Insurance status and outcomes in laparoscopic adjustable gastric banding.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is a proven method for achieving long-term weight loss, but there has been controversy regarding how pay status impacts outcomes after surgery. OBJECTIVES: To compare outcomes of LAGB with respect to percentage excess weight loss (%EWL), perioperative complications, and number of band adjustments between insured and self-financed patients. METHODS: Retrospective analysis of data (n=108) including demographics, comorbidities, operative complications, and %EWL for 5 years postsurgery. RESULTS: There were no demographic differences between the Insured Group and the Self-financed Group, except mean preoperative BMI (P=0.049). There were no complications reported and no differences in %EWL between the groups. CONCLUSIONS: This is the first study assessing outcomes and complication rates with respect to pay status in an outpatient surgery center bariatric patient population. These results demonstrate that self-financed patients did not achieve greater weight loss compared with privately insured patients undergoing LAGB.

Osteochondral Tissue Cell Viability Is Affected by Total Impulse during Impaction Grafting.

OBJECTIVE: Osteochondral graft transplantation has garnered significant attention because of its ability to replace the lesion with true hyaline cartilage. However, surgical impaction of the graft to anchor it into the defect site can be traumatic and lead to cell death and cartilage degeneration. This study aimed to test the hypothesis that increasing impulse magnitude during impaction of osteochondral plugs has a direct effect on loss of cell viability. DESIGN: In this controlled laboratory study, the impaction force was kept constant while the impulse was varied. Ninety-six osteochondral plugs were extracted from the trochlea of bovine stifle joints and were randomly assigned into 3 experimental and 1 (nonimpacted) control group. The transferred impulse of the experimental groups reflected the median and the lower and upper quartiles of preceding clinical measurements. Data were obtained at day 0, day 4, and day 8; at each point, cell viability was assessed using the Live/Dead staining kit and histological assessments were performed to visualize matrix structural changes. RESULTS: After impaction, cartilage samples stayed intact and did not show any histological signs of matrix disruption. As expected, higher impulse magnitudes introduced more cell death; however, this relationship was lost at day 8 after impaction. CONCLUSION: Impulse magnitude has a direct effect on cell viability of the graft. Because impulse magnitude is mostly governed by the press-fit characteristics of the recipient site, this study aids in the definition of optimal insertion conditions for osteochondral grafts.

Benefits of surgeon-performed ultrasound for primary hyperparathyroidism.

BACKGROUND: Focused, minimally invasive parathyroidectomy (MIP) is widely accepted when preoperative imaging localizes a single parathyroid adenoma. Many surgeons use (99m)Tc-sestamibi scintigraphy (MIBI) +/-, a cervical ultrasound for preoperative localization. We propose that surgeon-performed ultrasound (SUS) is the only imaging modality required in most patients with primary hyperparathyroidism (pHPT), resulting in patient convenience and reduced cost. MATERIALS AND METHODS: Since July 2006, patients with pHPT underwent MIP based solely on a positive SUS. Intraoperative parathyroid hormone assay was used to determine the extent of operation. A retrospective review from July 2006 through December 2008 identified 160 patients who underwent parathyroidectomy after SUS on their initial office visit. RESULTS: SUS correctly identified an enlarged parathyroid gland in 119/160 (74%) patients. In 41 patients, SUS was the only localizing study. MIBI was done in 119 patients. In 54 patients, SUS confirmed the MIBI, and in 28 patients with a negative MIBI, SUS was positive. In the 41 patients with a negative SUS, an MIBI was positive in ten. Ninety-eight patients had MIP. Theoretically, 85 MIBIs were unnecessary because of a positive SUS corresponding to a potential cost savings of at least $90,000. CONCLUSION: SUS to localize parathyroid adenomas is accurate and facilitates MIP. It provides substantial cost savings and patient convenience and should be the first diagnostic procedure performed for patients suspected to have pHPT. MIBI can be reserved for those patients in whom ultrasound has failed to localize a parathyroid gland.