Browsing by Author "Guerron, Alfredo D"

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    Asthma medication usage is significantly reduced following bariatric surgery.
    (Surgical endoscopy, 2019-06) Guerron, Alfredo D; Ortega, Camila B; Lee, Hui-Jie; Davalos, Gerardo; Ingram, Jennifer; Portenier, Dana

    Introduction

    Asthma is an important healthcare problem affecting millions in the United States. Additionally, a large proportion of patients with asthma suffer from obesity. These patients exhibit poor asthma control and reduced therapy response, increasing utilization of healthcare resources. Pulmonary symptoms improve after bariatric surgery (BS), and we hypothesized that asthma medication usage would decrease following BS.

    Methods

    A retrospective data analysis was performed in adult patients from a single institution's database. Patients with obesity using at least one asthma medication pre-operatively who underwent BS were studied for up to 3-years post-operation. Poisson generalized linear mixed models for repeated measures were used to evaluate the effects of time and procedure type on the number of asthma medication.

    Results

    Bariatric patients with at least one prescribed asthma medication (mean 1.4 ± 0.6) were included (n = 751). The mean age at time of operation was 46.8 ± 11.6 years, mean weight was 295.9 ± 57 lbs, and mean body mass index (BMI) was 49 ± 8.2 kg/m2; 87.7% were female, 33.4% had diabetes, 44.2% used gastroesophageal reflux disease (GERD) medication, and 64.4% used hypertension medication. The most common procedure was Roux-en-Y gastric bypass (79%), followed by sleeve gastrectomy (10.7%), adjustable gastric banding (8.1%), and duodenal switch (2.3%). The mean number of prescribed asthma medications among all procedures decreased by 27% at 30 days post-operation (p < 0.0001), 37% at 6 months (p < 0.0001), 44% at 1 year (p < 0.0001), and 46% at 3 years (p < 0.0001) after adjusting for risk factors. No significant differences in medication use over time between procedure types were observed. In the adjusted analysis, the mean number of asthma medications was 12% higher in patients using at least one GERD medication (p = 0.015) and 8% higher with 10-unit increase in pre-operative BMI (p = 0.006).

    Conclusion

    BS significantly decreases asthma medication use starting 30 days post-operation with a sustained reduction for up to 3 years.
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    Foramen of Winslow Hernia: a Review of the Literature Highlighting the Role of Laparoscopy.
    (Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2019-08-16) Moris, Demetrios; Tsilimigras, Diamantis I; Yerokun, Babatunde; Seymour, Keri A; Guerron, Alfredo D; Fong, Philip A; Spartalis, Eleftherios; Sudan, Ranjan
    Foramen of Winslow hernia (FWH) is an extremely rare entity accounting for up to 8% of internal hernias and 0.08% of all hernias. Only 150 cases of FWH have been described in the literature to date with a peak incidence between the third and sixth decades of life. Three main mechanisms seem to be implicated in the FWH pathogenesis: (a) excessive viscera mobility, (b) abnormal enlargement of the foramen of Winslow, and (c) changes in the intra-abdominal pressure. The presence of an abnormally long bowel, enlargement of the right liver lobe or cholecystectomy, a "wandering cecum," and defects of the gastrohepatic ligaments are some reported predisposing factors. Timely diagnosis through computed tomography facilitates the appropriate treatment before complications are evident. Although open repair has been mostly utilized, recently laparoscopic approach seems to gain ground due to the encouraging preliminary results. To date, the debate continues as to whether prophylactic measures to prevent recurrence of the FWH need to be undertaken: closure of the foramen, fixation of the highly mobilized viscera, or both.