Robotic Surgery Is More Expensive with Similar Outcomes in Sleeve Gastrectomy: Analysis of the NIS Database.

The aim of this study was to compare postoperative outcomes after robotic-assisted and laparoscopic bariatric sleeve gastrectomy (SG). Sleeve gastrectomy is traditionally performed using laparoscopic techniques. Robotic-assisted surgery enables surgeons to perform minimally invasive SG, but with unknown benefits. Using a national database, we compared postoperative outcomes after laparoscopic SG and robotic-assisted SG. National data from individuals undergoing elective SG in the National Inpatient Sample database between 2011 and 2013 were analyzed. Propensity score matching was used to match robotic and laparoscopic groups by demographics, comorbidities, and hospital characteristics. The matching cohorts were compared. A total of 26,195 patients who underwent elective SG for morbid obesity were included. Of these, 25,391 (96.9%) were completed via laparoscopy, whereas 804 (3.1%) were performed with robotic assistance. There were no significant differences in demographics and subsequent postoperative complications. The inhospital mortality was similar. Length of hospital stay was statistically different, with a mean of 1.88 in laparoscopic versus 2.08 days in robotic (P < 0.001). Higher total hospital charges were noted in the robotic-assisted SG group (median US$38,569 vs US$54,658, P < 0.001). These differences were evident even after adjusting for confounding factors: wound infection, atelectasis, bowel obstruction, pneumonia, and bowel obstruction (P < 0.001).

Gallstone ileus presenting as intussusception: A case report.

BACKGROUND: Gallstone ileus is a complication of acute cholecystitis that accounts for 25% of bowel obstruction cases in the elderly. To our knowledge, only one other case of gallstone ileus presenting as intussusception has been reported in the literature, and involved non-operative management with an unfavorable outcome. CASE PRESENTATION: Here we report the case of 69year old woman presenting with symptoms of acute small bowel obstruction with a surgical history significant for cholecystectomy 30 years prior. Computed tomographic imaging showed a target sign in the small bowel consistent with intussusception, but intraoperative diagnosis revealed this to be a gallstone. A simple enterolithotomy was conducted and the patient has since been symptom free. DISCUSSION: Gallstone ileus has a high mortality rate (12-17%) and is an important differential diagnosis to consider, especially as the elderly population throughout the world continues to grow. CONCLUSION: As radiographic features of gallstones are variable we suggest maintaining a high index of suspicion for gallstone ileus in any elderly patient presenting with SBO, even with a seemingly contradictory surgical history.

Trends in bariatric surgery from 2008 to 2012.

BACKGROUND: Obesity is a global epidemic that has been increasing in prevalence. The only treatment method for durable weight loss is bariatric surgery. The aim of this study was to observe trends in usage and outcomes of bariatric operations used in the United States from 2008 to 2012. METHODS: Analysis was performed on bariatric surgery admissions from 2008 to 2012 based off of the Nationwide Inpatient Sample database. Data were selected from using International Classification of Disease, 9th Revision codes correlating to bariatric procedures for the purpose of obesity. Annual estimates and trends were reviewed for patient demographics, procedure type, patient outcomes, and length of stay (LOS). RESULTS: A total of 598,756 bariatric procedures were examined. Laparoscopic gastric bypass was the most commonly used surgical method in 2008 (58.2%). A decreasing trend in its use, and the use of laparoscopic gastric banding (LGB), was equipoised with increasing use of laparoscopic sleeve gastrectomy (LSG). Use of LSG accounted for 8.2% of procedures in 2011 and 39.6% in 2012. LGB and LSG had the lowest rates of complications, in-hospital morbidity and mortality, and the shortest LOS whereas open bypass and duodenal switch had the highest rates of complications, in-hospital morbidity and mortality, and longest LOSs. Overall rates of venous thromboembolism increased from .08% in 2008 to .215% in 2012. Respiratory complications decreased from 6.1% to 3.9%. There were no observed trends in rates of renal complications, visceral injury, bleeding, and infections. In-hospital morbidity decreased, whereas mortality rates were stable at .1%. CONCLUSIONS: The utilization of bariatric procedures has reached a plateau in the United States. Changes in the composition of procedural types suggest that LSG has become a popular alternative to gastric bypass and LGB.

Surgical management of inferior vena cava strut penetration causing hydronephrosis: case report.

We present a case of penetration of inferior vena cava (IVC) by primary struts of Cook Celect filter and impingement on right ureter, causing symptomatic hydronephrosis and hydroureter, which was managed surgically by ureterolysis, mobilization of the ureter by retroperitoneal approach, excision of the filter strut, and omental wrap around the ureter.