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Article ; Online: We asked the experts: Normalize challenges, build community, and develop mentorship: A guide for proactive institutional support for child rearing during surgical training.

Colley, Alexis / Yap, Ava / Trang, Karen / Kornblith, Lucy Z / Varma, Madhulika G / Vu, Lan

2024 Volume 48, Issue 3, Page(s) 524–526

MeSH term(s)	Humans ; Child ; Mentors ; Child Rearing ; Surveys and Questionnaires
Language	English
Publishing date	2024-02-16
Publishing country	United States
Document type	Editorial
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1002/wjs.12095
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Article ; Online: Expert Commentary on Rectal Prolapse.

Varma, Madhulika G

Diseases of the colon and rectum

2017 Volume 60, Issue 11, Page(s) 1135–1136

MeSH term(s)	Humans ; Rectal Prolapse
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000000954
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Article: Proof-of-concept for intervention to prevent post-operative ileus in patients undergoing ileostomy formation.

Greenberg, Anya L / Kelly, Yvonne M / Sarin, Ankit / Varma, Madhulika G

Perioperative medicine (London, England)

2022 Volume 11, Issue 1, Page(s) 25

Abstract: Background: Preventing post-operative ileus (POI) is important given its associated morbidity and increased cost of care. The authors' prior work showed that POI in patients with newly created ileostomies is associated with a post-operative day (POD) 2 ... ...

Abstract	Background: Preventing post-operative ileus (POI) is important given its associated morbidity and increased cost of care. The authors' prior work showed that POI in patients with newly created ileostomies is associated with a post-operative day (POD) 2 net fluid balance of > + 800 mL. The purpose of this study was to conduct an initial assessment of the efficacy of a pilot intervention. Methods: This is a single-institution, pre-post-intervention, proof-of-concept study conducted on the Colorectal Surgery service at the University of California, San Francisco. The study included 58 procedures with ileostomy formation by board-certified colorectal surgeons between August 13, 2020 and June 1, 2021. The intervention included three adjustments to the standard Enhanced Recovery After Surgery protocol: addition of diuresis, delay in advancement to solid food, and earlier stoma intubation. Demographics, intraoperative factors, post-operative fluid balance, and outcomes (POI, post-procedure length of stay [LOS], hospitalization cost, and re-admissions) were compared between patients pre- and post-intervention. Results: Eight (13.8%) of the 58 procedures in the intervention period were associated with POI vs. a baseline POI rate of 32.6% (p = 0.004). Compared to patients without intervention, those with intervention had 67% less odds of POI (OR 0.33, 95% CI 0.15-0.73, p = 0.01). This difference remained significant when adjusted for age, gender, body mass index, procedure duration, and operative approach (adjusted OR 0.32, 95% CI 0.14-0.72, p = 0.01). Average POD2 stoma output was 0.3 L greater (1.1 L vs. 0.8L; p < 0.001) and net fluid balance was 1.8 L lower (+ 0.3 L vs. + 2.1 L; p < 0.00001) for these 58 cases. Average post-procedure LOS was 1.9 days lower (5.3 vs. 7.2 days, p < 0.001) and direct cost was $5561 lower ($21,652 vs. $27,213, p = 0.004), with no difference in 30-day readmissions (p = 0.43). Conclusions: This pilot intervention shows promise for reduction in POI in patients with newly created ileostomies. Additional assessment is needed to confirm these initial findings.
Language	English
Publishing date	2022-07-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2683800-X
ISSN	2047-0525
ISSN	2047-0525
DOI	10.1186/s13741-022-00257-0
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Article: Translation and Validation Testing of the Constipation-Related Quality of Life Scale for Use in Japan.

Hamaguchi, Sugihiro / Varma, Madhulika G / Nakagawa, Hiroaki / Ozaka, Akihiro / Shimizu, Sayaka / Maeshibu, Takako / Wakita, Takafumi / Green, Joseph / Fukuhara, Shunichi

Cureus

2023 Volume 15, Issue 11, Page(s) e48661

Abstract: Introduction Establishing a scale that can easily be used to appropriately measure the impact of constipation on the quality of life in Japan is a first step toward addressing this important health issue. We developed a Japanese language version of the ... ...

Abstract	Introduction Establishing a scale that can easily be used to appropriately measure the impact of constipation on the quality of life in Japan is a first step toward addressing this important health issue. We developed a Japanese language version of the Constipation-Related Quality of Life scale, which has 18 items and four subscales, and then subjected it to validation testing. Methods After translation according to a standardized and commonly used procedure, the Japanese version of the Constipation-Related Quality of Life scale was administered to people in an internet-based panel, in March 2023. The participants included 1,276 adults who had constipation (median age: 60 years, 690 {54.1%} males). The outcome measures included the Constipation-Related Quality of Life scale, the Constipation Scoring System (an index of constipation severity), and the Medical Outcomes Study (MOS) eight-item short form (a measure of generic health-related quality of life). Results Confirmatory factor analysis (four-factor model) indicated that all 18 Constipation-Related Quality of Life items had sufficiently high factor loadings (0.686-0.926). Internal consistency reliability was high (Cronbach's alpha: 0.86-0.94). Scores on the social impairment subscale and on the distress subscale of the Constipation-Related Quality of Life scale were significantly worse in the participants who had worse scores on the social functioning and mental health domains, respectively, of the MOS eight-item short form, which indicates good concurrent validity. Regarding criterion-based validity, the four subscale scores differed significantly among the four constipation-severity groups. The four subscale scores were also 1.16-4.53 times more sensitive than the MOS eight-item short form's mental component score to differences among the four constipation-severity groups (relative validity: 1.16-4.53), which indicates good discriminant validity. Conclusion The Japanese version of the Constipation-Related Quality of Life scale can be used with confidence in its factor structure, its concurrent, criterion-based, and discriminant validity, and its internal consistency reliability.
Language	English
Publishing date	2023-11-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.48661
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Article: Risk factors and outcomes associated with postoperative ileus following ileostomy formation: a retrospective study.

Greenberg, Anya L / Kelly, Yvonne M / McKay, Rachel E / Varma, Madhulika G / Sarin, Ankit

Perioperative medicine (London, England)

2021 Volume 10, Issue 1, Page(s) 55

Abstract: Background: Postoperative ileus (POI) is associated with increased patient discomfort, length of stay (LOS), and healthcare cost. There is a paucity of literature examining POI in patients who have an ileostomy formed at the time of surgery. We aimed to ...

Abstract	Background: Postoperative ileus (POI) is associated with increased patient discomfort, length of stay (LOS), and healthcare cost. There is a paucity of literature examining POI in patients who have an ileostomy formed at the time of surgery. We aimed to identify risk factors for and outcomes associated with POI following ileostomy formation. Methods: We included 261 consecutive non-emergent cases that included formation of an ileostomy by a board-certified colorectal surgeon at our institution from July 1, 2015, to June 30, 2020. Demographic, clinical, and intraoperative factors associated with increased odds of POI were evaluated. Post-procedure LOS, hospitalization cost, and re-admissions between patients with and without POI were compared. Results: Out of 261 cases, 85 (32.6%) were associated with POI. Patients with POI had significantly higher body mass index (BMI) than those without POI (26.6 kg/m Conclusions: Minimizing fluid overload, particularly in the first 48 h after surgery, may be a strategy to reduce POI in patients undergoing ileostomy formation, and thus decrease postoperative LOS and hospitalization cost. Fluid restriction, diuresis, and changes in diet advancement or early stoma intubation should be considered measures that may improve outcomes and should be studied more intensively.
Language	English
Publishing date	2021-12-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2683800-X
ISSN	2047-0525
ISSN	2047-0525
DOI	10.1186/s13741-021-00226-z
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Article ; Online: Sew or staple: does it make a difference?

Varma, Madhulika G

Inflammatory bowel diseases

2010 Volume 17, Issue 4, Page(s) 1046–1047

Language	English
Publishing date	2010-11-04
Publishing country	England
Document type	Comment ; Journal Article
ZDB-ID	1340971-2
ISSN	1536-4844 ; 1078-0998
ISSN (online)	1536-4844
ISSN	1078-0998
DOI	10.1002/ibd.21496
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Article ; Online: Robotic repair of perineal hernias: a video vignette and review of the literature.

Watanaskul, Sarah / Schwab, Marisa E / Colley, Alexis / Chern, Hueylan / Varma, Madhulika G / Hoffman, William Y / Sarin, Ankit

Surgical endoscopy

2022 Volume 37, Issue 3, Page(s) 2290–2294

Abstract: Background: Perineal hernias can be secondarily acquired following abdominoperineal resection of the rectum. While transabdominal minimally invasive techniques have traditionally used laparoscopy, there are few studies published on the robotic platform, ...

Abstract	Background: Perineal hernias can be secondarily acquired following abdominoperineal resection of the rectum. While transabdominal minimally invasive techniques have traditionally used laparoscopy, there are few studies published on the robotic platform, which has been gaining popularity for other types of hernia repairs. We review the existing literature, share a video vignette, and provide practical tips for surgeons interested in adopting this approach. Methods: A literature search in Pubmed was performed to include all articles in English describing robotic repair of perineal hernias with identification of variables of interest related to repair. A case presentation with an accompanying video vignette and lessons learned from the experience are provided. Results: Seven case reports (four containing video) published between 2019 and 2022 were included. Most articles (n = 5) utilized the Da Vinci Si or Xi, and most patients (n = 5) had undergone abdominoperineal resection with neoadjuvant chemotherapy to treat rectal cancer. Patients were positioned in Trendelenburg with rightward tilt (n = 2), modified lithotomy (n = 1), or a combination of the two (n = 1). All articles (n = 7) reported closing the defect and using mesh. Three articles describe placing five ports (one camera, three robotic, one assistant). There were no significant intraoperative or postoperative complications reported, and no recurrence noted at 3-27 months follow-up. Based on our experience, as shown in the video vignette, we recommend lithotomy positioning, using porous polypropylene mesh anchored to the periosteum of the sacrum and peritoneum overlying the bladder and side wall, and placing a drain above the mesh. Conclusions: A robotic transabdominal approach to perineal hernia repair is a viable alternate to laparoscopy based on low complication rates and lack of recurrence. Prospective and longer duration data are needed to compare the techniques.
MeSH term(s)	Humans ; Robotic Surgical Procedures ; Prospective Studies ; Hernia, Abdominal/surgery ; Herniorrhaphy/methods ; Laparoscopy ; Surgical Mesh/adverse effects
Language	English
Publishing date	2022-08-18
Publishing country	Germany
Document type	Review ; Video-Audio Media ; Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-022-09521-2
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Article ; Online: Simple interventions for complex complications: moving surgery forward.

Cohan, Jessica N / Varma, Madhulika G

Diseases of the colon and rectum

2014 Volume 57, Issue 1, Page(s) 3–4

MeSH term(s)	Catheter-Related Infections/prevention & control ; Colectomy ; Cross Infection/prevention & control ; Female ; Humans ; Male ; Postoperative Complications/prevention & control ; Rectum/surgery ; Urinary Catheterization/methods ; Urinary Tract Infections/prevention & control
Language	English
Publishing date	2014-01
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000000018
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Article: Survival impact of bowel resection at the time of interval cytoreductive surgery for advanced ovarian cancer.

McNamara, Blair / Guerra, Rosa / Qin, Jennifer / Craig, Amaranta D / Chen, Lee-May / Varma, Madhulika G / Chapman, Jocelyn S

Gynecologic oncology reports

2021 Volume 38, Page(s) 100870

Abstract: Objectives: To evaluate the impact of bowel resection at the time of interval cytoreductive surgery on survival.: Methods: We identified patients with advanced ovarian cancer who underwent neoadjuvant chemotherapy and interval cytoreductive surgery ... ...

Abstract	Objectives: To evaluate the impact of bowel resection at the time of interval cytoreductive surgery on survival. Methods: We identified patients with advanced ovarian cancer who underwent neoadjuvant chemotherapy and interval cytoreductive surgery between 2008 and 2018 from a single-institution tumor registry. Kaplan-Meier survival analysis and Cox proportional hazards models were performed comparing patients who underwent bowel resection to those who did not. Results: Of 158 patients, 43 (27%) underwent bowel resection. Rates of optimal (95%) and sub-optimal (5%) resection did not differ with bowel resection. Patients that required bowel resection had worse three-year survival (43% vs. 63%), even after adjusting for confounding variables of age, stage, number of neoadjuvant cycles, R0 resection, and ASA score (HR 2.27, p < 0.01). Adjusted progression-free survival did not differ between groups (HR 0.92, p = 0.72). Patients who underwent bowel resection were more likely to require blood transfusion (p < 0.01), and have a longer hospital stay (5 days vs 7.5 days, p < 0.01). Conclusions: Bowel resection at the time of interval cytoreduction confers a greater than 2-fold increased risk of mortality and does not impact progression-free survival. Long-term sequelae of the
Language	English
Publishing date	2021-09-25
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2818505-5
ISSN	2352-5789
ISSN	2352-5789
DOI	10.1016/j.gore.2021.100870
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Article ; Online: Differences in Symptom Severity and Quality of Life in Patients With Obstructive Defecation and Colonic Inertia.

Chou, Adriana B / Cohan, Jessica N / Varma, Madhulika G

Diseases of the colon and rectum

2015 Volume 58, Issue 10, Page(s) 994–998

Abstract: Background: Little is known about how obstructive defecation and colonic inertia symptoms contribute to constipation-related quality of life.: Objective: We sought to characterize the differences in quality of life in patients with severe obstructive ...

Abstract	Background: Little is known about how obstructive defecation and colonic inertia symptoms contribute to constipation-related quality of life. Objective: We sought to characterize the differences in quality of life in patients with severe obstructive defecation and colonic inertia symptoms. Design: This study was a cross-sectional analysis of a prospective database. Setting: Patients were enrolled at a single tertiary referral center. Patients: We included consecutive adults with severe symptoms of obstructive defecation (n = 115) or colonic inertia (n = 90) as measured by the Constipation Severity Instrument. Main outcome measures: The primary outcomes measured were the Pelvic Floor Distress Inventory, Constipation-Related Quality of Life instrument, Pelvic Floor Impact Questionnaire, and 12-item Short Form Health Survey. Results: Although physical examination and anorectal physiology testing were similar between groups, patients with severe obstructive defecation symptoms reported worse pain, distress, and constipation-specific quality of life than patients with severe colonic inertia symptoms (all p < 0.001). Specifically, patients with severe obstructive defecation symptoms showed greater quality-of-life impairment related to eating, bathroom habits, and social functioning (all p ≤ 0.01). Furthermore, patients with severe obstructive defecation symptoms had inferior global quality of life on the 12-item Short Form Health Survey physical component score (p = 0.03) and mental component score (p = 0.06). Limitations: The use of patient self-report instruments resulted in a proportion of patients with incomplete data. Conclusion: Quality of life was impaired in both groups of patients; however, patients with severe obstructive defecation symptoms were affected to a significantly greater extent. The fact that there were no differences in objective findings on physical examination or anorectal physiology studies highlights the importance of assessing quality of life during the evaluation and treatment of constipated patients.
MeSH term(s)	Adult ; Colon/physiopathology ; Constipation/diagnosis ; Constipation/physiopathology ; Constipation/psychology ; Cross-Sectional Studies ; Fecal Impaction/diagnosis ; Fecal Impaction/physiopathology ; Fecal Impaction/psychology ; Female ; Gastrointestinal Motility ; Humans ; Male ; Pelvic Floor/physiopathology ; Prospective Studies ; Quality of Life/psychology ; Severity of Illness Index ; Surveys and Questionnaires ; Symptom Assessment/methods
Language	English
Publishing date	2015-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000000439
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