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Article ; Online: Laparoscopic Band Removal with Transgastric Gastrogastric Fistula Creation for Gastric Outlet Obstruction After Vertical Banded Gastroplasty.

Arefanian, Saeed / A Wheeler, Andrew

2023 Volume 33, Issue 8, Page(s) 2625–2626

MeSH term(s)	Humans ; Gastroplasty/adverse effects ; Obesity, Morbid/surgery ; Laparoscopy ; Gastric Outlet Obstruction/etiology ; Gastric Outlet Obstruction/surgery ; Fistula/surgery ; Reoperation
Language	English
Publishing date	2023-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1070827-3
ISSN	1708-0428 ; 0960-8923
ISSN (online)	1708-0428
ISSN	0960-8923
DOI	10.1007/s11695-023-06700-5
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Article ; Online: Laparoscopic Conversion of Gastric Bypass to Distal Gastric Bypass for Inadequate Weight Loss.

Arefanian, Saeed / Perez, Samuel / Wheeler, Andrew A

Obesity surgery

2024 Volume 34, Issue 2, Page(s) 702–703

Abstract: Background: Although uncommon, significant weight recurrence after Roux-en-Y gastric bypass (RYGB) can occur. Options are limited to help patients achieve additional weight loss, and improved techniques for revisional/conversional surgery are needed to ... ...

Abstract	Background: Although uncommon, significant weight recurrence after Roux-en-Y gastric bypass (RYGB) can occur. Options are limited to help patients achieve additional weight loss, and improved techniques for revisional/conversional surgery are needed to achieve optimal outcomes while avoiding significant side effects. Although limited data exist regarding distalization of the Roux limb to achieve a longer biliopancreatic limb leading to some level of malabsorption, we have seen adequate weight loss with minimal significant side effects in patients undergoing this procedure with our approach. An appropriate technical approach to this procedure is important to avoid immediate and long-term complications. Methods and results: We present a video describing our approach to Roux limb distalization for weight gain after gastric bypass, describing our approach for work-up, operative technical pearls, and postoperative monitoring in these patients. A 61 year-old female who initially had good weight loss after RYGB with a body mass index (BMI) nadir of 33, from a preoperative BMI of 53, experienced weight recurrence with her BMI increasing to 48. After preoperative nutritional optimization, dietary counseling, and behavioral counseling, she underwent conversion of RYGB to distalization of Roux limb to create a distal RYGB. She tolerated the procedure well and was discharged on postoperative day 2. At 1-year follow-up, her BMI had decreased to 37 with improvement in dyslipidemia, elevation of liver transaminases, and improvement in hemoglobin A1C. This reflects the impact of this procedure on not only weight loss but also concurrent metabolic diseases associated with obesity. Conclusion: We present a case of distalization of a RYGB for weight recurrence, highlighting the technical pearls when performing the procedure. Accurate, intraoperative measurement of the total alimentary limb length is essential to achieve weight loss while minimizing malnutrition and vitamin deficiencies. Assessment of preoperative nutritional levels for evidence of any protein calorie malnutrition is important during surgical decision-making when this conversional metabolic operation is considered. Frequent, postoperative nutritional monitoring is important and occurs with a full bariatric nutritional panel at 3, 6, 9, and 12 months then yearly thereafter. Using our approach, we feel that conversion of RYGB to distalization of Roux limb can lead to improved weight loss without significant side effects.
MeSH term(s)	Humans ; Female ; Middle Aged ; Gastric Bypass/methods ; Obesity, Morbid/surgery ; Bariatric Surgery ; Laparoscopy/methods ; Weight Loss ; Reoperation/methods ; Retrospective Studies
Language	English
Publishing date	2024-01-08
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1070827-3
ISSN	1708-0428 ; 0960-8923
ISSN (online)	1708-0428
ISSN	0960-8923
DOI	10.1007/s11695-023-07026-y
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Article ; Online: The impact of internet-based patient self-education of surgical mesh on patient attitudes and healthcare decisions prior to hernia surgery.

Miller, Matthew P / Arefanian, Saeed / Blatnik, Jeffrey A

Surgical endoscopy

2019 Volume 34, Issue 11, Page(s) 5132–5141

Abstract: Background: As internet access improves, patient self-education continues to increase. However, patient surgical background, e-literacy, and media exposure potentially influence what information patients search online. This impacts patient concern, ... ...

Abstract	Background: As internet access improves, patient self-education continues to increase. However, patient surgical background, e-literacy, and media exposure potentially influence what information patients search online. This impacts patient concern, healthcare decisions, and subsequent patient-physician interactions. The purpose of this pilot study is to characterize hernia patients' use and the impact of internet self-education regarding surgical mesh. Methods: The target population included patients presenting for evaluation of hernia repair with mesh. A total of 30 patients were enrolled. Patients took surveys before and after the initial surgical consult. The surveys evaluated internet use, mesh research completed, the impact on patient opinions/decisions, and the impact of research on the patient-physician interaction. Results: The average age of the patients was 58.7 years; sixteen had prior surgery with surgical mesh. 93% of patients were aware of surgical mesh through the media, and 60% were motivated by the media to conduct research. 90% of patients conducted research, and 67% used the internet. Patients with negative attitudes toward mesh had more media exposure in comparison to those with neutral or positive attitudes (p = 0.046), and they were more likely to have researched surgical mesh because of media influence (p = 0.033). This group had the highest rate of perceived knowledge on mesh risks and the lowest regarding benefits (p = 0.013). Patients who had prior surgery without complication had the most positive attitude toward surgical mesh (p = 0.010) and were less likely to plan to do future internet research (p = 0.041) in comparison to patients who had surgery with complications or no prior surgery. Conclusions: Patients' attitudes and perceived knowledge regarding surgical mesh are associated with media exposure and internet research. These attributes along with prior surgical experience impact the patient-physician relationship and shared decision-making model regarding patient care.
MeSH term(s)	Adult ; Aged ; Attitude to Health ; Computer-Assisted Instruction ; Decision Making ; Female ; Health Knowledge, Attitudes, Practice ; Health Surveys ; Herniorrhaphy/education ; Herniorrhaphy/psychology ; Humans ; Internet ; Male ; Middle Aged ; Patient Acceptance of Health Care/psychology ; Patient Education as Topic ; Physician-Patient Relations ; Pilot Projects ; Surgical Mesh
Language	English
Publishing date	2019-12-12
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-019-07300-0
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Article ; Online: Robotic Approach to Paraesophageal Hernia Repair Results in Low Long-Term Recurrence Rate and Beneficial Patient-Centered Outcomes.

Gerull, William D / Cho, Daniel / Kuo, Iris / Arefanian, Saeed / Kushner, Bradley S / Awad, Michael M

Journal of the American College of Surgeons

2020 Volume 231, Issue 5, Page(s) 520–526

Abstract: Background: Little is known regarding important long-term outcomes after robotic paraesophageal hernia (PEH) repairs, such as symptom relief and recurrence rates. The aim of this study was to evaluate the long-term clinical outcomes in a large series of ...

Abstract	Background: Little is known regarding important long-term outcomes after robotic paraesophageal hernia (PEH) repairs, such as symptom relief and recurrence rates. The aim of this study was to evaluate the long-term clinical outcomes in a large series of patients undergoing robotic PEH repair. Study design: This prospective, IRB-approved study analyzed adult patients who underwent robotic PEH repair, from 2010 to 2014, at a high-volume tertiary academic medical center. Detailed information on patient characteristics, perioperative factors, and long-term patient-reported outcomes for up to 5 years postoperatively were collected. Objective long-term outcomes included radiographic evidence of PEH recurrence at 1, 3, and 5 years postoperatively. Results: A total of 233 patients underwent robotic PEH repair during the study period-70% were primary, 30% were revisional. Seventy-eight percent of patients (181) had a type III PEH, 21% (49) had a type IV, and 1% (3) had a type II. At 5 years postoperatively, 62% of patients (145 of 233) were available for follow-up, with a radiographic recurrence rate of 9% (13 of 145). Additionally, there was a significant improvement in the GERD-HRQL score at 5 years postoperatively (preoperative: 25.6 ± 8.7, 5-year postoperative, 4.5 ± 1.7, p < 0.01, 95% CI 19.7 to 22.5). Conclusions: This study represents one of the largest longitudinal robotic foregut surgical databases to date. Our results demonstrate that robotic PEH repair with an experienced surgical team is a safe and effective alternative to laparoscopic repair, with excellent long-term outcomes, including a very low recurrence rate.
MeSH term(s)	Aged ; Female ; Hernia, Hiatal/surgery ; Herniorrhaphy/methods ; Humans ; Male ; Patient Reported Outcome Measures ; Prospective Studies ; Recurrence ; Reoperation ; Robotic Surgical Procedures
Language	English
Publishing date	2020-08-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1016/j.jamcollsurg.2020.07.754
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Article ; Online: Favorable peri-operative outcomes observed in paraesophageal hernia repair with robotic approach.

Gerull, William D / Cho, Daniel / Arefanian, Saeed / Kushner, Bradley S / Awad, Michael M

Surgical endoscopy

2020 Volume 35, Issue 6, Page(s) 3085–3089

Abstract: Background: The robotic surgical approach offers enhanced visualization, dexterity and reach, which may facilitate the more technically demanding portions of paraesophageal hernia (PEH) repair such as hiatal reconstruction and mediastinal dissection. We ...

Abstract	Background: The robotic surgical approach offers enhanced visualization, dexterity and reach, which may facilitate the more technically demanding portions of paraesophageal hernia (PEH) repair such as hiatal reconstruction and mediastinal dissection. We sought to compare the peri-operative clinical outcomes of the laparoscopic vs. robotic approach to PEH repair. Methods: A prospective, IRB-approved database was maintained for all robotic PEH repairs performed by a single surgeon at a tertiary academic hospital from 2009 to 2019. A retrospective review of laparoscopic PEH over this same time period was used as a comparison group. Outcome measures included: operative time, conversion to open, need for an esophageal lengthening procedure, operative equipment costs and length of stay (LOS). Results: 1854 patients underwent PEH repair during this time period (830 robotic; 1024 laparoscopic). Demographics of both groups were similar, including BMI and PEH type, although a higher proportion of robotic cases were re-operative PEH repairs (32.5% vs 24.0%; p < 0.001). Patients who underwent a robotic PEH had a significant reduction in esophageal lengthening procedures performed (0.1% vs. 11.0%; p < 0.001), conversion to open (0% vs. 7.0%; p < 0.001), and LOS (1.8 days vs. 3.1 days; p < 0.001). Intra-operative equipment costs were similar. Conclusions: In one of the largest robotic PEH case series reported to date, there were significant improvements in peri-operative outcomes in patients undergoing a robotic-assisted approach. Although a greater number of patients in the robotic group were redo PEH repairs, when compared to the laparoscopic group, there were no conversions to open and significantly fewer esophageal lengthening procedures, both of which carry significant morbidity. The similar intra-operative costs were likely balanced by the higher costs associated with stapling equipment and conversions in the laparoscopic group. Our findings show that the robotic PEH repair is safe and can result in improved peri-operative outcomes.
MeSH term(s)	Hernia, Hiatal/surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Prospective Studies ; Recurrence ; Retrospective Studies ; Robotic Surgical Procedures ; Treatment Outcome
Language	English
Publishing date	2020-06-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-020-07700-7
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Article ; Online: Examination of abdominal wall perfusion using varying suture techniques for midline abdominal laparotomy closure.

Kushner, Bradley S / Arefanian, Saeed / McAllister, Jared / Tan, Wen Hui / Grant, Matthew / MacGregor, Robert / Majumder, Arnab / Blatnik, Jeffrey A

Surgical endoscopy

2021 Volume 36, Issue 6, Page(s) 3843–3851

Abstract: Background: With a growing interest in the primary prevention of incisional hernias, it has been hypothesized that different suturing techniques may cause various levels of tissue ischemia. Using ICG laser-induced fluorescence angiography (ICG-FA), we ... ...

Abstract	Background: With a growing interest in the primary prevention of incisional hernias, it has been hypothesized that different suturing techniques may cause various levels of tissue ischemia. Using ICG laser-induced fluorescence angiography (ICG-FA), we studied the effect of different suture materials and closure techniques on abdominal wall perfusion. Methods: Fifteen porcine subjects underwent midline laparotomy, bilateral skin flap creation, and three separate 7 cm midline fascial incisions. Animals underwent fascial closure with 5 different techniques: (1) Running 0-PDS® II (polydioxanone) Suture with large bites; (2) Running 0-PDS II Suture with small bites; (3) Interrupted figure-of-eight (8) PDS II Suture, (4) Running 0-barbed STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device large bite; (5) Running 0-STRATAFIX Symmetric PDS Plus Device small bites. ICG-FA signal intensity was recorded prior to fascial incision (baseline), immediately following fascial closure (closure), and at one-week (1-week.). Post-mortem, the abdominal walls were analyzed for inflammation, neovascularity, and necrosis. Results: PDS II Suture with small bites, fascial closure at the caudal 1/3 of the abdominal wall, and the 1-week time period were all independently associated with increased tissue perfusion. There was also a significant increase in tissue perfusion from closure to 1-week when using small bites PDS II Suture compared to PDS II Suture figure-of-8 (p < 0.001) and a trend towards significance when compared with large bites PDS II Suture (p = 0.056). Additionally, the change in perfusion from baseline to 1 week with small bites was higher than with figure of 8 (p = 0.002). Across all locations, small bite PDS II Suture has greater total inflammation than figure of 8 (p < 0.001). Conclusions: The results suggest that the small bite technique increases abdominal wall perfusion and ICG-FA technology can reliably map abdominal wall perfusion. This finding may help explain the reduced incisional hernia rates seen in clinical studies with the small bite closure technique.
MeSH term(s)	Abdominal Wall/surgery ; Abdominal Wound Closure Techniques ; Animals ; Humans ; Incisional Hernia/surgery ; Inflammation ; Laparotomy/methods ; Perfusion ; Polydioxanone ; Suture Techniques ; Sutures ; Swine
Chemical Substances	Polydioxanone (31621-87-1)
Language	English
Publishing date	2021-08-27
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-021-08701-w
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Article ; Online: Neutral Sphingomyelinase 2 Inhibition Limits Hepatic Steatosis and Inflammation.

Al-Rashed, Fatema / Arefanian, Hossein / Madhoun, Ashraf Al / Bahman, Fatemah / Sindhu, Sardar / AlSaeed, Halemah / Jacob, Texy / Thomas, Reeby / Al-Roub, Areej / Alzaid, Fawaz / Malik, M D Zubbair / Nizam, Rasheeba / Thanaraj, Thangavel Alphonse / Al-Mulla, Fahd / Hannun, Yusuf A / Ahmad, Rasheed

Cells

2024 Volume 13, Issue 5

Abstract: Non-alcoholic fatty liver disease (NAFLD) is manifested by hepatic steatosis, insulin resistance, hepatocyte death, and systemic inflammation. Obesity induces steatosis and chronic inflammation in the liver. However, the precise mechanism underlying ... ...

Abstract	Non-alcoholic fatty liver disease (NAFLD) is manifested by hepatic steatosis, insulin resistance, hepatocyte death, and systemic inflammation. Obesity induces steatosis and chronic inflammation in the liver. However, the precise mechanism underlying hepatic steatosis in the setting of obesity remains unclear. Here, we report studies that address this question. After 14 weeks on a high-fat diet (HFD) with high sucrose, C57BL/6 mice revealed a phenotype of liver steatosis. Transcriptional profiling analysis of the liver tissues was performed using RNA sequencing (RNA-seq). Our RNA-seq data revealed 692 differentially expressed genes involved in processes of lipid metabolism, oxidative stress, immune responses, and cell proliferation. Notably, the gene encoding neutral sphingomyelinase,
MeSH term(s)	Mice ; Animals ; Non-alcoholic Fatty Liver Disease/metabolism ; Sphingomyelin Phosphodiesterase ; Mice, Inbred C57BL ; Inflammation ; Obesity/metabolism ; Esterases
Chemical Substances	Sphingomyelin Phosphodiesterase (EC 3.1.4.12) ; Esterases (EC 3.1.-)
Language	English
Publishing date	2024-03-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2661518-6
ISSN	2073-4409 ; 2073-4409
ISSN (online)	2073-4409
ISSN	2073-4409
DOI	10.3390/cells13050463
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Article ; Online: Effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) on weight loss and biomarker parameters in morbidly obese patients: a 12-month follow-up.

Toolabi, Karamollah / Arefanian, Saeed / Golzarand, Mahdieh / Arefanian, Hossein

Obesity surgery

2011 Volume 21, Issue 12, Page(s) 1834–1842

Abstract: Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is suggested as the gold standard of the surgical techniques for morbid obesity treatment. The aim of this study was to evaluate the weight loss and biomarker parameter changes over a 1-year ... ...

Abstract	Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is suggested as the gold standard of the surgical techniques for morbid obesity treatment. The aim of this study was to evaluate the weight loss and biomarker parameter changes over a 1-year period following LRYGB in Iranian morbidly obese patients. Methods: Sixty patients who had undergone LRYGB from June 2006 to August 2008 were followed up. Complication rates and changes in anthropometric indices, metabolic parameters, and obesity-related comorbidities were evaluated. Results: During the mean follow-up duration of 27.2 ± 9.4 months, the mean weight reduced from 128.8 ± 20.4 to 86.9 ± 12.7 kg with excess weight loss (%EWL) of 63.8 ± 15.6%. The male young-adolescent patients showed more weight loss than females. Biochemical parameter changes were reduction of fasting blood sugar by 19%, total cholesterol by 17%, triglyceride by 30%, low-density lipoprotein by 19%, aspartate aminotransferase by 44%, alanine aminotransferase by 52%, alkaline phosphatase by 33%, and uric acid by 19%, while high-density lipoprotein (HDL) levels increased by 22%. HDL level change was the only biomarker factor showing correlation with age (P = 0.005, r = -0.353, R(2) = 0.125). Obesity comorbidities were resolved considerably. There were two cases of surgical complications and no case of mortality. Conclusion: LRYGB appears to be a safe and effective procedure with a low complication rate in Iranian morbidly obese patients. It results in weight loss, reduction in obesity comorbidities, increasing HDL, and decreasing other measured plasma biochemical parameters. Based on our results, we suggest that LRYGB would benefit young male morbidly obese patients more than others.
MeSH term(s)	Adolescent ; Adult ; Biomarkers/blood ; Female ; Follow-Up Studies ; Gastric Bypass/methods ; Humans ; Iran ; Laparoscopy ; Male ; Obesity, Morbid/blood ; Obesity, Morbid/surgery ; Time Factors ; Weight Loss
Chemical Substances	Biomarkers
Language	English
Publishing date	2011-10-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1070827-3
ISSN	1708-0428 ; 0960-8923
ISSN (online)	1708-0428
ISSN	0960-8923
DOI	10.1007/s11695-011-0525-8
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Article ; Online: Osteoid osteoma of the rib presenting as thoracic outlet syndrome.

Kargar, Saeed / Arefanian, Saeed / Ghasemi, Afsaneh / Binesh, Fariba / Heiranizadeh, Naeimeh

The Annals of thoracic surgery

2013 Volume 96, Issue 6, Page(s) 2221–2223

Abstract: Osteoid osteoma of the rib is a rare condition mostly mentioned in case report studies as lesions involving posterior region of the rib causing scoliosis. This report presents a 22-year-old man who complained of neurologic thoracic outlet syndrome ... ...

Abstract	Osteoid osteoma of the rib is a rare condition mostly mentioned in case report studies as lesions involving posterior region of the rib causing scoliosis. This report presents a 22-year-old man who complained of neurologic thoracic outlet syndrome symptoms. The pathologic study of the resected mass of the first rib confirmed the diagnosis of osteoid osteoma. This unique presentation of the osteoid osteoma as thoracic outlet syndrome suggests that this pathologic involvement of the ribs is not confined to the symptoms of pain and scoliosis.
MeSH term(s)	Biopsy ; Bone Neoplasms/complications ; Bone Neoplasms/diagnosis ; Bone Neoplasms/surgery ; Diagnosis, Differential ; Humans ; Male ; Osteoma, Osteoid/complications ; Osteoma, Osteoid/diagnosis ; Osteoma, Osteoid/surgery ; Ribs ; Thoracic Outlet Syndrome/diagnosis ; Thoracic Outlet Syndrome/etiology ; Thoracic Outlet Syndrome/surgery ; Thoracic Surgical Procedures/methods ; Tomography, X-Ray Computed ; Young Adult
Language	English
Publishing date	2013-12
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2013.04.118
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Article ; Online: Retrograde Intrarenal Surgery Versus Shock Wave Lithotripsy for Renal Stones Smaller Than 2 cm: A Randomized Clinical Trial.

Javanmard, Babak / Kashi, Amir Hossein / Mazloomfard, Mohammad Mohsen / Ansari Jafari, Anahita / Arefanian, Saeed

Urology journal

2016 Volume 13, Issue 5, Page(s) 2823–2828

Abstract: Purpose: To compare outcomes of retrograde intrarenal surgery (RIRS) with extracorporeal shock wave lithotripsy (SWL) for stones ≤ 2 cm.: Materials and methods: Patients who were diagnosed with kidney stones of ≤ 2 cm underwent RIRS or SWL in a ... ...

Abstract	Purpose: To compare outcomes of retrograde intrarenal surgery (RIRS) with extracorporeal shock wave lithotripsy (SWL) for stones ≤ 2 cm. Materials and methods: Patients who were diagnosed with kidney stones of ≤ 2 cm underwent RIRS or SWL in a parallel group randomized clinical trial with balanced randomization [1:1] from 2011 to 2014. The primary outcome of interest was stone free rate after a single session intervention. Patients were evaluated by ultrasonography and KUB at 1 and 3 months after the intervention for the presence of residual stone by a radiologist who was blinded to the study. Results: The stone free rate one month after a single session intervention in the RIRS group was higher than the SWL group (90% versus 75%, P = .03). The success rates after two sessions of RIRS versus SWL were 96.7% versus 88.3% respectively. (P = .08) Patients in the RIRS group had significantly lower postoperative visual analogue pain score compared to the SWL group (5.2 ± 2.8 versus 3.1 ± 2.7, P < .001). Steinstrasse formation and renal hematoma were observed in 4 and one patient in the SWL group versus no patient in the RIRS group. Postoperative hospital stay was significantly shorter in the SWL group (6.7 ± 1.3 versus18.9 ± 4.3 hours, P < .001). Conclusion: The RIRS procedure is a safe treatment option for renal stones of ≤2cm with less pain and higher success rate at first session compared to SWL. .
MeSH term(s)	Adult ; Female ; Humans ; Kidney Calculi/pathology ; Kidney Calculi/surgery ; Kidney Calculi/therapy ; Lithotripsy/adverse effects ; Male ; Prospective Studies ; Single-Blind Method
Language	English
Publishing date	2016-10-10
Publishing country	Iran
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial
ZDB-ID	2251940-3
ISSN	1735-546X ; 1735-1308
ISSN (online)	1735-546X
ISSN	1735-1308
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