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3. Regional Anesthetic Use in Trans-Hiatal Esophagectomy. Are They Worth Consideration? A Case Series

Author

Mitchell,William, Roser,Thomas, Heard,Jessica, Logarajah,Shankar, Ok,John, Jay,John, Osman,Houssam, and Jeyarajah,D Rohan

Subjects
Local and Regional Anesthesia
Abstract

William Mitchell,1,* Thomas Roser,1,* Jessica Heard,2 Shankar Logarajah,2 John Ok,1,2 John Jay,2 Houssam Osman,1,2 D Rohan Jeyarajah1,2 1Burnett School of Medicine at Texas Christian University, Fort Worth, TX, USA; 2Methodist Richardson Medical Center, Richardson, TX, USA*These authors contributed equally to this workCorrespondence: D Rohan Jeyarajah, Tel +1 972 619 3500, Email rohanjeyarajah@tcu.eduBackground: Esophagectomy traditionally has high levels of perioperative morbidity and mortality due to surgical techniques and case complexity. While thoracic epidural analgesia (TEA) is considered first-line for postoperative analgesia after esophagectomy, complications can arise related to its sympathectomy and mobility impairment. Additionally, it has been shown that postoperative outcomes are improved with early extubation following esophagectomy. Our aim is to describe the impact of transversus abdominis plane (TAP) blocks on extubation rates following esophagectomy when uncoupled from TEA.Methods: This is a case series of 42 patients who underwent trans-hiatal esophagectomy between 2019 and 2022 who received a TAP block without TEA. The primary outcomes of interest were the rates of extubation within the operating room (OR) and reintubation. Secondary outcomes included: intensive care unit (ICU) and hospital length of stay (LOS), opioid pain medication use, post-operative hypotension, fluid administration, postoperative pain scores, development of anastomotic leak, and 30-day readmission.Results: The mean age at operation was 63 years and 97.6% of patients were represented by American Society of Anesthesia (ASA) physical status class III or IV. Thirty-four (81%) patients immediately extubated postoperatively. Nine patients (21.4%) underwent reintubation during their hospital course. Only seven patients (16.7%) required vasopressors postoperatively. The median LOS was five days in the ICU and 10 days in the hospital. TAP block alone was found to be equivalent to TAP with additional regional blocks (TAP+) on the basis of immediate extubation, reintubation, ICU and hospital LOS, and reported postoperative pain.Conclusion: The results of this study demonstrated immediate extubation is possible using TAP blocks while limiting post-operative hypotension and fluid administration. This was shown despite the elevated comorbidity burden of this study’s population. Overall, this study supports the use of TAP blocks as a possible alternative for primary analgesia in patients undergoing trans-hiatal esophagectomy.Trial Registration: This study includes participants who were retrospectively registered. IRB# 037.HPB.2018.R.Keywords: trans-hiatal, esophagectomy, transversus abdominis plane, TAP, quadratus lumborum, QL, block, epidural, ERAS, analgesia

Published
2023

5. An Unusual Case of Biliary Cystadenoma

Author

Brant, Nicholson, primary, Darwish, Muhammad, additional, Osman, Houssam, additional, Cho, Edward, additional, McLaren, Patrick, additional, Benzie, Annie, additional, Kabbani, Wareef, additional, and Jeyarajah, Dhiresh Rohan, additional

Published
2022
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7. “Infiltrative” Versus “Mass-Forming” Pancreatic Cancer: A New Radiological Classification System for Pancreatic Head Ductal Carcinoma and Its Pathological Correlation

Author

Darwish, Muhammad B., primary, Logarajah, Shankar, additional, McLaren, Patrick J., additional, Benzie, Annie L., additional, Schmidt, Jason, additional, Saad, Assad J., additional, Salicru, Mauricio, additional, Jackson, Terence, additional, Vedantam, Shyam, additional, Carenza, Jeffery, additional, Sanders, Clayton, additional, Nagatomo, Kei, additional, Cho, Edward, additional, Osman, Houssam, additional, and Jeyarajah, Dhiresh Rohan, additional

Published
2022
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21. To Wrap or Not to Wrap After Heller Myotomy

Author

Darwish, Muhammad B., primary, Logarajah, Shankar I., additional, Nagatomo, Kei, additional, Jackson, Terence, additional, Benzie, Annie Laurie, additional, McLaren, Patrick James, additional, Cho, Edward, additional, Osman, Houssam, additional, and Jeyarajah, D. Rohan, additional

Published
2021
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37. Whipple pancreatoduodenectomy: A technical illustration.

Author

Logarajah SI, Jackson T, Darwish M, Nagatomo K, Cho E, Osman H, and Jeyarajah DR

Abstract

Background: The Whipple procedure in its current form owes its evolution to the groundbreaking and innovative work of giants in the field of surgery. From being a multistep procedure with high morbidity and mortality, it is now ubiquitously performed in a single setting, often offered via minimally invasive approaches. Training to perform this procedure is an arduous task, and different training paradigms vary significantly., Objectives/methods: The purpose of this paper is to share a standard method by which the surgeon can perform the Whipple procedure in a systematic manner. Using illustrations to make the steps clearer, the authors will postulate that an improvement in mean operative time can be realistically achieved by most pancreatic surgeons. The focus is also on presenting this complex procedure as reproducible and teachable techniques for trainees., Conclusion: This illustrated review of the Whipple procedure as performed at our institution is intended to help facilitate a streamlined and stepwise progression through what is undoubtedly a challenging surgical procedure. Although the procedure described will not apply to all Whipple operations given the heterogeneity in anatomy and circumstances, our hope is that this will lead to a more efficient procedure and decreased operating room time and costs as well as provide a framework to teach and measure technical progress for surgical trainees., (© 2021 Published by Elsevier Inc.)

Published
2021
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38. Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study.

Author

Osman H, Parikh J, Patel S, and Jeyarajah DR

Subjects
Adult, Cross-Sectional Studies, Curriculum, Education, Medical, Graduate methods, Educational Measurement, Female, Hepatectomy education, Humans, Internship and Residency organization & administration, Male, Pancreatectomy education, Clinical Competence, Fellowships and Scholarships organization & administration, Gastroenterology education, General Surgery education, Surveys and Questionnaires
Abstract

Background: The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training., Methods: A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed., Results: A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships., Conclusions: Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training., (© 2014 International Hepato-Pancreato-Biliary Association.)

Published
2015
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