Medicine and Health Sciences Commons^™

Early And Late Complications Of Bariatric Operation., Robert Lim, Alec Beekley, Dirk C. Johnson, Kimberly A. Davis

Department of Surgery Faculty Papers

Weight loss surgery is one of the fastest growing segments of the surgical discipline. As with all medical procedures, postoperative complications will occur. Acute care surgeons need to be familiar with the common problems and their management. Although general surgical principles generally apply, diagnoses specific to the various bariatric operations must be considered. There are anatomic considerations which alter management priorities and options for these patients in many instances. These problems present both early or late in the postoperative course. Bariatric operations, in many instances, result in permanent alteration of a patient's anatomy, which can lead to complications at any …

Reducing Gastrointestinal Anastomotic Leak Rates: Review Of Challenges And Solutions, Benjamin Philllips

Department of Surgery Faculty Papers

Various techniques and interventions have been developed in an effort to obviate gastrointestinal anastomotic leaks. This review is intended to delineate potential modifications that can be made to reduce the risk of anastomotic leaks following gastrointestinal surgery. It may also serve to aid in identifying patients who are at increased risk of anastomotic leak. Modifiable risk factors for leak discussed include malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and surgical anastomotic technique. Based upon literature review, operative techniques should include minimizing operative time, reducing ischemia, and utilizing stapled anastomoses. …

Oncologic Efficacy Is Not Compromised, And May Be Improved With Minimally Invasive Esophagectomy., Adam C Berger, Aaron Bloomenthal, Benny Weksler, Nathaniel Evans, Karen A Chojnacki, Charles J Yeo, Ernest L Rosato

Department of Surgery Faculty Papers

BACKGROUND: Major morbidity and mortality rates continue to be high in large series of transthoracic esophagectomies. Minimally invasive approaches are being increasingly used. We compare our growing series of minimally invasive (combined thoracoscopic and laparoscopic) esophagectomies (MIEs) with a series of open transthoracic esophagectomies.

STUDY DESIGN: We identified 65 patients who underwent an MIE with thoracoscopy/laparotomy (n = 11), Ivor Lewis (n = 2), or 3-hole approach (n = 52). These patients were compared with 53 patients who underwent open Ivor-Lewis esophagectomy (n = 15) or 3-hole esophagectomy (n = 38) over the past 10 years.

RESULTS: The MIE and …

Optimal Technical Management Of Stump Closure Following Distal Pancreatectomy: A Retrospective Review Of 215 Cases., Lisa J. Harris, Hamid Abdollahi, Timothy Newhook, Patricia K. Sauter, Albert G. Crawford, Karen A. Chojnacki, Ernest L. Rosato, Eugene P. Kennedy, Charles J. Yeo, Adam C. Berger

Department of Surgery Faculty Papers

BACKGROUND: Pancreatic fistula (PF) is a major source of morbidity following distal pancreatectomy (DP). Our aim was to identify risk factors related to PF following DP and to determine the impact of technique of transection and stump closure.

METHODS: We performed a retrospective review of 215 consecutive patients who underwent DP. Perioperative and postoperative data were collected and analyzed with attention to PF as defined by the International Study Group of Pancreatic Fistula.

RESULTS: PF developed in 36 patients (16.7%); fistulas were classified as Grade A (44.4%), B (44.4%), or C (11.1%). The pancreas was transected with stapler (n = …

Impact Of Obesity On Perioperative Morbidity And Mortality Following Pancreaticoduodenectomy, Timothy K. Williams, Ernest L. Rosato, Eugune P. Kennedy, Karen A. Chojnacki, Jocelyn Andrel, Terry Hyslop, Cataldo Doria, Patricia K. Sauter, Jordan Bloom, Charles J. Yeo, Adam C. Berger

Department of Surgery Faculty Papers

Background: Obesity has been implicated as a risk factor for perioperative and postoperative complications. The aim of this study was determine the impact of obesity on morbidity and mortality in patients undergoing pancreaticoduodenectomy (PD).

Study Design: Between January 2000 and July 2007, 262 patients underwent PD at Thomas Jefferson University Hospital (TJUH), of whom 240 had complete data, including body mass index (BMI) for analysis. Data on BMI, preoperative parameters, operative details, and post-operative course were collected. Patients were categorized as obese (BMI >30 kg/m2), overweight (25≤BMI<30), or normal weight (BMI<25). Complications were graded according to previous published scales. Other endpoints included length of postoperative hospital stay, blood loss, and operative duration. Analyses were performed using univariate and multivariable models.

Results: There were 103 (42.9%) normal weight, 71 (29.6%) overweight and 66 (27.5%) …