Is it necessary to perform full pathologic review of all gastric remnants following sleeve gastrectomy?

BACKGROUND: This study attempts to determine if enough pathological abnormalities in gastric remnants from sleeve gastrectomy exist to warrant full pathologic evaluation in all remnants. METHODS: Data was collected on patients undergoing sleeve gastrectomy between 08/01/2011 and 06/30/2014. Significant abnormalities were classified as any pathology that might require follow-up or treatment beyond standard follow-up. Age, comorbidities, gender, and Helicobacter pylori titers were analyzed and compared with pathology specimens using 95% confidence intervals and Phi contingency coefficients. RESULTS: Full pathologic evaluation was available for 351/387 patients (91.2%). No examples of malignancy or dysplasia were identified. Gastritis was the most common abnormality. There was a statistically significant association between preoperative H. pylori and significantly abnormal pathology (p = 0.003). Other comorbidities had no association. CONCLUSIONS: These results suggest that full pathologic evaluation of the gastric remnant following sleeve gastrectomy is unnecessary, particularly when gross pathology is not noted at initial operation.

Ethanol embolization of arteriovenous fistulas: a primary mode of therapy.

Arteriovenous fistulas (AVFs) can be posttraumatic or congenital vascular malformations. In the initial arteriographic evaluation, chronic AVFs potentially can be confused with arteriovenous malformations (AVMs). The authors studied five patients with a single AVF and one patient with numerous AVFs. Three patients had undergone surgery for treatment of their AVFs, one patient had undergone isobutyl-2-cyanoacrylate (IBCA) embolization, and two patients had undergone no prior therapy. The AVFs recurred in the three patients who had undergone surgery and in the patient who had undergone IBCA embolization. All patients underwent ethanol embolization of their AVFs. Angiograms obtained immediately after embolization documented closure of all AVFs. At follow-up, none of the embolized lesions have recurred. The authors conclude that ethanol embolotherapy can cure these problematic lesions. Extreme caution, however, must be employed with the use of intravascular ethanol because nontarget embolization can potentially result in tissue devitalization. In this study, two patients developed a small focal area of skin necrosis that did not require skin grafting and healed with conservative management.

Abdominal aortic aneurysm repair in patients with pelvic kidney. Technical considerations and literature review.

Effective methods for performing abdominal aortic aneurysmectomy associated with congenital pelvic kidney are presented. The embryology and surgical anatomy of these lesions are reviewed. Ordinarily, successful aortic reconstruction can be performed with low risk to the pelvic kidney by use of readily available in situ cold perfusion. Two illustrative case reports applying this method are presented. The recently reported technique of double proximal clamping of the aorta was also employed in one case. This technique allows lumbar collaterals within the aneurysm to perfuse the kidney during construction of the proximal aortic anastomosis, thereby minimizing absolute renal ischemic time. Both in situ cold perfusion and double proximal clamping are effective methods for renal preservation that do not rely on complex extraanatomic techniques. A review of the literature with a discussion of the advantages and disadvantages of previously reported methods of renal preservation is presented.

Surgical management of proboscoid herniae.

The management of a large proboscoid umbilical hernia presents challenging problems to the surgeon. As children and parents are concerned with the appearance of the actual hernia they are also intensely interested in the postsurgical result. Presented is a simple one-stage umbilicoplasty that allows repair of the fascial defect and the management of the redundant skin in such a way as to produce a "scarless" and natural-appearing umbilicus.

A modified technique for use of the intraluminal valve cutter in in situ saphenous vein grafts.

A modified technique for the use of the disposable intraluminal valve cutter in the performance of in situ saphenous vein arterial bypass grafts is presented. The technique results in a more physiologic dilatation of the vein and can be expeditiously performed with minimal intimal trauma to the vein graft. Long incisions necessary to expose the entire vein with the use of other techniques can be avoided, thereby decreasing the potential for wound healing problems commonly associated with vascular reconstruction in ischemic limbs.

A practical approach to wound care in patients with complex enterocutaneous fistulas.

A practical, low cost method for controlling high output enterocutaneous fistulas is presented herein. The technique is advantageous because it provides for excellent protection of the skin, is low in cost and is constructed from readily available materials. It is applicable to all fistulas which do not readily accept prefabricated base plate appliances. Its components are so simple that minimal time for wound care on the part of the surgeon, nursing staff or stomal therapist is required.

Alcohol-related trauma. The surgeon's responsibility.

Four thousand fifty-six consecutive emergency room trauma visits in a small community hospital were evaluated to determine the extent of coexisting alcohol usage. The magnitude of the alcohol problem is documented in this series by the fact that more than 40% of the patients requiring admission had elevated blood alcohol tests. Eight of nine traumatic fatalities were alcohol-related. The need for early recognition of problem drinkers is emphasized by the fact that 85% of known alcoholics are not receiving formal treatment. Reasons for failure to recognize the problem are discussed. The responsibility of the surgeon aggressively to pursue early identification is stressed.

Intraoperative hemodynamic investigations during portacaval shunt.

We studied the hemodynamics of hepatic blood flow before and after creation of portacaval shunts in 28 patients. Electromagnetic flow recordings were used to measure hepatic arterial flow (HAF) and portal venous flow (PVF) with respect to total hepatic blood flow (THBF). No correlation between PVF and portal pressure was found, but PVF was directly related to liver function. The concept that patients with low PVF tolerate shunts better (with respect to postoperative course and encephalopathy) than those with high PVF was not supported. Our investigations suggest the existence of a compensatory mechanism that tends to maintain THBF by increasing HAF following creation of a shunt. This compensatory increase occurs only in those patients with good liver function and normal or enlarged livers.