Biomedical subjects

Jon C Gould

Publications and source records attributed to Jon C Gould.

9 recordsLinked to original sources

PubMed2006

Laparoscopic gastric bypass: risks vs. benefits up to two years following surgery in super-super obese patients.

BACKGROUND: Super-super obesity (body mass index [BMI] >/= 60 kg/m(2)) is thought to be a risk factor for complications and mortality in laparoscopic Roux-en-Y gastric bypass. Excess weight loss has been demonstrated to be diminished compared with less obese patients following surgery. However, we hypothesize that super-super obese patients who undergo laparoscopic gastric bypass can realize major improvements in their health and a good quality of life without a significantly increased risk of complications when compared with less obese patients. METHODS: From July 2002 to July 2005, University of Wisconsin Health bariatric surgeons performed 288 consecutive laparoscopic Roux-en-Y gastric bypass procedures. Patients were divided into 2 groups: BMI >/= 60 kg/m(2) (n = 28) and BMI < 60 kg/m(2) (n = 260). The groups were compared at defined time intervals during a 2-year period following surgery. Comparison criteria included complications, weight loss, comorbidities, and quality of life. RESULTS: Both groups had similar morbidity and mortality rates. Excess weight loss was shown to be less, but total pounds lost were greater, for the super-super obese patients at all postoperative time intervals specified for postoperative analysis. Despite this fact, overall health improved to a similar degree in each group of patients following surgery; both groups also had similar Moorehead-Ardelt quality of life scores. Using the Bariatric Analysis and Reporting Outcome System (BAROS) to categorize outcomes, the average result for a patient in either group of patients would be considered "very good" at 1 year following surgery. CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass can be accomplished safely even in extremely obese patients. Although excess weight loss in the super-super obese is diminished postoperatively when compared with less obese patients, health is improved and quality of life is good regardless of a patient's preoperative BMI. Therefore, laparoscopic gastric bypass is a good option even in the extremely obese.

Adult↗

PubMed2006

Bariatric surgery.

It is estimated that more than 5% of US adults are morbidly obese (body mass index higher than 40). Morbid obesity is associated with adverse health conditions including prolonged morbidity and early mortality while affecting people of lower socioeconomic means. A variety of surgical procedures have evolved over the past 30 years to address this problem with varying degrees of success and longevity. For those patients achieving dramatic weight loss, reconstructive cosmetic surgery is often necessary or desirable. Techniques to achieve this are described.

Adult↗

PubMed2005

A 25-year single institution analysis of health, practice, and fate of general surgeons.

OBJECTIVE: The objective of this study was to analyze nearly 3 decades of surgical residents from an established training program to carefully define individual outcomes on personal and professional health and practice satisfaction. SUMMARY BACKGROUND DATA: A paucity of data exists regarding the health and related practice issues of surgeons post-residency training. Despite several studies examining surgeon burnout and alcohol dependency problems, there have been no detailed reports defining health problems in practicing surgeons or preventive health patterns in this physician population. Important practice factors, including family and practice stress, that may impact on surgical career longevity and satisfaction have similarly received minimal focused examination. METHODS: All former surgery residents at the University of Wisconsin from 1978 to 2002 were contacted. Detailed direct interview or phone contact was made to ensure confidentiality and to obtain reliable data. Interviews concentrated on serious health and practice issues since residency completion. RESULTS: One hundred ten of 114 (97%) former residents were contacted. There were 100 males and 14 females with 2 deaths (accident, suicide). Including deaths and those lost to follow up, 15 (13.2%) were non-practicing; 5 voluntarily (3 planned, 1 accident, 1 arthritis) and 4 involuntarily (alcohol/substance dependency). Eighty-nine percent were married or remarried with a 21.4% divorce rate post-residency. Major health issues occurred in 32% of all surveyed and in 50% of those ages > or =50. Only 10% reported complete lack of weekly exercise activity with 62% exercising at least 3 times per week. Body mass index increased from 23.9 +/- 1.5 kg/m (age <40) to 26.6 +/- 3.0 kg/m (P = 0.009) by age > or =50. Alcohol dependency was confirmed in 7.3%. Overall, 75% of surgeons surveyed were satisfied with their practice/career. CONCLUSION: Despite a high job satisfaction rate, surgeon health may be compromised in up to 50% by age > or =50, with a 20% voluntary or involuntary retirement rate. Alcohol dependency occurred in up to 7.3% of surgeons, which contributed to the practice attrition rate. The success and length of a career in surgery is defined by post-residency factors rarely examined during training and include major and minor health issues, preventive health patterns/exercise, alcohol use or dependency, family life, and practice satisfaction. Surgeons mentoring during the course of surgical training should be improved to inform of important health and practice issues and consequences.

Adult↗

PubMed2005

Transgastric laparoscopic resection of a giant esophageal lipoma.

We present an unusual case of a giant, pedunculated esophageal lipoma originating in the mid-esophagus ball-valving through the gastroesophageal junction resulting in intermittent obstruction and hemorrhage. Endoscopic ultrasonography revealed a 1 cm in diameter vessel in the stalk of the polyp, and endoscopic resection was not performed. Transgastric laparoscopic resection with endoscopic guidance was successfully performed using 2 balloon-tipped laparoscopic trocars inserted laparoscopically into the gastric lumen through separate gastrotomies. Intraoperative esophagoscopy confirmed proper port placement and the exact location of the mass. Under direct visualization, a Snowden-Pencer grasper was used to pull the polyp down into the stomach and an Endo-GIA blue articulating stapler was used to transect its stalk. The polyp was retrieved via an endopouch placed through the intragastric laparoscopic port. We conclude that transgastric laparoscopy should be considered for the resection of a variety of pedunculated esophageal lesions when the use of standard endoscopic techniques is not possible.

Digestive System Surgical Procedures↗

PubMed2003

Telerobotic foregut and esophageal surgery.

Computer-assisted telerobotic surgery has many potential advantages over standard laparoscopy in foregut and esophageal surgery. The high-definition, three-dimensional images produced by the optics of these systems can facilitate identification of anatomy and dissection during surgery. The full range of motion afforded by the multiarticulated instruments can be beneficial in completing complex laparoscopic tasks such as suturing and intracorporeal knot tying. Tremor filtration and motion scaling allows for more precise movements during surgery. The remote console provides the operating surgeon with a comfortable ergonomic position during the sometimes long and complex procedures. Despite the many advantages of these systems, however, several limitations still exist. It is expected that the development and refinement of these technologies will address many of these issues. With continued progress, it is likely that this technology will disseminate widely throughout the surgical community.

Digestive System Surgical Procedures↗

PubMed2003

Laparoscopic parastomal hernia repair.

Parastomal hernia is a common complication of ostomy construction. The morbidity and recurrence rates associated with repair can be quite high. Among the various approaches to repair, the lowest recurrence rates are associated with the use of mesh. We report a case in which a parastomal hernia was repaired laparoscopically. By employing this minimally invasive approach, our patient avoided the morbidity associated with laparotomy for intraperitoneal mesh placement.

Aged↗

PubMed2002

Evolution of minimally invasive bariatric surgery.

BACKGROUND: Minimally invasive Roux-en-Y gastric bypass is a procedure that is being performed with increasing frequency. It is an advanced laparoscopic procedure with a steep learning curve. With experience, it can be performed in a reasonable amount of time with minimal morbidity. METHODS: We first performed minimally invasive gastric bypass with the hand-assisted laparoscopic surgery (HALS) technique. After significant experience with HALS, we changed our approach to completely laparoscopic (LS). Our technique for all cases involves a circular stapled gastrojejunostomy with a 25-mm anvil passed transgastrically. RESULTS: From June 1998 to January 2002, 304 patients underwent minimally invasive gastric bypass. Our first 81 cases were with HALS, and the rest were LS. The incidence of early major and minor perioperative complications for the entire series was 5.6% and 7.9%, respectively. Early reoperation (less than 30 days) was required in 4.6% of all patients. There was 1 leak (1.2%) in the HALS group and 4 anastomotic leaks (1.8%) in the LS group. Other measured outcomes were similar in each group with the exception of wound hernia (16% HALS vs 0.9% LS). Weight loss after 1 year was 44% for HALS and 56% for LS. We have not had any deaths in our series. CONCLUSIONS: HALS may have certain advantages in selected patients and early in a surgeon's experience with minimally invasive gastric bypass. With experience, good results are possible with either approach.

Adult↗

PubMed2002

Computer-assisted robotic antireflux surgery.

Antireflux surgery has evolved significantly since its inception 50 years ago. The current standard is laparoscopic fundoplication. The computer-assisted telemanipulator, a new device recently approved for use in laparoscopy, reduces some of the shortcomings of the laparoscopic approach. This review specifically discusses the role of this novel surgical tool in antireflux surgery.

Adult↗

PubMedDate not supplied

Building a laparoscopic surgical skills training laboratory: resources and support.

BACKGROUND: Technical skills have historically been developed and assessed in the operating room. Multiple pressures including resident work hour limitations, increasing costs of operating room time, and patient safety concerns have led to an increased interest in conducting these activities in a safe, reproducible environment. To address some of these issues, many residency programs have developed laparoscopic surgical skills training laboratories. We sought to determine the current status of laparoscopic skills laboratories across residency programs. METHODS: In December 2004, surveys were mailed to all 251 United States general surgery residency program directors. This brief 2-page survey consists of 9 questions regarding laparoscopic skills training laboratories. RESULTS: Of the 251 mailed surveys, 111 completed surveys were returned (44%). Of the respondents, 81 have laparoscopic skills training laboratories in place (80%). Skills laboratories that used a defined curriculum, and general surgery programs that shared their laboratories with other training programs were determined to have significantly more resources. A wide variety of funding sources have been used to develop and support these skills laboratories. CONCLUSIONS: Significant variability in training practices and equipment currently used exists between laboratories. A more efficient, standardized approach to skills training across residency programs is a desirable goal for the immediate future.

Data Collection↗