients who received LPD or OPD at Shandong Provincial Hospital from January 2015 to December 2022 were analyzed retrospectively. The bias between groups were balanced by 1:1 propensity score matching (PSM). Kaplan-Meier survival curves described long-term survival outcomes in overweight pancreatic ductal adenocarcinoma (PDAC) patients.</p><p><strong>Results: </strong>A total of 502 overweight patients were enrolled in the study. There were 276 patients in the LPD group and 226 in the OPD group. After matching, 196 patients were enrolled in each group. Compared with the OPD group, the LPD group had fewer estimated blood loss (EBL) (140 vs. 200 mL, P < 0.001), more lymph node dissection (14 vs. 12, P = 0.010), and shorter postoperative length of stay (LOS) (13 vs. 16 days, P < 0.001). There were no significant differences in severe complications, 90-day readmission and mortality rates (all P > 0.05). The subgroup analysis of obese patients also showed that the LPD group had fewer intraoperative EBL, more lymph node dissection, and shorter LOS. The survival analysis showed that overweight patients with PDAC who underwent LPD or OPD had similar overall survival (OS) (23.8 vs.25.7 months, P = 0.963) after PSM.</p><p><strong>Conclusion: </strong>It is safe and feasible for overweight patients undergoing LPD to have less EBL, more lymph node harvesting, and a shorter LOS. There was no statistically significant difference in long-term survival outcomes among overweight PDAC patients between the two approaches.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"881-890"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2025-01-21DOI: 10.1007/s00464-025-11530-w
Nisha Narula, Bethany J Slater, Patricia Sylla, Sunjay S Kumar, Elisa Calabrese, Joe Nadglowski, Deborah S Keller
Introduction: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee develops evidence-based surgical guidelines. Involvement of patient partners is important to ensure patient concerns and values are adequately addressed and incorporated. This standard operating procedure (SOP) for the process of patient partner involvement within the guidelines is described here.
Methods: This document outlines the SAGES Patient Partners SOP to involve patient partners in a consistent and reproducible manner.
Results: SAGES has now developed a SOP to include patient partners so that patient views are represented in current guidelines.
Conclusion: Guidelines must be patient centric and in order to do so must include patient partners. The SAGES Guidelines Patient Engagement Update to Standard operating Procedure aims to provide an outline for systematically doing so.
{"title":"Society of American Gastrointestinal and Endoscopic Surgeons guidelines development: patient engagement update to standard operating procedure.","authors":"Nisha Narula, Bethany J Slater, Patricia Sylla, Sunjay S Kumar, Elisa Calabrese, Joe Nadglowski, Deborah S Keller","doi":"10.1007/s00464-025-11530-w","DOIUrl":"10.1007/s00464-025-11530-w","url":null,"abstract":"<p><strong>Introduction: </strong>The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee develops evidence-based surgical guidelines. Involvement of patient partners is important to ensure patient concerns and values are adequately addressed and incorporated. This standard operating procedure (SOP) for the process of patient partner involvement within the guidelines is described here.</p><p><strong>Methods: </strong>This document outlines the SAGES Patient Partners SOP to involve patient partners in a consistent and reproducible manner.</p><p><strong>Results: </strong>SAGES has now developed a SOP to include patient partners so that patient views are represented in current guidelines.</p><p><strong>Conclusion: </strong>Guidelines must be patient centric and in order to do so must include patient partners. The SAGES Guidelines Patient Engagement Update to Standard operating Procedure aims to provide an outline for systematically doing so.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"687-690"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-19DOI: 10.1007/s00464-024-11422-5
George Skenteris, Trey Singletary, Lindsay Grasso, Stella Self, David P Schammel, Christine M G Schammel, Wes Jones, A Michael Devane
Background: Evaluation of lesions of the biliary tract are essential to diagnose given the dismal outcomes of cholangiocarcinoma. Historically, these diagnoses were made using brush biopsies obtained under Endoscopic Retrograde Cholangiopancreatography (ERCP). To increase the accuracy of biliary biopsies, SpyGlassTM Discover cholangioscopy guided biopsy has been developed, providing greater tissue yield and direct visualization of the biliary epithelium. We evaluated the diagnostic accuracy of ERCP guided brushings and SpyGlassTM Discover guided biopsies at a single institution.
Methods: Following IRB approval, all diagnostic biliary biopsies utilizing both ERCP guided brushings and/or SpyGlassTM Discover between 8/2015 and 6/2022 were retrospectively evaluated. Demographic and clinicopathologic data were collected. Fischer's t-tests and Chi-square analyses were completed as appropriate (p < 0.05).
Results: Overall, 46 patients with an average age of 61 years were included in this study; 59% of the patients were female and 41% were male. 87% of patients had at least one SpyGlassTM Discover guided biopsy and one ERCP guided brushing and 13% of patients had at least one SpyGlassTM Discover guided biopsy alone. SpyGlassTM Discover correctly identified 82% of malignancies while brushings identified only 47% of malignancies.
Conclusions: SpyGlassTM Discover guided biopsies yield a greater diagnostic result than ERCP guided brushings. Therefore, SpyGlassTM Discover should be considered as the standard for diagnosing biliary lesions at our institution in conjunction with ERCP procedure. The classification of visual characteristics of biliary lesions should be investigated in the future as the high-resolution image generated by SpyGlassTM Discover can allow for detailed visual observation of strictures and potentially aid in better characterization and location of disease.
{"title":"Effectiveness of cholangioscopy guided biopsy versus ERCP guided brushings in diagnosing malignant biliary strictures.","authors":"George Skenteris, Trey Singletary, Lindsay Grasso, Stella Self, David P Schammel, Christine M G Schammel, Wes Jones, A Michael Devane","doi":"10.1007/s00464-024-11422-5","DOIUrl":"10.1007/s00464-024-11422-5","url":null,"abstract":"<p><strong>Background: </strong>Evaluation of lesions of the biliary tract are essential to diagnose given the dismal outcomes of cholangiocarcinoma. Historically, these diagnoses were made using brush biopsies obtained under Endoscopic Retrograde Cholangiopancreatography (ERCP). To increase the accuracy of biliary biopsies, SpyGlassTM Discover cholangioscopy guided biopsy has been developed, providing greater tissue yield and direct visualization of the biliary epithelium. We evaluated the diagnostic accuracy of ERCP guided brushings and SpyGlassTM Discover guided biopsies at a single institution.</p><p><strong>Methods: </strong>Following IRB approval, all diagnostic biliary biopsies utilizing both ERCP guided brushings and/or SpyGlassTM Discover between 8/2015 and 6/2022 were retrospectively evaluated. Demographic and clinicopathologic data were collected. Fischer's t-tests and Chi-square analyses were completed as appropriate (p < 0.05).</p><p><strong>Results: </strong>Overall, 46 patients with an average age of 61 years were included in this study; 59% of the patients were female and 41% were male. 87% of patients had at least one SpyGlassTM Discover guided biopsy and one ERCP guided brushing and 13% of patients had at least one SpyGlassTM Discover guided biopsy alone. SpyGlassTM Discover correctly identified 82% of malignancies while brushings identified only 47% of malignancies.</p><p><strong>Conclusions: </strong>SpyGlassTM Discover guided biopsies yield a greater diagnostic result than ERCP guided brushings. Therefore, SpyGlassTM Discover should be considered as the standard for diagnosing biliary lesions at our institution in conjunction with ERCP procedure. The classification of visual characteristics of biliary lesions should be investigated in the future as the high-resolution image generated by SpyGlassTM Discover can allow for detailed visual observation of strictures and potentially aid in better characterization and location of disease.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"1140-1146"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-11-13DOI: 10.1007/s00464-024-11381-x
Maha Mourad, Julie E Kim, Sharon E Phillips, Vishal M Kothari, Ivy N Haskins
Introduction: The Distressed Communities Index (DCI) is a stratification tool that captures socioeconomic disparities based on zip code. To date, no prior study has investigated the association of DCI score and inguinal hernia repair outcomes. This study aims to evaluate the association between DCI score and 30-day outcomes following inguinal hernia repair using the Abdominal Core Health Quality Collaborative (ACHQC) database. We hypothesize that patients with higher DCI scores will have a higher number of comorbidities and 30-day postoperative events.
Methods and procedures: All patients who underwent inguinal hernia repair from 2015 to 2023 with an available DCI score and 30-day follow-up data available were included. Patients were stratified into DCI quintiles based on zip code. Primary outcomes of interest were 30-day hernia-specific postoperative outcomes. Pearson's chi-squared and Kruskal-Wallis tests were used to compare DCI scores with comorbid conditions and perioperative outcomes.
Results: 30,927 patients were included for analysis; 12,206 patients were classified as prosperous (40%), 7190 patients as comfortable (23%), 4884 patients as mid-tier (16%), 3485 patients as at-risk (11%), and 3162 as distressed (10%). Distressed patients were more likely to have ASA 3 or higher and comorbidities including hypertension, diabetes, ESRD, and COPD (p < 0.001). Patients with higher DCI scores were significantly more likely to undergo an emergency operation and have a longer OR time (p < 0.001). Distressed patients were also more likely to experience a major wound complication requiring readmission (p = 0.05) and reoperation (p < 0.001).
Conclusion: DCI scores are strongly linked to surgical risk and outcomes following inguinal hernia repair. Special consideration should be given to DCI scores when optimizing patients prior to inguinal hernia repair.
{"title":"Association of DCI with number of preoperative comorbidities and 30-day outcomes following inguinal hernia repair: an analysis of the ACHQC database.","authors":"Maha Mourad, Julie E Kim, Sharon E Phillips, Vishal M Kothari, Ivy N Haskins","doi":"10.1007/s00464-024-11381-x","DOIUrl":"10.1007/s00464-024-11381-x","url":null,"abstract":"<p><strong>Introduction: </strong>The Distressed Communities Index (DCI) is a stratification tool that captures socioeconomic disparities based on zip code. To date, no prior study has investigated the association of DCI score and inguinal hernia repair outcomes. This study aims to evaluate the association between DCI score and 30-day outcomes following inguinal hernia repair using the Abdominal Core Health Quality Collaborative (ACHQC) database. We hypothesize that patients with higher DCI scores will have a higher number of comorbidities and 30-day postoperative events.</p><p><strong>Methods and procedures: </strong>All patients who underwent inguinal hernia repair from 2015 to 2023 with an available DCI score and 30-day follow-up data available were included. Patients were stratified into DCI quintiles based on zip code. Primary outcomes of interest were 30-day hernia-specific postoperative outcomes. Pearson's chi-squared and Kruskal-Wallis tests were used to compare DCI scores with comorbid conditions and perioperative outcomes.</p><p><strong>Results: </strong>30,927 patients were included for analysis; 12,206 patients were classified as prosperous (40%), 7190 patients as comfortable (23%), 4884 patients as mid-tier (16%), 3485 patients as at-risk (11%), and 3162 as distressed (10%). Distressed patients were more likely to have ASA 3 or higher and comorbidities including hypertension, diabetes, ESRD, and COPD (p < 0.001). Patients with higher DCI scores were significantly more likely to undergo an emergency operation and have a longer OR time (p < 0.001). Distressed patients were also more likely to experience a major wound complication requiring readmission (p = 0.05) and reoperation (p < 0.001).</p><p><strong>Conclusion: </strong>DCI scores are strongly linked to surgical risk and outcomes following inguinal hernia repair. Special consideration should be given to DCI scores when optimizing patients prior to inguinal hernia repair.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"1243-1250"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-11-18DOI: 10.1007/s00464-024-11264-1
Stephanie Joseph, Jean-Christophe Rwigema, Derrius Anderson, Shun Ishi, Trevor Crafts, Kristine Kuchta, Woody Denham, John Linn, H Mason Hedberg, Michael B Ujiki
Background: There are several surgical options each with their potential for complications, differences in length of procedure, and in meaningful outcomes. This study aims to explore those outcomes after Roux-en-Y Gastric Bypass (RYGB) and Loop Duodenal Switch (LDS).
Objective: The purpose of this project is to offer a comparative analysis of RYGB and LDS at the NorthShore University Health System for up to 4 years postoperatively.
Methods: A retrospective review of a prospectively maintained database was queried for all patients who underwent RYGB and LDS from 2019 to 2023. Demographic, preoperative, post-operative data, and Quality of Life (QOL) data were included. χ2 and Kruskal-Wallis tests were used for comparison. Statistical significance was set at p < 0.05.
Results: Patient database included 238 patients who underwent RYGB, and 54 who underwent LDS. Initial BMI was significantly higher in LDS compared to RYGB (56.9 ± 8.0; 46.5 ± 7.3; p < 0.01). There were no statistically significant differences between reported comorbidities. There were no differences in intraoperative complications between the two groups, however postoperative complications were significantly higher in the LDS population (16.7%, 7.1%; p < 0.01). Percent total body weight loss (%TBWL) was significantly different at 2 years post operatively with LDS having more %TBWL than RYGB (LDS: N = 10, %TBWL = 44.7 ± 14.1%; RYGB: N = 47) There were no statistically significant differences at any other postoperative time point. Subgroup analysis was completed in patients with initial BMI 50. There were no significant differences at any postoperative time point. QOL data showed no significant difference between both procedures at all postoperative timepoints.
Conclusion: Patients who undergo LDS are more likely to experience postoperative complications compared to RYGB with no added benefit in weight loss or comorbidity resolution up to 3 years post operatively.
{"title":"Loop duodenal switch confers more complications with little gain of weight loss compared to Roux-en-Y gastric bypass.","authors":"Stephanie Joseph, Jean-Christophe Rwigema, Derrius Anderson, Shun Ishi, Trevor Crafts, Kristine Kuchta, Woody Denham, John Linn, H Mason Hedberg, Michael B Ujiki","doi":"10.1007/s00464-024-11264-1","DOIUrl":"10.1007/s00464-024-11264-1","url":null,"abstract":"<p><strong>Background: </strong>There are several surgical options each with their potential for complications, differences in length of procedure, and in meaningful outcomes. This study aims to explore those outcomes after Roux-en-Y Gastric Bypass (RYGB) and Loop Duodenal Switch (LDS).</p><p><strong>Objective: </strong>The purpose of this project is to offer a comparative analysis of RYGB and LDS at the NorthShore University Health System for up to 4 years postoperatively.</p><p><strong>Methods: </strong>A retrospective review of a prospectively maintained database was queried for all patients who underwent RYGB and LDS from 2019 to 2023. Demographic, preoperative, post-operative data, and Quality of Life (QOL) data were included. χ<sup>2</sup> and Kruskal-Wallis tests were used for comparison. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>Patient database included 238 patients who underwent RYGB, and 54 who underwent LDS. Initial BMI was significantly higher in LDS compared to RYGB (56.9 ± 8.0; 46.5 ± 7.3; p < 0.01). There were no statistically significant differences between reported comorbidities. There were no differences in intraoperative complications between the two groups, however postoperative complications were significantly higher in the LDS population (16.7%, 7.1%; p < 0.01). Percent total body weight loss (%TBWL) was significantly different at 2 years post operatively with LDS having more %TBWL than RYGB (LDS: N = 10, %TBWL = 44.7 ± 14.1%; RYGB: N = 47) There were no statistically significant differences at any other postoperative time point. Subgroup analysis was completed in patients with initial BMI 50. There were no significant differences at any postoperative time point. QOL data showed no significant difference between both procedures at all postoperative timepoints.</p><p><strong>Conclusion: </strong>Patients who undergo LDS are more likely to experience postoperative complications compared to RYGB with no added benefit in weight loss or comorbidity resolution up to 3 years post operatively.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"1261-1268"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Fewer studies have been conducted on the diagnostic value of capsule endoscopy, CT enterography and enteroscopy in suspected small bowel bleeding. This study aimed at analyzing the diagnostic and clinical value of capsule endoscopy, CT enterography and enteroscopy for suspected small bowel bleeding.
Methods: This retrospective study compared the diagnostic rate and consistency of findings among groups. In addition, diagnostic rates were compared between combined enteroscopy versus uncombined enteroscopy associated with capsule endoscopy or CT enterography, as well as the influencing factors of diagnostic outcomes. The complete enteroscopy rates and diagnostic rates were analyzed for the one-day enteroscopy group and the non-one-day enteroscopy group.
Results: There was no significant difference in diagnostic rates between capsule endoscopy (n = 70) and CT enterography (n = 122) (χ2 = 3.334; p = 0.068), while the diagnostic rate of enteroscopy (n = 396) is higher than capsule endoscopy (χ2 = 10.064; p = 0.002) and CT enterography (χ2 = 42.661; p < 0.001). Diagnostic rates were much higher in patients with a successful completion of docking inspection (n = 64) than in undocked patients (n = 60) (85.9% vs 46.7%; p < 0.001), even though these patients still had combined capsule endoscopy or CT enterography. The complete enteroscopy rates (χ2 = 0.364; P = 0.546) and diagnostic rates (χ2 = 2.511; P = 0.113) of enteroscopy in the one-day group (n = 55) were not significantly different from those in the non-one-day group (n = 25).
Conclusions: Enteroscopy is the more reliable method of diagnosing suspected small bowel bleeding among enteroscopy, capsule endoscopy and CT enterography. Moreover, uncompleted enteroscopy combined with capsule endoscopy or CT enterography may not yet be a substitute for successful completion of docking enteroscopy in clinical practice.
背景:关于胶囊内镜、CT 肠造影和肠镜对疑似小肠出血的诊断价值的研究较少。本研究旨在分析胶囊内镜、CT 肠造影和肠镜对疑似小肠出血的诊断和临床价值:这项回顾性研究比较了各组的诊断率和检查结果的一致性。方法:这项回顾性研究比较了各组间的诊断率和检查结果的一致性。此外,还比较了联合肠镜检查和未联合肠镜检查与胶囊内镜检查或 CT 肠造影检查的诊断率,以及诊断结果的影响因素。分析了一天肠镜检查组和非一天肠镜检查组的完整肠镜检查率和诊断率:胶囊内镜检查(n = 70)与 CT 肠造影检查(n = 122)的诊断率无明显差异(χ2 = 3.334; p = 0.068),而肠镜检查(n = 396)的诊断率高于胶囊内镜检查(χ2 = 10.064; p = 0.002)和CT肠造影(χ2 = 42.661; P 2 = 0.364; P = 0.546),一天组(n = 55)肠镜检查的诊断率(χ2 = 2.511; P = 0.113)与非一天组(n = 25)无显著差异:结论:在肠镜检查、胶囊内镜检查和 CT 肠造影检查中,肠镜检查是诊断疑似小肠出血的更可靠方法。此外,在临床实践中,未完成的肠镜联合胶囊内镜或 CT 肠造影检查可能还不能替代成功完成的对接肠镜检查。
{"title":"Clinical value of capsule endoscopy, CT enterography and enteroscopy in the diagnosis of suspected small bowel bleeding.","authors":"Yiling Xiong, Ruiri Jin, Sheng Chen, Xingxing Liu, Zhenyu Wu, Die Zhang, Chunyan Zeng, Youxiang Chen","doi":"10.1007/s00464-024-11405-6","DOIUrl":"10.1007/s00464-024-11405-6","url":null,"abstract":"<p><strong>Background: </strong>Fewer studies have been conducted on the diagnostic value of capsule endoscopy, CT enterography and enteroscopy in suspected small bowel bleeding. This study aimed at analyzing the diagnostic and clinical value of capsule endoscopy, CT enterography and enteroscopy for suspected small bowel bleeding.</p><p><strong>Methods: </strong>This retrospective study compared the diagnostic rate and consistency of findings among groups. In addition, diagnostic rates were compared between combined enteroscopy versus uncombined enteroscopy associated with capsule endoscopy or CT enterography, as well as the influencing factors of diagnostic outcomes. The complete enteroscopy rates and diagnostic rates were analyzed for the one-day enteroscopy group and the non-one-day enteroscopy group.</p><p><strong>Results: </strong>There was no significant difference in diagnostic rates between capsule endoscopy (n = 70) and CT enterography (n = 122) (χ<sup>2</sup> = 3.334; p = 0.068), while the diagnostic rate of enteroscopy (n = 396) is higher than capsule endoscopy (χ<sup>2</sup> = 10.064; p = 0.002) and CT enterography (χ<sup>2</sup> = 42.661; p < 0.001). Diagnostic rates were much higher in patients with a successful completion of docking inspection (n = 64) than in undocked patients (n = 60) (85.9% vs 46.7%; p < 0.001), even though these patients still had combined capsule endoscopy or CT enterography. The complete enteroscopy rates (χ<sup>2</sup> = 0.364; P = 0.546) and diagnostic rates (χ<sup>2</sup> = 2.511; P = 0.113) of enteroscopy in the one-day group (n = 55) were not significantly different from those in the non-one-day group (n = 25).</p><p><strong>Conclusions: </strong>Enteroscopy is the more reliable method of diagnosing suspected small bowel bleeding among enteroscopy, capsule endoscopy and CT enterography. Moreover, uncompleted enteroscopy combined with capsule endoscopy or CT enterography may not yet be a substitute for successful completion of docking enteroscopy in clinical practice.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"792-801"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-02DOI: 10.1007/s00464-024-11415-4
Daphne Remulla, Sara M Maskal, Ryan C Ellis, Kimberly P Woo, William C Bennet, Aldo Fafaj, Salvador Navarrete, David M Krpata, Benjamin T Miller, Clayton C Petro, Ajita S Prabhu, Michael J Rosen, Lucas R Beffa
Introduction: Recurrent paraesophageal hernia (PEH) repair presents significant technical challenges, with limited data weighing the benefit to the operative risk. This study aims to describe our experience with recurrent PEH repair, including long-term surgical and patient reported outcomes (PROs).
Methods: We conducted a retrospective review of recurrent PEH repairs from June 2018-March 2023 using our institutional database. A blinded review of post-operative imaging was conducted to assess for recurrence. Quality of life (QOL) and decision regret were measured using the GERD Health-Related Quality-of-Life (GERD-HRQL) questionnaire and Decision Regret Scale (DRS) at maximum follow up.
Results: Eighty-eight patients underwent recurrent PEH repair at our institution for PEH, classified as type II (13.6%), type III (72.7%) and type IV (13.6%). There was significant heterogeneity in operative techniques used: one-third of patients had mesh placed at the hiatus, 11.4% had a Collis gastroplasty, and one-third of patients underwent fundoplication. Intraoperative complications included gastric (5.7%), esophageal (2.3%), vascular (1.1%) and pulmonary (1.1%) injuries. Follow up was available for 73 patients with median follow up of 35.2 months. Of patients with radiographic follow up, 20 (35.7%) had a radiographic recurrence: 12 (21.4%) were 2-5 cm and 8 (14.3%) were > 5 cm. Patients reporting PROs (53 patients; 60.2%) reported low symptom severity (mean GERD-HRQL 13.1 ± 12) and low decision regret (mean DRS 13.3 ± 19.4) with 75.5% scoring in the lowest quartile (DRS < 25). Radiographic recurrence was associated with worse QOL (p < 0.05), but no significant difference in decision regret (p = 0.125).
Conclusion: We found significant heterogeneity amongst recurrent PEH repair techniques with continued high recurrence rate during follow up. Radiographic recurrence was correlated with worse QOL, yet patients reported low symptom severity and low decision regret, suggesting continued value in these challenging operations. Future studies should aim to identify more effective techniques to reduce recurrence rates in this patient population.
复发性食道旁疝(PEH)修复存在重大的技术挑战,有限的数据衡量手术风险的益处。本研究旨在描述我们对复发性PEH修复的经验,包括长期手术和患者报告的结果(PROs)。方法:我们使用我们的机构数据库对2018年6月至2023年3月期间的复发性PEH修复进行了回顾性分析。对术后影像进行盲法回顾以评估复发。在最大随访时,使用GERD健康相关生活质量(GERD- hrql)问卷和决策后悔量表(DRS)测量生活质量(QOL)和决策后悔。结果:88例PEH患者在我院接受了复发性PEH修复,分为II型(13.6%)、III型(72.7%)和IV型(13.6%)。使用的手术技术存在显著的异质性:三分之一的患者在裂孔处放置补片,11.4%的患者进行了Collis胃成形术,三分之一的患者进行了眼底复制。术中并发症包括胃(5.7%)、食管(2.3%)、血管(1.1%)和肺(1.1%)损伤。73例患者随访,中位随访35.2个月。在x线随访的患者中,20例(35.7%)x线复发:2-5 cm 12例(21.4%),5 -5 cm 8例(14.3%)。报告PROs的患者(53例;60.2%)报告症状严重程度低(平均GERD-HRQL 13.1±12)和决策后悔低(平均DRS 13.3±19.4),最低四分位数评分为75.5% (DRS结论:我们发现复发性PEH修复技术之间存在显著异质性,随访期间复发率持续较高。影像学复发与较差的生活质量相关,但患者报告症状严重程度低,决策后悔率低,提示这些具有挑战性的手术的持续价值。未来的研究应旨在确定更有效的技术来降低这类患者的复发率。
{"title":"Patient reported outcomes and decision regret scores in redo-paraesophageal hernia repair.","authors":"Daphne Remulla, Sara M Maskal, Ryan C Ellis, Kimberly P Woo, William C Bennet, Aldo Fafaj, Salvador Navarrete, David M Krpata, Benjamin T Miller, Clayton C Petro, Ajita S Prabhu, Michael J Rosen, Lucas R Beffa","doi":"10.1007/s00464-024-11415-4","DOIUrl":"10.1007/s00464-024-11415-4","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrent paraesophageal hernia (PEH) repair presents significant technical challenges, with limited data weighing the benefit to the operative risk. This study aims to describe our experience with recurrent PEH repair, including long-term surgical and patient reported outcomes (PROs).</p><p><strong>Methods: </strong>We conducted a retrospective review of recurrent PEH repairs from June 2018-March 2023 using our institutional database. A blinded review of post-operative imaging was conducted to assess for recurrence. Quality of life (QOL) and decision regret were measured using the GERD Health-Related Quality-of-Life (GERD-HRQL) questionnaire and Decision Regret Scale (DRS) at maximum follow up.</p><p><strong>Results: </strong>Eighty-eight patients underwent recurrent PEH repair at our institution for PEH, classified as type II (13.6%), type III (72.7%) and type IV (13.6%). There was significant heterogeneity in operative techniques used: one-third of patients had mesh placed at the hiatus, 11.4% had a Collis gastroplasty, and one-third of patients underwent fundoplication. Intraoperative complications included gastric (5.7%), esophageal (2.3%), vascular (1.1%) and pulmonary (1.1%) injuries. Follow up was available for 73 patients with median follow up of 35.2 months. Of patients with radiographic follow up, 20 (35.7%) had a radiographic recurrence: 12 (21.4%) were 2-5 cm and 8 (14.3%) were > 5 cm. Patients reporting PROs (53 patients; 60.2%) reported low symptom severity (mean GERD-HRQL 13.1 ± 12) and low decision regret (mean DRS 13.3 ± 19.4) with 75.5% scoring in the lowest quartile (DRS < 25). Radiographic recurrence was associated with worse QOL (p < 0.05), but no significant difference in decision regret (p = 0.125).</p><p><strong>Conclusion: </strong>We found significant heterogeneity amongst recurrent PEH repair techniques with continued high recurrence rate during follow up. Radiographic recurrence was correlated with worse QOL, yet patients reported low symptom severity and low decision regret, suggesting continued value in these challenging operations. Future studies should aim to identify more effective techniques to reduce recurrence rates in this patient population.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"850-858"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-16DOI: 10.1007/s00464-024-11460-z
Dylan Cuva, Manish Parikh, Avery Brown, Eduardo Somoza, John K Saunders, Julia Park, Jeffrey Lipman, Peter Einersen, Patricia Chui
Background: Conversion from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) may be indicated for patients due to insufficient weight loss or weight regain.
Objectives: To assess weight loss outcomes and factors predictive of improved weight loss in patients undergoing RYGB after SG and create an algorithm to estimate postoperative weight loss in these patients.
Setting: University Hospital.
Methods: Retrospective review of patients who underwent conversion from SG to RYGB from 2015 to 2022 was performed, assessing pre-and post-operative weights for each procedure.
Results: 114 patients were included (84% female, pre-SG BMI 49.3 ± 10.2). Post-SG, patients achieved a maximum %TBWL of 31.2% ([6.6-58.2] ± 10.1%), %EWL of 56.8%([13.3-97.3] ± 16.4%), and total body weight regain of 53.9%([0.0-144.4] ± 31.3%). Conversion to RYGB resulted in peak %TBWL of 18.8% at 8 months, leveling off at 13.5% thereafter. Factors predictive of greater weight loss post-conversion included higher BMI at time of SG (each 5 kg/m2 increase yielded 0.8% greater %TBWL [95% CI 0.5-1%, p < 0.0001]) and peak %EWL ≥ 40% after SG (yielding 5.5% more %TBWL, 95%CI 3.9-7.1%, p < 0.0001). Conversely, those who had ≥ 20% weight regain after SG had 4.1% less %TBWL (95%CI 2.5-5.7%, p < 0.0001) after conversion. These factors were used to create BE-CALM, an algorithm to predict %TBWL one year after conversion to RYGB.
Conclusions: Conversion from SG to RYGB is effective for further weight loss. Patients who have higher starting BMI, ≥ 40% %EWL or ≤ 20% weight regain after SG demonstrate the most effective weight loss post-conversion.
{"title":"BE-CALM: a clinical score to predict weight loss after conversion from sleeve gastrectomy to Roux-en-Y gastric bypass.","authors":"Dylan Cuva, Manish Parikh, Avery Brown, Eduardo Somoza, John K Saunders, Julia Park, Jeffrey Lipman, Peter Einersen, Patricia Chui","doi":"10.1007/s00464-024-11460-z","DOIUrl":"10.1007/s00464-024-11460-z","url":null,"abstract":"<p><strong>Background: </strong>Conversion from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) may be indicated for patients due to insufficient weight loss or weight regain.</p><p><strong>Objectives: </strong>To assess weight loss outcomes and factors predictive of improved weight loss in patients undergoing RYGB after SG and create an algorithm to estimate postoperative weight loss in these patients.</p><p><strong>Setting: </strong>University Hospital.</p><p><strong>Methods: </strong>Retrospective review of patients who underwent conversion from SG to RYGB from 2015 to 2022 was performed, assessing pre-and post-operative weights for each procedure.</p><p><strong>Results: </strong>114 patients were included (84% female, pre-SG BMI 49.3 ± 10.2). Post-SG, patients achieved a maximum %TBWL of 31.2% ([6.6-58.2] ± 10.1%), %EWL of 56.8%([13.3-97.3] ± 16.4%), and total body weight regain of 53.9%([0.0-144.4] ± 31.3%). Conversion to RYGB resulted in peak %TBWL of 18.8% at 8 months, leveling off at 13.5% thereafter. Factors predictive of greater weight loss post-conversion included higher BMI at time of SG (each 5 kg/m<sup>2</sup> increase yielded 0.8% greater %TBWL [95% CI 0.5-1%, p < 0.0001]) and peak %EWL ≥ 40% after SG (yielding 5.5% more %TBWL, 95%CI 3.9-7.1%, p < 0.0001). Conversely, those who had ≥ 20% weight regain after SG had 4.1% less %TBWL (95%CI 2.5-5.7%, p < 0.0001) after conversion. These factors were used to create BE-CALM, an algorithm to predict %TBWL one year after conversion to RYGB.</p><p><strong>Conclusions: </strong>Conversion from SG to RYGB is effective for further weight loss. Patients who have higher starting BMI, ≥ 40% %EWL or ≤ 20% weight regain after SG demonstrate the most effective weight loss post-conversion.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"1050-1055"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}