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Innovative Techniques to Address Bariatric Surgery Complications

Innovative Techniques to Address Bariatric Surgery Complications

Millions of patients find it extremely difficult to achieve durable weight loss without medical intervention. Many opt for bariatric surgery to achieve a healthier weight, but up to 30% of patients who undergo these procedures regain weight. There are a variety of reasons for regaining weight after bariatric surgery. In some cases, there may be dysfunction of the stomach pouch that was surgically created. Others may experience dangerous and painful complications, such as fistulas and leaks. Patients who experience these types of post-bariatric surgical problems are reluctant to undergo another invasive procedure to correct the issues. Alternatives to Bariatric Surgery Complications In recent years, an important treatment alternative has emerged for this patient population thanks to advanced endoscopy. Using this approach, we can address post-bariatric surgery problems like fistulas, ulcers, and lap band erosion with less invasive endoscopic surgery techniques. Advanced endoscopy enables clinicians to: Locate and repair defects. Close leaks and fistulas with endoscopic sutures. Reduce patient discomfort. Reduce postoperative recovery time. Help re-establish proper pouch dimensions. Help stop weight gain and aid in weight loss. With advanced endoscopy, we’re able to perform endoscopic pouch reduction surgery to restore the stomach pouch to its original post-surgery dimensions and halt weight gain. These procedures help patients experience less postoperative discomfort, as there is minimal to no blood loss, no external cuts, and no need to re-route the existing anatomy. This results in shorter hospital recovery times, with most patients going home the same day. Advanced endoscopic techniques can be beneficial to manage complications after bariatric surgery. These include repairing and/or addressing gastric pouch dysfunction/defects, esophageal and gastric fistulas, sleeve...

Colonoscopy Practices & Perceptions Among Endoscopists

Previous research has shown that fatigue is an under­estimated cause of underperformance among physicians. The issue of production pressure and its effect on quality of care permeates every aspect of the healthcare industry, including colonoscopy. Studies suggest that fatigue or other byproducts of production pressure may negatively influence the quality of colonoscopy, which could affect the quality of colon cancer screening. Surveying the Endoscopy Scene In a recent issue of Gastrointestinal Endoscopy, my colleagues and I published the results of a 40-question online survey designed to assess the perceptions of practicing endoscopists regarding production pressure and its effects on their personal performance of colonoscopy. According to our results, 92% of respondents indicated that production pressure influenced one or more aspects of their endoscopic practices. Examples of production pressure included: Proceeding with colonoscopy in patients with unfavorable risk/benefit ratios. Reducing the length of time spent inspecting the colon. Postponing polypectomy for a subsequent session. Our study also found that almost half (48%) of respondents  witnessed the effects of production pressure on a colleague. Respondents working fee-for-service and those with more than 10 years since completing their fellowship were more likely to describe their weekly workloads as “excessive” when compared with those who were salaried or less than 10 years out of training. Our survey also showed that many respondents don’t have enough time for pre-procedural assessment, and some believed that patients were discharged from their unit prematurely. About two of every five respondents (42%) identified one or more sources of inefficiency within their practice, such as an inadequate number of procedure rooms, insufficient staff, or too few beds in the...

Trends in Anesthesia Use During Gastroenterology Procedures

In the United States, use of anesthesia during gastrointestinal endoscopies and colonoscopies appears to have increased substantially from 2003 to 2009, according to a retrospective analysis of claims data during this study period. The proportion of procedures that used anesthesia services increased from about 14% in 2003 to more than 30% in 2009. Researchers noted that more than 65% of services were delivered to low-risk patients. Use ranged from 13% in the western part of the U.S. to 59% in the northeastern Abstract: JAMA, March 21,...

A Minimally Invasive Alternative to Open Spine Surgery

Roughly 80% of Americans experience back pain at some point in their life. While the pain goes away in the vast majority of cases, about 5% of patients with aching backs will develop chronic pain. In the United States, at least $50 billion is spent each year on medications, hot and cold packs, and other methods of treating back pain. Data show that back pain is second only to headaches as the most common neurological ailment in the United States. Until recently, the only option for people with back pain when other methods of pain control have failed has been open surgery, which involves general anesthesia, a hospital stay, large scars, and long recovery times. Unfortunately, these surgeries fail to provide lasting relief in many cases, leaving many patients to rely on narcotic pain relievers for the rest of their lives. Smaller is Better Newer, minimally invasive procedures are being explored and appear to be particularly promising for patients with chronic back pain. Endoscopic spine procedures can be used to correct many of the conditions that cause chronic back pain or to repair failed previous surgeries. These procedures allow surgeons to see the spine and surrounding tissue without making large incisions. Spine surgery is a common procedure for the treatment of lower back pain, and these operations typically use cages, bone grafts, bars, and screws. If patients continue to have pain, they may develop failed back surgery syndrome (FBSS). For people suffering with FBSS, the pain is often much worse than it was prior to their surgery. Many FBSS patients are disabled, isolated, and heavily medicated. Research suggests that...
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