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J Esteban Varela

Publications and source records attributed to J Esteban Varela.

8 recordsLinked to original sources
PubMed2006

Comparison of laparoscopic and open gastrectomy for gastric cancer.

BACKGROUND: The role of minimally invasive gastrectomy in the treatment of gastric cancer is not well defined. The aim of the current study was to compare the operative outcomes and adequacy of resection of laparoscopic gastrectomy compared to open gastrectomy for gastric cancer. METHODS: The clinical course of 15 consecutive patients who underwent minimally invasive gastrectomy or esophagogastrectomy for gastric cancer were compared with that of 21 patients who underwent open gastrectomy. Main outcome measures included operative time, blood loss, length of stay, morbidity, 30-day mortality, and adequacy of lymphadenectomy and resection margins. RESULTS: There was no conversion to laparotomy in the laparoscopic group. Intraoperative blood loss was significantly lower in the laparoscopic group (138 mL vs. 357 mL). There was no significant differences in the mean operative time (244 vs. 241 min.), transfusion rate (6% vs. 29%), median length of stay (6 vs. 7 days), morbidity (7% vs. 24%), or number of lymph nodes harvested (15 vs. 14 nodes) between the 2 groups. Resection margins were negative in all patients. There were no leaks and the 30-day mortality was 0 in both groups. Anastomotic strictures were higher in the laparoscopic patients. CONCLUSION: Laparoscopic gastrectomy is feasible and can be performed safely with adequate lymphadenectomy compared with open gastrectomy.

Aged↗
PubMed2006

Outcomes of bariatric surgery in the elderly.

The Medicare Coverage Advisory Committee recently concluded that evidence supports the safety and effectiveness of bariatric surgery in the general adult population. However, more information is needed on the role of bariatric surgery in the elderly. The aim of this study was to examine the outcome of bariatric surgery in the elderly performed at academic centers. Using International Classification of Diseases, 9th Revision diagnosis and procedure codes, we obtained data from the University HealthSystem Consortium Clinical Data Base for all elderly (>60 years) and nonelderly (19-60 years) patients who underwent bariatric surgery for the treatment of morbid obesity between 1999 and 2005. Outcome measures, including patient characteristics, length of stay, 30-day readmission, morbidity, and observed and expected (risk-adjusted) mortality, were compared between groups. Bariatric surgery in the elderly represents 2.7 per cent (n = 1,339) of all bariatric operations being performed at academic centers. Of the 99 University HealthSystem Consortium centers performing bariatric surgery, 78 centers (79%) perform bariatric surgery in the elderly. Compared with nonelderly patients, elderly patients who underwent bariatric surgery had more comorbidities, longer lengths of stay (4.9 days vs 3.8 days, P < 0.01), more overall complications (18.9% vs 10.9%, P < 0.01), pulmonary complications (4.3% vs 2.3%, P < 0.01), hemorrhagic complications (2.5% vs 1.5%, P < 0.01), and wound complications (1.7% vs 1.0%). The in-hospital mortality rate was also higher in the elderly group (0.7% vs 0.3%, P = 0.03). When risk adjusted, the observed-to-expected mortality ratio for the elderly group was 0.9. In a subset of elderly patients with a pre-existing cardiac condition (n = 236), the in-hospital mortality was 4.7 per cent. Bariatric surgery in the elderly represents only a small fraction of the number of bariatric operations performed at academic centers. Although the morbidity and mortality is higher in the elderly, bariatric surgery in the elderly is considered as safe as other gastrointestinal procedures because the observed mortality is better than the expected (risk-adjusted) mortality.

Adult↗
PubMed2006

Reduction in prescription medication costs after laparoscopic gastric bypass.

Morbidly obese patients undergoing bariatric surgery commonly have multiple obesity-related comorbidities, including hypertension (HTN), diabetes mellitus (DM), hyperlipidemia (HLP), and gastroesophageal reflux (GERD). Medical management of these conditions can be costly. The aim of this study was to determine changes in the monthly prescription medication costs in morbidly obese patients who underwent laparoscopic gastric bypass. We examined the data on 77 morbidly obese patients receiving medications prescribed for GERD, DM, HTN, and/or HLP before and after laparoscopic gastric bypass. Changes in medication usage were recorded at 3-month intervals. The retail cost for these medications was obtained from drugstore.com. There were 55 women with a mean age of 45 +/- 11 years. The mean body mass index was 47 +/- 6. The mean excess body weight loss was 67 +/- 14 per cent at 1 year. The mean number of prescription medication per patient was reduced from 2.4 preoperatively to 0.2 at 12 months after surgery. The mean monthly medication cost decreased from dollars 196 preoperatively to dollars 54 one month after surgery, representing a 72 per cent cost savings. One month postoperatively, medication cost saving for GERD was 81 per cent; for DM was 69 per cent; for HLP was 53 per cent; and for HTN was 43 per cent. The mean monthly medication cost savings for the first year after surgery was dollars 168, with a yearly savings of dollars 2016 per patient. Improvement of GERD, DM, HLP, and HTN occur as early as 1 month after laparoscopic gastric bypass results in substantial monthly medication cost savings.

Adolescent↗
PubMed2006

Retrocecal appendix location and perforation at presentation.

Retrocecal appendicitis has been theorized to follow a more insidious course than other anatomic variants. To determine the influence of retrocecal anatomy on clinical course of appendicitis, 200 adult patients treated at a major university medical center with the diagnosis of appendicitis from 2001 to 2004 were retrospectively studied. Computed tomography (CT) scans of adult patients with an ultimate diagnosis of appendicitis were analyzed to determine an association between retrocecal appendix and perforation of the appendix at presentation. A higher perforation rate in the retrocecal group would imply patient delay in presentation from more tolerable symptoms. CT scans were examined for retrocecal location and perforation. No significant association was found between retrocecal anatomy and perforation rates at presentation (chi-square = 2.1, P = 0.15, odds ratio = 1.6, 95% confidence interval [0.8-3.0]). However, the risk of perforation was 60 per cent higher in the retrocecal group. By regression analysis, age and the presence of a fecalith on CT scan were predictors of appendix perforation. Appendix location was not. In this study, we found no significant association between retrocecal appendix anatomy and perforation at presentation.

Adult↗
PubMed2003

Splanchnic perfusion during delayed, hypotensive, or aggressive fluid resuscitation from uncontrolled hemorrhage.

The purpose of this study was to determine the effect of three different fluid resuscitation strategies on splanchnic perfusion in a clinically relevant model of uncontrolled hemorrhage after liver trauma. Anesthetized swine were instrumented with a gastric near-infrared spectroscopy probe (GStO2), a jejunal tonometer (PrCO2), a portal vein catheter (SpvO2, lactate), and an ultrasonic blood flow probe on the superior mesenteric artery. The liver was lacerated to produce uncontrolled hemorrhage and a shock state characterized by a 40-60% decrease in cardiac output and a decrease in mean arterial pressure (MAP) to 42 +/- 1 mmHg. Animals were randomly assigned to either delayed resuscitation (n = 6); hypotensive resuscitation with lactated Ringer's infusion to MAP = 60 mmHg (n = 6); or aggressive resuscitation with LR to MAP >/= 75 mmHg (n = 6). For the remainder of the protocol, the treatment was identical. The data showed that blood loss (47 +/- 7 and 45 +/- 10 mL/kg) and total fluid requirements (118 +/- 73 and 171 +/- 85 mL/kg) were similar with either hypotensive or aggressive resuscitation. In contrast, with delayed resuscitation, both values were lower (27 +/- 2 mL/kg and 87 +/- 33 mL/kg, both P < 0.05). Despite aggressive resuscitation, SpvO2 and GstO2 were about 10% lower (both P < 0.05 within group) and PrCO2 was about 20 mmHg higher (P < 0.05 within group) than the corresponding values in the other two groups. Thus, delayed resuscitation minimized the blood loss but did not restore tissue oxygenation, whereas aggressive resuscitation was associated with maximal blood loss and splanchnic hypoperfusion. For this reason, it is reasonable to conclude that hypotensive resuscitation might be an effective strategy to maintain splanchnic perfusion after blunt abdominal trauma and uncontrolled hemorrhage.

Acid-Base Equilibrium↗
PubMed2003

The risk of death for Jehovah's Witnesses after major trauma.

BACKGROUND: Trauma surgeons are faced with life-threatening blood loss in patients such as Jehovah's Witnesses. We assessed and compared the risks of death after major trauma for Jehovah's Witnesses and other religious groups. METHODS: A retrospective cohort study was conducted between August 1992 and September 1999 in a Level I academic trauma center. Statistical methods included Tukey's one-way analysis of variance, chi2 analysis, and bivariate and multivariate logistic regression analyses. RESULTS: The cohort consisted of 556 patients: 82 Jehovah's Witnesses (14.7%), 52 Baptists (9.4%), 101 Catholics (18.2%), and 321 patients belonging to other religious groups (57.7%). Mean Injury Severity Scores for 433 patients were 10.3 +/- 9, 8.9 +/- 10, 10.3 +/- 11, and 11.3 +/- 14, respectively. There were no significant differences in mean Injury Severity Scores between religious groups, and no statistically significant associations between religion and Injury Severity Scores were identified. Significant predictors of mortality were age, systolic blood pressure at admission, Glasgow Coma Scale score, and type of trauma. Jehovah's Witnesses were 6% more likely to die after major trauma than Baptists, 20% more likely than Catholics, and as likely as patients from any other religious groups. CONCLUSION: After controlling for age, race, systolic blood pressure, Glasgow Coma Scale score, and type of trauma, Jehovah's Witnesses have a nonsignificant increased risk of death after major trauma compared with other religious groups.

Adolescent↗