Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Sep 2008
Comparative StudySurgical specialization and operative mortality in hepato-pancreatico-biliary (HPB) surgery.
Surgeon specialization has been shown to result in improved outcomes but may not be the sole measure of surgical quality in hepato-pancreatico-biliary (HPB) surgery. We attempted to determine which factors predominate in optimal patient outcomes between volume, surgeon, and hospital resources. ⋯ Non-TX surgeons performed the majority of pancreatic and liver surgery in the US. Hospital factors like support of transplantation but not surgical specialty, appeared to impact operative mortality. Future regulatory benchmarks should consider these types of center-based facilities and resources to assess patient outcomes.
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J. Gastrointest. Surg. · Sep 2008
Comparative StudyBehavior of the infection by Helicobacter pylori of the gastric remnant after subtotal gastrectomy and Roux-en-Y anastomosis for benign diseases.
Reinfection by Helicobacter pylori of the gastric remnant after partial gastrectomy has been implicated in the development of gastric cancer at the gastric stump. ⋯ After partial gastrectomy and Roux-en-Y anastomosis for benign disease, there are three different patterns of behavior regarding reinfection or not by H. pylori. A total of 41% of patients presented H. pylori reinfection at the gastric remnant after Roux-en-Y anastomosis, which increased parallel to the length of follow-up.
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J. Gastrointest. Surg. · Aug 2008
Comparative StudyInterval period tumor progression: does delayed hepatectomy detect occult metastases in synchronous colorectal liver metastases?
Rapid remnant liver recurrence in patients with synchronous colorectal liver metastases (CRLM) is occasionally experienced after simultaneous colorectal and liver resection. We evaluated the tumor progression during interval periods to determine whether delayed hepatic resection detects occult metastases. ⋯ Tumor progression was recognized and occult metastases were detected after the interval reevaluation. Delayed hepatectomy may be a useful approach to reduce rapid remnant liver recurrence in synchronous CRLM.
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J. Gastrointest. Surg. · Aug 2008
Comparative StudyEvaluation of surgical outcomes and gallbladder characteristics in patients with biliary dyskinesia.
This study was designed to compare symptomatic outcomes following cholecystectomy in patients with biliary dyskinesia. ⋯ The results of this study suggest that biliary dyskinesia should be considered as part of the spectrum of symptomatic gallbladder disease that can be successfully treated with cholecystectomy and that biliary dyskinesia is associated with GERD and gastritis.
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J. Gastrointest. Surg. · Aug 2008
Comparative StudyMortality rate associated with 56 consecutive esophagectomies performed at a "low-volume" hospital: is procedure volume as important as we are trying to make it?
Esophagectomy procedures have been associated with high morbidity and mortality rates. Recent articles in the literature have focused on the relationship between operative volume and the rates of mortality and morbidity in association with esophagectomy. The common theme among these publications is the statistically significant correlation between high-volume centers (typically defined as at least 10 esophagectomies per year) and lower mortality rates. The authors hypothesized that an individual surgeon's expertise with the various esophagectomy procedures would better correlate to mortality rates than the absolute number performed in an institution per year. ⋯ If low-volume esophagectomy centers are to be defined in the literature as completing <10 procedures per year, then these data represent such an institution. While several authors have demonstrated a correlation between lower mortality rates and high-volume esophagectomy hospitals, our results support surgeon experience as potentially being more significant than absolute number of procedures performed in an institution per year.