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1.
Surg Obes Relat Dis ; 2024 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-38991936

RESUMEN

BACKGROUND: Sleeve gastrectomy (SG) is the most commonly performed metabolic and bariatric surgery (MBS) procedure. Technical considerations related to the performance of SG are well established and reported in the literature but not in relation to robotic-assisted (RA) SG. We report the results of the first modified Delphi consensus-building exercise addressing technical considerations of RA da Vinci (dV) SG. OBJECTIVES: Develop best practices for the performance of robotic-assisted da Vinci sleeve gastrectomy. SETTING: Survey based consensus statement. METHODS: A consensus building committee (CBC) was created comprising 10 experts in the field of RA surgery and MBS based on strict selection criteria. The CBC developed 49 consensus statements which were then shared with 240 experts in RA surgery. Our stopping criterion was stability in responses (≤15%). The consensus cut point was 70%. RESULTS: The overall response rate was 49%. In the first round of voting, there was consensus agreement on 25 statements (51%), consensus disagreement on 14 (28%), and no consensus on the remaining statements (21%). In the second round of voting, we reached agreement on 3 additional statements. Experts recommended the use of the number of pauses generated by the stapler to guide choice of staple height (91.2%) and to upsize the staple height when using buttressing (92%). There was also consensus (81.4%) that the use of the closed staple height of 1.00 mm (white) is acceptable and that stapling of the antrum using a 1.5-mm staple (blue load) is also acceptable (73%). CONCLUSIONS: Collective expert opinion structured through a modified Delphi consensus statement presents a practical guide for surgeons interested in performing dV-SG.

2.
Obes Surg ; 33(3): 879-889, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-36633761

RESUMEN

PURPOSE: Metabolic and bariatric surgery (MBS) is an evidence-based safe, effective treatment for obesity. However, only half of referred or eligible persons complete the procedure for unknown reasons. The proposed study examined the association between the degree of body appreciation and the decision to complete MBS by ethnicity. METHODS: This prospective cohort study included 409 participants who had been referred to a bariatric surgeon or an obesity medicine program between August 2019 and May 2022. Participants completed a survey about health behaviors and psychosocial characteristics, including body appreciation by MBS completion status (Y/N). Multivariate logistic regression models generated adjusted odd ratios (aOR) and 95% confidence intervals (CIs) of body appreciation among MBS completers vs. non-completers. RESULTS: The sample mean age was 47.18 years (SD 11.63), 87% were female. 39.6% identified as non-Hispanic White (NHW), 38.5% as non-Hispanic Black (NHB), and 17.6% as Hispanic. Over a third of the sample (31.05%, n = 127) completed MBS. "Often" experiencing body appreciation was the most significant predictor of MBS completion (aOR: 28.19, 95% CI: 6.37-124.67, p-value < 0.001), followed by "Sometimes" (aOR: 20.47, 95% CI: 4.82-86.99, p-value < 0.001) and "Always" (aOR: 13.54, 95% CI: 2.55-71.87, p-value < 0.01) after controlling for sex, age, and race/ethnicity. There was not a significant interaction between body appreciation and race/ethnicity (p-value = 0.96). CONCLUSION: Results showed a significant association between body appreciation and MBS completion, controlling for sex, age, and race/ethnicity. MBS clinical settings may want to assess body appreciation as a pre-operative screener among ethnically diverse patients.


Asunto(s)
Cirugía Bariátrica , Imagen Corporal , Obesidad Mórbida , Femenino , Humanos , Masculino , Persona de Mediana Edad , Negro o Afroamericano , Obesidad Mórbida/cirugía , Estudios Prospectivos , Población Blanca , Hispánicos o Latinos , Adulto
3.
Arch Surg ; 144(7): 612-7, 2009 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-19620539

RESUMEN

HYPOTHESIS: Evaluation of 12 or more lymph nodes (LNs) with colorectal cancer (CRC) resection may not improve detection of stage III disease. DESIGN: Retrospective review after intervention. SETTING: Community teaching hospital. PATIENTS: We evaluated 701 consecutive operative CRC cases ascertained from our Cancer Registry. INTERVENTION: Patients undergoing resection before (n = 553) a multidisciplinary initiative emphasizing the importance of LN counts were compared with those undergoing operation afterward (n = 148). MAIN OUTCOME MEASURES: Number of LNs evaluated, proportion of patients with stage III disease, and proportion of patients with N1 vs N2 disease. RESULTS: Demographic, tumor, and treatment variables were similar for both groups, except for younger age, fewer white patients, and more laparoscopic resections in the late period. Lymph node counts increased from a mean (SEM [median]) of 12.8 (0.3 [12]) to 17.3 (0.7 [16]) (P < .001), with 53.0% of the early vs 71.6% of the late patients having at least 12 LNs examined. The proportion diagnosed as having stage III CRC was 204 of 553 (36.9%) for the early group vs 48 of 148 (32.4%) for the late group (P = .31). Among patients with positive LNs, the distribution of N1 and N2 disease was unchanged (early, 50.5% N1 and 49.5% N2; late, 54.2% N1 and 45.8% N2; P = .54). CONCLUSIONS: Increased LN retrieval does not identify a greater number of patients with stage III CRC nor does it increase the proportion of patients with positive LNs with N2 disease. Our data suggest that harvest of at least 12 LNs as a quality or performance measure appears unfounded.


Asunto(s)
Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colectomía/normas , Femenino , Humanos , Laparoscopía , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Calidad de la Atención de Salud , Sistema de Registros , Recolección de Tejidos y Órganos
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