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Giudicelli G, Gero D, Romulo L, Chirumamilla V, Iranmanesh P, Owen CK, Bauerle W, Garcia A, Lucas L, Mehdorn AS, Pandey D, Almuttawa A, Cabral F, Tiwari A, Lambert V, Pascotto B, De Meyere C, Yahyaoui M, Haist T, Scheffel O, Robert M, Nuytens F, Azagra S, Kow L, Prasad A, Vaz C, Vix M, Bindal V, Beckmann JH, Soussi D, Vilallonga R, El Chaar M, Wilson EB, Ahmad A, Teixeira A, Hagen ME, Toso C, Clavien PA, Puhan M, Bueter M, Jung MK. Global benchmarks in primary robotic bariatric surgery redefine quality standards for Roux-en-Y gastric bypass and sleeve gastrectomy. Br J Surg 2024; 111:znad374. [PMID: 37981863 PMCID: PMC10771137 DOI: 10.1093/bjs/znad374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/26/2023] [Accepted: 10/21/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Whether the benefits of the robotic platform in bariatric surgery translate into superior surgical outcomes remains unclear. The aim of this retrospective study was to establish the 'best possible' outcomes for robotic bariatric surgery and compare them with the established laparoscopic benchmarks. METHODS Benchmark cut-offs were established for consecutive primary robotic bariatric surgery patients of 17 centres across four continents (13 expert centres and 4 learning phase centres) using the 75th percentile of the median outcome values until 90 days after surgery. The benchmark patients had no previous laparotomy, diabetes, sleep apnoea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI greater than 50 kg/m2, or age greater than 65 years. RESULTS A total of 9097 patients were included, who were mainly female (75.5%) and who had a mean(s.d.) age of 44.7(11.5) years and a mean(s.d.) baseline BMI of 44.6(7.7) kg/m2. In expert centres, 13.74% of the 3020 patients who underwent primary robotic Roux-en-Y gastric bypass and 5.9% of the 4078 patients who underwent primary robotic sleeve gastrectomy presented with greater than or equal to one complication within 90 postoperative days. No patient died and 1.1% of patients had adverse events related to the robotic platform. When compared with laparoscopic benchmarks, robotic Roux-en-Y gastric bypass had lower benchmark cut-offs for hospital stay, postoperative bleeding, and marginal ulceration, but the duration of the operation was 42 min longer. For most surgical outcomes, robotic sleeve gastrectomy outperformed laparoscopic sleeve gastrectomy with a comparable duration of the operation. In robotic learning phase centres, outcomes were within the established benchmarks only for low-risk robotic Roux-en-Y gastric bypass. CONCLUSION The newly established benchmarks suggest that robotic bariatric surgery may enhance surgical safety compared with laparoscopic bariatric surgery; however, the duration of the operation for robotic Roux-en-Y gastric bypass is longer.
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Affiliation(s)
- Guillaume Giudicelli
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lind Romulo
- Department of Surgery, Orlando Health, University of Central Florida, Orlando, Florida, USA
| | - Vasu Chirumamilla
- Bariatric and Robotic Center of Excellence, Mather Northwell Hospital Health, Port Jefferson, New York, USA
| | - Pouya Iranmanesh
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Christopher K Owen
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Wayne Bauerle
- Department of Surgery, Division of Bariatric Surgery, St. Luke’s University Health Network, Bethlehem, Pennsylvania, USA
| | - Amador Garcia
- Endocrine-Metabolic and Bariatric Unit, Robotic Surgery, Vall Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lisa Lucas
- Department of Endocrine and Digestive Surgery, University Hospital of Poitiers, Poitiers, France
| | - Anne-Sophie Mehdorn
- Department of General, Abdominal, Thoracic, Transplantation and Paediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
- Kurt Semm Centre for Laparoscopic and Robot Assisted Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Dhananjay Pandey
- Institute of Minimal Access, Bariatric and Robotic Surgery, Max Super Speciality Hospital, Delhi NCR, India
| | - Abdullah Almuttawa
- Department of Endocrine and Digestive Surgery, Strasbourg University Hospital – IRCAD, Strasbourg, France
- Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Abhishek Tiwari
- Department of Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Virginia Lambert
- Adelaide Bariatric Centre, Department of Surgery, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Beniamino Pascotto
- General and Minimally Invasive (Laparoscopic and Robotic) Surgery Department, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | | | - Marouan Yahyaoui
- Department of Digestive and Bariatric Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Haist
- Department of General and Visceral Surgery, Asklepios Paulinen Klinik, Wiesbaden, Germany
| | - Oliver Scheffel
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - Maud Robert
- Department of Digestive and Bariatric Surgery, Hôpital Edouard Herriot, Lyon, France
| | | | - Santiago Azagra
- General and Minimally Invasive (Laparoscopic and Robotic) Surgery Department, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Lilian Kow
- Adelaide Bariatric Centre, Department of Surgery, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Arun Prasad
- Department of Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Carlos Vaz
- Robotic Surgery Unit, Cuf Tejo Hospital, Lisbon, Portugal
| | - Michel Vix
- Department of Endocrine and Digestive Surgery, Strasbourg University Hospital – IRCAD, Strasbourg, France
| | - Vivek Bindal
- Institute of Minimal Access, Bariatric and Robotic Surgery, Max Super Speciality Hospital, Delhi NCR, India
| | - Jan H Beckmann
- Department of General, Abdominal, Thoracic, Transplantation and Paediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
- Kurt Semm Centre for Laparoscopic and Robot Assisted Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David Soussi
- Department of Endocrine and Digestive Surgery, University Hospital of Poitiers, Poitiers, France
| | - Ramon Vilallonga
- Endocrine-Metabolic and Bariatric Unit, Robotic Surgery, Vall Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maher El Chaar
- Department of Surgery, Division of Bariatric Surgery, St. Luke’s University Health Network, Bethlehem, Pennsylvania, USA
| | - Erik B Wilson
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Arif Ahmad
- Bariatric and Robotic Center of Excellence, Mather Northwell Hospital Health, Port Jefferson, New York, USA
| | - Andre Teixeira
- Department of Surgery, Orlando Health, University of Central Florida, Orlando, Florida, USA
| | - Monika E Hagen
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Minoa K Jung
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
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El Chaar M, Michaud A, Stoltzfus J, Alvarado LA. Improving Operating Room Efficiency of Robotic-Assisted Metabolic and Bariatric Surgery Through Standardization. Obes Surg 2023; 33:3411-3421. [PMID: 37804468 DOI: 10.1007/s11695-023-06850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION The use of robotic-assisted (RA) surgery in the field of metabolic and bariatric surgery (MBS) is controversial because of cost concerns and issues related to efficiency. The objective of this study is to evaluate the operating room efficiency in performing RA-MBS prior and after the implementation of a standardized surgical approach. MATERIALS AND METHODS All MBS cases entered into our database between October 2017 and October 2022 were collected and analyzed before and after the introduction of the standardized approach (SA). The outcome variables consisted of operation time (OT), turnover time (TT), wheels in-wheels out (WW), and console time (CT). Procedures were divided into Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and revisional bariatric surgery (RBS). RESULTS For RYGB (n = 185), we found a significant reduction in OT, TT, and WW after SA (129 min vs 139 min; 37 min vs 73 min; 165 min vs 175 min, respectively, p < 0.05). For SG (n = 253), we found a significant reduction in turnover time (TT) after SA. For RBS (n = 201), we also found a significant reduction in OT, TT, WW, and CT after SA ( 157 min vs 177 min; 36 min vs 72 min; 194 min vs 216 min; 119 min vs 134 min, respectively, p < 0.05). CONCLUSION Using a standardized surgical approach, we were able to demonstrate improved operation room efficiency as demonstrated by a reduction in operation length, turnover time, and the overall time of the procedure for primary RYGB and revisional procedures and turnover time for primary sleeve procedures.
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Affiliation(s)
- Maher El Chaar
- Department of Surgery, St. Luke's University Hospital and Health Network, 1736 Hamilton Street, Allentown, PA, 18104, USA.
| | - Allincia Michaud
- St. Luke's University Hospital and Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Jill Stoltzfus
- St. Luke's University Hospital and Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Luis A Alvarado
- St. Luke's University Hospital and Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
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Faugno-Fusci D, Perrone J, Michaud A, Stoltzfus J, Alvarado LA, El Chaar M. Outcomes of Staple Line Reinforcement Following Robotic Assisted Sleeve Gastrectomy Based on MBSAQIP Database. Obes Surg 2023; 33:2662-2670. [PMID: 37515695 DOI: 10.1007/s11695-023-06740-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION The objective of this study is to evaluate the outcomes for Staple Line Reinforcement (SLR) in RA-SG based on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for 2019. MATERIALS AND METHODS We selected patients who underwent RA-SG in the MBSAQIP PUF (Public Utility File) for the year 2019 and grouped them based on their SLR status: Oversewing (OS), Buttressing (BR), both OS and BR and neither. Our primary outcomes were bleeding, organ space infection (OSI), and adverse events (AEs), and our secondary outcomes were operation length, hospital length of stay, readmissions, and conversion to open rates. We conducted separate chi square or one-way analysis of variance (ANOVA) as appropriate and multivariable direct logistic regression models for the categorical outcomes. RESULTS We found 115,621 patients with complete data of which there were 16,494 who underwent RA-SG. Our results did not show a statistically significant decrease in incidence of postoperative bleeding for BR and OS (Adjusted OR = 0.782, p = 0.2291 and Adjusted OR of 0.482, p = 0.054 for BR and OS respectively). There was a statistically significant effect for SLR status on operation length, with OS patients having the highest operative times (log-transformed mean = 2.03), followed by both BR + OS patients (log-transformed mean = 1.99). BR patients had the shortest operation length. CONCLUSION SLR did not result in any significant differences related to bleeding, OSI or AEs following RA-SG according to MBSAQIP for the year 2019. However, OS resulted in significantly longer operative time compared to BR alone.
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Affiliation(s)
- David Faugno-Fusci
- Department of Surgery, St Luke's University Hospital and Health Network, 1736 Hamilton Street, Allentown, PA, 18104, USA
| | - John Perrone
- Department of Surgery, St Luke's University Hospital and Health Network, 1736 Hamilton Street, Allentown, PA, 18104, USA
| | - Allincia Michaud
- St Luke's University Hospital and Health Network-Research Institute, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Jill Stoltzfus
- St Luke's University Hospital and Health Network-Research Institute, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Luis A Alvarado
- St Luke's University Hospital and Health Network-Research Institute, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Maher El Chaar
- Department of Surgery, St Luke's University Hospital and Health Network, 1736 Hamilton Street, Allentown, PA, 18104, USA.
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El Chaar M, Petrick A, Clapp B, Stoltzfus J, Alvarado LA. Outcomes of Robotic-Assisted Bariatric Surgery Compared to Standard Laparoscopic Approach Using a Standardized Definition: First Look at the 2020 Metabolic and Bariatric Surgery Accreditation Quality Improvement Project (MBSAQIP) Data. Obes Surg 2023; 33:2025-2039. [PMID: 37184827 DOI: 10.1007/s11695-023-06585-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE The primary objective of this study is to evaluate the outcomes of robotic-assisted (RA-) approach compared to the standard laparoscopic (L-) approach using the 2020 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry Public Use File (PUF). Our secondary objective is to establish standards for the reporting of outcomes using PUF. MATERIALS AND METHODS Using the PUF database (n = 168,568), patients were divided into sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), revisions, and conversions and then analyzed separately. We created balanced covariate through propensity score matching and inverse probability treatment weighting (IPTW). We also conducted multivariable relative risk regression to confirm our results. RESULTS For RYGB, the incidence of "transfusion" was significantly lower in the RA-RYGB compared to the L-RYGB. There was no significant difference in the rate of Serious Event Occurrences (SEOs) or rate of intervention at 30 days. For SG, there was a higher rate of "transfusion" in the RA group. Incidence of SEOs was also significantly higher in the RA-group. There was no significant difference in SEOs for conversions; however, revisions had a trend toward a lower rate of SEOs favoring the robotic approach. Operative times were significantly higher for all RA-groups. CONCLUSION RA- approach in metabolic and bariatric surgery (MBS) remains controversial because of differences in outcomes. The use of SEOs as reported by MBSAQIP in its semi-annual report can be used as a composite score to assess outcomes while using PUF. Further studies are needed to compare RA- to L- MBS.
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Affiliation(s)
- Maher El Chaar
- Department of Surgery, St Luke's University Hospital and Health Network, 1736 Hamilton Street, Allentown, PA, 18104, USA.
| | - Anthony Petrick
- Geisinger Clinic, 100 N Academy Ave, Danville, PA, 17821, USA
| | - Benjamin Clapp
- Texas Tech Health Sciences Cente School of Medicine, 4801 Alberta Ave, El Paso, TX, 79905, USA
| | - Jill Stoltzfus
- St Luke's University Hospital and Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Luis A Alvarado
- Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX, 79905, USA
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Bauerle WB, Mody P, Estep A, Stoltzfus J, El Chaar M. Current Trends in the Utilization of a Robotic Approach in the Field of Bariatric Surgery. Obes Surg 2023; 33:482-491. [PMID: 36572836 PMCID: PMC9792156 DOI: 10.1007/s11695-022-06378-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE The utilization rate of robotic surgery for bariatric procedures is not well-described. Our study identified the proportion of metabolic and bariatric surgery (MBS) procedures in the United States between 2015 and 2020 performed using a robotic (R-) or laparoscopic (L-) approach. MATERIALS AND METHODS A descriptive analysis of the 2015-2020 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant User Data File (PUF) datasets was performed. The primary outcome was (1) surgical cases performed annually and (2) proportion of cases performed using a R- or L- approach. Analysis was done separately for sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and revisional bariatric surgery (RBS). Statistical analysis consisted of means and proportions, fold difference, annual slope, and Student's t tests or chi-square tests as appropriate, with statistical significance set to p < .05. RESULTS A total of 1,135, 214 procedures were captured between 2015 and 2020. R-RYGB increased from 2554 to 6198 (6.8% to 16.7%), R-SG increased from 5229 to 17,063 (6.0% to 17.2%), R-RBS increased from 993 to 3386 (4.7% to 17.4%), and R-BPD-DS increased from 221 to 393 (22.0% to 28.4%). The greatest annual increase was observed among R-RBS and R-SG (3.70-fold difference; slope 2.4% per year and 2.87-fold difference; slope 2.2% per year, respectively). CONCLUSION There is a nationwide increase in the utilization of a R- approach in bariatric surgery. There are concerns related to the potential increase in healthcare expenditures related to robotics. Further studies are needed to establish key performance indicators along with guidelines for training, adoption and utilization of a R- approach.
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Affiliation(s)
- Wayne B Bauerle
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Pooja Mody
- Division of Bariatric Surgery, Department of Surgery, St. Luke's University Hospital and Network, Bethlehem, PA, USA
| | - Allison Estep
- Division of Bariatric Surgery, Department of Surgery, St. Luke's University Hospital and Network, Bethlehem, PA, USA
| | - Jill Stoltzfus
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Maher El Chaar
- Division of Bariatric Surgery, Department of Surgery, St. Luke's University Hospital and Network, Bethlehem, PA, USA.
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Munshower E, Ren E, Bauerle WB, Ruland J, Stoltzfus J, McDonald M, Baillie DR, Chaar ME. Cost analysis of robotic assisted general surgery cases in a single academic institution. J Robot Surg 2022; 17:557-564. [PMID: 35939166 DOI: 10.1007/s11701-022-01434-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
Laparoscopy is currently the standard approach for minimally invasive general surgery procedures. However, robotic surgery is now increasingly being used in general surgery. Robotic surgery provides several advantages such as 3D-visualization, articulated instruments, improved ergonomics, and increased dexterity, but is also associated with an increased overall cost which limits its widespread use. In our institution, the robotic assisted approach is frequently used for the performance of general surgery cases including inguinal hernias, cholecystectomies and paraesophageal hernia (PEH) repairs. The primary aim of the study was to evaluate the differences in cost between a robotic and laparoscopic approach for the above-mentioned cases. With IRB approval, we conducted a retrospective cost analysis of patients undergoing inguinal hernia repairs, cholecystectomies and PEH repairs between June 2018 and November 2020. Patients who had a concomitant procedure, a revisional surgery, or bilateral inguinal hernia repair were excluded from the study. Cost analysis was performed using a micro-costing approach. Statistical significance was denoted by p < 0.05. There were no differences among the different groups in relation to age, gender, ethnicity, and BMI. The overall cost of the robotic (R-) approach compared to a laparoscopic (L-) approach was significantly lower for cholecystectomy ($3,199.96 vs $4019.89, p < 0.05). For inguinal hernia repairs and PEH repairs without mesh, we found no significant difference in overall costs between the R- and L- approach (R- $3835.06 vs L- $3783.50, p = 0.69) and (R- $6852.41 vs L- $6819.69, p = 0.97), respectively. However, the overall cost of PEH with mesh was significantly higher for the R- group compared to the L- group (R- $7,511.09 vs L- $6,443.32, p < 0.05). Based on our institutional cost data, use of a robotic approach when performing certain general surgery cases does not seem to be cost prohibitive.
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Affiliation(s)
- Eva Munshower
- Temple/St. Luke's School of Medicine, Bethlehem, PA, USA
| | - Emily Ren
- Temple/St. Luke's School of Medicine, Bethlehem, PA, USA
| | - Wayne B Bauerle
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Janice Ruland
- Cost Accounting Department, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jill Stoltzfus
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Marian McDonald
- Department of Surgery, Division of Minimally Invasive Surgery, St. Luke's University Hospital and Health Network, Allentown, PA, USA
| | - Daniel R Baillie
- Department of Surgery, Division of Minimally Invasive Surgery, St. Luke's University Hospital and Health Network, Allentown, PA, USA
| | - Maher El Chaar
- Department of Surgery, Division of Bariatric Surgery, St. Luke's University Hospital and Health Network, Allentown, PA, USA.
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Vosburg RW, Chaar ME, Djouzi SE, Docimo S, Choi D, LaMasters T, Srivastava G, Shukla AP, Oviedo RJ, Fitch A, Azagury DE. Literature review on anti-obesity medication use for metabolic and bariatric surgery patients from the ASMBS clinical issues committee. Surg Obes Relat Dis 2022; 18:1109-1119. [DOI: 10.1016/j.soard.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
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Craggs-Dino L, El Chaar M, Husain FA, Rogers AM, Lima AG, Sadegh M, Bashiti J, Chapmon K. American Society for Metabolic and Bariatric Surgery Review on Fasting for Religious Purposes after Surgery. Surg Obes Relat Dis 2022; 18:861-871. [DOI: 10.1016/j.soard.2022.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
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Chaar ME, King K, Salem JF, Arishi A, Galvez A, Stoltzfus J. Retraction notice to “Robotic surgery results in better outcomes following Roux-en-Y gastric bypass: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program analysis for the years 2015–2018” [SOARD 17/4 (2021) 694-700]. Surg Obes Relat Dis 2022; 18:299. [DOI: 10.1016/j.soard.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kamau J, Kearny S, Jaworek A, Snyder R, El Chaar M. Anaphylactic Food Allergy After Roux-en-Y Gastric Bypass. Cureus 2021; 13:e17710. [PMID: 34650884 PMCID: PMC8489797 DOI: 10.7759/cureus.17710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/26/2022] Open
Abstract
The prevalence of obesity in the United States is projected to increase as high as 85% by 2030. Weight loss is associated with improved morbidity and mortality outcomes. Roux-en-Y gastric bypass (RYGB) is an effective procedure recommended for individuals with morbid obesity for weight loss. We report the case of a patient who developed worsening food allergic reactions after RYGB surgery that progressed to an anaphylactic reaction. A 36-year-old female developed an anaphylactic reaction to an ingredient in guacamole eight years after RYGB surgery. Prior to the surgery, she had symptoms consistent with oral allergy syndrome. After the gastric bypass, however, she experienced worsening symptoms. On this occasion, she developed throat tightness prompting a visit to the emergency department where she required emergent intubation for airway protection. Blood testing to assess for an immunoglobin E-mediated allergy to common foods was negative. Despite the negative test, the allergist maintained a high suspicion for the progression of food-pollen syndrome following gastric bypass. Disruption of protein digestion from stomach bypass surgery may result in dietary proteins large enough to elicit immune responses being presented to the immune-rich intestinal mucosa. Additional consideration should be given to patients with a preexisting history of food allergic reactions undergoing RGYB surgery.
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Affiliation(s)
- James Kamau
- Internal Medicine, St. Luke's University Health Network, Easton, USA
| | - Shannon Kearny
- Allergy and Immunology, St. Luke's University Health Network, Bethlehem, USA
| | - Aaron Jaworek
- Otolaryngology, St. Luke's University Health Network, Bethlehem, USA
| | - Richard Snyder
- Internal Medicine, St. Luke's University Health Network, Easton, USA
| | - Maher El Chaar
- Bariatric Surgery, St. Luke's University Health Network, Bethlehem, USA
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El Chaar M, King K, Salem JF, Arishi A, Galvez A, Stoltzfus J. Robotic surgery results in better outcomes following Roux-en-Y gastric bypass: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program analysis for the years 2015-2018. Surg Obes Relat Dis 2020; 17:694-700. [PMID: 33509729 DOI: 10.1016/j.soard.2020.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/15/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The use of robotic surgery in bariatric patients is controversial. OBJECTIVES To evaluate the outcome of robotic surgery in Roux-en-Y gastric bypass (RYGB) patients. SETTING Tertiary-care referral hospital. METHODS A total of 149,132 patients who underwent RYGB in the 2015 to 2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database were included in our initial analysis. The propensity-matched analysis that was performed resulted in 21,736 patients, whose data were utilized to compare outcomes of the robotic (R) and laparoscopic (L) groups. Patients were also compared after dividing them into obese (body mass index [BMI] < 50 kg/m2) and super-obese categories (BMI ≥ 50 kg/m2). RESULTS R-RYGB patients had a significantly lower 30-day incidence of serious adverse events (SAEs) and bleeding (2.0% and .7%, respectively, for R-RYGB versus 2.4% and 1.3%, respectively, for L-RYGB; P ≤ .05) but a higher incidence of 30-day reoperation compared to L-RYGB patients (2.7% versus 2.3%, respectively; P ≤ .05). The R-RYGB group also had a shorter length of hospital stay compared to the L-RYGB group (1.98 versus 2.02 days, respectively; P ≤ .05), but higher readmission rates (7.1% versus 5.8%, respectively; P ≤ .05). The robotic approach also resulted in lower mortality rates for those in the super-obese category. In that BMI category, 30-day mortality rates were .4% versus .2% for L-RYGB and R-RYGB patients, respectively (P ≤ .05). CONCLUSION The use of robotic surgery in bariatric patients is controversial. Our analysis, based on the MBSAQIP database for the years 2015 to 2018, demonstrated lower overall SAEs and bleeding rates, in addition to a shorter hospital stay, favoring robotic RYGB compared to laparoscopic RYGB. However, readmission and reoperation rates were higher in the robotic group. Randomized controlled trials are needed to further clarify the benefit of robotic surgery in bariatric patients.
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Affiliation(s)
- Maher El Chaar
- St Luke's University Hospital and Health Network, Department of Surgery, Pennsylvania; Temple Lewis Katz School of Medicine, Allentown, Pennsylvania.
| | - Keith King
- St Luke's University Hospital and Health Network, Department of Surgery, Pennsylvania
| | - Jean F Salem
- St Luke's University Hospital and Health Network, Department of Surgery, Pennsylvania
| | - AbdulAziz Arishi
- St Luke's University Hospital and Health Network, Department of Surgery, Pennsylvania
| | - Alvaro Galvez
- St Luke's University Hospital and Health Network, Department of Surgery, Pennsylvania
| | - Jill Stoltzfus
- St Luke's University Hospital and Health Network, Department of Surgery, Pennsylvania; Temple Lewis Katz School of Medicine, Allentown, Pennsylvania
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El Chaar M. How can we shape our future as bariatric surgeons and win the fight against obesity in an ever-changing healthcare industry? Surg Obes Relat Dis 2020; 17:466-468. [PMID: 33309399 DOI: 10.1016/j.soard.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/07/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Maher El Chaar
- Fellowship Director Bariatric Surgery, St Luke's University Hospital and Health Network, Temple University, Allentown, Pennsylvania
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King K, Galvez A, Stoltzfus J, Claros L, El Chaar M. Robotic-Assisted Surgery Results in a Shorter Hospital Stay Following Revisional Bariatric Surgery. Obes Surg 2020; 31:634-639. [PMID: 33078338 DOI: 10.1007/s11695-020-05022-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Revisional surgery is rapidly growing within the field of bariatric surgery. The use of robotic assisted surgery, considered controversial by many, may offer advantages in revisional bariatric surgery (RBS). There are few studies comparing laparoscopic and robotic-assisted RBS. The aim of this study is to compare the safety and outcome of laparoscopic and robotic RBS in a single accredited center. METHODS A retrospective analysis of data collected prospectively on patients undergoing either laparoscopic (L-RBS) or robotic (R-RBS) RBS between January 1, 2017 and December 31, 2019 was performed. The primary outcomes included length of stay (LOS), 30-day major and minor complication rates, readmission rates, and mortality rates. RESULTS A total of 167 patients were included in our analysis. Fifty-two patients underwent R-RBS (31%), and 115 underwent L-RBS (69%). Thirty-day major and minor complication rates for R-RBS and L-RBS were 1.9% and 5.8% vs 5.2% and 5.2%, respectively (p > .05). There was no difference in readmission rates (3.8% vs 8.7%, p > 0.05) or intraoperative blood loss (35.5 mL vs 37.4 mL, p > .05) between R-RBS and L-RBS. R-RBS resulted in a shorter length of stay when compared with L-RBS (40.2 h vs 62.6 h, p < .05). CONCLUSIONS R-RBS has a decreased, albeit non-significant, rate of 30-day major complications with no difference in minor complications, readmission rates, or intraoperative blood loss when compared with L-RBS. R-RBS resulted in a decreased length of stay when compared with L-RBS. Randomized clinical trials are needed to better elucidate our findings.
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Affiliation(s)
- Keith King
- St Luke's University Hospital and Health Network, Bethlehem, PA, USA
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Alvaro Galvez
- St Luke's University Hospital and Health Network, Bethlehem, PA, USA
| | - Jill Stoltzfus
- St Luke's University Hospital and Health Network, Bethlehem, PA, USA
- Lewis Katz School of Medicine-Temple University, Philadelphia, PA, USA
| | - Leonardo Claros
- St Luke's University Hospital and Health Network, Bethlehem, PA, USA
- Lewis Katz School of Medicine-Temple University, Philadelphia, PA, USA
| | - Maher El Chaar
- St Luke's University Hospital and Health Network, Bethlehem, PA, USA.
- Lewis Katz School of Medicine-Temple University, Philadelphia, PA, USA.
- St. Luke's University Health Network, 240 Cetronia Road Suite 205, North Allentown, PA, 18104, USA.
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Duarte-Chavez R, Stoltzfus J, Marino D, Chaput K, El Chaar M. Correction to: "Which Factors Correlate with Marginal Ulcer After Surgery for Obesity?". Obes Surg 2020; 30:4828. [PMID: 33044688 DOI: 10.1007/s11695-020-05021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the original article, the author names were presented incorrectly; their family names and given names were inverted.
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Affiliation(s)
- Rodrigo Duarte-Chavez
- Department of Medicine, Division of Gastroenterology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA.
| | - Jill Stoltzfus
- Department of Research, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Daniel Marino
- Robert Wood Johnson Medical School, 1 Robert Wood Johnson place, New Brunswick, NJ, 08901, USA
| | - Kimberly Chaput
- Department of Medicine, Division of Gastroenterology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Maher El Chaar
- Department of Surgery, Division of Bariatric Surgery, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
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King K, Galvez A, Stoltzfus J, Claros L, El Chaar M. Correction to: Cost Analysis of Robotic Roux-en-Y Gastric Bypass in a Single Academic Center: How Expensive Is Expensive? Obes Surg 2020; 31:472-473. [PMID: 32820353 DOI: 10.1007/s11695-020-04897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Keith King
- St. Luke's University Health Network, Bethlehem, PA, USA
- St. Luke's University Health Network, Suite 205 North, 240 Cetronia Road, Allentown, PA, 18104, USA
| | - Alvaro Galvez
- St. Luke's University Health Network, Bethlehem, PA, USA
- St. Luke's University Health Network, Suite 205 North, 240 Cetronia Road, Allentown, PA, 18104, USA
| | - Jill Stoltzfus
- St. Luke's University Health Network, Bethlehem, PA, USA
- Temple Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Leonardo Claros
- St. Luke's University Health Network, Bethlehem, PA, USA
- Temple Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Maher El Chaar
- St. Luke's University Health Network, Bethlehem, PA, USA.
- Temple Lewis Katz School of Medicine, Philadelphia, PA, USA.
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King K, Galvez A, Stoltzfus J, Claros L, El Chaar M. Cost Analysis of Robotic Roux-en-Y Gastric Bypass in a Single Academic Center: How Expensive Is Expensive? Obes Surg 2020; 30:4860-4866. [PMID: 32720261 DOI: 10.1007/s11695-020-04881-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although the use of da Vinci robotic platforms in bariatric surgery is gaining momentum, it is still controversial because of financial concerns. OBJECTIVES The objective of our study is to evaluate the cost of robotically assisted Roux-en-Y gastric bypass (R-RYGB) versus conventional laparoscopic Roux-en-Y gastric bypass (L-RYGB). METHODS We analyzed consecutive primary bariatric patients who underwent R-RYGB and compared them with patients who underwent L-RYGB during the same time period. Primary outcomes were overall cost for length of stay, operating time, and supplies. Direct cost data was generated using the StrataJazz reporting module, which is fed daily from EPIC, our electronic health record system, and contains hospital-based data only. Secondary outcomes were 30-day rates of complications, reoperations, and readmissions. RESULTS We found no difference in primary or secondary outcomes following R-RYGB and L-RYGB. The overall cost for R-RYGB and L-RYGB was not statistically different (median total cost for R-RYGB and L-RYBG was $6431.34 and $6349.09, P > 0.05, respectively). Operating time cost was significantly higher for R-RYGB compared with L-RYGB ($2248.51 versus $19,836.29, respectively, P < 0.0001, respectively). R-RYGB had lower cost of supplies as well as a shorter length of stay compared with L-RYGB (mean 1.5 versus 1.7 days, respectively). CONCLUSIONS Our study revealed no cost difference between R-RYGB and L-RYGB, with a decreased cost of supplies and trend toward lower hospital stay favoring R-RYGB. Further studies are needed to evaluate the outcomes of R-RYGB compared with L-RYGB; however, the cost of robotic surgery may not be a prohibitive factor.
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Affiliation(s)
- Keith King
- St. Luke's University Health Network, Bethlehem, PA, USA. .,St. Luke's University Health Network, Suite 205 North, 240 Cetronia Road, Allentown, PA, 18104, USA.
| | - Alvaro Galvez
- St. Luke's University Health Network, Bethlehem, PA, USA.,St. Luke's University Health Network, Suite 205 North, 240 Cetronia Road, Allentown, PA, 18104, USA
| | - Jill Stoltzfus
- St. Luke's University Health Network, Bethlehem, PA, USA.,Temple Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Leonardo Claros
- St. Luke's University Health Network, Bethlehem, PA, USA.,Temple Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Maher El Chaar
- St. Luke's University Health Network, Bethlehem, PA, USA.,Temple Lewis Katz School of Medicine, Philadelphia, PA, USA
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El Chaar M, King K, Al-Mardini A, Galvez A, Claros L, Stoltzfus J. Thirty-Day Outcomes of Bariatric Surgery in Adolescents: a First Look at the MBSAQIP Database. Obes Surg 2020; 31:194-199. [PMID: 32712784 PMCID: PMC7382644 DOI: 10.1007/s11695-020-04866-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Bariatric surgery is the only effective treatment of severe obesity. The number of adolescents undergoing bariatric surgery is increasing. However, bariatric surgery in adolescents is controversial. OBJECTIVE The purpose of this study is to evaluate the outcomes of bariatric surgery in adolescents based on the MBSAQIP database (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project). METHODS We analyzed the 2015-2017 MBSAQIP database; patients ≤ 19 years of age were included in our analysis. Primary outcomes were 30-day serious adverse events (SAEs), organ space infection (OSI), re-intervention, and re-operation rates. Secondary outcomes included operation length, hospital stay, and re-admission rates. We conducted separate Mann-Whitney rank sums tests, chi-square, or Fisher's exact tests as appropriate, with p < .05 denoting statistical significance. RESULTS A total of 1983 adolescent patients were included in our analysis. The average age and BMI were 18.1 and 47.5, respectively. Of adolescent patients, 21.7% underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) and 78.3% underwent laparoscopic sleeve gastrectomy (LSG). The 30-day SAE and readmission rates were significantly lower for LSG compared with LRYGB (2.9% and 2.6% vs 6.5% and 5.6%, respectively; p < 0.05). The 30-day reoperation rate was also lower for LSG compared with LRYGB albeit not significant (1.1% and vs 2.3%; p = 0.05). The 30-day intervention rate for LSG was significantly lower, however, compared with LRYGB (1.2% vs 3%; p < 0.05). Compared with adult patients, > 19 years old (n = 353,726), we found no difference in our outcomes. However, adolescents had significantly shorter operation length. CONCLUSION In adolescents, LSG had fewer SAE, re-intervention, and readmission rates compared with LRYGB. There was no difference in outcomes between adolescents and adults.
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Affiliation(s)
- Maher El Chaar
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,Temple Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Keith King
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA. .,St Luke's University Health Network, 240 Cetronia Road, Suite 205 North, Allentown, PA, 18104, USA.
| | - Amin Al-Mardini
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA
| | - Alvaro Galvez
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,St Luke's University Health Network, 240 Cetronia Road, Suite 205 North, Allentown, PA, 18104, USA
| | - Leonardo Claros
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,Temple Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Jill Stoltzfus
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,Temple Lewis Katz School of Medicine, Philadelphia, PA, USA
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Galvez A, King K, El Chaar M, Matin A, Claros L. A Curious Case of a Staple Line Leak Presenting 18 Months After Sleeve Gastrectomy: Our Management Approach. Obes Surg 2020; 31:421-423. [PMID: 32617924 DOI: 10.1007/s11695-020-04825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Alvaro Galvez
- St Luke's Weight Management Center, St Luke's University Health Network, North 240 Cetronia Rd, Allentown, PA, USA.
| | - Keith King
- St Luke's Weight Management Center, St Luke's University Health Network, North 240 Cetronia Rd, Allentown, PA, USA
| | - Maher El Chaar
- St Luke's Weight Management Center, St Luke's University Health Network, North 240 Cetronia Rd, Allentown, PA, USA
| | - Ayaz Matin
- St Luke's Weight Management Center, St Luke's University Health Network, North 240 Cetronia Rd, Allentown, PA, USA
| | - Leonardo Claros
- St Luke's Weight Management Center, St Luke's University Health Network, North 240 Cetronia Rd, Allentown, PA, USA
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El Chaar M, King K, Pastrana M, Galvez A, Stoltzfus J. Outcomes of robotic surgery in revisional bariatric cases: a propensity score-matched analysis of the MBSAQIP registry. J Robot Surg 2020; 15:235-239. [PMID: 32474795 DOI: 10.1007/s11701-020-01098-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/26/2020] [Indexed: 11/29/2022]
Abstract
In recent years, there has been a significant increase in the number of Revisional Bariatric Surgery (RBS) cases performed to address complications and weight recidivism. The use of the da Vinci robotic platform, considered controversial by many, may offer advantages in RBS. The objective of our study is to compare the outcomes of Robotic RBS (R-RBS) to Laparoscopic RBS (L-RBS). Using the 2015-2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we selected all RBS and we matched R-RBS to L-RBS using a propensity score matching system to create balanced groups. Our primary outcomes were 30-day Serious Adverse Events (SAE), 30-day Organ Specific Infection (OSI), 30-day reoperation and 30-day interventions. Our secondary outcomes included length of operation and 30-day readmission. We conducted separate Mann-Whitney rank sums tests or chi-square tests and Fisher exact test. R-RBS and L-RBS included 220 patients each. The overall incidence of 30-day SAEs, 30-day OSIs, 30-day reoperations, 30-day interventions were lower for R-RBS (6.4%, 0.9%, 2.7% and 2.3%, respectively) compared L-RBS (7.7%, 1.4%, 3.6% and 3.6%, respectively). Subgroup analysis showed that R-RBS had a lower rate of complications for the Gastric Bypass procedure but not for Sleeve gastrectomy cases. However, 30-day readmission was higher for R-RBS compared to L-RBS (9.1% vs 6.4% respectively). None of the analyses reached statistical significance. R-RBS took significantly longer compared to L-RBS (169 min vs 138 min, p < 0.05). Our study shows that R-RBS has lower complication rate albeit non-significant as compared to L-RBS.
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Affiliation(s)
- Maher El Chaar
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,Temple Lewis Katz School of Medicine, Philadelphia, USA
| | - Keith King
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA. .,St. Luke's University Health Network, 240 Cetronia Road, Suite 205 North, Allentown, PA, 18104, USA.
| | - Marlon Pastrana
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,St. Luke's University Health Network, 240 Cetronia Road, Suite 205 North, Allentown, PA, 18104, USA
| | - Alvaro Galvez
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,St. Luke's University Health Network, 240 Cetronia Road, Suite 205 North, Allentown, PA, 18104, USA
| | - Jill Stoltzfus
- St. Luke's University Health Network (SLUHN), Bethlehem, PA, USA.,Temple Lewis Katz School of Medicine, Philadelphia, USA
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El Chaar M, King K, Galvez Lima A. Are black and Hispanic persons disproportionately affected by COVID-19 because of higher obesity rates? Surg Obes Relat Dis 2020; 16:1096-1099. [PMID: 32522406 PMCID: PMC7211681 DOI: 10.1016/j.soard.2020.04.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/22/2022]
Abstract
Background On March 13, 2020, the World Health Organization declared COVID-19 a pandemic. Shortly after that, it was reported that mortality rates in New York City (NYC), the epicenter of the pandemic in the United States, were found to be significantly higher in black and Hispanic populations. Objectives The aim of this article is to evaluate the mortality rates in NYC among the different ethnic groups and the different boroughs as they relate to the obesity rates to see whether this issue merits further evaluation. Setting NYC. Methods COVID-19 data were obtained from the official New York authorities in relation to total number of cases in the different boroughs of NYC. Age-adjusted COVID-19–related mortality rates of the different ethnic groups were also obtained. These data were cross-compared with historic community health data on obesity rates previously published and also obesity rates among the different ethnic groups in NYC. Results The 2 NYC boroughs that have the highest mortality rates are the Bronx (6%) and Brooklyn (5.4%). Both the Bronx and Brooklyn were also found to have the highest obesity rates at 32% and 27%, respectively. The 2 ethnic groups with the highest obesity rates (Hispanic and black) were also found to have the highest age-adjusted mortality rates per 100,000 compared with the other ethnic groups (22.8% and 19.8%, respectively). Conclusions The Hispanic and black populations in NYC seem to be disproportionately affected by the COVID-19 pandemic because of the higher incidence of mortality rates. Obesity may have played a role in the high incidence of mortality in those ethnic groups.
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Affiliation(s)
- Maher El Chaar
- St Luke's University Hospital and Health Network, Bethlehem, Pennsylvania; Temple Lewis Katz School of Medicine, Philadelphia, Pennsylvania.
| | - Keith King
- St Luke's University Hospital and Health Network, Bethlehem, Pennsylvania
| | - Alvaro Galvez Lima
- St Luke's University Hospital and Health Network, Bethlehem, Pennsylvania
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Pastrana M, Stoltzfus J, AlMandini A, El Chaar M. Evolution of outcomes of robotic bariatric surgery: first report based on MBSAQIP database. Surg Obes Relat Dis 2020; 16:916-922. [PMID: 32340825 DOI: 10.1016/j.soard.2020.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 11/12/2019] [Accepted: 01/04/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Robotic surgery is increasingly being used in bariatric surgery; however, the benefits of robotic surgery in bariatrics remain controversial. OBJECTIVES The objective of this study was to compare the outcomes of robotic bariatric surgery with laparoscopic surgery over a 3-year period between 2015 and 2017 using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. SETTING University Hospital, United States. METHODS Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the years 2015 to 2017, we included patients who underwent primary robotic or laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass procedures. Patients were divided into either robotic or laparoscopic groups. Primary outcomes included serious adverse events, organ space infection (OSI), readmissions, reoperations, and interventions at 30 days. Secondary outcomes included operation length and hospital stay. We performed propensity score matching based on clinically relevant preoperative variables to create balanced groups before analysis. We analyzed our data using separate Cochran-Mantel-Haenszel tests with year as the stratification variable and conducted subgroup analyses for robotic patients only using separate t tests for proportions, with P < .05 denoting statistical significance. RESULTS Of the 315,647 patients available for comparison in the 2015 to 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant User Files, there were 41,364 matched in the final data set. Using the Cochran-Mantel-Haenszel test, we found a significant association between year of performance and outcomes for OSI, 30 day-readmission, and intervention. The incidence of OSI after laparoscopic and robotic cases was .3% and .4%, respectively, in 2015 versus .2% and .3%, respectively, in 2017 (P = .04, odds ratio = 1.49). Thirty-day readmission for robotic cases was 5.2% in 2015 and 4.0% in 2017 (P < .05, odds ratio = 1.16). The incidence of 30-day intervention for robotic cases also dropped from 2.2% in 2015 to 1.3% in 2017 (P < .05, odds ratio = 1.37). Using a Student's t test, there was also a statistically significant decrease in serious adverse events in the robotic group between 2015 and 2017 (incidence of serious adverse events in 2015 was 5.2% versus 3.7% in 2017, P < .05). Rate of 30-day reoperation for the robotic group did change over time but was comparable to the laparoscopic group (1.4% versus 1.3%). CONCLUSIONS Our study showed between 2015 and 2017 the outcomes of robotic bariatric surgery have improved as evidenced by the significant decrease in the rate of OSI, readmissions, and interventions at 30 days.
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Affiliation(s)
- Marlon Pastrana
- St. Luke's University Hospital and Health Network (SLUHN), Bethlehem, Pennsylvania
| | - Jill Stoltzfus
- St. Luke's University Hospital and Health Network (SLUHN), Bethlehem, Pennsylvania
| | - Amin AlMandini
- St. Luke's University Hospital and Health Network (SLUHN), Bethlehem, Pennsylvania
| | - Maher El Chaar
- St. Luke's University Hospital and Health Network (SLUHN), Bethlehem, Pennsylvania.
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Pastrana M, Stoltzfus J, Claros L, El Chaar M. Outcomes of robotic bariatric surgery in super-obese patients: first report based on MBSAQIP database. Surg Obes Relat Dis 2019; 16:71-79. [PMID: 31767380 DOI: 10.1016/j.soard.2019.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/22/2019] [Accepted: 10/10/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Bariatric surgery in the super-obese (SO) patient population represents a challenge. Although the robotic platform is increasingly used for these patients, there are limited data on outcomes compared with conventional laparoscopy. OBJECTIVE Our study compared the safety and short-term outcomes of robotic and laparoscopic platforms for SO patients compared with morbidly obese patients based on the 2015 to 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. SETTING University Hospital, United States. METHODS We evaluated all primary robotic and laparoscopic cases and extracted 30-day outcomes in patients with body mass index <50 and ≤50 kg/m2. For our primary analysis, we used the Cochran-Mantel-Haenszel method with surgery type Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) as the stratification variable to determine the association between body mass index categories and outcomes. RESULTS A total of 355,278 patients were included in our analysis. For the robotic RYGB (R-RYGB) group (n = 6645) and R-SG (n = 15,984) there were 1674 SO patients (25.2%) and 3688 SO patients (23.1%), respectively.For the laparoscopic RYGB (LRYGB) group (n = 95,374) and LSG group (n = 237,275), there were 24,991 (26.2%) and 51,524 SO patients (21.7%), respectively. The incidence of serious adverse events in SO patients for R-RYGB and LRYGB groups was 7.6% versus 7.2% (P > .05) and 4% versus 3.5% (P > .05) for R-SG and L-SG, respectively. The incidence of organ space infection in SO patients for R-RYGB and LRYGB groups was .5% versus .4% (P > .05) and .4% versus .2% (P < .05) for R-SG and LSG, respectively. CONCLUSIONS Based on 2015 to 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data, we found no difference in outcomes between robotic and laparoscopic approaches in SO patients. There was a higher incidence of serious adverse events in SO patients compared with morbidly obese patients for both approaches.
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Affiliation(s)
- Marlon Pastrana
- St Luke's University Hospital and Health Network, Lewis Katz School of Medicine at Temple University, Allentown, Pennsylvania
| | - Jill Stoltzfus
- St Luke's University Hospital and Health Network, Lewis Katz School of Medicine at Temple University, Allentown, Pennsylvania
| | - Leonardo Claros
- St Luke's University Hospital and Health Network, Lewis Katz School of Medicine at Temple University, Allentown, Pennsylvania
| | - Maher El Chaar
- St Luke's University Hospital and Health Network, Lewis Katz School of Medicine at Temple University, Allentown, Pennsylvania.
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El Chaar M, Pastrana M. A252 Robotic Revision of Chronic Marginal Ulcer and Bilateral Truncal Vagotomy Following a Roux en Y Gastric Bypass. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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El Chaar M, Pastrana M, Claros L. A618 Robotic Revision of a Bleeding Marginal Ulcer Following a Roux en Y Gastric Bypass. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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El Chaar M, Al-Mardini A, Pastrana M, Stoltzfus J. A138 Outcomes of Bariatric Surgery in Adolescents: First Look Based on MBSAQIP. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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El Chaar M, Pastrana M, Stoltzfus J. A148 Safety of Robotic Surgery in the Super Obese Patients: First Analysis Using MBSAQIP data 2015-2017. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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El Chaar M, Pastrana MP, Claros L, Stoltzfus J. A142 Evolution of Robotic Outcomes in Bariatric Surgery: First look at MBSAQIP database. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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El Chaar M. Comment on: Effect of the closure of mesenteric defects in laparoscopic Roux-En-Y gastric bypass: a prospective study. Surg Obes Relat Dis 2019; 15:1909-1911. [PMID: 31551183 DOI: 10.1016/j.soard.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Maher El Chaar
- Department of Bariatric Surgery, St. Luke's University Hospital and Health Network, Lewis Katz School of Medicine, Allentown, Pennsylvania
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El Chaar M, Stoltzfus J, Melitics M, Claros L, Zeido A. 30-Day Outcomes of Revisional Bariatric Stapling Procedures: First Report Based on MBSAQIP Data Registry. Obes Surg 2019; 28:2233-2240. [PMID: 29876840 DOI: 10.1007/s11695-018-3140-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The number of bariatric revisional cases has nearly doubled since 2011, and now comprises 13.6% of the total number of cases. The objective of this study is to evaluate the outcomes and safety of the two most common stapling revisional procedures, namely, sleeve and gastric bypass in comparison to primary stapling procedures using the MBSAQIP data registry. METHODS We reviewed all the sleeve and gastric bypass cases entered between January 1, 2015, and December 31, 2015, in the MBSAQIP data registry. We, then, identified sleeve and bypass patients who have had a previous bariatric procedure. Demographics and 30 day outcomes of all sleeve and gastric bypass patients were analyzed. We conducted within group comparisons comparing primary sleeve gastrectomy (PS) and primary gastric bypass (PB) patients to revisional sleeve (RS) and revisional gastric bypass (RB) patients, respectively. We, then, conducted group comparisons comparing RS to RB patients. RESULTS The total number of patients analyzed was 141,577 (98,292 or 69% sleeve patients and 43,285 or 31% gastric bypass patients). Among the sleeve patients, 92,666 (94%) had a PS and 5626 (6%) had RS. Among the bypass patients, 39,567 (91%) had a PB and 3718 patients (9%) had RB. 30-day readmission rate of RS was significantly higher as compared to PS (4.1 vs 0.4%, p < 0.05). The incidence of at least one complication requiring reoperation or reintervention within 30 days following RS was twice as high as compared to PS (1.9 and 2% for RS vs 0.9 and 1.1% for PS respectively, p < 0.05). Length of stay and 30 day mortality rates for PS and RS were the same. 30-day readmission rate of RB as compared to PB was 8.3 vs 6.3% (p < 0.05). Also, the incidence of at least one complication requiring reoperation or reintervention following RB was 3.9 and 4%, respectively vs 2.4 and 2.7% for PB (p < 0.05). In addition, readmission rates and unplanned admission rates to the ICU were significantly higher for RB compared to RS (8.3 and 2% for RB vs 4.1 and 0.9% for RS respectively, p < 0.05). The incidence of at least one reoperation or one intervention following RB were also significantly higher compared to RS (3.9 vs 1.9% and 4 vs 2% respectively, p < 0.05). CONCLUSION Revisional stapling procedures are safe but the rates of complications following RS and RB are twice as high compared to PS and PB. Also, RB are more likely to develop complications compared to RS.
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Affiliation(s)
- Maher El Chaar
- St Luke's University Hospital and Health Network, Allentown, PA, USA.
| | - Jill Stoltzfus
- St Luke's University Hospital and Health Network, Allentown, PA, USA
| | - Maureen Melitics
- St Luke's University Hospital and Health Network, Allentown, PA, USA
| | - Leonardo Claros
- St Luke's University Hospital and Health Network, Allentown, PA, USA
| | - Ahmad Zeido
- St Luke's University Hospital and Health Network, Allentown, PA, USA
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El Chaar M, Stoltzfus J, Melitics M, Claros L, Zeido A. Correction to: 30-Day Outcomes of Revisional Bariatric Stapling Procedures: First Report Based on MBSAQIP Data Registry. Obes Surg 2019; 29:2357. [DOI: 10.1007/s11695-019-03886-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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El Chaar M, Gacke J, Ringold S, Stoltzfus J. Cost analysis of robotic sleeve gastrectomy (R-SG) compared with laparoscopic sleeve gastrectomy (L-SG) in a single academic center: debunking a myth! Surg Obes Relat Dis 2019; 15:675-679. [PMID: 31043334 DOI: 10.1016/j.soard.2019.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although use of the da Vinci robotic platform in bariatric surgery is gaining momentum, there are financial concerns. OBJECTIVES Our retrospective study evaluated the cost of robotically assisted sleeve gastrectomy (R-SG) versus conventional laparoscopic sleeve gastrectomy (L-SG). SETTING Center of Excellence bariatric surgery center in Allentown, Pennsylvania. METHODS We analyzed consecutive patients who underwent primary R-SG and compared them with L-SG patients. Primary outcomes were overall cost for length of stay, operating time, and supplies. Secondary outcomes were 30-day complications, reoperations, and readmissions. RESULTS We had no adverse events in either group. The overall cost for R-SG and L-SG was not statistically different (mean total cost for R-SG and L-SG was $5308.99 and $4918.88, respectively). Operating time cost was significantly higher for R-SG compared with L-SG ($1340 versus $112 for R-SG and L-SG, respectively). R-SG had a shorter length of stay compared with L-SG (1.4 versus 1.5 d, respectively). CONCLUSIONS Our study revealed no difference in cost R-SG and L-SG, with a trend toward shorter length of stay for R-SG over time.
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Affiliation(s)
- Maher El Chaar
- St. Luke's University Health Network, Allentown, Pennsylvania; Temple University/St Luke's University Health Network, School of Medicine, Allentown, Pennsylvania.
| | - Jacob Gacke
- Temple University/St Luke's University Health Network, School of Medicine, Allentown, Pennsylvania
| | - Samuel Ringold
- University of Michigan College of Engineering, Ann Arbor, Michigan
| | - Jill Stoltzfus
- Temple University/St Luke's University Health Network, School of Medicine, Allentown, Pennsylvania; Research Institute, St. Luke's University Health Network, Allentown, Pennsylvania
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El Chaar M, Stoltzfus J, Gersin K, Thompson K. A novel risk prediction model for 30-day severe adverse events and readmissions following bariatric surgery based on the MBSAQIP database. Surg Obes Relat Dis 2019; 15:1138-1145. [PMID: 31053498 DOI: 10.1016/j.soard.2019.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/21/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although bariatric surgery is safe, some patients fear serious complications. OBJECTIVES This retrospective study used the 2015 Metabolic and Bariatric Surgery Accreditation Quality Improvement Project (MBSAQIP) database to evaluate patient outcomes for gastric bypass (GB) and sleeve gastrectomy and to develop a risk prediction model for serious adverse events (SAEs) and readmission rates 30 days after surgery. SETTING MBSAQIP national patient database. METHODS We created separate exploratory multivariable logistic regression models for SAEs and readmissions. We then externally validated both models using the 2016 MBSAQIP Participant Use Data File. RESULTS Significant predictors of SAEs were preoperative body mass index (adjusted odds ratio [AOR] 1.07, P < .0001); GB surgery (AOR 2.08, P < .0001); cardiovascular disease (AOR 1.43, P < .0001); smoking (AOR 1.12, P = .04); diabetes (AOR 1.15, P = .0001); hypertension (AOR 1.17, P < .0001); limited ambulation (AOR 1.48, P < .0001); sleep apnea (AOR 1.12, P = .001); history of pulmonary embolism (AOR 2.81, P < .0001); and steroid use (AOR 1.40, P = .001). Significant predictors of readmissions were GB surgery (AOR 1.81, P < .0001); female sex (AOR 1.26, P < .0001); diabetes (AOR 1.08, P = .04); hypertension (AOR 1.11, P = .004); preoperative body mass index (AOR 1.05, P < .0001); sleep apnea (AOR 1.11, P = .002); history of pulmonary embolism (AOR 2.35, P < .0001); cardiovascular disease (AOR 1.61, P < .0001); smoking (AOR 1.14, P = .01); and limited ambulation (AOR 1.55, P < .0001). External validation supported these covariates, with similar model discriminative power. CONCLUSIONS Our exploratory regression models may be used by clinicians to counsel patients about surgical risks, although future external validation should occur in non-North American populations.
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Affiliation(s)
- Maher El Chaar
- St Luke's University Hospital and Health Network, Lewis Katz School of Medicine at Temple University, Allentown, Pennsylvania.
| | - Jill Stoltzfus
- St Luke's University Hospital and Health Network, Lewis Katz School of Medicine at Temple University, Allentown, Pennsylvania
| | - Keith Gersin
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Kyle Thompson
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
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El Chaar M, Stoltzfus J. Assessment of Sleeve Gastrectomy Surgical Technique: First Look at 30-Day Outcomes Based on the MBSAQIP Database. J Am Coll Surg 2018; 227:564-572. [DOI: 10.1016/j.jamcollsurg.2018.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 12/29/2022]
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Chaar ME, Stoltzfus J. First look at the Outcomes of the Different Sleeve Gastrectomy (SG) Surgical Techniques Reported in MBSAQIP: What Did We Learn? Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chaar ME, Stoltzfus J, Gersin KS, Thompson KJ. A Novel Risk Prediction Model for Complications and Readmissions Following Bariatric Surgery Based on the MBSAQIP database. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lundberg P, Seoane J, Wolfe S, El Chaar M. Robotic gastric bypass is getting better: first results from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lundberg PW, Stoltzfus J, El Chaar M. 30-day outcomes of robot-assisted versus conventional laparoscopic sleeve gastrectomy: First analysis based on MBSAQIP. Surg Obes Relat Dis 2018; 15:1-7. [PMID: 30497847 DOI: 10.1016/j.soard.2018.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/30/2018] [Accepted: 10/20/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most popular bariatric procedure in the United States. Although standardized, variation exists in how the staple line is managed. Robotic approaches to SG (RSG) are increasing, though benefits compared with the conventional laparoscopic approach (LSG) remain controversial. OBJECTIVE Evaluate the safety of RSG versus LSG using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry, controlling for variation in staple-line management. SETTING University health network, United States. METHODS SG cases from January 1 to December 31, 2016, in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry were included. Demographic characteristics and 30-day outcomes were analyzed with separate Mann-Whitney rank sums tests, χ2 tests, or Fisher's exact tests, with P < .05 denoting statistical significance. Multivariate regression analysis was performed to control for method of staple-line treatment. RESULTS Of the 107,726 patients who underwent SG, 7385 were RSG. Treatment of the staple line was associated with a significantly lower rate of bleeding, with odds ratios of .69 and .58 for staple-line reinforcement alone and staple-line reinforcement plus oversewing, respectively. Multivariate analysis revealed RSG had a higher rate of organ space infection than LSG (odds ratio 2.07). Otherwise, RSG did not significantly differ from LSG save for a longer median operative time (89 versus 63 min, respectively, P < .0001). CONCLUSIONS RSG is a growing alternative to the conventional laparoscopic approach. According to the 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, the RSG carries a higher risk of organ space infection. The reasons behind this finding require further study.
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Affiliation(s)
| | - Jill Stoltzfus
- St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Maher El Chaar
- St. Luke's University Health Network, Bethlehem, Pennsylvania.
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Lundberg PW, Wolfe S, Seaone J, Stoltzfus J, Claros L, El Chaar M. Robotic gastric bypass is getting better: first results from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Surg Obes Relat Dis 2018; 14:1240-1245. [PMID: 30580769 DOI: 10.1016/j.soard.2018.05.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/30/2018] [Accepted: 05/26/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of robotic platforms in performing laparoscopic Roux-en-Y gastric bypass (LRYGB) is increasing, though their safety compared with the conventional laparoscopic approach remains unclear. OBJECTIVE The objective of this study was to evaluate perioperative data and 30-day outcomes of conventional and robot-assisted LRYGB using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. SETTING University health network, United States. METHODS We reviewed all conventional and robot-assisted LRYGB cases entered between January 1 and December 31, 2016 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Demographic characteristics and 30-day outcomes were analyzed based on separate Mann-Whitney rank sums tests, χ2, or Fisher's exact tests as appropriate, with P ≤ .05 denoting statistical significance with no adjustment for multiple testing. RESULTS Of the 39,425 patients who underwent LRYGB, 2822 were robot-assisted. The robot-assisted approach required significantly more time (138 versus 108 min, P < .0001). Rates of organ space infection, bleeding, and other significant adverse events after the conventional and robot-assisted approaches were .3% versus .5% (P = .13), 1.1% versus .8% (P = .11), and 2.3% versus 2.3% (P = .96), respectively. There were also no significant differences in the rates of mortality, length of stay, reoperation, or readmission between the 2 groups. CONCLUSIONS Robot-assisted LRYGB is an increasingly popular alternative to the conventional laparoscopic approach. According to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, the early safety of these 2 techniques is equal, although the robotic approach requires more operative time.
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Affiliation(s)
| | - Samantha Wolfe
- St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Jacqueline Seaone
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jill Stoltzfus
- St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Leonardo Claros
- St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Maher El Chaar
- St. Luke's University Health Network, Bethlehem, Pennsylvania
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Chaar ME, Lundberg P, Stoltzfus J. Thirty-day outcomes of sleeve gastrectomy versus Roux-en-Y gastric bypass: first report based on Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Surg Obes Relat Dis 2018; 14:545-551. [DOI: 10.1016/j.soard.2018.01.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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Qiu J, Lundberg PW, Javier Birriel T, Claros L, Stoltzfus J, El Chaar M. Revisional Bariatric Surgery for Weight Regain and Refractory Complications in a Single MBSAQIP Accredited Center: What Are We Dealing with? Obes Surg 2018; 28:2789-2795. [DOI: 10.1007/s11695-018-3245-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Groller KD, Teel C, Stegenga KH, El Chaar M. Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement. Surg Obes Relat Dis 2018; 14:785-796. [PMID: 29703505 DOI: 10.1016/j.soard.2018.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/10/2018] [Accepted: 02/10/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. OBJECTIVE To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. SETTING Participants were recruited from a university hospital-based WMC in Pennsylvania. METHODS This qualitative descriptive study used purposive sampling and inductive content analysis. RESULTS A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. CONCLUSION Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes.
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Affiliation(s)
- Karen D Groller
- Moravian College, Helen S. Breidegam School of Nursing, Bethlehem, Pennsylvania.
| | - Cynthia Teel
- University of Kansas School of Nursing, Kansas City, Kansas
| | | | - Maher El Chaar
- Medical School of Temple University, St. Luke's University Hospital and Health Network, Allentown, Pennsylvania
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Hon HH, Birriel TJ, Chaar ME. Gastric sleeve migration conversion to a Roux-en-Y gastric bypass in combination with wedge fundectomy and paraesophageal hernia repair. Surg Obes Relat Dis 2018; 14:426-427. [PMID: 29366717 DOI: 10.1016/j.soard.2017.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/01/2017] [Accepted: 12/08/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Heidi H Hon
- Department of Surgery, Section of Bariatric Surgery, The Research Institute, and Department of Research & Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania.
| | - T Javier Birriel
- Department of Surgery, Section of Bariatric Surgery, The Research Institute, and Department of Research & Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Maher El Chaar
- Department of Surgery, Section of Bariatric Surgery, The Research Institute, and Department of Research & Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania
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Miletics M, Claros L, Stoltzfus J, Davis T, Chaar ME. Progression to surgery: online versus live seminar. Surg Obes Relat Dis 2017; 14:382-385. [PMID: 29275094 DOI: 10.1016/j.soard.2017.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate progression to surgery rates for live and online seminar and assess weight loss outcome comparisons at 1-year postoperation. SETTING University Hospital Network, Allentown, PA, USA. METHODS The entry point into our program was an information seminar where prospective patients are educated about obesity, bariatric surgery, indications and contraindications, risks and benefits, and our center's process. Between January of 2009 and November of 2011, only live information seminars were offered. In November of 2011, we started offering an online information seminar to reach those who are unable to attend a live seminar. Tracking of live versus online seminar attendance was documented in our database. RESULTS Between November 1, 2011 and September 30, 2015, 3484 people completed an information seminar. Of those, 2744 attendees came to a live seminar while 740 completed the online seminar. A significantly higher number of live seminar attendees, 78.1% (2144/2744) progressed to an office visit compared with online seminar attendees 66.5% (492/740), P<.0001. Similarly significant, 40.1% (1101/2744) of live seminar attendees progressed to surgery versus 29.7% (220/740) of online attendees (P<.0001). Sex (78.2% female for live seminar versus 79.5% female for online seminar, P = .65) and initial body mass index (46.3 ± 7.4 for live seminar versus 45.3 ± 7.1 for online seminar, P = .09) were very similar between the groups. Online seminar attendees' age (42.7 ± 12.1) was younger than that of the live seminar attendees' (47.3 ± 12.3) (P<.0001) but has little clinical value. CONCLUSION Our results demonstrated that live seminar attendees are more likely to progress to surgery and therefore should continue to be offered.
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Affiliation(s)
- Maureen Miletics
- St. Luke's Weight Management Services, St. Luke's University Health Network, Bethlehem, Pennsylvania.
| | - Leonardo Claros
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, the Medical School of Temple University/St Luke's University Health Network, Bethlehem, Pennsylvania
| | - Jill Stoltzfus
- Research Institute and Medical School of Temple University/St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Terri Davis
- St. Luke's Weight Management Services, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Maher El Chaar
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, the Medical School of Temple University/St Luke's University Health Network, Bethlehem, Pennsylvania
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El Chaar M, Stoltzfus J, Elias B, Claos L. Laparoscopic Roux-en-Y Gastric Bypass vs. Mini Gastric Bypass: A Systematic Review of the Literature. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Noto J, El Chaar M, Claros L, Stoltzfus J. Laparoscopic Sleeve Gastrectomy versus Laparoscopic Roux-en-Y Gastric Bypass: Single Center Experience with 4 Years Follow UP. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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El Chaar M, Claros L, Smith E. Laparoscopic Sleeve Gastrectomy Conversion to Roux-en-Y Gastric Bypass and Repair of Paraesophageal Hernia. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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47
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El Chaar M, Stoltzfus J, Lundberg P. 30-Day outcomes of Sleeve Gastrectomy (SG) vs Roux en Y Gastric Bypass (RYGB): First Look at MBSAQIP data. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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48
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El Chaar M, Claros L, Stoltzfus J, Qiu J. Conversion of Sleeve Gastrectomy to Gastric Bypass: Incidence, Indications and Outcomes. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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49
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Miletics M, El Chaar M, Claros L, Stoltzfus J, Davis T. Online Seminar vs. Live Seminar: Which One Should We Offer? Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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50
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El Chaar M, Hon H, Claros L. Gastric Sleeve Migration resulting in Laparoscopic Conversion to Roux-en-Y- Gastric Bypass in Combination with Collis Gastroplasty and Paraesophageal Hernia Repair. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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