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Background Minimally invasive approaches to esophagectomy have gained popularity worldwide; however, unplanned conversion to an open approach is not uncommon. This study sought to investigate risk factors associated with converting to an open approach and to evaluate outcomes following conversion.Methods Patients undergoing minimally invasive esophagectomy (MIE) for cancer were identified using the 2016-2019 Procedure Targeted NSQIP Database. Multivariable, stepwise logistic regression analysis was performed to investigate factors associated with unplanned conversion to open esophagectomy. Propensity-matched comparison of robotic (RAMIE) to traditional MIE was performed.Results A total of 1347 patients were included; 140 patients (10%) underwent conversion to open. Morbid obesity, diabetes, hypertension, American Society of Anesthesiologists class, and squamous cell carcinoma were associated with a higher likelihood of conversion. A robotic approach was associated with a lower likelihood of conversion to open (OR .57, 95% CI 0.32-.99). On multivariable analysis, squamous cell carcinoma pathology was the only variable independently associated with higher odds of conversion (OR 2.66, 95% CI 1.02-6.98). Propensity-matched comparison of RAMIE vs MIE showed no significant difference in conversion rate (6.5% vs 9.1%, P= .298), morbidity, or mortality.Discussion A robotic approach to esophagectomy was associated with a lower likelihood of unplanned conversion to open, and patients who were converted to open experienced worse outcomes. Future studies should aim to determine why a robotic esophagectomy approach may lead to fewer open conversions as it may be an underappreciated benefit of this newest operative approach.

Background Currently, there is no nationally accepted protocol for addressing weight regain or inadequate weight loss after MBS.Objectives To devise, implement, and evaluate a protocol targeting weight regain or inadequate weight loss in MBS patients at our institution.Setting Vanderbilt University Medical Center, Nashville, TN, United StatesMethods Patients at least 6 months following primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) who achieved or were trending toward <50% excess body weight loss or who regained ≥10% of their lowest postoperative weight, were identified and referred for medical weight loss (MWL) intervention. Exclusion criteria were body mass index (BMI) ≤ 27 kg/m2, treatment with adjustable gastric banding, and conversion from SG to RYGB.Results 2274 patients who were >6 months out from surgery were evaluated over 12 months. 93 patients (86% female) met criteria for inclusion. 69 (74%) patients agreed to intervention and were followed for an average of 165 days (SD 106.89 days), demonstrating a mean weight change of −5.11 kg (SD 6.86 kg), and BMI change of −1.81 kg/m2(SD 2.37 kg/m2). Patients who spent <90 days in a MWL program demonstrated less average weight loss (1.75 kg vs 6.48 kg) (P= .0042), and less change in BMI (−.63 kg/m2vs −2.29 kg/m2) (P= .0037) when compared to patients who spent >90 days in the MWL intervention.Conclusions This study identifies criteria for intervention in patients suffering weight regain or inadequate weight loss after MBS and demonstrates that standardized identification and referral for treatment results in modest weight loss.

Background: Long-term outcomes of SIRC are not well established. Furthermore, SIRC is only now being considered more frequently for patients with independent risk factors for PSH, such as obesity. As such, the paucity of data on longer-term post-surgical outcomes of SIRC is particularly notable as it pertains to obese patients. Methods: All patients undergoing cholecystectomy performed by two surgeons at our institution from 2008–2018 were reviewed. Our inclusion criteria were patients who underwent SIRC or multiport laparoscopic cholecystectomy (MPLC) and had at least one month of postoperative follow-up. Patients who underwent additional procedures at the time of cholecystectomy were excluded. Our outcomes of interest were the 30-day POC rate and the long-term PSH rate. Analysis was conducted on an intention-to-treat basis, using logistic regression analysis for POC and time-to-event analysis for PSH. Results: We examined 584 patients who underwent either SIRC (51%) or MPLC (49%). Of the 296 patients who underwent SIRC, 15 (5%) developed a POC and 23 (8%) developed a PSH. Of the 288 patients who underwent MPLC, 11 (4%) developed a POC, and 28 (10%) developed a PSH. Procedure group and obesity was not associated with the risk of POC (p= 0.29, p= 0.21, respectively). Procedure group was not associated with an increased risk of PSH (p= 0.29). Obese patients, however, were 1.94 times more likely to develop PSH compared to non-obese patients overall (p= 0.02). Conclusions: There is no statistically significant difference in POC and PSH rate following SIRC when compared with MPLC in patients in the same BMI group. Male gender and prior abdominal surgery are risk factors for POC, while advancing age and obesity are risk factors for PSH.

THE TREMENDOUS increase in the incidence of pelvic endometriosis during the last few years, together with the protean manifestations of the disease, make it of interest not only to the gynecologist but to the general abdominal surgeon as well. Since the days of Sampson's illuminating studies, more and more cases of endometriosis have been encountered on the gynecologic services of university hospitals, until today the disease is discovered to some degree in roughly half the patients subjected to abdominopelvic operation. It is my opinion that this increased incidence is not merely an apparent increase, resulting from a more critical evaluation of this much discussed disease, but is a real one. There has been much conjecture as to the cause of this increased incidence. More intrauterine and cervical instrumentation, particularly curettage, tubal insufflation and cervical cautery, with subsequent stenosis, are thought to be important factors. Perhaps the decreased frequency of gonorrheal

A series of patients with previously treated but progressively advancing malignancies of the female genitalia have been given testosterone propionate in arbitrary dosage of 140 to 150 mg, weekly. Cases include carcinomas of the breast, ovary, Fallopian tube, uterine corpus and cervix. A preliminary report of five cases in detail including carcinomas of the uterine corpus and cervix is presented. These patients have been receiving treatment for ten months. A theoretical consideration of the basis for this clinical investigation is given and our observations noted. Symptomatically, these patients have been definitely improved. Feeling of well-being, improved morale, control of menopausal symptoms, and increased libido have all been regularly observed and these observations alone seemed to us to warrant the administration of male hormone in this unfortunate group of patients. To date, there is nothing to indicate any regression or even retardation of the malignant process.

Gregg1 in 1941 was the first to suggest a relationship between maternal rubella and congenital defects in the child. He studied 78 cases of congenital cataract associated with cardiac or other lesions and in 68 obtained a maternal history of rubella during pregnancy. Since this initial work in Australia, many reports have appeared on this subject. Various congenital defects, particularly cataracts, cardiac malformations and deafness have been reported. Mental retardation, hypospadias, talipes equinovarus, underdevelopment, difficult feeding problems and dental abnormalities also have been mentioned.Further studies disclosed that rubella in the mother during the first trimester of pregnancy is most likely to affect the child. Swan,2 Evans3 and their Australian colleagues followed Gregg's lead and concluded that congenital defects resulted in 100 per cent of babies born to mothers having rubella in the first two months of pregnancy and 50 per cent of children born to women