J Chris Eagon

Washington University in St. Louis, San Luis, Missouri, United States

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Publications (8)30.2 Total impact

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    ABSTRACT: Introduction Growing number of patients requires revisional bariatric surgery. This study compares perioperative course and outcomes of revisional versus primary bariatric surgery. Methods Patients who underwent revisional bariatric surgery from Jan 1997 to Sept 2012 were reviewed retrospectively. Every revisional patient with BMI >35 and age Results Two hundred and fifty five patients underwent revisional bariatric surgery with resulting Roux-en-Y gastric bypass anatomy while 1,674 patients underwent primary gastric bypass in the same time interval. Of 255 patients, 172 patients were paired with 172 primary gastric bypass patients. Revisional bariatric group had preoperative BMI 48 ± 9, age 52 ± 9 years, 93 % female, 44 % laparoscopic, 30 % diabetic, 60 % hypertensive. Primary bypass patients had preoperative BMI 49 ± 8, age 52 ± 9 years, 93 % female, 97 % laparoscopic, 49 % diabetic, 67 % hypertensive. Compared to primary bypass patients, revisional patients had significantly higher estimated blood loss (463.7 vs. 113.3 mL), longer operative time (272.5 vs. 175.5 min), greater risk for ICU stay (N = 24, 14 % vs. N = 2, 1 %), and longer hospital stay (5.6 vs. 2.5 days). There were significantly more intraoperative liver (N = 13, 8 % vs. N = 1, 1 %) and spleen (N = 18, 10 % vs. N = 0) injuries, and more enterotomies (N = 9, 5 % vs. N = 0) in the revisional group. There were also significantly more postoperative complications (N = 94, 55 % vs. N = 48, 28 %), readmissions (N = 27, 16 % vs. N = 12, 7 %), and reoperations (N = 16, 9 % vs. N = 3, 2 %) within 30 days of surgery. Mean percentage weight loss at 1 year was significantly less for revisional patients (27 vs. 37 %). There was no significant difference in 30 day mortality between the two groups (N = 6 vs. 0). Conclusion Even in experienced hands, complex revisional bariatric surgery should be approached with significant caution, especially given that weight loss is less substantial.
    Surgical Endoscopy 10/2014; 29(6). DOI:10.1007/s00464-014-3848-4 · 3.31 Impact Factor
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    ABSTRACT: Intraoperative perforation is a potentially major complication of laparoscopic (lap) foregut surgery. This study analyzed the incidence, mechanism, and outcomes of intraoperative perforations during these procedures in a large institutional experience. All patients who underwent lap foregut surgery including laparoscopic antireflux surgery (LARS), paraesophageal hernia (PEH) repair, Heller myotomy, and reoperative hiatal hernia (redo HH) repair at the authors' institution from August 2004 to September 2012 were reviewed retrospectively. Perforation events and postoperative outcomes were analyzed, and complications were graded by the modified Clavien system. All data are expressed as means ± standard deviations or as medians. Statistical analysis was performed using Fisher's exact test and the Mann-Whitney U test. In this study, the repairs for 1,223 patients were analyzed (381 LARS procedures, 379 PEH repairs, 313 Heller myotomies, 150 redo HH repairs). Overall, 51 patients (4.2 %) had 56 perforations resulting from LARS (n = 4, 1 %), PEH repair (n = 7, 1.8 %), Heller myotomy (n = 18, 5.8 %), and redo HH repair (n = 22, 14.6 %). Redo HH was significantly more likely to result in perforations than LARS or PEH repair (p < 0.001). The locations of the perforations were esophageal in 13 patients (23.6 %), gastric in 40 patients (72.7 %), and indeterminate in 2 patients (3.6 %). The most common mechanisms of perforations were suture placement for LARS (75 %) and traction for PEH repair (43 %) and for Heller myotomy during the myotomy (72 %). The most redo HH perforations resulted from dissection/wrap takedown (73 %) and traction (14 %). Perforations were recognized and repaired intraoperatively in 43 cases (84 %) and postoperatively in eight cases (16 %). Perforations discovered postoperatively were more likely to require reoperation (75 vs 2 %; p < 0.001), to require more gastrointestinal and radiologic interventions (50 vs 2 %; p = 0.004), and to have higher morbidity (88 vs 26 %; p = 0.004) than perforations recognized intraoperatively. In a high-volume center, intraoperative perforations are the most frequent with reoperative HH repair. If perforations are recognized and repaired intraoperatively, they require minimal postoperative intervention. Unrecognized perforations usually require reoperation and result in significantly greater morbidity.
    Surgical Endoscopy 09/2013; DOI:10.1007/s00464-013-3167-1 · 3.31 Impact Factor
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    ABSTRACT: In morbidly obese patients, oscillometric blood pressure measurements with an upper-arm cuff are often difficult to perform. The alternative method, invasive blood pressure monitoring, can be difficult to place and is associated with risks. A wrist-mounted blood pressure-monitoring device, the Vasotrac, provides accurate blood pressure measurements in lean patients. Even in the obese, wrist morphology remains relatively unchanged. We thus assessed the degree to which blood pressure measurements with the Vasotrac on the wrist and cuff measurements agree with invasive arterial blood pressure monitoring. We evaluated 22 morbidly obese patients undergoing bariatric surgery lasting 3.8+/-1.1 h. Intraoperative blood pressure was simultaneously measured using the Vasotrac mounted on one wrist; an arterial catheter was inserted in the opposite radial artery, and an oscillometric cuff was positioned on the upper arm. Preoperative patient comfort was evaluated on a scale from 1 to 10, with 10 being most uncomfortable, just after the first oscillometric cuff inflation. Values from the Vasotrac and arterial catheter were recorded at 5-s intervals. Bias, precision, and clinically acceptable agreement were calculated between the two continuous monitoring devices and between the arterial catheter and the cuff measurements, with the arterial catheter providing the reference value. The patients' age was 44.3+/-9.5 years (mean+/-SD), body mass index was 66.7+/-13.8 kg/m2, and arm circumference was 48.6+/-7.5 cm. Patients found the Vasotrac more comfortable than the oscillometric device [1.7+/-1.8 vs 5.3+/-0.5 (P=0.009)]. A total of 40,411 pairs of values from the Vasotrac and arterial catheter were recorded. Lin's concordance correlation coefficient (95% CI) for mean arterial blood pressure measured between the arterial line and the Vasotrac was 0.74 (0.67, 0.82). The bias (mean error) was -0.25 mmHg; however, the Bland-Altman limits where 95% of individual pressure differences are expected to fall was (-20, 20) mmHg. The precisions for diastolic and systolic pressures were even worse. The Vasotrac was more comfortable than an oscillometric device. Although the average accuracy was good, individual mean Vasotrac and noninvasive blood pressure pressures often differed considerably from arterial values. These results suggest that the Vasotrac monitor should not be substituted for an arterial catheter in super-obese patients.
    Obesity Surgery 08/2008; 19(6):717-24. DOI:10.1007/s11695-008-9607-7 · 3.74 Impact Factor
  • Deron J Tessier, J Chris Eagon
    Current problems in surgery 03/2008; 45(2):68-137. DOI:10.1067/j.cpsurg.2007.12.003 · 1.42 Impact Factor
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    ABSTRACT: Roux-en-Y gastric bypass is the most frequently performed bariatric surgery for morbid obesity. Gastrojejunal anastomotic strictures are a relatively frequent postoperative complication. To evaluate the clinical outcomes and therapeutic response to through-the-scope balloon dilation performed to treat anastomotic strictures after Roux-en-Y gastric bypass surgery. Single-center, retrospective study. Academic medical center. Between 1997 and 2005, 801 patients with morbid obesity underwent Roux-en-Y gastric bypass surgery at our institution. The development of an anastomotic stricture after Roux-en-Y gastric bypass surgery. The response to through-the-scope balloon dilation after diagnosis. Forty-three of 801 patients (5.4%) developed an anastomotic stricture (26 of 294 open surgeries [8.8%]; 17 of 507 laparoscopic surgeries [3.4%]; P < .001). Strictures were dilated to 15.5 +/- 0.4 mm. There were no perforations or clinically significant bleeding after dilation; 93% of the strictures were successfully managed with 1 or 2 endoscopic sessions. Dilation to at least 15 mm did not affect weight loss at 1 year when compared with the group without a stricture (percentage excess weight loss: stricture group, 76%; no stricture group, 74%). Single-center, retrospective study. Endoscopic balloon dilation is a safe and effective method for the management of gastrojejunostomy strictures after Roux-en-Y gastric bypass. Dilation to at least 15 mm is safe and decreases the need for further endoscopic dilation.
    Gastrointestinal Endoscopy 08/2007; 66(2):248-52. DOI:10.1016/j.gie.2006.10.012 · 4.90 Impact Factor
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    ABSTRACT: Pancreatic leak remains a significant cause of morbidity after distal pancreatectomy. We report the use of an absorbable mesh to reinforce a stapled pancreatic transection line for distal pancreatectomy. Forty consecutive distal pancreatectomies (33 open and 7 laparoscopic) were performed since the introduction of mesh reinforcement. We utilized an inclusive definition of pancreatic leak to critically evaluate the staple line reinforcement material. In addition, we compared the pancreatic leak rate for this case series with the antecedent 40 cases where mesh reinforcement was not available. In the prospective series there was 1 leak in 29 cases (3.5%) in which mesh reinforcement was utilized, and 4 leaks in 11 cases (36%) when mesh was not utilized (p < 0.005). The 12.5% leak rate for the 40 cases during the prospective period, compared favorably to the 27.5% leak rate for the 40 cases preceding the study period (p = 0.09). Twenty-nine cases receiving mesh compared favorably to the 23 stapled cases in the control series, reducing leak rate from 22 to 3.5% (p = 0.04). Mesh reinforcement of the stapled pancreatic transection line reduced the pancreatic leak rate after distal pancreatectomy. Mesh reinforcement was possible with open or laparoscopic resections. No complications were attributable to the use of absorbable mesh.
    Journal of Gastrointestinal Surgery 02/2007; 11(1):59-65. DOI:10.1007/s11605-006-0042-6 · 2.39 Impact Factor
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    ABSTRACT: Risk of wound infection is increased in morbidly obese surgical patients, in part because a major determinant of wound infection risk, tissue oxygenation, is marginal. Unlike in lean patients, supplemental inspired oxygen (Fio2) only slightly improves tissue oxygenation in obese patients. Mild hypercapnia improves tissue oxygenation in lean patients but has not been evaluated in obese patients. We thus tested the hypothesis that mild hypercapnia markedly improves tissue oxygenation in morbidly obese patients given Fio2 80% during major abdominal surgery. Thirty obese patients (body mass index 61.5 +/- 17 kg/m2) scheduled for open gastric bypass were randomly assigned to normocapnia (n = 15, end-tidal Pco2 35 mm Hg) or hypercapnia (n = 15, end-tidal Pco2 50 mm Hg); Fio2 was 80%. Anesthetic management and other confounding factors were controlled. Tissue oxygen tension was measured subcutaneously at the upper arm using a polarographic probe in a silastic tonometer. Demographic characteristics, cardiovascular measurements, and Pao2 (222 +/- 48 versus 230 +/- 68 mm Hg in normocapnic versus hypercapnic; mean +/- sd; P = 0.705) were comparable in the groups. Tissue oxygen tension, however, was greater in hypercapnic than in normocapnic patients (78 +/- 31 versus 56 +/- 13 mm Hg; P = 0.029). Mild hypercapnia increased tissue oxygenation by an amount believed to be clinically important and could potentially reduce the risk of surgical wound infection in morbidly obese patients.
    Anesthesia and analgesia 10/2006; 103(3):677-81. DOI:10.1213/01.ane.0000229715.71464.90 · 3.42 Impact Factor
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    ABSTRACT: The potential for human adipose-derived mesenchymal stem cells (AMSC) to traffic into various tissue compartments was examined using three murine xenotransplantation models: nonobese diabetic/severe combined immunodeficient (NOD/SCID), nude/NOD/SCID, and NOD/SCID/MPSVII mice. Enhanced green fluorescent protein was introduced into purified AMSC via retroviral vectors to assist in identification of cells after transplantation. Transduced cells were administered to sublethally irradiated immune-deficient mice through i.v., intraperitoneal, or subcutaneous injection. Up to 75 days after transplantation, tissues were harvested and DNA polymerase chain reaction (PCR) was performed for specific vector sequences as well as for human Alu repeat sequences. Duplex quantitative PCR using human β-globin and murine rapsyn primers assessed the contribution of human cells to each tissue. The use of the novel NOD/SCID/MPSVII mouse as a recipient allowed rapid identification of human cells in the murine tissues, using an enzyme reaction that was independent of surface protein expression or transduction with an exogenous transgene. For up to 75 days after transplantation, donor-derived cells were observed in multiple tissues, consistently across the various administration routes and independent of transduction parameters. Tissue localization studies showed that the primary MSC did not proliferate extensively at the sites of lodgement. We conclude that human AMSC represent a population of stem cells with a ubiquitous pattern of tissue distribution after administration. AMSC are easily obtained and highly amenable to current transduction protocols for retroviral transduction, making them an excellent avenue for cell-based therapies that involve a wide range of end tissue targets.
    Stem Cells 09/2006; 25(1):220 - 227. DOI:10.1634/stemcells.2006-0243 · 7.70 Impact Factor