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Use of intraluminal indocyanine green to detect anastomotic leak after laparoscopic gastrojejunostomy (with video)

Pacheco, Tulio Brasileiro Silva; Zielinski, Gregory; Levine, Jun
PMID: 38519339
ISSN: 1878-7886
CID: 5640982

Predictors of Length of Hospital Stay After Reduction of Internal Hernia in Patients With a History of Roux-en-Y Gastric Bypass

Sohail, Amir H; Hurwitz, Joshua C; Silverstein, Jeffrey; Hakmi, Hazim; Sajan, Abin; Ye, Ivan B; Pacheco, Tulio Brasileiro Silva; Zielinski, Gregory R; Gangwani, Manesh Kumar; Petrone, Patrizio; Levine, Jun; Kella, Venkata; Brathwaite, Collin E M; Goparaju, Anirudha
BACKGROUND:Postoperative internal hernias after Roux-en-Y gastric bypass (RYGB) have an incidence of 2%-9% and are a surgical emergency. Evidence on factors associated with length of stay (LOS) after emergent internal hernia reduction in RYGB patients is limited. METHODS:This is a retrospective review of patients who underwent internal hernia reduction after RYGB at our tertiary care center over a 5 year period from 2015 to 2020. Demographics, comorbidities, and intra- and postoperative hospital course were collected. Univariate and multivariate linear regressions were used to investigate factors associated with LOS. RESULTS:< .001) were independent risk factors for increased LOS. CONCLUSION/CONCLUSIONS:The most common location of IH after RYGB is Petersen's defect, followed by jejuno-jejunal mesenteric defect. LOS was significantly associated with male sex, exploratory laparotomy, and resection of small bowel.
PMID: 38227350
ISSN: 1555-9823
CID: 5655492

Operative Experience of Esophageal Surgery among General Surgery Residents in the United States: An Analysis of ACGME Operative Case Logs

Sohail, Amir Humza; Martinez, Kevin A; Flesner, Samuel L; Martinez, Christian; Nguyen, Hoang; Jreisat, Bshara H; Ye, Ivan B; Goyal, Aman; Rohail, Amal; Pacheco, Tulio B S; Williams, Caroline E; Askeri, Aysha; Levine, Jun
INTRODUCTION/BACKGROUND:Esophageal surgery is an essential component of general surgery training and encompasses several types of cases that are logged by general surgery residents. There is a scarcity of data on the quality and volume of esophageal surgery experience during surgical residency in the United States. We analyzed trends for 9 different esophageal procedure categories logged by residents in the United States, with the aim to identify areas for improvement in training. METHODS:We conducted a retrospective analysis of operative case logs of all general surgery residents graduating from programs accredited by the ACGME over a fourteen-year period from 2009 to 2023. Data on mean esophageal cases reported by graduates, including mean in each procedure subcategory were retrieved. Cases were categorized as either surgeon chief or surgeon junior for each procedure category. Mann-Kendall trend test was used to obtain tau statistics and p-value for trends in mean operative surgical volume for the total number of cases in each operative category over the study period. Trends in surgeon chief and surgeon junior cases were also investigated for each operative category. RESULTS:The mean number of all esophageal procedures performed per resident during their training increased significantly from 10.5 in 2009 to 16 in 2022 (τ = 0.833, p < 0.001). This trend observed among all esophageal procedures during this 14-year study can be largely attributed to the steady increase in the number and proportion of laparoscopic esophageal antireflux procedures performed (τ = 0.950, p < 0.001). Additionally, esophagectomy procedures had a statistically significant, but modest, increase during the study period (τ = 0.505, p = 0.023), from a mean of 1 case during training in 2009 to a peak of 1.3 in 2020. Although the general trend of esophagus procedures increased during the study period, most categories (7 out of 9) either decreased or did not significantly change. Esophagogastrectomy volume decreased significantly by 30%, from 1 per resident during their training in 2009 to 0.7 in 2022 (τ = -0.510, p = 0.018), esophageal diverticulectomy procedures decreased by 50% from 0.2 to 0.1 (τ = -0.609, p = 0.009), and operations for esophageal stenosis decreased by 75% from 0.4 to 0.1 (τ = -0.734, p = 0.001). Mean number of esophageal bypasses (τ = -0.128, p = 0.584), repair of perforated esophageal disease (τ = -0.333, p = 0.156), and other major esophagus procedures (τ = 0.416, p = 0.063) did not significantly change. CONCLUSION/CONCLUSIONS:The operative volume of esophageal surgery that general surgery residents in the United States are exposed to has significantly risen over the past 14 years, largely driven by the increase in laparoscopic antireflux procedures. However, given the recent advances and the resultant heterogeneity in both esophageal surgery, the increase in resident operative volume is still inadequate to ensure the training of safe and adept esophageal surgeons, necessitating postresidency specialized training for trainees interested in esophageal surgery.
PMID: 38556439
ISSN: 1878-7452
CID: 5726202

Impact of Enhanced Recovery After Surgery (ERAS) Combined with Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) Protocol on Patient Outcomes, Length of Stay and Opioid Prescription After Bariatric Surgery

Silverstein, Jeffrey; Sohail, Amir H; Silva-Pacheco, Tulio B; Khayat, Adam; Amodu, Leo; Cherasard, Patricia; Levine, Jun; Goparaju, Anirudha; Kella, Venkata; Shahidul, Islam; Petrone, Patrizio; Brathwaite, Collin E M
BACKGROUND:Evidence shows that 14.2% of opioid-naive patients have long-term opioid dependence after bariatric surgery. Enhanced recovery after surgery (ERAS) protocols are widely used in bariatric surgery, while bariatric surgery targeting opioid prescriptions (BSTOP) protocols were recently introduced. We will investigate the combined impact of ERAS and BSTOP protocols after bariatric surgery. METHODS:We conducted a retrospective review for patients who underwent either a sleeve gastrectomy or Roux-en-Y gastric bypass at a tertiary care center. Pre-intervention and post-intervention data were compared. Primary outcomes were length of stay (LOS), 30-day readmission, 30-day complications, and discharge on opioids. Multivariate Poisson regression with robust standard error was used to analyze LOS. RESULTS:There was no significant difference in 30-day emergency room visits (3.3% vs. 4.0%; p value = 0.631), 30-day readmission (4.4% vs. 5.4%; p value = 0.577) or 30-day complication rate (4.2% vs. 6.4%; p value = 0.199). LOS was significantly lower in the post-intervention group; mean (interquartile range) 2 (1-2) days vs. 1 (1-2) day, p value < 0.001. On multivariate analysis, the post-intervention group had 0.74 (95% confidence interval 0.65-0.85; p value < 0.001) times lower LOS as compared to pre-intervention group. Patients with DM had a significantly longer LOS (relative risk: 1.22; p = 0.018). No other covariates were associated with LOS (p value < 0.05 for all). BSTOP analysis found a significant difference between the two groups. Discharge on opioids decreased from 40.6% pre-intervention to 7.1% post-intervention. CONCLUSION:ERAS and BSTOP protocols reduced length of stay and opioid need at discharge without an increase in complication or readmission rates.
PMID: 37653212
ISSN: 1708-0428
CID: 5618242

Esophagus

Chapter by: Zohourian, Tirajeh; Bizekis, Costas; Levine, Jun; Zervos, Michael
in: The ABSITE Blueprints by
[S.l.] : Springer International Publishing, 2023
pp. 137-169
ISBN: 9783031326424
CID: 5717672

Stomach

Chapter by: Amodu, Leo; Levine, Jun; Whittington, Jennifer; Brathwaite, Collin E.M.
in: The ABSITE Blueprints by
[S.l.] : Springer International Publishing, 2023
pp. 171-199
ISBN: 9783031326424
CID: 5717812

Upper Gastrointestinal Bleeding

Chapter by: Levine, Jun L.
in: Acute Care Surgery in Geriatric Patients by
[S.l.] : Springer International Publishing, 2023
pp. 423-430
ISBN: 9783031306501
CID: 5717842

Gastric Banding with Previous Roux-en-Y Gastric Bypass (Band over Pouch): Not Worth the Weight

Sohail, Amir H; Howell, Raelina S; Brathwaite, Barbara M; Silverstein, Jeffrey; Amodu, Leo; Cherasard, Patricia; Petrone, Patrizio; Goparaju, Anirudha; Levine, Jun; Kella, Venkata; Brathwaite, Collin E M
Background and Objectives/UNASSIGNED:Revisional bariatric surgery continues to increase. Laparoscopic adjustable gastric banding (LAGB) after previous Roux-en-Y gastric bypass (RYGB), known colloquially as "band-overpouch" has become an option despite a dearth of critically analyzed long-term data. Methods/UNASSIGNED:Our prospectively maintained database was retrospectively reviewed for patients who underwent band-overpouch at our Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Center of Excellence in a 18-year period ending October 31, 2021. We evaluated: demographics, comorbidities, operative procedures, and outcomes (30-day and > 30-day). Results/UNASSIGNED:During the study period, of 4,614 bariatric procedures performed, 42 were band-overpouch with 39 (93%) being women. Overall, mean age was 49.8 years (range 26-75), a mean weight 251 pounds (range 141-447), and mean body mass index 42.4 (range 26-62). Comorbidities 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 0.5-11). Mean excess weight loss was 14.9%, 24.3%, and 28.2% at 6 months, 1 year and ≥ 3 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 (1 anastomotic ulcer), 6-year (1 LAGB explant and Roux-en-Y revision), and 8-year (1 LAGB erosion). One 5-year mortality occurred (2.4%), in association with hospitalization for chronic illness and malnutrition. Band erosions were successfully treated surgically without replacement. Conclusion/UNASSIGNED:Band-overpouch is associated with moderate excess weight loss and has good short-term safety outcomes.
PMCID:9205461
PMID: 35815327
ISSN: 1938-3797
CID: 5269002

Laparoscopic repair of incarcerated transverse colon internal hernia in a patient with Crohn's disease

Hakmi, Hazim; Hashmi, Hassan; Hunt, Jackson; Levine, Jun
ISI:000606141800016
ISSN: 2042-8812
CID: 4773142

Management of Anastomotic Leak after Bariatric Surgery at a Metabolic and Bariatric Surgery Center of Excellence [Meeting Abstract]

Goparaju, Anirudha; Howell, Raelina S.; Levine, Jun L.; Brathwaite, Collin E. M.
ISI:000492749600153
ISSN: 1072-7515
CID: 4223262