Esophageal Duplication Cysts in 97 Adult Patients: A Systematic Review.

BACKGROUND: Esophageal duplication cysts are a rare congenital cystic malformation from faulty intrauterine recanalization of the esophagus during the 4-8th weeks of development. They account for 20% of all gastrointestinal duplication cysts and commonly involve the distal esophagus. Presenting symptoms may be related to size and location. MATERIALS AND METHODS: Following the PRISMA guidelines, a systematic review was performed by searching published literature in various databases. Data from 97 reported case reports were pooled to present a descriptive and statistical analysis. RESULTS: Patient population was composed of 51(52.5%) males and 46 (47.5%) females, and mean ages was 42.3 years (18-77). Distal cysts were the most prevalent. Seventy-nine (81.4%) patients were symptomatic; common symptoms included dysphagia, chest pain, cough and weight loss. Fifteen (15.5%) patients were treated conservatively and 75 (84.5%) by surgical treatment, among them thoracotomy in 30 (30.9%) patients and VATS in 17 (17.5%) patients. Mean length of hospital stay was 8.6 days (range: 1-26 days). One fatality was registered. Location, unlike size, was not found to influence presenting symptoms or treatment employed. Frequency of conservative treatment was not significantly different between symptomatic and asymptomatic patients. Open approaches were associated with longer stays than their minimally invasive counterparts. CONCLUSION: Esophageal duplication cysts remain rare in adults and are frequently located in the distal esophagus. Larger cysts are more likely to cause symptoms. Various surgical techniques may successfully be employed in the treatment of this pathology. Minimally invasive procedures have a shorter hospital stay.

Revisional Roux-en-Y gastric bypass after failed gastric banding: a case-matched study.

BACKGROUND: Revisional surgery is technically demanding and is usually associated with higher intraoperative and perioperative risks than primary procedures. The objective of this study is to compare outcomes of patients who had gastric bypass procedures performed as a rescue procedure for failed gastric banding, with those who had a primary gastric bypass. MATERIALS AND METHODS: The group of patients undergoing revisional gastric bypass for failed gastric band was matched in a 1:2 ratio with control patients who underwent a primary RYGB, based on gender, score, preoperative body mass index, and comorbidities. Data were retrospectively retrieved. RESULTS: Thirty one (33.3%) patients underwent band removal and gastric bypass (group A) and 62 (66.6%) only primary gastric bypass (group B). Nonsignificant differences were seen in operative time, operative bleeding, or length of stay. Complications were more frequent in group A. Postoperative weight at 12-month follow-up was greater in group A, however, not statistically significant. Changes in weight, both absolute, and percentage were not different between groups. This observation was also true for BMI, in which no significant differences were seen. Overall, mean follow-up was 16 ± 3.2 months. CONCLUSION: Gastric bypass can be performed as revisional bariatric surgery, with low complication rates and acceptable outcomes, though not with the same safety as a primary procedure. Gastric bypass is a satisfactory option for patients with a failed gastric band.

Use of the self-reported critical view of safety in laparoscopic cholecystectomy during residency.

BACKGROUND: Even though the goal of safely performing cholecystectomy is already a priority in general surgical training programs, we aimed to study how many residents and attendings reached the critical view of safety (CVS) in laparoscopic cholecystectomy. MATERIALS AND METHODS: Retrospective review of prospectively collected data of all patients with biliary surgical conditions, which underwent laparoscopic cholecystectomy and their corresponding postoperative notes with self-reported CVS from May 2019 to May 2020 in an academic hospital. Comparisons of operative variables between postgraduate year and attendings were made. RESULTS: Laparoscopic cholecystectomy was performed in 126 elective cases (62.6%) and 75 (37.3%) emergency cases. On 105 (83.3%) of the elective cases and on 54 (66.7%) emergency cases, a CVS was successfully performed. PGY3 and PGY5 had higher odds of achieving CVS compared to attendings OR 6.09 (95% CI 2.05 to 8.07) and 4.51 (95% CI 1.0 to 10.20), respectively. Overall, attendings had decreased odds ratio of achieving CVS of 0.488 when compared to all residents. Elective procedures had increased odds ratios of achieving CVS of 3.44 (95% CI 1.52 to 7.74). On elective cases, attendings performed significantly faster procedures when compared to PGY2-4, but not PGY5. No differences were seen between operative speeds between PGY. Third-year residents were identified as having the highest frequency of CVS; however, these differences were not statistically significant. In emergency cases, blood loss, operative time, CVS, and bile duct injuries revealed non-significant differences between operators. CONCLUSION: CVS was reached significantly more often in elective than in emergency surgeries. There is still a lack of residents and attending surgeons who still failed to complete CVS during LC, highlighting the need for further education. Future studies should be attempted to repeat this study with a larger sample size and multiple coaching sessions to determine long-term efficacy.

Pregnant patients with internal hernia after gastric bypass: a single-center experience.

BACKGROUND: Bariatric surgery has been a popular way for many women to reach a healthy body mass index, and as a consequence, a decreased body mass, which causes a greater chance of fertility, with improved pregnancy and better maternal outcomes. OBJECTIVE: Describe a single-center experience of pregnancies complicated by internal hernias after gastric bypass. SETTING: Academic Medical Center. METHODS: During 2011 and 2019 a series of patients were treated for internal hernia after gastric bypass at our teaching hospital. The hospital records were retrospectively reviewed. RESULTS: Seven women were treated. Median age was 33 years (range: 24-39 yr). Median gestational age was 25.6 weeks (range: 5-33 wk). Median time from Roux-en-Y gastric bypass to pregnancy was 4 years (range: 1-7 yr). Median body mass index was 24 kg/m2 (range: 24-31 kg/m2). Five (71.4%) patients underwent an exploratory laparotomy, and 2 (28.5%) patients a diagnostic laparoscopy. In all patients, an internal hernia of the small bowel in the Petersen space was encountered. Median length of pregnancy was 38 weeks (range: 33.6-39.6 wk). Six (85.7%) patients underwent C-section, and 1 (14.2%) patient gave birth by vaginal delivery. There was only 1 maternal postoperative complication and no fetal postoperative complications. Median follow-up was 9 months (range: 2-20 mo). CONCLUSION: The rapid growth in bariatric surgery on obese women of fertile age could result in more cases of internal herniation during pregnancy in the future. An internal hernia should be suspected when encountering a postgastric bypass pregnant patient with abdominal pain, nausea, and vomiting.

Transferring face-to-face sessions to virtual sessions in surgical education: a survey-based assessment of a single academic general surgery program.

BACKGROUND: The purpose of this survey-based study was to evaluate the implementation of virtual learning in a single academic general surgery program, compared with the well-established face-to-face academic curriculum used before. METHODS: From April 2020 to the present, virtual sessions were created via Zoom Videos Communications, Inc. (San Jose, CA, USA). A survey composed of 15 questions about the perceived quality and utility of the virtual sessions was developed. The survey was sent out to all general surgery residents of a general surgery program in November of 2020. RESULTS: All residents enrolled in the program answered the survey, i.e., 22 (73.3%) men and 8 (26.7%) women with 6 (20.2%) residents per year (PGY 1-PGY 5). Over half of residents (n = 17, 56.7%) felt similar academic performance during online sessions when compared to the older model. Perceptions of the level of organization of academic sessions increased during the online model (n = 20, 66.7%). Twenty (66.7%) residents agreed it was easier to attend sessions during the online model. Fourteen (46.7%) residents reported their attendance to the sessions increased, and 14 (46.7%) residents would prefer this modality after the pandemic is over, with 8 (26.7%) being neutral about it. CONCLUSION: This study, to our knowledge, is the first to survey general surgery residents about the transition from a face-to-face curriculum to an e­learning curriculum. The demonstrated effectiveness of the transition from face-to-face academic activities to virtual activities makes it a feasible tool for graduate medical education programs to adjust to a virtual model.

Single-operator cholangioscopy and electrohydraulic lithotripsy for the treatment of Mirizzi syndrome.

INTRODUCTION: Mirizzi syndrome is an infrequent complication of long-standing cholelithiasis. Extrinsic compression of the common hepatic duct is usually caused by an impacted stone in Hartmann's pouch or cystic duct resulting in the development of cholecystobiliary fistula. This syndrome is classified based on the presence and severity of cholecystobiliary fistula. Mirizzi syndrome is challenging to diagnose preoperatively and may require complex biliary surgical procedures for resolution. RESULTS: We present three patients with Mirizzi syndrome with different clinical presentations. All were successfully treated by cholangioscopy with electrohydraulic lithotripsy. Endoscopic treatment is a safe alternative with a high success rate. Single-operator cholangioscopy combined with lithotripsy has been shown to have a 90-100% success rate in the treatment of biliary stones. CONCLUSION: Herein, we present our experience treating Mirizzi syndrome with single-operator cholangioscopy guided electrohydraulic lithotripsy. Difficult management of Mirizzi syndrome has led to research of new treatment options to minimize the risk of high-rate complications. Single-operator cholangioscopy in combination with laser lithotripsy is an adequate and safe alternative for the treatment of this condition.

Solitary ulcer in cecum, mimicking a carcinoma: A case report.

INTRODUCTION: Solitary ulcers in the colon are rare and infrequent; little over 200 cases have been reported in medical literature. We present a case of a patient presenting with a solitary colonic ulcer associated with NSAIDs intake, mimicking a malignant lesion. A review of the literature is also revised. PRESENTATION OF CASE: 68- year-old female patient with past history of nonsteroidal anti-inflammatory drugs (NSAID) intake for chronic pain, complaining of severe abdominal pain was admitted to our teaching hospital. The diagnosis of a low-grade dysplasia was made with colonoscopy and biopsy, a malignant lesion could not be ruled out. A laparoscopy right colectomy was performed without complications. The final diagnosis resulted in a solitary cecal ulcer. DISCUSSION: The majority of the cases of solitary colonic ulcers occur in the ascending colon, at the cecum, which has been attributed mostly to the intake of NSAIDs. There could be solitary colonic ulcers in other portions of the large intestine, caused by different etiologies: ischemia, inflammatory disease, sterocoraceus ulcers, ulcers caused by infections, among other more uncommon causes. The diagnosis is often made through a biopsy of the tissue during a colonoscopy, with either surgical or conservative care. CONCLUSION: The diagnosis of solitary cecal ulcer should be considered in patients presenting with RLQ abdominal pain and with history of NSAIDs consumption. Recognition of this diagnosis by surgeons, ruling out malignancies, understanding the morphologic features, and carefully taking the patient's history are essential for the diagnosis and treatment of this uncommon disease.

[Omental torsion. Case Report]. / Torsión de epiplón. Reporte de caso.

BACKGROUND: Omental torsion is an infrequent cause of acute abdomen and its symptoms are non-specific, often presenting with pain at the right iliac fossa as the only symptom. Its aetiology remains unknown, but different risk factors have been associated with the disease, including obesity, congenital malformations, and tumours. These risk factors have been classified as predisposing or triggering, primary or secondary, and external or internal. CLINICAL CASE: The is a case of a 24-year-old male who complained about pain in the right iliac fossa without any other symptoms. The diagnosis was acute appendicitis, but during the laparoscopic approach, omental torsion was found. CONCLUSION: The diagnosis of omental torsion is is complex. However, computed tomography and ultrasound have been used successfully. The treatment for omental torsion is the resection of necrotised tissue by a laparoscopic approach.