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The current role of barbed sutures in fascial closure of ventral hernia repair: a multicenter study using the abdominal core health quality collaborative database
Arias-Espinosa, Luis; Wang, Annie; Wermelinger, Joao Pedro; Olson, Molly A.; Phillips, Sharon; Xie, Weipeng; de Pena Pena, Xavier; Pereira, Xavier; Damani, Tanuja; Malcher, Flavio
Background: Barbed sutures (BS) have been increasingly used in the last two decades across surgical disciplines but little is known about how widespread their adoption has been in ventral hernia repair (VHR). The aim of this study was to document the use of barbed sutures in VHR in a multicenter database with associated clinical and patient-reported outcomes. Method: Prospectively collected data from the Abdominal Core Health Quality Collaborative database was retrospectively reviewed, including all adult patients who underwent VHR with fascial closure from 2020 to 2022. A univariate analysis compared patients with BS against non-barbed sutures (NBS) across the preoperative, intraoperative, and postoperative timeframes including patient-reported outcomes concerning quality of life and pain scores. Results: A total of 4054 patients that underwent ventral hernia repair with BS were compared with 6473 patients with non-barbed sutures (NBS). Overall, BS were used in 86.2% of minimally invasive ventral hernia repairs and about 92.2% of robotic surgery compared to only 9.6% of open procedures. Notable differences existed in patient selection, including a higher BMI (32 vs 30.5; p < 0.001), more incisional hernias (63.3% vs 51.1%; p < 0.001), wider hernias (4 cm vs 3 cm; p < 0.001), and higher ASA score (p < 0.001) in patients with BS. Outcomes in patients with BS included a shorter length of stay (mean days; 1.4 vs 2.4; p < 0.001), less SSI (1.5% vs 3.6%; p < 0.001), while having similar SSO (7.6% vs 7.3%; p = 0.657), readmission (3.0 vs 3.2; p = 0.691), and reoperation (1.5% vs 1.45%; p = 0.855), at a longer operative time (p < 0.001). Hernia-specific questionnaires for quality of life (HerQLes) and pain in patients with BS had a worse preoperative score that was later matched and favorable compared to NBS (p = 0.048). PRO concerning hernia recurrence suggest around 10% at two years of follow-up (p = 0.532). Conclusion: Use of barbed sutures in VHR is widespread and highly related to MIS. Outcomes from this multicenter database cannot be reported as superior but suggest that barbed sutures do not have a negative impact on outcomes.
SCOPUS:85204624454
ISSN: 0930-2794
CID: 5715592
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
Outcomes in Minimally Invasive Sleeve Gastrectomy and Implications for Surgical Resident Education
Lima, Diego L; Profeta, Rebeca Dominguez; Berk, Robin; Pereira, Xavier; Moran-Atkin, Erin; Choi, Jenny; Camacho, Diego
PMID: 37432795
ISSN: 1557-9034
CID: 5591712
Robotic versus open lateral abdominal hernia repair: a multicenter propensity score matched analysis of perioperative and 1-year outcomes
Pereira, X; Lima, D L; Huang, L-C; Salas-Parra, R; Shah, P; Malcher, F; Sreeramoju, P
PURPOSE/OBJECTIVE:Lateral abdominal hernias are inherently challenging surgical entities. As such, there has been an increase in the adoption of robotic platforms to approach these challenging hernias. Our study aims to assess and compare outcomes between open (oLAHR) and robotic (rLAHR) lateral abdominal hernia repair using a national hernia-specific database. METHODS:A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative was performed to include all adult patients who underwent elective lateral hernia repair. A propensity score match analysis was conducted, and univariate analyses were conducted to compare these two surgical modalities across perioperative timeframes. RESULTS:The database identified 2569 patients. Our analysis matched 665 patients to either the open or robotic groups. The median length of stay, surgical site occurrences (SSO), and surgical site occurrences requiring procedural interventions (SSOPI) were higher in the oLAHR versus the rLAHR group. Overall, oLAHR had a significantly higher rate of having any post-operative complications or any SSO/SSOPI. There was no difference in quality-of-life measures between groups at 30 days and 1 year. CONCLUSION/CONCLUSIONS:Robotic abdominal hernia repair is a safe alternative compared to the open repair of lateral abdominal hernias with better perioperative outcomes. Despite having a longer operative time, the robotic approach can offer a significantly shorter length of stay and an overall lower rate of complications. Ultimately, there is no difference in the quality-of-life measures both at 30 days and 1 year between the open and robotic approaches.
PMID: 36422725
ISSN: 1248-9204
CID: 5384352
Assessing outcomes in laparoscopic vs open surgical management of adhesive small bowel obstruction
Chin, Ryan L; Lima, Diego L; Pereira, Xavier; Romero-Velez, Gustavo; Friedmann, Patricia; Dawodu, Gbalekan; Sterbenz, Kaitlin; Yamada, Jaclyn; Sreeramoju, Prashanth; Smith, Vance; Malcher, Flavio
BACKGROUND:Small bowel obstruction is typically managed nonoperatively; however, refractory small bowel obstructions or closed loop obstructions necessitate operative intervention. Traditionally, laparotomy has long been the standard operative intervention for lysis of adhesions of small bowel obstructions. But as surgeons become more comfortable with minimally invasive techniques, laparoscopy has become a widely accepted intervention for small bowel obstructions. The objective of this study was to compare the outcomes of laparoscopy to open surgery in the operative management of small bowel obstruction. METHODS:This is a retrospective analysis of operative small bowel obstruction cases at a single academic medical center from June 2016 to December 2019. Data were obtained from billing data and electronic medical record for patients with primary diagnosis of small bowel obstruction. Postoperative outcomes between the laparoscopic and open intervention groups were compared. The primary outcome was time to return of bowel function. Secondary outcomes included length of stay, 30-day mortality, 30-day readmission, VTE, and reoperation rate. RESULTS:The cohort consisted of a total of 279 patients with 170 (61%) and 109 (39%) patients in the open and laparoscopic groups, respectively. Patients undergoing laparoscopic intervention had overall shorter median return of bowel function (4 vs 6 days, p = 0.001) and median length of stay (8 vs 13 days, p = 0.001). When stratifying for bowel resection, patients in the laparoscopic group had shorter return of bowel function (5.5 vs 7 days, p = 0.06) and shorter overall length of stay (10 vs 16 days, p < 0.002). Patients in the laparoscopic group who did not undergo bowel resection had an overall shorter median return of bowel function (3 vs 5 days, p < 0.0009) and length of stay (7 vs 10 days, p < 0.006). When comparing surgeons who performed greater than 40% cases laparoscopically to those with fewer than 40%, there was no difference in patient characteristics. There was no significant difference in return of bowel function, length of stay, post-operative mortality, or re-admission laparoscopic preferred or open preferred surgeons. CONCLUSION/CONCLUSIONS:Laparoscopic intervention for the operative management of small bowel obstruction may provide superior clinical outcomes, shorter return of bowel function and length of stay compared to open operation, but patient selection for laparoscopic intervention is based on surgeon preference rather than patient characteristics.
PMID: 35587296
ISSN: 1432-2218
CID: 5247662
A comparison of outcomes between class-II and class-III obese patients undergoing robotic ventral hernia repair: a multicenter study
Kudsi, O Y; Gokcal, F; Bou-Ayash, N; Watters, E; Pereira, X; Lima, D L; Malcher, F
BACKGROUND:) obese patients after robotic VHR (RVHR). METHODS:) systems. RESULTS:were included in the study. PSM analysis stratified these into 69 patients for each of the class-II and class-III groups. When comparing matched groups, there were no differences in any of the variables across all timeframes, except for a higher rate of Polytetrafluoroethylene (PTFE)-based mesh use in the class-III group (39.1% vs 17.4%, p = 0.008). The estimated recurrence-free time was 76.4 months (95% CI = 72.5-80.4) for the class-II group and 80.4 months (95% CI = 78-82.8) for the class-III group. CONCLUSION/CONCLUSIONS:This multicenter study showed no difference in outcomes after RVHR between matched class-II and class-III obese patients.
PMID: 35305193
ISSN: 1248-9204
CID: 5339862
Robotic vs Open Lateral Hernia Repair: A Multicenter Propensity Score-Matched Analysis of 30-day Outcomes [Meeting Abstract]
Lima, D L; Pereira, X; Salas, Parra R D; Martins, De Oliveira F M; Sreeramoju, P V
INTRODUCTION: Lateral ventral hernia repair (LVHR) is a challenging surgical dilemma due to location, different anatomical considerations, and low volume of cases. Our study aims to compare and assess early 30-day outcomes between open LVHR (oLVHR) and robotic-assisted LVHR (rLVHR) approach.
METHOD(S): A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was performed to include all adult patients who underwent elective LVHR based on European Hernia Society classification. A 1:1 propensity score match (PSM) analysis was conducted for balanced groups. Univariate analysis was performed to compare the 2 groups (oLVHR and rLVHR) across preoperative, intraoperative, and postoperative timeframes.
RESULT(S): ACHQC database identified 2,569 LVHR patients. A PSM analysis stratified 665 patients to each oLVHR and rLVHR group. Median length of stay is higher in the oLVHR 3 days (interquartile range [IQR] 1 to 5) vs rLVHR 1 day (IQR 0 to 2; p < 0.001). The surgical site infection rate was higher in the oLVHR 3% vs 1% (p = 0.006). Surgical site occurrence (SSO) such as wound cellulitis was also found at a higher rate in the oLVHR 21% vs the rLVHR 0% (p < 0.001). Seroma rate was higher in the rLVHR (6.5% vs 5.6%, p < 0.001). oLVHR had 18% postoperative complication compared with rLVHR 12% (p < 0.001). There was no difference in quality-of-life measures (HerQLes and PROMIS pain 3a surveys) between groups at 30 days and 1 year.
CONCLUSION(S): Robotic-assisted LVHR is safe with decreased length of stay and SSO compared with the conventional open approach. However, it does carry a higher seroma rate with no clinical significance
EMBASE:639438932
ISSN: 1879-1190
CID: 5366702
Can a Fully Articulating Electromechanical Laparoscopic Needle Driver Compare with a Robotic Platform in Transabdominal Preperitoneal Inguinal Hernia Repair?
Lima, Diego Laurentino; Pereira, Xavier; Malcher, Flavio
PMID: 35447037
ISSN: 1557-9034
CID: 5218502
Postoperative pneumonia after bariatric surgery during the COVID-19 pandemic: a National Surgical Quality Improvement Program study
Grosser, Rachel; Romero-Velez, Gustavo; Pereira, Xavier; Moran-Atkin, Erin; Choi, Jenny; Camacho, Diego R
BACKGROUND:During the COVID-19 pandemic, surgical centers had to weigh the benefits and risks of conducting bariatric surgery. Obesity increases the risk of developing severe COVID-19 infections, and therefore, bariatric surgery is beneficial. In contrast, surgical patients who test positive for COVID-19 have higher mortality rates. OBJECTIVE:This study investigates the national prevalence of postoperative pneumonia during the COVID-19 pandemic in the bariatric surgery population. SETTING/METHODS:The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. METHODS:This is a cross-sectional study using the ACS-NSQIP database. The population of concern included patients who underwent sleeve gastrectomy and Roux-en-Y gastric bypass procedures. Information was extracted on rate of postoperative pneumonia and other 30-day complications between 2018 and 2020. RESULTS:All baseline characteristics were similar among patients who underwent bariatric surgery between 2018 and 2020. However, there was a 156% increase in postoperative pneumonia in 2020 compared with the previous year. Furthermore, despite the similar postoperative complication rates across the years, there was a statistically significant increase in all-cause mortality in 2020. The multivariate analysis showed that having surgery in 2020 was a statistically significant risk factor for pneumonia development postoperatively. CONCLUSIONS:This study showed a statistically significant increase in the prevalence of postoperative pneumonia during the COVID-19 pandemic among bariatric surgery patients. Surgical centers must continuously evaluate the risks associated with healthcare-associated exposure to COVID-19 and weigh the benefits of bariatric surgery.
PMCID:9212841
PMID: 35843783
ISSN: 1878-7533
CID: 5285042
Risk Factors for Surgical Site Infection in the Undeserved Population After Ventral Hernia Repair: A 3936 Patient Single-Center Study Using National Surgical Quality Improvement Project
Romero-Velez, Gustavo; Lima, Diego L; Pereira, Xavier; Farber, Benjamin A; Friedmann, Patricia; Malcher, Flavio; Sreeramoju, Prashanth
PMID: 35319294
ISSN: 1557-9034
CID: 5206682