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Background: BMI is a risk factor for recurrence and post-operative complications in both open and laparoscopic totally extraperitoneal approach (TEP) repair. Robotic surgery using the transabdominal preperitoneal approach (TAPP) is a safe and viable option for inguinal hernia repair (IHR). The objective of this study is to determine how difference in BMI influences rate of operative time, complications, and rate of recurrence in a robotic TAPP IHR. Methods: We performed a retrospective review of patients who underwent robotic inguinal hernia repair between 2012 and 2019 at a Veterans Health Administration facility (N = 304). The operating time, outcomes, and overall morbidity and mortality for robotic IHR were compared between three different BMI Groups. These groups were divided into: "Underweight/Normal Weight" (BMI < 25) n = 102, "Pre-Obese" (BMI 25–29.9) n = 120, and "Obese" (BMI 30 +) n = 82. Results: The average operating time of a bilateral IHR by BMI group was 83.5, 98.4, and 97.8 min for BMIs < 25, 25–29.9, and 30 +, respectively. Operating time was lower in the Underweight/Normal BMI group compared to the Pre-Obese group (p = 0.006) as well as the Obese group (p = 0.001). For unilateral repair, the average operation length by group was 65.2, 70.9, and 85.6 min for BMIs < 25, 25–29.9, and 30 +, respectively, demonstrating an increased time for Obese compared to Underweight/Normal BMI (p = 0.001) and for Obese compared to Pre-Obese (p = 0.01). Demographic/comorbidity variables were not significantly different, except for a higher percentage of white patients in the Underweight/Normal BMI group compared to the Pre-Obese and Obese groups (p = 0.02 and p = 0.0003). There was no significant difference in complications or recurrence. Conclusion: BMI has a significant impact on the operating time of both unilateral and bilateral robotic hernia repair. Despite this increased operative time, BMI group did not differ significantly in postoperative outcomes or in recurrence rates. [ABSTRACT FROM AUTHOR]

Background: Hiatal Hernia Repairs (HHR) are performed by both general surgeons (GS) and thoracic surgeons (TS). However, there are limited literature with respect to outcomes of HHR based on specialty training. The objective of this study was to compare the utilization, perioperative outcomes, and cost for HHR performed by GS versus TS.Methods: The Vizient database was used to identify patients who underwent elective laparoscopic HHR between October 2014 and June 2018. Patients were grouped according to surgeon's specialty (GS vs. TS). Patient demographics and outcomes including in-hospital mortality were compared between groups.Results: During the study period 13,764 patients underwent HHR by either GS or TS. GS performed 9930 (72%) cases while TS performed 3834 (28%) cases. There was no significant difference between GS versus TS with regard to serious morbidity (1.28% vs. 1.30%, p = 0.97) or mortality (0.10% vs. 0.21%, p = 0.19). The mortality index was 0.24 for GS versus 0.45 for TS. Compared to TS, laparoscopic HHR performed by GS was associated with a shorter LOS (2.57 days vs. 2.72 days, p < 0.001) and lower mean hospital costs ($7139 vs. $8032, p < 0.0001).Conclusions: Within the context of academic centers, laparoscopic HHRs are mostly performed by GS with comparable outcome between general versus thoracic surgeons. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sleeve gastrectomy has become the procedure of choice for the treatment of morbid obesity. Robotic sleeve gastrectomy is an alternative surgical option, but its utilization has been low. The aim of this study was to evaluate the contemporary outcomes of robotic sleeve gastrectomy (RSG) versus laparoscopic sleeve gastrectomy (LSG) using a national database from accredited bariatric centers.Study Design: Using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, clinical data for patients who underwent RSG or LSG were examined. Emergent and revisional cases were excluded. A multivariate logistic regression model was utilized to compare the outcomes between RSG and LSG.Results: A total of 75,079 patients underwent sleeve gastrectomy with 70,298 (93.6%) LSG and 4781 (6.4%) RSG. Preoperative sleep apnea and hypoalbumenia were significantly higher in the RSG group (P < 0.01). Mean length of stay was similar between RSG and LSG (1.8 ± 2.0 vs. 1.7 ± 2.0 days, P = 0.17). Operative time was longer in the RSG group (102 ± 43 vs. 74 ± 36 min, P < 0.01). There was no significant difference in 30-day mortality between the RSG versus LSG group (0.02% vs. 0.01%, AOR 0.85; 95% CI 0.11-6.46, P = 0.88). However, RSG was associated with higher serious morbidity (1.1% vs. 0.8%, AOR 1.40; 95% CI 1.05-1.86, P < 0.01), higher leak rate (1.5% vs. 0.5%, AOR 3.14; 95% CI 2.65-4.42, P < 0.01), and higher surgical site infection rate (0.7% vs. 0.4%, AOR 1.55; 95% CI 1.08-2.23, P = 0.01).Conclusions: Robotic sleeve gastrectomy has longer operative time and is associated with higher postoperative morbidity including leak and surgical site infections. Laparoscopy should continue to be the surgical approach of choice for sleeve gastrectomy. [ABSTRACT FROM AUTHOR]

Morbidly obese patients often have impaired respiratory mechanics leading to restrictive and obstructive lung diseases. Weight loss after bariatric surgery has been shown to improve or resolve many obesity-related comorbidities. However, few studies have examined long-term changes in pulmonary mechanics after bariatric surgery. We hypothesize that pulmonary function improves after surgically induced weight loss. We examined the pulmonary function of 104 morbidly obese patients who underwent laparoscopic gastric bypass or gastric banding. Pulmonary studies, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and forced expiratory volume at midexpiratory phase (FEV25–75%) were measured preoperatively and at 3-month intervals. All results are expressed as a percentage of the baseline values. There were 80 females and 24 males with a mean age of 41 years. The mean body mass index was 48 kg/m2. The mean percentage of excess body weight loss at 12 months was 54%. At 12 months postoperatively, restrictive pulmonary mechanics significantly improved as demonstrated by an increase in the FEV1 to 112% of baseline value, increase in the FVC to 109% of baseline value, increase in the PEF to 115% of baseline value, and increase in the FEV25–75% to 130% of baseline value. Additionally, the percentage of patients with obstructive lung pattern (FEV1/FVC ratio less than 0.8) decreased from 9.6% preoperatively to 1.9% postoperatively ( p = 0.03). Weight loss after laparoscopic gastric bypass significantly improves restrictive and obstructive respiratory mechanics. The improvements were observed as early as 3 months postoperatively. [ABSTRACT FROM AUTHOR]

Introduction: Gastric cardia cancer with involvement of the esophagus may require an esophagogastrectomy to obtain negative tumor margins. Multiple studies have shown that minimally invasive esophagectomy is a safe approach for the treatment of esophageal cancer [1-3]. We describe the technique of a minimally invasive Ivor-Lewis esophagectomy in a 55-year-old patient with a gastric cardia tumor.Methods: In the laparoscopic phase, diagnostic laparoscopy was negative for metastasis. The stomach and distal esophagus were mobilized. The stomach was divided distal to the tumor and a thin gastric conduit was created. The specimen was removed through an extended abdominal port. In the thoracoscopic phase, the esophagus was mobilized. To ensure adequate proximal margins the esophageal stump was divided 1 cm below the azygous vein. A gastroesophageal anastomosis was created using a circular stapler.Results: Total operative time was 210 min (laparoscopic time, 135 min; thoracoscopic time, 75 min). There were no intraoperative complications. Tumor margins were negative and there were 44 lymph nodes harvested. On postoperative day 2 the patient was transferred to the surgical floor and started on enteral feeds. On postoperative day 4 the esophagram was negative for leaks or obstruction. Patient was started on an oral diet and discharged on postoperative day 5. Final pathology revealed a T3N1M0 (stage III) gastric cardia tumor. The patient underwent adjuvant chemoradiation therapy and at 15 months postoperatively the patient was recurrence free.Conclusion: We recently reported our experience with 104 minimally invasive esophagectomy procedures, of which seven patients had a diagnosis of gastric cardia cancer [4]. The mean number lymph nodes harvested was 23 ± 12. Minimally invasive Ivor-Lewis esophagogastrectomy for the treatment of gastric cardia cancer is technically feasible and safe for large gastric cardia tumors. [ABSTRACT FROM AUTHOR]

Gastric cardia cancer with involvement of the esophagus may require an esophagogastrectomy to obtain negative tumor margins. Multiple studies have shown that minimally invasive esophagectomy is a safe approach for the treatment of esophageal cancer [–]. We describe the technique of a minimally invasive Ivor–Lewis esophagectomy in a 55-year-old patient with a gastric cardia tumor. In the laparoscopic phase, diagnostic laparoscopy was negative for metastasis. The stomach and distal esophagus were mobilized. The stomach was divided distal to the tumor and a thin gastric conduit was created. The specimen was removed through an extended abdominal port. In the thoracoscopic phase, the esophagus was mobilized. To ensure adequate proximal margins the esophageal stump was divided 1 cm below the azygous vein. A gastroesophageal anastomosis was created using a circular stapler. Total operative time was 210 min (laparoscopic time, 135 min; thoracoscopic time, 75 min). There were no intraoperative complications. Tumor margins were negative and there were 44 lymph nodes harvested. On postoperative day 2 the patient was transferred to the surgical floor and started on enteral feeds. On postoperative day 4 the esophagram was negative for leaks or obstruction. Patient was started on an oral diet and discharged on postoperative day 5. Final pathology revealed a T3N1M0 (stage III) gastric cardia tumor. The patient underwent adjuvant chemoradiation therapy and at 15 months postoperatively the patient was recurrence free. We recently reported our experience with 104 minimally invasive esophagectomy procedures, of which seven patients had a diagnosis of gastric cardia cancer []. The mean number lymph nodes harvested was 23 ± 12. Minimally invasive Ivor–Lewis esophagogastrectomy for the treatment of gastric cardia cancer is technically feasible and safe for large gastric cardia tumors. [ABSTRACT FROM AUTHOR]