Faculty Bibliography

Background: Revisional bariatric surgery continues to increase. Laparoscopic adjustable gastric banding (LAGB) after previous Roux-en-y gastric bypass (RNY), known colloquially as "band-over-pouch" has become an option despite a dearth of critically analyzed long-term data.
Method(s): Our prospectively-maintained database was retrospectively reviewed for patients who underwent band-over-pouch at our MBSAQIP Center of Excellence in a 15-year period ending February 2019. We evaluated: demographics, comorbidities, operative procedures, and outcomes (30-day and >30-day).
Result(s): During the period, of 4,614 bariatric procedures performed, 42 were band-over-pouch with 39 (93%) being women. Overall, the mean age was 49.8 years (range 26-75), a mean weight 251 pounds (range 141-447) and mean BMI 42.4 (range 26-75). Co-morbidities included: hypertension (n=31; 74%), diabetes (n=27; 64%), obstructive sleep apnea (n=26; 62%), gastroesophageal reflux disease (n=26; 62%), and osteoarthritis (n=25; 60%). All procedures were performed laparoscopically with no conversions to open. Mean length of stay was 1.2 days (range 1-3). Mean follow-up time was 4.2 years (range 0.5-10). Mean excess weight loss was 14.9%, 24.3%, and 28.2% at 6 months, 1 year and 4 years, respectively. There was one 30-day trocar-site hematoma requiring transfusion. Long-term events included: 1-year (1 endoscopy for retained food; 1 internal hernia), 3-year (1 LAGB erosion; 1 LAGB explant), 4-year (1anastomotic ulcer), 6-year (1 LAGB explant and RNY revision), and 8-year (1 LAGB erosion). Two 5-year mortalities occurred (4.8%); both in association with hospitalization for chronic illness and malnutrition. Both erosions were successfully treated surgically.
Conclusion(s): Band-over-pouch warrants further analysis before widespread adoption as a revisional procedure.
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Resuscitative endovascular balloon occlusion of the aorta (REBOA) represents an innovative method by which noncompressible bleeding in the torso can be mitigated until definitive treatment can be obtained. To perform a systematic review of the literature on the use of the REBOA in trauma patients. An English and Spanish literature search was performed using MEDLINE, PubMed, and Scopus, from 1948 to 2018. Keywords used were aortic balloon occlusion, resuscitative endovascular balloon, REBOA, hemorrhage, and resuscitative endovascular balloon occlusion of the aorta. The eligilibility criteria included only original and human subject articles. Nontrauma patients, nonbleeding pathology, letters, single case reports, reviews, and pediatric patients were excluded. Two hundred forty-six articles were identified, of which 17 articles were included in this review. The total number of patients was 1340; 69 per cent were men and 31 per cent women. In 465 patients, the aortic zone location was described: 83 per cent the balloon was placed in aortic zone I and 16 per cent in zone III. Systolic blood pressure increased at an average of 52 mmHg before and after aortic occlusion. Although 32 patients (2.4%) presented clinical complications derived from the procedure, no mortality was reported. The trauma-related mortality rate was 58 per cent (776/1340). REBOA is a useful resource for the management of noncompressive torso hemorrhage with promising results in systolic blood pressure and morbidity. Indications for its use include injuries in zones 1 and 3, whereas it is not clear for zone 2 injuries. Additional studies are needed to define the benefits of this procedure.

BACKGROUND:Pre-peritoneal pelvic packing (PPP) is a technique used for treating pelvic hemorrhage in patients with pelvic fractures and hemodynamic instability after a high-energy trauma representing a life-threatening situation. The aim of this study was to perform a comprehensive review of the literature. METHODS:A review of the medical literature was performed, based on the following inclusion criteria: patients sustaining pelvic fractures with hemodynamic instability and the inclusion of PPP as a tool for hemorrhage control. Articles not involving human patients, review articles, surveys, pediatric patients, hemodynamic stability, case reports, and not directly related publications; such as angiography with or without embolization, and REBOA use for hemorrhage control as a primary outcome evaluation were excluded from this search. RESULTS:Eleven articles out of seventy-seven identified publications between 2008 and 2018 met the inclusion criteria and were included in this review. CONCLUSIONS:PPP is a surgical approach used in life-threatening situations due to pelvic fracture with high risk of death for exsanguination. Performed expediently, good results can be obtained with a decrease in the need for blood products, improved systolic blood pressure, and a decrease in mortality rates overall. This makes PPP an important life-saving tool.

Background/UNASSIGNED:Robotic complex abdominal wall reconstruction (r-AWR) using transversus abdominis release (TAR) is associated with decreased wound complications, morbidity, and length of stay compared with open repair. This report describes a single-institution experience of r-AWR. Methods/UNASSIGNED:A retrospective chart review was performed on patients who underwent r-AWR by a single surgeon (D.H.) from August 2015 through October 2018. Results/UNASSIGNED:. Forty-one patients presented with an initial ventral hernia (74.5%) and 14 with a recurrent hernia (25.5%). Five patients had a grade 1 hernia (9.1%), 46 had a grade 2 hernia (83.6%), and 4 had a grade 3 hernia (7.3%) according to the Ventral Hernia Working Group system. Thirty-four (62%) patients underwent TAR, 21 (38%) patients underwent bilateral retrorectus release, and 10 (18.2%) patients underwent concomitant inguinal hernia repair. Mean operative time with TAR was 294 (range 106 to 472) minutes and 183 (range 126 to 254) minutes without TAR. Mean length of stay was 1.5 (range 0 to 10) days. Mean follow-up was 10.7 (range 1 to 52) weeks with no hernia recurrences. Seromas occurred in 6 (10.9%) patients, with 2 (3.6%) requiring drainage. Two (3.6%) 30-day readmissions occurred with no conversions to open or 30-day mortalities. Conclusions/UNASSIGNED:r-AWR with and without TAR is a safe and feasible procedure associated with a short LOS, low complication rate, and low recurrence even within the surgeon's learning curve experience.