Outcomes of Bariatric Surgery With Concomitant Hiatal Hernia Repair Using an Absorbable Tissue Matrix.

BACKGROUND: Hiatal hernias are a common finding in patients who undergo bariatric surgery with an incidence of about 20% of all bariatric patients. Controversy exists on the utility of a biosynthetic tissue matrix (BTM) usage in combination with crural repair. This study was designed to explore the safety and benefits of the use of a BTM during concomitant hiatal hernia repair with bariatric surgical procedures. METHODS: This was a retrospective chart review of bariatric surgical patients who underwent a concomitant hiatal hernia repair at a single practice at a tertiary academic medical center from January 2014 to February 2019. RESULTS: A total of 420 patients were reviewed. Hiatal BTM reinforcement, recurrence, and postoperative proton pump inhibitor use were reported by type of operation. Recurrence was higher in gastric bypass patients who underwent hiatal hernia repair with suture cruroplasty alone vs. those who also underwent hiatal BTM reinforcement (7.1% vs. 3.7%, P = .52) and significantly higher in gastric sleeve patients who underwent hiatal hernia repair with suture cruroplasty alone vs. those who also underwent hiatal BTM reinforcement (7.1% vs. .5%, P = .01). No patient required reoperation for hiatal hernia recurrence. DISCUSSION: Performing Roux-en-Y gastric bypass or vertical sleeve gastrectomy with concomitant hiatal hernia repair is safe and durable. Employing crural reinforcement with BTM may be of benefit in reducing recurrence rates of hiatal hernia, particularly in sleeve gastrectomy patients.

Outcomes of total hip arthroplasty in patients with osteonecrosis of the femoral head-a current review.

The purpose of this review was to analyze (1) patient-reported outcomes and implant survivorship of osteonecrosis (ON) patients following total hip arthroplasty (THA), (2) if prior hip-preserving procedures influence these outcomes, (3) if resurfacing procedures alter outcomes; and (4) how these outcomes may have been impacted by the choice of different bearing surfaces. Today, with implant innovations such as cementless constructs, ceramic bearing surfaces, and highly cross-linked polyethylene, ON patients derive great benefit and have high survivorship following THA. Most studies have shown that previous hip-preserving procedures do not have a deleterious effect on outcomes. Literature on the use of ceramic and highly cross-linked polyethylene bearing surfaces have shown that these implant designs are useful in younger and more active patients. Future research should evaluate the long-term outcomes and survivorship of these new THA constructs.

The humanitarian emergency in Burundi: evaluation of the operational strategy for management of nutritional crisis.

OBJECTIVE: To evaluate the impact and appropriateness of programmes for the management and treatment of severe malnutrition in emergency situations. DESIGN: A central unified database was set up with all data and statistics provided by nutritional centres (NC) active in Burundi. SETTING: The paper describes the case of Burundi as an example of the response of the humanitarian community to nutritional crisis. SUBJECTS: Since 1999, more than one million (1,054,210) severely malnourished patients were treated in NC established in Burundi. RESULTS: Peaks of beneficiaries were registered in 2000 and 2001; the admission rate started to decrease in 2002. In 2004, twenty therapeutic feeding centres (TFC) and 224 supplementary feeding centres (SFC) were active for the treatment of 127,420 beneficiaries. Nutritional programmes were present in every province with a coverage rate of 55%. The most convincing impact of the nutritional programme in Burundi was the reduction of mortality rate in children under 5 years of age; an impact on the prevalence of acute malnutrition could not be demonstrated. Children under 5 years old accounted for 62% of beneficiaries in TFC and 76% in SFC. TFC performance indicators fulfilled the minimum standards in disaster response; the performance of SFC was not so optimal with a low recovery rate (69% v. >80%) and a high non-respondent rate (16% v. <5%). With the combination of coverage and cure rate, the programme met 44% of the assessed needs in 2004. CONCLUSIONS: In Burundi the stabilisation of security conditions permitted a combination of humanitarian responses ranging from emergency activities to strengthening of community-based initiatives that could correct the coverage and impact limitations.

Malnutrition in food-surplus areas: experience from nutritional surveillance for decentralized planning in Haiti.

In Haiti, a novel approach to nutritional surveillance was developed on the basis of a low-cost, simple-to-repeat set of household surveys in all nine administrative departments using sentinel community sites. This system allows each department to independently conduct follow-up surveys as needed. The results of the first round of surveys conducted in 1995 show lower malnutrition rates in typical food-deficient departments and high levels of malnutrition in several food-surplus areas. Further analyses underscore the importance of variables related to child-care practices and of care-enabling factors such as household food security, health environment, and caregivers' time and education. These findings challenge the traditional thinking among a majority of Haitian policy makers who look at the malnutrition problem solely from the perspective of local food production.