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1.
Obes Surg ; 34(4): 1122-1130, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38366263

RESUMO

A global shift is occurring as hospital procedures move to ambulatory surgical settings. Surgeons have performed outpatient sleeve gastrectomy (SG) in bariatric surgery since 2010. However, prospective trials are needed to ensure its safety before widespread adoption. PURPOSE: The study aimed to present a comprehensive report on the prospective data collection of 30-day outcomes of outpatient primary laparoscopic SG (LSG). This trial seeks to assess whether outpatient LSG is non-inferior to hospital-based surgery in selected patients who meet the outpatient surgery criteria set by the American Society for Metabolic and Bariatric Surgery. MATERIALS AND METHODS: This study is funded by the Society of American Gastrointestinal and Endoscopic Surgeons and has been approved by the Advarra Institutional Review Board (Pro00055990). Cognizant of the necessity for a prospective approach, data collection commenced after patients underwent primary LSG procedures, spanning from August 2021 to September 2022, at six medical centers across the USA. Data centralization was facilitated through ArborMetrix. Each center has its own enhanced recovery protocols, and no attempt was made to standardize the protocols. RESULTS: The analysis included 365 patients with a mean preoperative BMI of 43.7 ± 5.7 kg/m2. Rates for 30-day complications, reoperations, readmissions, emergency department visits, and urgent care visits were low: 1.6%, .5%, .2%, .2%, and 0%, respectively. Two patients (0.5%) experienced grade IIIb complications. There were no mortalities or leaks reported. CONCLUSION: The prospective cohort study suggests that same-day discharge following LSG seems safe in highly selected patients at experienced US centers.


Assuntos
Cirurgia Bariátrica , Laparoscopia , Obesidade Mórbida , Humanos , Obesidade Mórbida/cirurgia , Estudos Prospectivos , Pacientes Ambulatoriais , Padrão de Cuidado , Laparoscopia/métodos , Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
2.
Surg Obes Relat Dis ; 14(10): 1442-1447, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30170954

RESUMO

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure that can be performed as an outpatient procedure. OBJECTIVES: The aim of the study was to determine whether same-day discharge LSG is safe when performed in an outpatient surgery center. SETTING: Outpatient surgery centers. METHODS: The medical records of 3162 patients who underwent primary LSG procedure by 21 surgeons at 9 outpatient surgery centers from January 2010 through February 2018 were retrospectively reviewed. RESULTS: Three thousand one hundred sixty-two patients were managed with enhanced recovery after surgery protocol and were included in this analysis. The mean age and preoperative body mass index were 43.1 ± 10.8 years and 42.1 ± 7.1 kg/m2, respectively. Sleep apnea, type 2 diabetes, gastroesophageal reflux disease, hypertension, and hyperlipidemia were seen in 14.4%, 13.5%, 24.7%, 30.4%, and 17.6% patients, respectively. The mean total operative time was 56.4 ± 16.9 minutes (skin to skin). One intraoperative complication (.03%) occurred. The hospital transfer rate was .2%. The 30-day follow-up rate was 85%. The postoperative outcomes were analyzed based on the available data. The 30-day readmission, reoperation, reintervention, and emergency room visit rates were .6%, .6%, .2%, and .1%, respectively. The 30-day mortality rate was 0%. The total short-term complication rate was 2.5%. CONCLUSIONS: Same-day discharge seems to be safe when performed in an outpatient surgery center in selected patients. It would appear that outpatient surgery centers are a viable option for patients with minimal surgical risks.


Assuntos
Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Laparoscopia/métodos , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Instituições de Assistência Ambulatorial/tendências , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios/tendências , Cirurgia Bariátrica/tendências , Índice de Massa Corporal , Utilização de Instalações e Serviços , Feminino , Previsões , Gastrectomia/tendências , Humanos , Laparoscopia/tendências , Masculino , Obesidade Mórbida/cirurgia , Duração da Cirurgia , Alta do Paciente/estatística & dados numéricos , Alta do Paciente/tendências , Readmissão do Paciente/estatística & dados numéricos , Readmissão do Paciente/tendências , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Centros Cirúrgicos/estatística & dados numéricos , Centros Cirúrgicos/tendências
3.
J Laparoendosc Adv Surg Tech A ; 26(4): 290-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27035739

RESUMO

BACKGROUND: Laparoscopic surgery is considered the standard approach for the treatment of paraesophageal hernias (PEHs). Despite its advantages, this approach is technically demanding with a significant learning curve. Data about the safety and utility of the robotically assisted paraesophageal hernia repair (RA-PEHR) are scarce. The aim of this study is to assess the feasibility and safety of robotic assistance for the treatment of PEH. MATERIALS AND METHODS: Between June 2010 and December 2015, patients who underwent elective RA-PEHR were included in a prospectively collected database. Demographic data, American Society of Anesthesiologists (ASA) classification, preoperative testing, operative time (OT), length of hospital stay (LOS), conversion rate, morbidity, and mortality were recorded and reviewed retrospectively. RESULTS: Sixty-one patients underwent RA-PEHR with mesh, 72% were female (mean age of 63 and mean body mass index [BMI] of 30). ASA classification was 2.6 (57% of patients had an ASA III). With respect to the type of the hernia, the preoperative diagnosis was: Type II 26%, III 64%, and IV 13%. OT averaged 186 minutes (88-360), including robot setup time. After the 16th case, OT significantly decreased by 4.09 minutes (P = .01). There were no conversions. The average blood loss was 51 mL. Perioperative complications, including intraoperative and 30-day complications, were 6% and 23%, respectively. The mean length of hospitalization was 2.6 (1-18) days. There were no deaths. Forty patients (66%) were available for follow-up, and length of follow-up was 17 ± 15 months. Anatomic recurrence was observed in 42% of patients and only 23% of patients were symptomatic. CONCLUSIONS: This report represents the largest series to date of RA-PEHR. RA-PEHR has proved to be feasible and safe with a learning curve comparable to the standard laparoscopic approach.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Estudos de Viabilidade , Feminino , Seguimentos , Hérnia Hiatal/classificação , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Curva de Aprendizado , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Recidiva , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
4.
Biophys Chem ; 128(2-3): 185-96, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17540497

RESUMO

Tetracycline depends on divalent metal ions for its biological function, but its multiple ionization states, conformations, and tautomers at varying solution conditions complicate its ion-binding equilibria, and the stoichiometry of the biologically relevant Ca2+ or Mg2+ complexes has not been clear. Isothermal titration calorimetry was used in the present work to study Ca2+ and Mg2+ binding to tetracycline. The two metal ions bind with distinct stoichiometries, one Ca2+ per tetracycline and one Mg2+ per two tetracyclines, and with differing dependence on solution conditions, indicating that these two ions bind TC differently. An endothermic process accompanies ion binding that is proposed to reflect conformational changes in tetracycline. The results identify conditions that limit the distribution of species and may facilitate structural study.


Assuntos
Cálcio/química , Magnésio/química , Tetraciclina/química , Concentração de Íons de Hidrogênio , Íons , Modelos Moleculares , Estrutura Molecular , Prótons , Sódio/química , Termodinâmica
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