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Ramdeen SL, Ajayeoba OO, Gabrielsen JD, Diehl DL. Endoscopically guided sutured gastropexy: a novel treatment of gastric volvulus. VideoGIE 2023; 8:401-403. [PMID: 37849782 PMCID: PMC10577362 DOI: 10.1016/j.vgie.2023.06.001] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Video 1An overview of the case, background information on gastric volvulus, 3-dimensional models of the different types of gastric volvuli, and novel endoscopic and surgical techniques.
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Affiliation(s)
- Sanjhai L Ramdeen
- Department of Minimally Invasive Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Olumide O Ajayeoba
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania
| | - Jon D Gabrielsen
- Department of Minimally Invasive Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - David L Diehl
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania
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2
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Shally L, Saeed K, Berglund D, Dudash M, Frank K, Obradovic VN, Petrick AT, Diehl DL, Gabrielsen JD, Parker DM. Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia. Surg Endosc 2022:10.1007/s00464-022-09652-6. [PMID: 36220985 DOI: 10.1007/s00464-022-09652-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous studies analyzing short-term outcomes for per-oral endoscopic myotomy (POEM) have shown excellent clinical response rates and shorter operative times compared to laparoscopic Heller myotomy (LHM). Despite this, many payors have been slow to recognize POEM as a valid treatment option. Furthermore, comparative studies analyzing long-term outcomes are limited. This study compares perioperative and long-term outcomes, cost-effectiveness, and reimbursement for POEM and LHM at a single institution. METHODS Adult patients who underwent POEM or LHM between 2014 and 2021 and had complete preoperative data with at least one complete follow up, were retrospectively analyzed. Demographic data, success rate, operative time, myotomy length, length of stay, pre- and postoperative symptom scores, anti-reflux medication use, cost and reimbursement were compared. RESULTS 58 patients met inclusion with 25 undergoing LHM and 33 undergoing POEM. There were no significant differences in preoperative characteristics. Treatment success (Eckardt ≤ 3) for POEM and LHM was achieved by 88% and 76% of patients, respectively (p = 0.302). POEM patients had a shorter median operative time (106 min. vs. 145 min., p = 0.003) and longer median myotomy length (11 cm vs. 8 cm, p < 0.001). All LHM patients had a length of stay (LOS) ≥ 1 day vs. 51.5% for POEM patients (p < 0.001). Both groups showed improvements in dysphagia, heartburn, regurgitation, Eckardt score, GERD HRQL, RSI, and anti-reflux medication use. The improvement in dysphagia score was greater in patients undergoing POEM (2.30 vs 1.12, p = 0.003). Median hospital reimbursement was dramatically less for POEM ($3,658 vs. $14,152, p = 0.002), despite median hospital costs being significantly lower compared to LHM ($2,420 vs. $3,132, p = 0.029). RESULTS POEM is associated with a shorter operative time and LOS, longer myotomy length, and greater resolution of dysphagia compared to LHM. POEM costs are significantly less than LHM but is poorly reimbursed.
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Affiliation(s)
- Lena Shally
- Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA, 18510, USA.
| | - Kashif Saeed
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Derek Berglund
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Mark Dudash
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Katie Frank
- Department of Population Health and Sciences, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Vladan N Obradovic
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Anthony T Petrick
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Jon D Gabrielsen
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - David M Parker
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
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Mekel G, Dessify BJ, Petrick AT, Gabrielsen JD, Falvo AM, Horsley RD, Parker DM. Outcomes of Bariatric Surgery in Patients on Chronic Opioids: Can Bariatric Surgery Assist with Decreasing Long-term Opioid Utilization? Obes Surg 2022; 32:786-791. [PMID: 35066783 DOI: 10.1007/s11695-021-05854-4] [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: 07/03/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of our study was to assess long-term opioid use following bariatric surgery in patients on preoperative narcotics. METHODS We evaluated patients utilizing preoperative opioids (OP) who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) from 2013 to 2020. Patients were propensity-matched to those without preoperative opioid use (NOP) by demographics and comorbidities. Our objectives were to compare opioid use at 1 and 3 years after surgery and evaluate perioperative outcomes. RESULTS A total of 806 patients, matched 1:1 were evaluated, with 82.7% being females. Mean age was 46.5 years in the OP and 45.6 years in the NOP (p = 0.0018), preoperative BMI was 45.8 in the OP and 46.1 in the NOP (p = 0.695). All patients were followed up for 1 year. In the OP, 156 (38.7%) patients were taking opioids 1 year after surgery as opposed to 27 (6.7%) in the NOP (p < 0.0001). Three years after surgery, 74 (37.5%) patients in the OP and 27 (14.4%) in the NOP were taking outpatient opioids (p < 0.0001). There was no statistically significant difference between OP and NOP groups in terms of readmissions (9.4% vs. 5.7% p = 0.06), reinterventions (3.7 vs. 1.7% p = 0.13), reoperations (3.5% vs. 1.5% p = 0.11), or emergency room visits (8.9% vs. 7.2% p = 0.44). There were no mortalities. CONCLUSION Most patients requiring preoperative opioids can be weaned off after bariatric surgery. Enhanced recovery pathways are key to obtaining these results. Preoperative opioid use is not associated with increased complications compared to opioid-naïve patients.
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Affiliation(s)
- Gabriel Mekel
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Brian J Dessify
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Anthony T Petrick
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Jon D Gabrielsen
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Alexandra M Falvo
- Department of Bariatric and Foregut Surgery, Geisinger Community Medical Center, 1800 Mulberry St., Scranton, PA, 18510, USA
| | - Ryan D Horsley
- Department of Bariatric and Foregut Surgery, Geisinger Community Medical Center, 1800 Mulberry St., Scranton, PA, 18510, USA
| | - David M Parker
- Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave., Danville, PA, 17822, USA.
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Affiliation(s)
- Harshit S Khara
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Jon D Gabrielsen
- Division of Foregut and Bariatric Surgery, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - David L Diehl
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Ryan D Horsley
- Division of Foregut and Bariatric Surgery, Geisinger Medical Center, Danville, Pennsylvania, United States
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Horsley RD, Vogels ED, McField DAP, Parker DM, Medico C, Dove J, Fluck M, Gabrielsen JD, Gionfriddo MR, Petrick AT. Multimodal Postoperative Pain Control Is Effective and Reduces Opioid Use After Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2019; 29:394-400. [PMID: 30317488 DOI: 10.1007/s11695-018-3526-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Opioids have been the mainstay for postoperative pain relief for many decades. Recently, opioid-related adverse events and death have been linked to postoperative dependency. Multimodal approaches to postoperative pain control may be part of the solution to this health care crisis. The safety and effectiveness of multimodal pain control regimens after laparoscopic Roux-en-Y gastric bypass (LRYGB) has not been well studied. The primary aim of our study was to determine if an evidence-based, multimodal pain regimen during hospitalization could decrease the total oral morphine equivalent (TME) use after LRYGB. STUDY DESIGN We conducted a retrospective cohort study comparing outcomes prior to the implementation of a multimodal pain protocol (December 2010-December 2012) to those after implementation (April 2013-July 2015). The protocol utilized oral celecoxib and scheduled oral acetaminophen for pain control, with opioids used only as needed for breakthrough pain. Data was extracted from an electronic medical record and an institutionally maintained database of all patients undergoing bariatric surgery at a single center. RESULTS Compared to controls, the multimodal pain regimen significantly reduced TME used and maximum pain scores with no change in mean pain scores. Multimodal pain protocol patients had a shorter length of stay with no increase in bleeding complications or marginal ulcer rates. CONCLUSIONS An opioid-sparing multimodal pain regimen adequately controls pain while reducing TME use. The regimen appears to be safe and was associated with a reduced length of stay in patients undergoing LRYGB.
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Affiliation(s)
- Ryan D Horsley
- Division of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 North Academy Ave, Danville, PA, 17822, USA.
| | - Ellen D Vogels
- Division of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 North Academy Ave, Danville, PA, 17822, USA
| | - Daaron A P McField
- Division of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 North Academy Ave, Danville, PA, 17822, USA
| | - David M Parker
- Division of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 North Academy Ave, Danville, PA, 17822, USA
| | - Charles Medico
- Enterprise Pharmacy, Geisinger, 100 North Academy Ave, Danville, PA, 17822, USA
| | - James Dove
- Division of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 North Academy Ave, Danville, PA, 17822, USA
| | - Marcus Fluck
- Division of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 North Academy Ave, Danville, PA, 17822, USA
| | - Jon D Gabrielsen
- Division of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 North Academy Ave, Danville, PA, 17822, USA
| | - Michael R Gionfriddo
- Center for Pharmacy Innovation and Outcomes, Geisinger, 190 Welles Street, Suite 128, Forty Fort, PA, USA
| | - Anthony T Petrick
- Division of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 North Academy Ave, Danville, PA, 17822, USA
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Buzalewski J, Parker DM, Mahan ME, Rambhajan A, Dove JT, Fluck MB, Horsley RD, Petrick AT, Gabrielsen JD. Equivalent Perioperative Outcomes for Laparoscopic Roux-en-Y Gastric Bypass Patients Discharged on Postoperative Day 1. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.020] [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: 11/24/2022]
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Lent MR, Benotti PN, Mirshahi T, Gerhard GS, Strodel WE, Petrick AT, Gabrielsen JD, Rolston DD, Still CD, Hirsch AG, Zubair F, Cook A, Carey DJ, Wood GC. All-Cause and Specific-Cause Mortality Risk After Roux-en-Y Gastric Bypass in Patients With and Without Diabetes. Diabetes Care 2017; 40:1379-1385. [PMID: 28760742 PMCID: PMC5606311 DOI: 10.2337/dc17-0519] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/09/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study assessed all-cause and specific-cause mortality after Roux-en-Y gastric bypass (RYGB) and in matched control subjects, stratified by diabetes status. RESEARCH DESIGN AND METHODS RYGB patients were matched by age, BMI, sex, and diabetes status at time of surgery to nonsurgical control subjects using data from the electronic health record. Kaplan-Meier curves and Cox regression were used to assess differences in all-cause and specific-cause mortality between RYGB patients and control subjects with and without diabetes. RESULTS Of the 3,242 eligible RYGB patients enrolled from January 2004 to December 2015, control subjects were identified for 2,428 (n = 625 with diabetes and n = 1,803 without diabetes). Median postoperative follow-up was 5.8 years for patients with diabetes and 6.7 years for patients without diabetes. All-cause mortality was reduced in RYGB patients compared with control subjects only for those with diabetes at the time of surgery (adjusted hazard ratio 0.44; P < 0.0001). Mortality was not significantly improved in RYGB patients without diabetes compared with control subjects without diabetes (adjusted hazard ratio 0.84; P = 0.37). Deaths from cardiovascular diseases (P = 0.011), respiratory conditions (P = 0.017), and diabetes P = 0.011) were more frequent in control subjects with diabetes than in RYGB patients with diabetes. RYGB patients without diabetes were less likely to die of cancer (P = 0.0038) and respiratory diseases (P = 0.046) than control subjects without diabetes but were at higher risk of death from external causes (P = 0.012), including intentional self-harm (P = 0.025), than control subjects without diabetes. CONCLUSIONS All-cause mortality benefits of RYGB are driven predominantly by patients with diabetes at the time of surgery. RYGB patients with diabetes were less likely to die of cardiovascular diseases, diabetes, and respiratory conditions than their counterparts without RYGB.
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Affiliation(s)
- Michelle R Lent
- Obesity Institute, Geisinger Clinic, Danville, PA .,Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | | | - Tooraj Mirshahi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA
| | - Glenn S Gerhard
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | | | | | | | - David D Rolston
- Department of Internal Medicine, Geisinger Clinic, Danville, PA
| | | | - Annemarie G Hirsch
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA
| | - Fahad Zubair
- Center for Nutrition and Weight Management, Geisinger Clinic, Danville, PA
| | - Adam Cook
- Obesity Institute, Geisinger Clinic, Danville, PA
| | - David J Carey
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA
| | - G Craig Wood
- Obesity Institute, Geisinger Clinic, Danville, PA
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Diehl DL, Gabrielsen JD, Strodel WE. The challenges of endoscopic retrograde cholangiopancreatography in gastric bypass patients: the game is not yet over. Gastroenterology 2015; 148:857-8. [PMID: 25726746 DOI: 10.1053/j.gastro.2014.11.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/21/2014] [Indexed: 12/02/2022]
Affiliation(s)
- David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania
| | - Jon D Gabrielsen
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - William E Strodel
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Gerhard GS, Benotti P, Wood GC, Chu X, Argyropoulos G, Petrick A, Strodel WE, Gabrielsen JD, Ibele A, Still CD, Kingsley C, DiStefano J. Identification of novel clinical factors associated with hepatic fat accumulation in extreme obesity. J Obes 2014; 2014:368210. [PMID: 25610640 PMCID: PMC4290025 DOI: 10.1155/2014/368210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The accumulation of lipids stored as excess triglycerides in the liver (steatosis) is highly prevalent in obesity and has been associated with several clinical characteristics, but most studies have been based on relatively small sample sizes using a limited set of variables. We sought to identify clinical factors associated with liver fat accumulation in a large cohort of patients with extreme obesity. METHODS We analyzed 2929 patients undergoing intraoperative liver biopsy during a primary bariatric surgery. Univariate and multivariate regression modeling was used to identify associations with over 200 clinical variables with the presence of any fat in the liver and with moderate to severe versus mild fat accumulation. RESULTS A total of 19 data elements were associated with the presence of liver fat and 11 with severity of liver fat including ALT and AST, plasma lipid, glucose, and iron metabolism variables, several medications and laboratory measures, and sleep apnea. The accuracy of a multiple logistic regression model for presence of liver fat was 81% and for severity of liver fat accumulation was 77%. CONCLUSIONS A limited set of clinical factors can be used to model hepatic fat accumulation with moderate accuracy and may provide potential mechanistic insights in the setting of extreme obesity.
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Affiliation(s)
- Glenn S. Gerhard
- Department of Medical Genetics and Molecular Biochemistry, Temple University School of Medicine, 3500 N. Broad Street, Philadelphia, PA 19140, USA
- *Glenn S. Gerhard:
| | - Peter Benotti
- Geisinger Obesity Research Institute, Danville, PA 17822, USA
| | - G. Craig Wood
- Geisinger Obesity Research Institute, Danville, PA 17822, USA
| | - Xin Chu
- Geisinger Obesity Research Institute, Danville, PA 17822, USA
| | | | - Anthony Petrick
- Geisinger Obesity Research Institute, Danville, PA 17822, USA
| | | | | | - Anna Ibele
- Geisinger Obesity Research Institute, Danville, PA 17822, USA
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Parker DM, Rambhajan A, Johanson K, Ibele A, Gabrielsen JD, Petrick AT. Urgent laparoscopic repair of acutely symptomatic PEH is safe and effective. Surg Endosc 2013; 27:4081-6. [DOI: 10.1007/s00464-013-3064-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/06/2013] [Indexed: 12/11/2022]
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Alaparthi M, Yeung WM, Plank A, Gabrielsen JD, Petrick AT. P-53 Low incidence of petersen's hernia after laparoscopic Roux-en-Y gastric bypass with a 2-stitch technique. Surg Obes Relat Dis 2011. [DOI: 10.1016/j.soard.2011.04.054] [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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Yeung WM, Alaparthi M, Gubrij K, Plank A, Gabrielsen JD, Petrick AT. SFR-108 Urgent and emergent laparoscopic re-operation after RYGB is feasible and results in short hospital stay. Surg Obes Relat Dis 2011. [DOI: 10.1016/j.soard.2011.04.163] [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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Sucandy I, Akmal YM, Gabrielsen JD. Spontaneous massive hemoperitoneum: A potentially life threatening presentation of the wandering spleen. N Am J Med Sci 2011; 3:99-102. [PMID: 22540075 PMCID: PMC3336896 DOI: 10.4297/najms.2011.399] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context: Wandering spleen is an unusual condition characterized by the absence or maldevelopment of one or all of the ligaments securing the spleen in its normal position in the left upper abdomen. Pedicular tortion with a complete vascular disruption is a rare but known potential complication of this mostly congenital disorder. Spontaneous hemoperitoneum with acute abdomen however, is a life threatening situation that has not been adequately reported in the adult literature. Case Report: A forty four year old man presented to the emergency department with an acutely distended and rigid abdomen. His past medical history was only significant for mild mental retardation. The patient denies prior abdominal operation or recent trauma. On initial examination, he appeared to be anxious, pale, and tachycardic. Fullness in the midpelvic region was easily appreciated on palpation. An enlarged pelvic spleen and free intraperitoneal fluid consistent with blood were seen on a CT scan. The patient was promptly taken for an exploratory laparotomy where a large rush of blood was encountered upon entering the abdomen. A volvulus of the splenic pedicle with an infarcted spleen was found mandating a splenectomy. Conclusions: Abnormally located spleen, splenomegaly, and finding of hemoperitoneum are highly suggestive of wandering spleen with tortioned pedicle. Despite its life threatening presentation, immediate laparotomy and splenectomy invariably result in good outcome.
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Affiliation(s)
- Iswanto Sucandy
- Department of Surgery, Abington Memorial Hospital, Abington, Pennsylvania, USA
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Sucandy I, Gabrielsen JD, Petrick AT. Postoperative mesenteric venous thrombosis: Potential complication related to minimal access surgery in a patient with undiagnosed hypercoagulability. N Am J Med Sci 2010; 2:329-32. [PMID: 22558583 PMCID: PMC3341641] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONTEXT Mesenteric venous thrombosis is a rare but potentially fatal complication associated with laparoscopy which has now become common practice and gold standard for many procedures in general surgery. There are only few scattered case reports in the literature describing this postoperative thrombotic event. CASE REPORT In the present study, we describe a patient presenting with severe abdominal pain at 25 days following an uneventful laparoscopic paraesophageal hernia (PEH) repair and nissen fundoplication. Exploratory laparotomy revealed an extensive small bowel ischemia requiring bowel resection followed by a second look laparotomy. Retrospectively performed hematologic workup revealed a genetic mutation associated with hyperhomocysteinemia in addition to her hyperfibrinogenemia. Previously published data were collected and discussed. CONCLUSIONS Mesenteric venous thrombosis is a rare but potentially serious complication after laparoscopic surgery especially in patients with underlying hypercoagulability. High index of suspicion is important in early diagnosis and subsequent treatment.
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Affiliation(s)
- Iswanto Sucandy
- Department of Surgery, Abington Memorial Hospital, Abington, PA, USA. (Previously at Geisinger Medical Center, PA , USA.),Correspondence to: Iswanto Sucandy, Department of Surgery, Abington Memorial Hospital, 1200 Old York Road, Abington, PA 19001, USA. Tel.: (551) 574 0076,
| | - Jon D Gabrielsen
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Anthony T Petrick
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Geisinger Medical Center, Danville, PA, USA
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Cavaretta M, Chinnappan K, Gabrielsen JD, Petrick AT. P-102: Effect of roux limb orientation in laparoscopic roux-en Y gastric bypass on gastrojejunostomy complications. Surg Obes Relat Dis 2010. [DOI: 10.1016/j.soard.2010.03.146] [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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Chinnappan K, Cavaretta M, Gabrielsen JD, Petrick AT. P-145: Adherence to “Proven Care” practice decreases length of hospital stay in gastric bypass patients. Surg Obes Relat Dis 2010. [DOI: 10.1016/j.soard.2010.03.189] [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: 11/25/2022]
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Petrick AT, Doll MC, Bolanowski A, Chokshi R, McCullough C, Gabrielsen JD, Still CD, Strodel WE. PL-222: “Provencare(SM)” inital results of a provider-driven pay-for-performance program for gastric bypass surgery. Surg Obes Relat Dis 2009. [DOI: 10.1016/j.soard.2009.03.050] [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: 10/20/2022]
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Pfeifer CC, Gabrielsen JD, Sucandy I, Buchanan T, Petrick AT. P37: Gastrojejunal anastomotic complications using 45mm versus 60mm linear stapler in over 500 patients undergoing laparoscopic RYGB. Surg Obes Relat Dis 2008. [DOI: 10.1016/j.soard.2008.03.223] [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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