Try a new search

Format these results:

Searched for:

person:malchf01

in-biosketch:true

Total Results:

53


How Appropriate Are Recommendations of Online Chat-Based Artificial Intelligence (ChatGPT) to Common Questions on Ventral Hernia Repair?

Lima, Diego Laurentino; Nogueira, Raquel; Liu, Jack; Claus, Christiano; Malcher, Flavio; Sreeramoju, Prashanth; Cavazzola, Leandro Totti
ChatGPT is a conversational AI model developed by OpenAI to generate human-like text based on the input it receives. ChatGPT has become increasingly popular, and the general public may use this tool to ask questions about different medical conditions. There is a lack of data to demonstrate ChatGPT is able to provide reliable information on medical conditions. The aim of our study is to assess the accuracy and appropriateness of ChatGPT answers to questions on ventral hernia management.
PMID: 38354285
ISSN: 1557-9034
CID: 5635792

Current trends and outcomes for unilateral groin hernia repairs in the United States using the Abdominal Core Health Quality Collaborative database: A multicenter propensity score matching analysis of 30-day and 1-year outcomes

Lima, Diego L; Nogueira, Raquel; Dominguez Profeta, Rebeca; Huang, Li-Ching; Cavazzola, Leandro Totti; Malcher, Flavio; Sreeramoju, Prashanth
BACKGROUND:Different unilateral groin hernia repair approaches have been developed in the last 2 decades. The most commonly done approaches are open inguinal hernia repair by the Lichenstein technique, laparoscopic approach by either total extraperitoneal or transabdominal preperitoneal, and robotic transabdominal preperitoneal approach. Hence, this study aimed to compare early and late postoperative outcomes in patients who underwent unilateral robotic transabdominal preperitoneal, laparoscopic transabdominal preperitoneal, and laparoscopic total extraperitoneal, and open groin hernia repair using a United States national hernia database, the Abdominal Core Health Quality Collaborative Database. METHODS:Prospectively collected data from the Abdominal Core Health Quality Collaborative database was retrospectively reviewed, including all adult patients who underwent elective unilateral groin hernia repair from 2015 to 2022, with a 1:1 propensity score match analysis conducted for balanced groups. The univariate analysis compared the groups across the preoperative, intraoperative, and postoperative timeframes. RESULTS:, the robotic approach had lower rates of surgical site occurrence (n = 12, 4%; P = .002) and seroma (n = 5, 2%; P < .001) compared with the other groups. When evaluating recurrence 1 year after surgery, the robotic transabdominal preperitoneal group had 10% versus 18% open groin hernia repair, 11% laparoscopic transabdominal preperitoneal, and 18% laparoscopic total extraperitoneal, but it was not statistically significant (P = .53). CONCLUSION/CONCLUSIONS:for surgical site occurrence and seroma than in other surgical techniques.
PMID: 38218685
ISSN: 1532-7361
CID: 5628762

Concomitant midline ventral and inguinal hernia repair: can we create an algorithmic approach?

Pacheco, T B S; Cordero, K; Arias-Espinosa, L; Hurwitz, J C; Malcher, F; Halpern, D
PURPOSE/OBJECTIVE:International guidelines exist for surgical treatment of either ventral or inguinal hernias repair (VHR; IHR). However, approach for managing both of them remains unestablished and is further complicated by newly developed surgical techniques and modalities (namely, robotic). This highlights the need for a tailored, algorithmic strategy to streamline surgical management. METHODS:An algorithm was developed by the directors of the NYU Langone Abdominal Core Health program of which four treatment groups were described: Group 1: open VHR and either laparoscopic or robotic IHR; Group 2: robotic transabdominal pre-peritoneal (TAPP) approach for both VHR and IHR; Group 3: robotic retro-muscular VHR and IHR; and Group 4: open repair for both. Demographics, comorbidities, operative characteristics, and surgical outcomes from November 2021 to July 2023 were retrospectively compared. RESULTS:, and 73% (n = 67) were ASA class II. Distribution of groups was: 48% (n = 44) in 1A, 8% (n = 7) in 1B, 8% (n = 7) in 2A, 3% (n = 3) in 2B, 23% (n = 21) in 3A, 8% (n = 7) in 3B, and 3% (n = 3) in 4. Ventral hernia size, OR time, and postoperative length of stay varied across groups. Postoperative outcomes at 30 days including emergency consults, readmissions, and complications, showed no differences across groups. CONCLUSION/CONCLUSIONS:Access without guidance to new minimally invasive surgical approaches can be a challenge for the general surgeon. We propose an algorithm for decision-making based on our experience of incorporating robotic surgery, when available, for repair of concomitant VHR and IHR with consistent favorable outcomes within a small sample of patients.
PMID: 38512506
ISSN: 1248-9204
CID: 5640732

Primary abandonment of the sac in the management of scrotal hernias: a dual-institution experience of short-term outcomes

Nikolian, V C; Pereira, X; Arias-Espinosa, L; Bazarian, A N; Porter, C G; Henning, J R; Malcher, F
PURPOSE/OBJECTIVE:Management of scrotal hernias presents as a common challenge, with operative interventions to address these hernias associated with higher rates of morbidity compared to those of less-complex pathology. Surgeons have advocated for the use of techniques such as primary abandonment of the distal sac as a potential means to reduce complications for operative intervention, with preliminary findings demonstrating feasibility. We sought to assess outcomes related to primary sac abandonment among patients undergoing minimally invasive (MIS) repair of scrotal hernias. METHODS:A review of prospectively maintained databases among two academic hernia centers was conducted to identify patients who underwent MIS inguinal hernia repairs with primary sac abandonment. Patient demographics, hernia risk factors, intraoperative factors, and postoperative outcomes were evaluated. Short-term outcomes related to patient-reported experiences and surgical-site occurrences requiring procedural intervention were queried. RESULTS:Sixty-seven male patients [median age: 51.6 years; interquartile range (IQR): 45-65 years] underwent inguinal hernia repair with primary sac abandonment. Anatomic polypropylene mesh was used in 98.5% cases. Rates of postoperative complications were low and included postoperative urinary retention (6%), clinically identified or patient-reported seromas/hematomas within a 30-day follow-up period (23.9%), deep venous thrombosis (1.5%), and pelvic hematoma (1.5%). No seromas or hematomas necessitated procedural interventions, with resolution of symptoms within three months of their operation date. CONCLUSION/CONCLUSIONS:We report a multi-center experience of patients managed with primary abandonment of the sac technique during repair of inguinoscrotal hernias. Utilization of this technique appears to be safe and reproducible with a low burden of short-term complications.
PMID: 38502368
ISSN: 1248-9204
CID: 5640402

Appropriateness of Online Chat-Based Artificial Intelligence (ChatGPT) Answers to Common Questions on Inguinal Hernia Repair

Lima, Diego Laurentino; Nogueira, Raquel; Chin, Ryan; Claus, Christiano; Malcher, Flavio; Sreeramoju, Prashanth; Cavazzola, Leandro Totti
ChatGPT is a conversational AI model developed by OpenAI designed to generate human-like text based on the input it receives. ChatGPT has become increasingly popular, and the general public may use this tool to ask questions about different medical conditions. There is a lack of data showing if ChatGPT is able to provide reliable information on medical conditions to the general public. The aim of our study is to assess the accuracy and appropriateness of ChatGPT answers to questions on inguinal hernia management.
PMID: 38126878
ISSN: 1557-9034
CID: 5628252

Correction to: Concomitant midline ventral and inguinal hernia repair: can we create an algorithmic approach? (Hernia, (2024), 10.1007/s10029-024-03008-w)

Pacheco, T. B.S.; Cordero, K.; Arias-Espinosa, L.; Hurwitz, J. C.; Malcher, F.; Halpern, D.
In this article the wrong figure appeared as Fig. 2; the Fig. 2 should have appeared as shown below. (Figure presented.) Algorithm for dominant ventral hernia The original article has been corrected.
SCOPUS:85191875707
ISSN: 1265-4906
CID: 5661892

Machine learning, deep learning and hernia surgery. Are we pushing the limits of abdominal core health? A qualitative systematic review

Lima, D. L.; Kasakewitch, J.; Nguyen, D. Q.; Nogueira, R.; Cavazzola, L. T.; Heniford, B. T.; Malcher, F.
Introduction: This systematic review aims to evaluate the use of machine learning and artificial intelligence in hernia surgery. Methods: The PRISMA guidelines were followed throughout this systematic review. The ROBINS"”I and Rob 2 tools were used to perform qualitative assessment of all studies included in this review. Recommendations were then summarized for the following pre-defined key items: protocol, research question, search strategy, study eligibility, data extraction, study design, risk of bias, publication bias, and statistical analysis. Results: A total of 13 articles were ultimately included for this review, describing the use of machine learning and deep learning for hernia surgery. All studies were published from 2020 to 2023. Articles varied regarding the population studied, type of machine learning or Deep Learning Model (DLM) used, and hernia type. Of the thirteen included studies, all included either inguinal, ventral, or incisional hernias. Four studies evaluated recognition of surgical steps during inguinal hernia repair videos. Two studies predicted outcomes using image-based DMLs. Seven studies developed and validated deep learning algorithms to predict outcomes and identify factors associated with postoperative complications. Conclusion: The use of ML for abdominal wall reconstruction has been shown to be a promising tool for predicting outcomes and identifying factors that could lead to postoperative complications.
SCOPUS:85193242426
ISSN: 1265-4906
CID: 5661052

Primary abandon of hernia sac for inguinoscrotal hernias: a safe way to cut corners

Claus, Christiano; Malcher, Flavio; Trauczynski, Pedro; Morrell, Alexander Charles; Morrell, Andre Luiz Gioia; Furtado, Marcelo; Ruggeri, João Rafael Bora; Lima, Diego L; Cavazzola, Leandro Totti
INTRODUCTION:Inguinoscrotal hernias (ISH) pose a challenge to surgeons with consistently higher rates of postoperative complications and recurrence rates. The aim of this study is to report our initial experience and early results with a new technique for inguinoscrotal hernia repair. METHODS:A review of a prospectively maintained multi-center database was conducted in patients who underwent minimally invasive repair using the "primary abandon-of-the-sac" (PAS) technique for inguinoscrotal hernias from March 2021 to July 2022. Demographics and outcomes were analyzed. Univariate analysis and multivariate logistic regression were performed. RESULTS:A total of 76 minimally invasive inguinal hernia repairs were performed. In 70 patients (92%) C-PAS was used as the technique to abandon the sac while in the remaining 6 patients, "pirate-eye-patch" technique was used. Median hernia ring was 3 (IQR 2.5-3.5) cm and median hernia sac was 9.5 (8-10.8) cm. Median operative time was 70 min (IQR 56-96). Seroma was present in 22 (28.9%) patients 7 days after surgery. Most had seroma only in the inguinal area (n = 19; 25%). Thirty days after surgery, 12 (15.8%) patients still had seroma in the inguinal area and 6 (7.9%) in the inguinoscrotal area. Ninety days after surgery, four (5.3%) patients had inguinal seroma, 2 (2.6%) scrotal seromas and 3 (3.9%) inguinoscrotal seromas. The size of the hernia sac was not associated with seroma formation 7 days after surgery (OR 1.06; 95% CI 0.89-1.2; P = 0.461) in the multivariate logistic regression. BMI was also not associated with seroma formation (OR 0.8; 95% CI 0.74-1.06; P = 0.2). CONCLUSIONS:Planned abandon of the hernia sac is an interesting alternative and is associated with a low rate of complications and acceptable seroma formation rates.
PMID: 37730850
ISSN: 1432-2218
CID: 5634902

Hiatal hernia repair with biosynthetic mesh reinforcement: a qualitative systematic review

Lima, Diego L; de Figueiredo, Sergio Mazzola Poli; Pereira, Xavier; Murillo, Felipe R; Sreeramoju, Prashanth; Malcher, Flavio; Damani, Tanuja
INTRODUCTION:Reinforcement of crural closure with synthetic resorbable mesh has been proposed to decrease recurrence rates after hiatal hernia repair, but continues to be controversial. This systematic review aims to evaluate the safety, efficacy, and intermediate-term results of using biosynthetic mesh to augment the hiatus. METHODS:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed throughout this systematic review. The Risk of Bias in Non-Randomized Studies of Interventions and Risk of Bias in Randomized Trials tools were used to perform qualitative assessment of all studies included in this review. Recommendations were then summarized for the following pre-defined key items: protocol, research question, search strategy, study eligibility, data extraction, study design, risk of bias, publication bias, and statistical analysis. RESULTS:The systematic literature search found 520 articles, 101 of which were duplicates and 355 articles were determined to be unrelated to our study and excluded. The full text of the remaining 64 articles was thoroughly assessed. A total of 18 articles (1846 patients) were ultimately included for this review, describing hiatal hernia repair using three different biosynthetic meshes-BIO-A, Phasix ST, and polyglactin mesh. Mean operative time varied from 127 to 223 min. Mean follow up varied from 12 to 54 months. There were no mesh erosions or explants. One mesh-related complication of stenosis requiring reoperation was reported with BIO-A. Studies showed significant improvement in symptom and quality-of-life scores, as well as satisfaction with surgery. Recurrence was reported as radiologic or clinical recurrence. Overall, recurrence rate varied from 0.9 to 25%. CONCLUSION:The use of biosynthetic mesh is safe and effective for hiatal hernia repair with low complications rates and high symptom resolution. The reported recurrence rates are highly variable due to significant heterogeneity in defining and evaluating recurrences. Further randomized controlled trials with larger samples and long-term follow-up should be performed to better analyze outcomes and recurrence rates.
PMID: 37721592
ISSN: 1432-2218
CID: 5605202

Robotic approach in complex ventral hernias: anterior component separation technique

Nogueira, Raquel; Lima, Diego Laurentino; ParraDavila, Eduardo; Malcher, Flavio
Open onlay ventral hernia repair is still one of the most-used surgical techniques for the repair of hernias worldwide. The robotic anterior component separation technique uses the surgeon's usual anatomical expertise on onlay mesh placement with the manipulation and advantages of minimally invasive surgery. It maintains the precepts of reestablishment the midline integrity and insertion of mesh in the preaponeurotic space, without contact with the viscera. The use of this technique is simple and quite reproducible if you compare it with other techniques. Also, the time spent in surgery does not last long.
PMCID:10280109
PMID: 37347101
ISSN: 2234-5248
CID: 5542862