Revisional anti-reflux surgery is complex. The most common revisional procedure following anti-reflux surgery is redo-fundoplication; however, there is a rate of diminishing return for each subsequent redo-fundoplication. In addition, postoperative complications involving the gastroesophageal junction or intraoperative complications may require resection of the gastroesophageal junction and reconstruction. There is limited data evaluating the options for patients undergoing resectional surgery following ARS, but this paper will review the current literature and provide an overview on the indications and reconstructive options following gastro-esophageal junction resection.
Purpose of Review
Racial disparities in surgical outcomes have been identified in multiple fields including bariatric surgery. Obesity and metabolic co-morbidities often affect racial minorities to a greater extent than Caucasian patients; however, the impact of bariatric surgery is often dampened. The purpose of this review is to evaluate possible racial difference in bariatric surgery outcomes.
Recent Findings
Obesity is a national epidemic which disproportionately affects racial minorities. Bariatric surgery, while safe and effective, has been shown to result in variable outcomes depending on the race of the patient. Non-Hispanic Black patients often have less weight loss, lower resolution of diabetes, and a higher rate of post-operative complications. Socioeconomic status has been theorized to account for the variance seen among races; however, various studies into socioeconomic factors have yielded mixed results.
Summary
Based on current evidence there remains a racial difference in some, but not all postoperative surgical outcomes. Despite these findings, bariatric surgery remains safe and effective and patients meeting criteria for bariatric surgery should strongly consider the options. However, further investigations are needed to bridge the racial differences in bariatric outcomes.
Background: The Achilles heel of antireflux surgery is hiatal hernia recurrence, and no treatment modalities to date have improved this outcome. Platelet-rich plasma (PRP) is an autologous therapy that promotes wound healing by upregulating extracellular matrix proteins, and it has excellent results in numerous surgical fields. Animal studies evaluating PRP use in hiatal hernia repair show favorable outcomes, yet its application in hiatal hernia repair in humans has not been described. Methods: This is a feasibility study of patients with large (>5 cm) paraesophageal hernia (PEH) who underwent PEH repair with PRP from 2/2021 to 1/2022. Safety, feasibility, and postoperative outcomes were investigated. Results: PRP was successfully administered during PEH repair in 12 consecutive patients. There were no significant adverse events. The methods for applying PRP to the repair were modified several times to optimize the technique. Administering PRP added an average of 5 minutes to the operative time. There were no significant postoperative complications or hernia recurrence on diagnostic imaging at latest follow up, with good subjective reflux control. Conclusion: PRP has excellent clinical outcomes in other surgical fields and may become an important new adjunct in antireflux surgery. This study shows PRP is safe and feasible in PEH repair, with little effect on operative time.
Magnetic sphincter augmentation (MSA) is an anti-reflux procedure with comparable outcomes to fundoplication, yet its use in patients with larger hiatal or paraesophageal hernias has not been widely reported. This review discusses the history of MSA and how its utilization has evolved from initial Food and Drug Administration (FDA) approval in 2012 for patients with small hernias to its contemporary use in patients with paraesophageal hernias and beyond.
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