Dr. Miroslav P Peev, MD - University of Chicago Medical Center - Cardiothoracic Surgery Fellow

Dr. Miroslav P Peev

MD

University of Chicago Medical Center

Cardiothoracic Surgery Fellow

Chicago, IL | United States

Main Specialties: Thoracic Surgery

Additional Specialties: Surgery

Dr. Miroslav P Peev, MD - University of Chicago Medical Center - Cardiothoracic Surgery Fellow

Dr. Miroslav P Peev

MD

Introduction

Primary Affiliation: University of Chicago Medical Center - Chicago, IL , United States

Specialties:

Additional Specialties:

Publications

23Publications

641Reads

120Profile Views

61PubMed Central Citations

The Role of Minimally Invasive and Endoscopic Technologies in Morbid Obesity Treatment: Review and Critical Appraisal of the Current Clinical Practice.

Obes Surg 2020 Feb;30(2):736-752

Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.

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http://dx.doi.org/10.1007/s11695-019-04302-8DOI Listing
February 2020
3.747 Impact Factor

Abscess due to perforated appendicitis: factors associated with successful percutaneous drainage.

Am J Surg 2016 Oct 20;212(4):794-798. Epub 2015 Oct 20.

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA.

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http://dx.doi.org/10.1016/j.amjsurg.2015.07.017DOI Listing
October 2016
12 Reads
2.291 Impact Factor

Clinical Outcomes of Inadequate Calorie Delivery and Protein Deficit in Surgical Intensive Care Patients.

Am J Crit Care 2016 07;25(4):318-26

D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital.

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http://dx.doi.org/10.4037/ajcc2016584DOI Listing
July 2016
42 Reads
1 Citation
1.600 Impact Factor

Abscess due to perforated appendicitis: factors associated with successful percutaneous drainage.

Am J Surg. 2015 Oct 20. pii: S0002-9610(15)00541-3. doi: 10.1016/j.amjsurg.2015.07.017

Am J Surg

BACKGROUND Percutaneous drainage is the standard treatment for perforated appendicitis with abscess. We studied factors associated with complete resolution (CR) with percutaneous drainage alone. METHODS: Ninety-eight patients underwent percutaneous drainage for acute appendicitis complicated by abscess (October 1990 to September 2010). CR was defined as clinical recovery, resolution of the abscess on imaging, and drain removal without recurrence. Patients achieving CR were compared with patients not achieving CR. RESULTS: The rate of CR was 78.6% (n = 77). Abscess grade was the only radiological factor associated with CR (P = .007). The CR rate was higher with transgluteal drainage (90.9% vs 79.2%) than with other anatomic approaches (P = .018) and higher with computed tomography-guided drainage than with ultrasound-guided drainage (82.7% vs 64.3%, P = .046). CONCLUSION: CR was more likely to be achieved in patients with lower abscess grade, computed tomography-guided drainage, and a transgluteal approach.

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October 2015
11 Reads

Sample entropy predicts lifesaving interventions in trauma patients with normal vital signs

J Crit Care. 2015 Aug;30(4):705-10. doi: 10.1016/j.jcrc.2015.03.018. Epub 2015 Mar 2

J Crit Care

INTRODUCTION Heart rate complexity, commonly described as a "new vital sign," has shown promise in predicting injury severity, but its use in clinical practice is not yet widely adopted. We previously demonstrated the ability of this noninvasive technology to predict lifesaving interventions (LSIs) in trauma patients. This study was conducted to prospectively evaluate the utility of real-time, automated, noninvasive, instantaneous sample entropy (SampEn) analysis to predict the need for an LSI in a trauma alert population presenting with normal vital signs. METHODS: Prospective enrollment of patients who met criteria for trauma team activation and presented with normal vital signs was conducted at a level I trauma center. High-fidelity electrocardiogram recording was used to calculate SampEn and SD of the normal-to-normal R-R interval (SDNN) continuously in real time for 2 hours with a portable, handheld device. Patients who received an LSI were compared to patients without any intervention (non-LSI). Multivariable analysis was performed to control for differences between the groups. Treating clinicians were blinded to results. RESULTS: Of 129 patients enrolled, 38 (29%) received 136 LSIs within 24 hours of hospital arrival. Initial systolic blood pressure was similar in both groups. Lifesaving intervention patients had a lower Glasgow Coma Scale. The mean SampEn on presentation was 0.7 (0.4-1.2) in the LSI group compared to 1.5 (1.1-2.0) in the non-LSI group (P < .0001). The area under the curve with initial SampEn alone was 0.73 (95% confidence interval [CI], 0.64-0.81) and increased to 0.93 (95% CI, 0.89-0.98) after adding sedation to the model. Sample entropy of less than 0.8 yields sensitivity, specificity, negative predictive value, and positive predictive value of 58%, 86%, 82%, and 65%, respectively, with an overall accuracy of 76% for predicting an LSI. SD of the normal-to-normal R-R interval had no predictive value. CONCLUSIONS: In trauma patients with normal presenting vital signs, decreased SampEn is an independent predictor of the need for LSI. Real-time SampEn analysis may be a useful adjunct to standard vital signs monitoring. Adoption of real-time, instantaneous SampEn monitoring for trauma patients, especially in resource-constrained environments, should be considered.

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August 2015
6 Reads

Diagnosis and deployment of a self-expanding foam for abdominal exsanguination: Translational questions for human use.

J Trauma Acute Care Surg. 2015 Mar;78(3):607-13. doi: 10.1097/TA.0000000000000558.

J Trauma Acute Care Surg

BACKGROUND We have previously described the hemostatic efficacy of a self-expanding polyurethane foam in lethal venous and arterial hemorrhage models. A number of critical translational questions remain, including prehospital diagnosis of hemorrhage, use with diaphragmatic injury, effects on spontaneous respiration, the role of omentum, and presence of a laparotomy on foam properties. METHODS: In Experiment 1, diagnostic blood aspiration was attempted through a Veress needle before foam deployment during exsanguination (n = 53). In Experiment 2: a lethal hepatoportal injury/diaphragmatic laceration was created followed by foam (n = 6) or resuscitation (n = 10). In Experiment 3, the foam was deployed in naïve, spontaneously breathing animals (n = 7), and respiration was monitored. In Experiments 4 and 5, the foam was deployed above (n = 6) and below the omentum (n = 6) and in naïve animals (n = 6). Intra-abdominal pressure and organ contact were assessed. RESULTS: In Experiment 1, blood was successfully aspirated from a Veress needle in 70% of lethal iliac artery injuries and 100% of lethal hepatoportal injuries. In Experiment 2, in the presence of a diaphragm injury, between 0 cc and 110 cc of foam was found within the pleural space. Foam treatment resulted in a survival benefit relative to the control group at 1 hour (p = 0.03). In Experiment 3, hypercarbia was observed: mean (SD) Pco2 was 48 (9.4) mm Hg at baseline and 65 (14) mm Hg at 60 minutes. In Experiment 4, abdominal omentum seemed to influence organ contact and transport in two foam deployments. In Experiment 5, there was no difference in intra-abdominal pressure following foam deployment in the absence of a midline laparotomy. CONCLUSION: In a series of large animal studies, we addressed key translational issues surrounding safe use of foam treatment. These additional data, from diagnosis to deployment, will guide human experiences with foam treatment for massive abdominal exsanguination where no other treatments are available.

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March 2015
11 Reads

Delayed laparotomy after selective non-operative management of penetrating abdominal injuries.

World J Surg 2015 Feb;39(2):380-6

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA,

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http://dx.doi.org/10.1007/s00268-014-2813-7DOI Listing
February 2015
19 Reads
2.642 Impact Factor

The influence of anesthesia on heart rate complexity during elective and urgent surgery in 128 patients.

J Crit Care 2015 Feb 27;30(1):145-9. Epub 2014 Aug 27.

Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jcrc.2014.08.008DOI Listing
February 2015
42 Reads
1 Citation
2.191 Impact Factor

The influence of anesthesia on heart rate complexity during elective and urgent surgery in 128 patients.

J Crit Care. 2015 Feb;30(1):145-9. doi: 10.1016/j.jcrc.2014.08.008. Epub 2014 Aug 27.

J Crit Care. 2015 Feb;30(1):145-9. doi: 10.1016/j.jcrc.2014.08.008. Epub 2014 Aug 27.

BACKGROUND As an emerging "new vital sign," heart rate complexity (by sample entropy [SampEn]) has been shown to be a useful trauma triage tool by predicting occult physiologic compromise and need for life-saving interventions. Sample entropy may be confounded by anesthesia possibly limiting its value intraoperatively. We investigated the effects of anesthesia on SampEn during elective and urgent surgical procedures. We hypothesized that SampEn is reduced by general anesthesia. METHODS: With institutional review board-approved waiver of informed consent, 128 patients undergoing elective or urgent general surgery were prospectively enrolled. Real-time heart rate complexity was calculated using SampEn through electrocardiogram recordings of 200 consecutive beats in a continuous sliding-window fashion. We recorded SampEn starting 10 minutes before induction until 10 minutes after emergence from anesthesia. The time before induction of anesthesia was categorized as period 1, the time after induction and before emergence as period 2 (intraoperative), and the time after emergence as period 3. We analyzed SampEn changes as patients moved between the different periods and made 3 comparisons: from period 1 with period 2 (comparison A), from period 2 with period 3 (comparison B). We also compared period 1 with period 3 SampEn (comparison C). RESULTS: The mean SampEn value for all patients before induction of anesthesia was 1.55 ± 0.58. In each 1 of the 3, comparisons there was a decline in SampEn. Comparison A had a mean decrease of 0.53 ± 0.55 (P < .0001), comparison B had a decrease of 0.13 ± 0.52 (P < .0051), and the mean SampEn difference for comparison C was 0.66 ± 0.53 (P < .0001). Certain pharmacologics had significant effect on SampEn as did need for urgent surgery and American Society of Anesthesiologists class. CONCLUSION: Sample entropy decreases after induction of anesthesia and continues to decrease even immediately after emergence in patients without any immediately life-threatening conditions. This finding may complicate interpretation low complexity as a predictor of life-saving interventions in patients in the perioperative period.

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February 2015
11 Reads

Causes and consequences of interrupted enteral nutrition: a prospective observational study in critically ill surgical patients.

JPEN J Parenter Enteral Nutr 2015 Jan 7;39(1):21-7. Epub 2014 Apr 7.

Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts Department of Surgery, Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1177/0148607114526887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402286PMC
January 2015
9 Reads
6 Citations
3.151 Impact Factor

Delayed Laparotomy After Selective Non-operative Management of Penetrating Abdominal Injuries

World Journal of Surgery

BACKGROUND: Main concern during the practice of selective non-operative management (SNOM) for abdominal stab wounds (SW) and gunshot wounds (GSW) is the potential for harm in patients who fail SNOM and receive a delayed laparotomy (DL). The aim of this study is to determine whether such patients suffer adverse sequelae because of delays in diagnosis and treatment when managed under a structured SNOM protocol. METHODS: 190 patients underwent laparotomy after an abdominal GSW or SW (5/04-10/12). Patients taken to operation within 120 min of admission were included in the early laparotomy (EL) group (n =153, 80.5 %) and the remaining in the DL group (n =37, 19.5 %). Outcomes included mortality, hospital stay, and postoperative complications. RESULTS: The median time from hospital arrival to operation was 43 min (range: 17-119) for EL patients and 249 min (range: 122-1,545) for DL patients. The average number and type of injuries were similar among the groups. Mortality and negative laparotomy were observed only in the EL group. There was no significant difference in the hospital stay between the groups. The overall complications were higher in the EL group (44.4 vs. 24.3 %, p =0.026). DL was independently associated with a lower likelihood for complications (OR 0.39, 95 % CI 0.16-0.98, p =0.045). Individual review of all DL patients did not reveal an incident in which complications could be directly attributed to the delay. CONCLUSIONS: In a structured protocol, patients who fail SNOM and require an operation are recognized and treated promptly. The delay in operation does not cause unnecessary morbidity or mortality.

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October 2014
11 Reads

Single-Stage Cholecystectomy at the Time of Pancreatic Necrosectomy Is Safe and Prevents Future Biliary Complications: a 20-Year Single Institutional Experience with 217 Consecutive Patients

Journal of Gastrointestinal Surgery

INTRODUCTION: Current guidelines recommend cholecystectomy (CCY) during the index admission for mild to moderate biliary pancreatitis as delayed CCY is associated with a substantial risk of recurrent biliary events. Delayed CCY is recommended in severe pancreatitis. The optimal timing of CCY in necrotizing pancreatitis, however, has not been well studied. We sought to determine the safety of single-stage CCY performed at the time of necrosectomy and its effectiveness in preventing subsequent biliary complications. METHODS: We retrospectively queried our institutional database of patients who underwent pancreatic necrosectomy for necrotizing pancreatitis from 1992 to 2012. RESULTS: We identified 217 consecutive patients who underwent pancreatic necrosectomy during the study period. The most common etiologies of pancreatitis were biliary (41 %) and alcoholic (24 %), with a median computed tomography (CT) severity index score of 6 ± 1.6 and a 63.6 % incidence of infected necrosis. Ninety-eight patients had undergone CCY prior to necrosectomy. Seventy patients (59 % of those with gallbladders in situ) underwent CCY at the time of pancreatic necrosectomy. CCY was not performed in the remaining 49 due to a clear non-biliary etiology (35 %), technical difficulty (29 %), intraoperative hemodynamic instability (18 %), or surgeon preference (18 %). Postoperative morbidity and mortality was no different between the CCY and no CCY groups, with no bile duct injury or bile leaks in patients undergoing CCY at the time of necrosectomy. Of the patients undergoing CCY, 43 % of patients without cholelithiasis or biliary sludge on preoperative imaging had gallstones or sludge identified pathologically after single-stage CCY. Of those who did not receive a single-stage CCY, biliary complications developed in 17 (35 %) of patients (21 % cholecystitis, 14 % recurrent gallstone pancreatitis) at a median time to incidence of 10 months. Seventeen (35 %) patients eventually received a postnecrosectomy cholecystectomy, of which 75 % required an open procedure. CONCLUSION: Single-stage CCY at the time of pancreatic necrosectomy is safe in selected patients and should be performed if technically feasible to prevent future biliary complications and reduce the need for a subsequent separate, often open, CCY.

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October 2014
17 Reads

Self-expanding foam for prehospital treatment of intra-abdominal hemorrhage: 28-day survival and safety.

J Trauma Acute Care Surg 2014 Sep;77(3 Suppl 2):S127-33

From the Arsenal Medical, Inc. (A.R., J.M., P.H., G.Z., R.B., M.H., U.S.), Watertown; and Department of Surgery (M.J.D., J.B., M.P.P., J.O.H., G.V., M.A.D., D.D.Y., P.J.F., D.R.K.), Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1097/TA.0000000000000380DOI Listing
September 2014
84 Reads
1 Citation
1.970 Impact Factor

Self-expanding foam for prehospital treatment of intra-abdominal hemorrhage: 28-day survival and safety.

J Trauma Acute Care Surg. 2014 Sep;77(3 Suppl 2):S127-33. doi: 10.1097/TA.0000000000000380.

J Trauma Acute Care Surgery

BACKGROUND: Intracavitary noncompressible hemorrhage remains a significant cause of preventable death on the battlefield and in the homeland. We previously demonstrated the hemostatic efficacy of an in situ self-expanding poly(urea)urethane foam in a severe, closed-cavity, hepatoportal exsanguination model in swine. We hypothesized that treatment with, and subsequent explantation of, foam would not adversely impact 28-day survival in swine. METHODS: Following a closed-cavity splenic transection, animals received either fluid resuscitation alone (control group, n = 6) or resuscitation plus foam treatment at doses of 100 mL (n = 6), 120 mL (n = 6), and 150 mL (n = 2). Foam was allowed to polymerize in situ and was explanted after 3 hours. The animals were recovered and monitored for 28 days. RESULTS: All 18 animals in the 100-mL, 120-mL, and control groups survived to the 28-day endpoint without complications. The 150-mL group was terminated after the acute phase (n = 2). En bloc explantation of the foam took less than 2 minutes and was associated with millimeter-sized remnant particles. All foam animals required some level of enteric repair (imbrication or resection). Excluding the aborted 150-mL group, all animals survived, with no differences in renal or hepatic function, serum chemistries, or semiquantitative abdominal adhesion scores. Histologic analysis demonstrated that remnant particles were associated with a fibrotic capsule and mild inflammation, similar to that of standard suture reaction. In addition, safety testing (including genotoxicity, pyrogenicity, and cytotoxicity) was performed consistent with the ISO-10993 standard, and the materials passed all tests. CONCLUSION: For a distinct dose range, 28-day recovery after foam treatment and explantation for noncompressible, intra-abdominal hemorrhage is not associated with significant physiologic or biochemical evidence of end-organ dysfunction. A foam volume exceeding the maximum tolerable dose was identified. Bowel repair is required to ensure survival.

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September 2014
6 Reads

Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study.

World J Emerg Surg 2014 14;9:37. Epub 2014 May 14.

Department of Surgery, Maggiore Hospital, Bologna, Italy.

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http://dx.doi.org/10.1186/1749-7922-9-37DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039043PMC
August 2014
125 Reads
35 Citations
1.062 Impact Factor

The influence of anesthesia on heart rate complexity during elective and urgent surgery in 128 patients

J Crit Care. 2014 Aug 27. pii: S0883-9441(14)00337-2. doi: 10.1016/j.jcrc.2014.08.008

Journal of Critical Care

BACKGROUND: As an emerging "new vital sign," heart rate complexity (by sample entropy [SampEn]) has been shown to be a useful trauma triage tool by predicting occult physiologic compromise and need for life-saving interventions. Sample entropy may be confounded by anesthesia possibly limiting its value intraoperatively. We investigated the effects of anesthesia on SampEn during elective and urgent surgical procedures. We hypothesized that SampEn is reduced by general anesthesia. METHODS: With institutional review board-approved waiver of informed consent, 128 patients undergoing elective or urgent general surgery were prospectively enrolled. Real-time heart rate complexity was calculated using SampEn through electrocardiogram recordings of 200 consecutive beats in a continuous sliding-window fashion. We recorded SampEn starting 10 minutes before induction until 10 minutes after emergence from anesthesia. The time before induction of anesthesia was categorized as period 1, the time after induction and before emergence as period 2 (intraoperative), and the time after emergence as period 3. We analyzed SampEn changes as patients moved between the different periods and made 3 comparisons: from period 1 with period 2 (comparison A), from period 2 with period 3 (comparison B). We also compared period 1 with period 3 SampEn (comparison C). RESULTS: The mean SampEn value for all patients before induction of anesthesia was 1.55 ± 0.58. In each 1 of the 3, comparisons there was a decline in SampEn. Comparison A had a mean decrease of 0.53 ± 0.55 (P < .0001), comparison B had a decrease of 0.13 ± 0.52 (P < .0051), and the mean SampEn difference for comparison C was 0.66 ± 0.53 (P < .0001). Certain pharmacologics had significant effect on SampEn as did need for urgent surgery and American Society of Anesthesiologists class. CONCLUSION: Sample entropy decreases after induction of anesthesia and continues to decrease even immediately after emergence in patients without any immediately life-threatening conditions. This finding may complicate interpretation low complexity as a predictor of life-saving interventions in patients in the perioperative period.

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August 2014
14 Reads

Development of a lethal, closed-abdomen, arterial hemorrhage model in noncoagulopathic swine

J Surg Res

BACKGROUND: Prehospital treatment for noncompressible abdominal bleeding, particularly due to large vascular injury, represents a significant unmet medical need on the battlefield and in civilian trauma. To date, few large animal models are available to assess new therapeutic interventions and hemostatic agents for prehospital hemorrhage control. METHODS: We developed a novel, lethal, closed-abdomen injury model in noncoagulopathic swine by strategic placement of a cutting wire around the external iliac artery. The wire was externalized, such that percutaneous distraction would result in vessel transection leading to severe uncontrolled abdominal hemorrhage. Resuscitation boluses were administered at 5 and 12 min. RESULTS: We demonstrated 86% mortality (12/14 animals) at 60 min, with a median survival time of 32 min. The injury resulted in rapid and massive hypotension and exsanguinating blood loss. The noncoagulopathic animal model incorporated clinically significant resuscitation and ventilation protocols based on best evidenced-based prehospital practices. CONCLUSION: A new injury model is presented that enables screening of prehospital interventions designed to control noncompressible arterial hemorrhage.

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April 2014
9 Reads

Self-expanding foam for prehospital treatment of severe intra-abdominal hemorrhage: dose finding study.

J Trauma Acute Care Surg 2014 Mar;76(3):619-23; discussion 623-4

From the Division of Trauma, Emergency Surgery and Surgical Critical Care (M.S.P., J.O.H., M.J.D., J.B., G.S.V., M.A.D., D.D.Y., P.J.F., D.R.K.), Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston; and Arsenal Medical, Inc. (A.R., J.M., G.Z., R.B., T.F., U.S.), Watertown, Massachusetts.

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http://dx.doi.org/10.1097/TA.0000000000000126DOI Listing
March 2014
63 Reads
6 Citations
1.970 Impact Factor

Revisional versus primary Roux-en-Y gastric bypass: a case-matched analysis

Surgical Endoscopy

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has been a widely performed bariatric procedure. Unfortunately, revisional surgery is required in 20-30% of cases. Data comparing revisional and primary gastric bypass procedures are scarce. This study compared revisional malabsorptive laparoscopic very very long limb (VVLL) Roux-en-Y gastric bypass (RYGB) with primary VVLL RYGB and tested the hypothesis that one-stage revisional laparoscopic VVLL RYGB is an effective procedure after failed LAGB. METHODS: In this study, 48 revisional VVLL RYGBs were matched one-to-one with 48 primary VVLL RYGBs. The outcome measures were operating time, conversion to open surgery, excess weight loss (EWL), and early and late morbidity. RESULTS: Surgical and medical morbidities did not differ significantly. No conversions occurred. The revisional group showed an EWL of 41.8% after 12 months of follow-up evaluation and 45.1% after 24 months based on the pre-revisional weight. The total EWL based on the weight before the LAGB was calculated to be 54.3% after 12 months and 57.2% after 24 months. The EWL in the primary RYGB group was significantly higher for both types of calculation: 41.8%/54.3% versus 64.1 % (p < 0.001 and <0.01) after 12 months and 45.1%/57.2% versus 70.4% (p < 0.001 and <0.002) after 24 months. CONCLUSIONS: Revisional laproscopic VVLL RYGB can be performed as a one-stage procedure by experienced bariatric surgeons but shows less effective EWL than primary RYGB procedures.

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February 2014
10 Reads

Real-time sample entropy predicts life-saving interventions after the Boston Marathon bombing.

J Crit Care 2013 Dec 10;28(6):1109.e1-4. Epub 2013 Oct 10.

Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.

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http://linkinghub.elsevier.com/retrieve/pii/S088394411300321
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http://dx.doi.org/10.1016/j.jcrc.2013.08.026DOI Listing
December 2013
7 Reads
2.191 Impact Factor

Influence of additional resection of the gastric fundus on excessive weight loss in laparoscopic very very long limb Roux-en-Y gastric bypass

Obesity Surgery

Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. The effect of the procedure is based on restriction, malabsorption and changes in hormonal axis. Ghrelin is an important appetite hormone which is produced mainly in the gastric fundus. By adding a resection of the gastric fundus, we hypothesized that excessive weight loss will be more prominent and the satiety feelings less pronounced compared to standard RYGB. A total of 73 patients with standard very very long limb (VVLL) RYGB (group A) were compared with 44 patients with VVLL RYGB with resection of the fundus (group B). Outcome measures were excessive weight loss (EWL), body mass index (BMI), early postoperative morbidity, change of co-morbidities, and appetite reduction as assessed by an appetite questionnaire over a postoperative period of 24 months. Groups were comparable in basic preoperative descriptions. Additional fundus resection did not influence EWL (group A 66.1 % vs. group B 70.6 %, p = 0.383) or BMI (group A 29 kg/m(2) vs. group B 27 kg/m(2), p = 0.199). No significant difference in morbidity or change of co-morbidities occurred. The appetite and satiety questionnaire showed no difference between group A and group B, respectively. Adding a resection of the gastric fundus in RYGB did not alter the clinical results, i.e., increased excessive weight loss, decrease of appetite, or increase of satiety. The value of removing a part of the ghrelin-producing cells might be overestimated.

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March 2013
9 Reads

Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study).

World J Emerg Surg 2013 Jan 3;8(1). Epub 2013 Jan 3.

Department of Surgery, Macerata Hospital, Macerata, Italy.

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http://escholarship.org/uc/item/1mx196t5.pdf
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http://link.springer.com/content/pdf/10.1186%2F1749-7922-8-1
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http://link.springer.com/content/pdf/10.1186%2F1749-7922-9-3
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http://dx.doi.org/10.1186/1749-7922-8-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538624PMC
January 2013
141 Reads
10 Citations
1.062 Impact Factor

Top co-authors

Peter J Fagenholz
Peter J Fagenholz

Massachusetts General Hospital

6
Yuchiao Chang
Yuchiao Chang

Massachusetts General Hospital

6
George C Velmahos
George C Velmahos

Massachusetts General Hospital

4
David R King
David R King

Massachusetts General Hospital

4
George Velmahos
George Velmahos

Massachusetts General Hospital

4
Offir Ben-Ishay
Offir Ben-Ishay

Children's Hospital Boston and Harvard Medical School

2
Yunfeng Cui
Yunfeng Cui

Tianjin Nankai Hospital

2
Miklosh Bala
Miklosh Bala

Hadassah-Hebrew University Medical Center

2
Carlos Augusto Gomes
Carlos Augusto Gomes

Hospital Universitário

2