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Stoma was considered enlarged if 2 cm diameter, and pouch enlarged if 6 cm long or 5 cm wide. Results: 275 patients underwent UE and gastric pouch and stoma measurement. Among these were 205 patients (Group 1; 86% female) who had poor weight loss ( 50% EWL) or weight regain post RYGB, and 70 patients (Group 2; 88% female) who had successful weight loss ( 50%EWL), at a mean postoperative time of 6.3 years ( 3.6). Pouch and stoma size were both normal in only 29% of group 1, compared to 43% of group 2 (p 0.03). In group 1, 42% had an enlarged stoma with normal pouch, compared to 27% of group 2 (p 0.03). An enlarged pouch and normal stoma was found in similar proportions in both groups (21% and 15% respectively, p 0.22). Conclusion: Normal sized pouch and stoma are associated with optimal weight loss after RYGB. Patients who don’t lose or regain weight are likely to have abnormal anatomy, particularly stoma enlargement. Further management strategies in these patients may focus on anatomic revision or reinforcement.

Background: The benefit of laparoscopy in the treatment of pediatric acute appendicitis continues to be controversial, particularly as it relates to operative time and costs. Methods: We reviewed the charts of 200 children who underwent appendectomy for acute appendicitis concurrently over 35 months at a large teaching children's hospital. Results: Laparoscopic (n = 106) and open (n = 95) appendectomies were performed. The operative times and postoperative lengths of hospital stay were similar for the two groups. The mean total hospital cost for the laparoscopic group ($5,572) was significantly higher than for the open group ($4,472); (p < 0.01). Conclusions: Notably, the results show similar operative times for laparoscopic and open appendectomy. The cost of laparoscopic appendectomy for acute appendicitis is higher than for the open procedure. This study challenges health care providers to reduce costs and develop new ways to measure beneficial outcomes in a pediatric population that may reveal laparoscopic benefits.