BMC Surg. 2011; 11: 13.
Published online 2011 June 9. doi: 10.1186/1471-2482-11-13 PMCID: PMC3141363
Copyright ©2011 Sikirica et al; licensee BioMed Central Ltd.
The inpatient burden of abdominal and gynecological adhesiolysis in the US
Vanja Sikirica,1 Bela Bapat,2 Sean D Candrilli,2 Keith L Davis,2 Malcolm Wilson,3 and Alan Johns4
1Shire Pharmaceuticals, Wayne, PA 19087 USA
2RTI Health Solutions, 200 Park Offices, Research Triangle Park, NC 27709 USA
3The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
4Texas Health Care, Fort Worth, TX 76109 USA
Corresponding author.
Vanja Sikirica: vsikirica@shire.com; Bela Bapat: bbapat@rti.org; Sean D Candrilli: scandrilli@rti.org; Keith L Davis: kldavis@rti.org; Malcolm Wilson: Malcolm.Wilson@christie.nhs.uk; Alan Johns: daj@womenssurgerygroup.com
Received January 5, 2011; Accepted June 9, 2011.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Other Sections▼
AbstractBackgroundMethodsResults and DiscussionConclusionsCompeting interestsAuthors' contributionsFundingPre-publication historyReferencesAbstractBackground
Adhesions are fibrous bands of scar tissue, often a result of surgery, that form between internal organs and tissues, joining them together abnormally. Postoperative adhesions frequently occur following abdominal surgery, and are associated with a large economic burden. This study examines the inpatient burden of adhesiolysis in the United States (i.e., number and rate of events, cost, length of stay [LOS]).Methods
Hospital discharge data for patients with primary and secondary adhesiolysis were analyzed using the 2005 Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. Procedures were aggregated by body system.Results
We identified 351,777 adhesiolysis-related hospitalizations: 23.2% for primary and 76.8% for secondary adhesiolysis. The average LOS was 7.8 days for primary adhesiolysis. We found that 967,332 days of care were attributed to adhesiolysis-related procedures, with inpatient expenditures totaling $2.3 billion ($1.4 billion for primary adhesiolysis; $926 million for secondary adhesiolysis). Hospitalizations for adhesiolysis increased steadily by age and were higher for women. Of secondary adhesiolysis procedures, 46.3% involved the female reproductive tract, resulting in 57,005 additional days of care and $220 million in attributable costs.Conclusions
Adhesiolysis remain an important surgical problem in the United States. Hospitalization for this condition leads to high direct surgical costs, which should be of interest to providers and payers.Keywords: Adhesions, adhesiolysis, abdominal, gynecological, burden of illness, hospitalizations.
Read Full Abstract here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141363/?tool=pmcentrez
Showing posts with label gastric bypass. Show all posts
Showing posts with label gastric bypass. Show all posts
Monday, October 24, 2011
Thursday, February 10, 2011
Peterson's Hernia after Gastric Bypass
A terrifying account of emergency adhesiolysis 10 years after a gastric bypass.
This was tricky. A middle aged lady ten years status post laparoscopic gastric bypass surgery (Roux en Y configuration) presented with crampy abdominal pain and nausea. Her plain films showed multiple dilated loops of small bowel. So I got a CT scan to better delineate the anatomy.
Bowel obstructions in Roux-n-Y gastric bypass patients always make me a little nervous. As opposed to garden variety, adhesion-mediated obstructions in people with normal anatomy, conservative treatment often fails in these patients. For one thing, you cannot adequately decompress them with nasogastric suction. Furthermore, the incidence of internal hernias is much higher, owing to the altered anatomy of the procedure (roux limbs and split mesenteries etc). So going into these cases, your threshold for surgery has to be exponentially higher than normal.
The scan above shows a subtle spiralling of some small bowel mesenteric vessels in the area where one would normally find the jejunojejunal anastomosis. Single views don't do the pathology justice; you really have to be able to scroll up and down through the loops of bowel on the scan. The patient looked uncomfortable, was tender, and I just didn't feel like dicking around for much longer. So I explored her in the OR.
She'd had two previous surgeries, prior to her gastric bypass even, for bowel obstructions secondary to an old hysterectomy, so things were pretty confusing, anatomically speaking, when I first entered her peritoneal cavity. The jejunojejunostomy appeared to be corkscrewed. That was clear enough from the beginning. Then I identified a decompressed limb of bowel going up to the gastric pouch (roux limb, a ha!). And then it looked like a bunch of small bowel had slipped through a space between the roux limb and the transverse mesocolon---classic Petersen's defect. Unfortunately, however, the bowel didn't want to slide back out of the space right away. It was stuck somewhere else further downstream. So I basically had to perform a full adhesiolysis of bowel, starting from terminal ileum and working back. To keep things organized, I literally had to place identifying stitches in the serosa of the proximal bowel as I flipped things back and forth. A couple of times it got a little hairy as the bowel started to turn bluish and I had to reverse my maneuvers, untwist things the correct way. Finally I freed everything up and the bulk of the small bowel was liberated, came rushing out from behind the defect. Looking down, the J-J anastomosis was normal again, the corkscrew configuration gone. I closed the defect, put in some voodoo-ish anti-adhesive Seprafilm and got the hell out.
Click on link to see imaging and read comments:
http://ohiosurgery.blogspot.com/2009/12/petersons-defect.html
This was tricky. A middle aged lady ten years status post laparoscopic gastric bypass surgery (Roux en Y configuration) presented with crampy abdominal pain and nausea. Her plain films showed multiple dilated loops of small bowel. So I got a CT scan to better delineate the anatomy.
Bowel obstructions in Roux-n-Y gastric bypass patients always make me a little nervous. As opposed to garden variety, adhesion-mediated obstructions in people with normal anatomy, conservative treatment often fails in these patients. For one thing, you cannot adequately decompress them with nasogastric suction. Furthermore, the incidence of internal hernias is much higher, owing to the altered anatomy of the procedure (roux limbs and split mesenteries etc). So going into these cases, your threshold for surgery has to be exponentially higher than normal.
The scan above shows a subtle spiralling of some small bowel mesenteric vessels in the area where one would normally find the jejunojejunal anastomosis. Single views don't do the pathology justice; you really have to be able to scroll up and down through the loops of bowel on the scan. The patient looked uncomfortable, was tender, and I just didn't feel like dicking around for much longer. So I explored her in the OR.
She'd had two previous surgeries, prior to her gastric bypass even, for bowel obstructions secondary to an old hysterectomy, so things were pretty confusing, anatomically speaking, when I first entered her peritoneal cavity. The jejunojejunostomy appeared to be corkscrewed. That was clear enough from the beginning. Then I identified a decompressed limb of bowel going up to the gastric pouch (roux limb, a ha!). And then it looked like a bunch of small bowel had slipped through a space between the roux limb and the transverse mesocolon---classic Petersen's defect. Unfortunately, however, the bowel didn't want to slide back out of the space right away. It was stuck somewhere else further downstream. So I basically had to perform a full adhesiolysis of bowel, starting from terminal ileum and working back. To keep things organized, I literally had to place identifying stitches in the serosa of the proximal bowel as I flipped things back and forth. A couple of times it got a little hairy as the bowel started to turn bluish and I had to reverse my maneuvers, untwist things the correct way. Finally I freed everything up and the bulk of the small bowel was liberated, came rushing out from behind the defect. Looking down, the J-J anastomosis was normal again, the corkscrew configuration gone. I closed the defect, put in some voodoo-ish anti-adhesive Seprafilm and got the hell out.
Click on link to see imaging and read comments:
http://ohiosurgery.blogspot.com/2009/12/petersons-defect.html
Sunday, June 22, 2008
Doctor performs rare surgery in Cedar Falls
By CJ HINES, Courier Correspondent
CEDAR FALLS --- Of the 11 cases of a rare laparoscopic surgery reported worldwide, one has been performed here in the Cedar Valley.Dr. J. Matthew Glascock, medical director for the Midwest Institute of Advanced Laparoscopic Surgery located at Sartori Memorial Hospital, heads the team of medical professionals who recently performed a laparoscopic Roux-ex-Y gastric bypass with visceral malrotation.Visceral malrotation is the twisting of the intestines, which occurs in the womb, Glascock said. While 75 percent of patients with malrotation are diagnosed by the age of 1, 25 percent aren't diagnosed until adulthood. These are usually discovered when the patient is undergoing another procedure or during an autopsy.While Glascock routinely performs the Roux-ex-Y gastric bypass operation, it is rare to perform one with a patient with visceral malrotation."It is an anomaly," Glascock said. "In normal anatomy, the person's large intestine frames the small intestines with the appendix in the lower righthand side of the abdomen. A person with visceral malrotation, everything is opposite. The large intestine and appendix are on the left side of the abdomen and the small intestine is on the right. The supporting structure never develops."Visceral malrotation occurs in 1 in 500 births in the United States, according to the Nemours Foundation, a national children's health care system and beneficiary of the Alfred I. duPont Testamentary Trust.Most people diagnosed with this condition have a Ladd's procedure during childhood, which involves removing the appendix and cutting the Ladd's bands, which are adhesions that attach from the beginning of the intestine to the abdominal wall.
The first gastric bypass patient identified with visceral malrotation had the surgery canceled and returned later for a gastric banding procedure.Approximately a year ago, Glascock encountered a second bypass patient with visceral malrotation while performing laparoscopic surgery. While the patient was still in the operating room, he discussed options with the patient's wife."Options offered were discontinuing surgery, changing the operation to adjustable gastric banding or converting to a laparotomy and attempting gastric bypass. The patient's wife elected converting from laparoscopy (done with scopes) to laparotomy (open incision) and gastric bypass with Ladd's procedure," said Sherri Greenwood, Sartori Hospital administrator and institute co-director. "The procedure was successfully completed."
Read More
http://www.wcfcourier.com/articles/2007/12/22/news/metro/c835535714319d50862573b9001492db.txt
CEDAR FALLS --- Of the 11 cases of a rare laparoscopic surgery reported worldwide, one has been performed here in the Cedar Valley.Dr. J. Matthew Glascock, medical director for the Midwest Institute of Advanced Laparoscopic Surgery located at Sartori Memorial Hospital, heads the team of medical professionals who recently performed a laparoscopic Roux-ex-Y gastric bypass with visceral malrotation.Visceral malrotation is the twisting of the intestines, which occurs in the womb, Glascock said. While 75 percent of patients with malrotation are diagnosed by the age of 1, 25 percent aren't diagnosed until adulthood. These are usually discovered when the patient is undergoing another procedure or during an autopsy.While Glascock routinely performs the Roux-ex-Y gastric bypass operation, it is rare to perform one with a patient with visceral malrotation."It is an anomaly," Glascock said. "In normal anatomy, the person's large intestine frames the small intestines with the appendix in the lower righthand side of the abdomen. A person with visceral malrotation, everything is opposite. The large intestine and appendix are on the left side of the abdomen and the small intestine is on the right. The supporting structure never develops."Visceral malrotation occurs in 1 in 500 births in the United States, according to the Nemours Foundation, a national children's health care system and beneficiary of the Alfred I. duPont Testamentary Trust.Most people diagnosed with this condition have a Ladd's procedure during childhood, which involves removing the appendix and cutting the Ladd's bands, which are adhesions that attach from the beginning of the intestine to the abdominal wall.
The first gastric bypass patient identified with visceral malrotation had the surgery canceled and returned later for a gastric banding procedure.Approximately a year ago, Glascock encountered a second bypass patient with visceral malrotation while performing laparoscopic surgery. While the patient was still in the operating room, he discussed options with the patient's wife."Options offered were discontinuing surgery, changing the operation to adjustable gastric banding or converting to a laparotomy and attempting gastric bypass. The patient's wife elected converting from laparoscopy (done with scopes) to laparotomy (open incision) and gastric bypass with Ladd's procedure," said Sherri Greenwood, Sartori Hospital administrator and institute co-director. "The procedure was successfully completed."
Read More
http://www.wcfcourier.com/articles/2007/12/22/news/metro/c835535714319d50862573b9001492db.txt
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