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206 results on '"Osman, Houssam"'

20. No Drain, No Problem: Serum-Based Marker Prediction of Clinically Relevant Postoperative Pancreatic Fistula

Author

Heard, Jessica C., Smith, Glen H., Tolman, Alex, Karumuri, Jashwanth S., Osman, Houssam G., and Jeyarajah, Rohan D.

Abstract

Background Postoperative day (POD) 1 drain amylase concentration (DAC) is considered the most accurate predictor for the development of a clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). Recent studies have associated drain placement with negative postoperative outcomes. This study aims to evaluate multiple biochemical markers and their associations with CR-POPF development in order to identify a reliable, non-drain dependent alternative to DAC.Methods This is a review of 53 consecutive PD patients between 2021 and 2022. Albumin, C-reactive protein (CRP), C-reactive protein-to-albumin ratio (CAR), DAC, white blood cell count, and procalcitonin values were compared by CR-POPF status. The discriminatory abilities of CAR, CRP, and DAC for CR-POPF were compared using receiver operating characteristic (ROC) curves.Results Six of 51 included patients developed a CR-POPF. Receiver operating characteristic curve analysis produced an area under the curve of .977 for POD 1 DAC (cut-off 5131.0 IU/L, sensitivity 100%, specificity 95.5%), .858 for POD 1 CRP (cut-off 52.5 mg/L, sensitivity 100%, specificity 72.7%), and 1.000 for POD 3 CAR (cut-off 99.2, sensitivity and specificity 100%). POD 3 CAR produced a positive and negative predictive value of 100%.Conclusion The CAR and CRP provide early and accurate identification of patients with post-PD CR-POPFs. These markers offer a method of safe CR-POPF detection, when the gold standard DAC is unavailable, ultimately allowing for early intervention and patient rescue.

Published
2024
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23. 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

27. 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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32. “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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44. Hiatal Hernia After Esophagectomy: A Single-Center Retrospective Analysis of a Rare Postoperative Phenomenon

Author

Benzie, Annie Laurie, Darwish, Muhammad B., Basta, Anthony, McLaren, Patrick J., Cho, Edward E., Osman, Houssam, Jay, John, and Jeyarajah, D. Rohan

Abstract

Development of a post-esophagectomy hiatal hernia (PEHH) is a rare, but problematic, sequela with the current reported prevalence ranging up to 20%. To determine the incidence rate of PEHH at our institution, a retrospective review of all transhiatal esophagectomies performed from 2012 to 2020 was conducted. Demographic, operative, and oncologic data were collected, rates of PEHH were calculated, and characteristics of subsequent repair were reviewed and analyzed. A total of 160 transhiatal esophagectomies were included, of which four patients (2.5%) developed a PEHH at a mean of 12 months postoperatively (range: 3-28 months) with symptomatology driving the diagnosis for three patients. The limited size of our study does not allow for statistically significant determinations regarding risk factors or method of repair. The true prevalence of a hiatal defect is likely higher than reported, as clinically asymptomatic patients are not captured in our current literature.

Published
2023
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