Manish Parikh

NYU Langone Medical Center, New York, New York, United States

Are you Manish Parikh?

Claim your profile

Publications (71)250.1 Total impact

  • Surgery for Obesity and Related Diseases 11/2015; 11(6):S204. DOI:10.1016/j.soard.2015.08.328 · 4.07 Impact Factor

  • Surgery for Obesity and Related Diseases 11/2015; 11(6):S80. DOI:10.1016/j.soard.2015.08.103 · 4.07 Impact Factor

  • Surgery for Obesity and Related Diseases 11/2015; 11(6):S17. DOI:10.1016/j.soard.2015.10.026 · 4.07 Impact Factor

  • Surgery for Obesity and Related Diseases 11/2015; 11(6):S66. DOI:10.1016/j.soard.2015.08.077 · 4.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Leak after laparoscopic sleeve gastrectomy (LSG) often presents after hospital discharge, making timely diagnosis difficult. This study evaluates the utility of radiological upper gastrointestinal (UGI) series and clinical indicators in detecting leak after LSG. Methods: A retrospective case-controlled study of 1762 patients who underwent LSG from 2006 to 2014 was performed. All patients with radiographically confirmed leaks were included. Controls consisted of patients who underwent LSG without leak, selected using a 10:1 case-match. Data included baseline patient characteristics, surgical characteristics, and UGI series results. Clinical indicators including vital signs, SIRS criteria, and pain score were compared between patients who developed leak and controls. Results: Of 1762 LSG operations, 20 (1.1 %) patients developed leaks and were compared with 200 case-matched controls. Three patients developed leak during their index admission [mean = 1.3 days, range (1, 2)], while the majority (n = 17) were discharged and developed symptoms at a mean of 17.1 days [range (4, 63)] postoperatively. Patients diagnosed with leak were similar to controls in baseline and surgical characteristics. Contrast extravasation on routine postoperative UGI identified two patients with early leaks, but was negative in the remainder (89 %). Patients with both early and delayed leaks demonstrated significant clinical abnormalities at the time of leak presentation, prior to confirmatory radiographic study. In multiple regression analysis, independent clinical factors associated with leak included fever [OR 16.6, 95 % CI (4.04, 68.10), p < 0.0001], SIRS criteria [OR 7.0, 95 % CI (1.47, 33.26), p = 0.014], and pain score ≥9 [OR 19.1, 95 % CI (1.38, 263.87), p = 0.028]. Conclusions: Contrast extravasation on routine postoperative radiological UGI series may detect early leaks after LSG, but the vast majority of leaks demonstrate normal results and present 2-3 weeks after discharge. Therefore, clinical indicators (specifically fever, SIRS criteria, and pain score) are the most useful factors to raise concern for leaks prior to confirmatory radiographic study and may be used as criteria to selectively obtain UGI studies after LSG.
    Surgical Endoscopy 09/2015; DOI:10.1007/s00464-015-4516-z · 3.26 Impact Factor

  • Surgery for Obesity and Related Diseases 09/2015; DOI:10.1016/j.soard.2015.09.004 · 4.07 Impact Factor
  • Monica Sethi · Manish Parikh ·

    Advances in Surgery 09/2015; 49(1):157-71. DOI:10.1016/j.yasu.2015.04.004
  • [Show abstract] [Hide abstract]
    ABSTRACT: Staple line leak is a serious complication of sleeve gastrectomy. Intraoperative methylene blue and air leak tests are routinely used to evaluate for leak; however, the utility of these tests is controversial. We hypothesize that the practice of routine intraoperative leak testing is unnecessary during sleeve gastrectomy. A retrospective cohort study was designed using a prospectively collected database of seven bariatric surgeons from two institutions. All patients who underwent sleeve gastrectomy from March 2012 to November 2014 were included. The performance of intraoperative leak testing and the type of test (air or methylene blue) were based on surgeon preference. Data obtained included BMI, demographics, comorbidity, presence of intraoperative leak test, result of test, and type of test. The primary outcome was leak rate between the leak test (LT) and no leak test (NLT) groups. SAS version 9.4 was used for univariate and multivariate analyses. A total of 1550 sleeve gastrectomies were included; most were laparoscopic (99.8 %), except for one converted and two open cases. Routine intraoperative leak tests were performed in 1329 (85.7 %) cases, while 221 (14.3 %) did not have LTs. Of the 1329 cases with LTs, there were no positive intraoperative results. Fifteen (1 %) patients developed leaks, with no difference in leak rate between the LT and NLT groups (1 vs. 1 %, p = 0.999). After adjusting for baseline differences between the groups with a propensity analysis, the observed lack of association between leak and intraoperative leak test remained. In this cohort, leaks presented at a mean of 17.3 days postoperatively (range 1-67 days). Two patients with staple line leaks underwent repeat intraoperative leak testing at leak presentation, and the tests remained negative. Intraoperative leak testing has no correlation with leak due to laparoscopic sleeve gastrectomy and is not predictive of the later development of staple line leak.
    Surgical Endoscopy 06/2015; DOI:10.1007/s00464-015-4286-7 · 3.26 Impact Factor

  • Osteoarthritis and Cartilage 04/2015; 23:A387-A388. DOI:10.1016/j.joca.2015.02.716 · 4.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Thirty-day readmission post-bariatric surgery is used as a metric for surgical quality and patient care. We sought to examine factors driving 30-day readmissions after laparoscopic sleeve gastrectomy (LSG). Methods: We reviewed 1257 LSG performed between March 2012 and June 2014. Readmitted and nonreadmitted patients were compared in their demographics, medical histories, and index hospitalizations. Multivariable regression was used to identify risk factors for readmission. Results: Forty-five (3.6 %) patients required 30-day readmissions. Forty-seven percent were readmitted with malaise (emesis, dehydration, abdominal pain) and 42 % with technical complications (leak, bleed, mesenteric vein thrombosis). Factors independently associated with 30-day readmission include index admission length of stay (LOS) ≥3 days (OR 2.54, CI = [1.19, 5.40]), intraoperative drain placement (OR 3.11, CI = [1.58, 6.13]), postoperative complications (OR 8.21, CI = [2.33, 28.97]), and pain at discharge (OR 8.49, CI = [2.37, 30.44]). Patients requiring 30-day readmissions were 72 times more likely to have additional readmissions by 6 months (OR 72.4, CI = [15.8, 330.5]). Conclusions: The 30-day readmission rate after LSG is 3.6 %, with near equal contributions from malaise and technical complications. LOS, postoperative complications, drain placement, and pain score can aid in identifying patients at increased risk for 30-day readmissions. Patients should be educated on postoperative hydration and pain management, so readmissions can be limited to technical complications requiring acute inpatient management.
    Gastroenterology 04/2015; 148(4):S-1170. DOI:10.1016/S0016-5085(15)33993-7 · 16.72 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To compare bariatric surgery versus intensive medical weight management (MWM) in patients with type 2 diabetes mellitus (T2DM) who do not meet current National Institutes of Health criteria for bariatric surgery and to assess whether the soluble form of receptor for advanced glycation end products (sRAGE) is a biomarker to identify patients most likely to benefit from surgery. Background: There are few studies comparing surgery to MWM for patients with T2DM and BMI less than 35. Methods: Fifty-seven patients with T2DM and BMI 30 to 35, who otherwise met the criteria for bariatric surgery were randomized to MWM versus surgery (bypass, sleeve or band, based on patient preference). The primary outcomes assessed at 6 months were change in homeostatic model of insulin resistance (HOMA-IR) and diabetes remission. Secondary outcomes included changes in HbA1c, weight, and sRAGE. Results: The surgery group had improved HOMA-IR (-4.6 vs +1.6; P = 0.0004) and higher diabetes remission (65% vs 0%, P < 0.0001) than the MWM group at 6 months. Compared to MWM, the surgery group had lower HbA1c (6.2 vs 7.8, P = 0.002), lower fasting glucose (99.5 vs 157; P = 0.0068), and fewer T2DM medication requirements (20% vs 88%; P < 0.0001) at 6 months. The surgery group lost more weight (7. vs 1.0 BMI decrease, P < 0.0001). Higher baseline sRAGE was associated with better weight loss outcomes (r = -0.641; P = 0.046). There were no mortalities. Conclusions: Surgery was very effective short-term in patients with T2DM and BMI 30 to 35. Baseline sRAGE may predict patients most likely to benefit from surgery. These findings need to be confirmed with larger studies.
    Annals of Surgery 10/2014; 260(4):617-624. DOI:10.1097/SLA.0000000000000919 · 8.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: The aim of this study was to determine the diagnostic accuracy of positron emission tomography (PET) in cancer patients undergoing adrenalectomy for presumed metastatic disease, utilizing the gold standard of histopathology. Methods: We retrospectively reviewed all adrenalectomies for metastatic disease performed at our institution over the last 12 years. Preoperative PET scans were compared with final pathology reports. Statistical analyses were performed with Fisher's exact test for categorical variables and Student's t test for continuous variables. Results: Forty-nine adrenalectomies were performed for metastatic disease. Thirty had preoperative PET imaging and were included in this analysis. Mean age was 65.5 ± 13.6 years (29-91) and 54 % were male. Mean size was 3.8 cm (0.4-7.1). Primary tumor distribution was 61 % (n = 17) pulmonary; 11 % (n = 3) breast; 7 % (n = 2) gastric; 7 % (n = 2) renal; and 4 % (n = 1) each of brain, lymphoma, melanoma, and uterine. Mean standardized uptake value (SUV) was 11 ± 7.3 (3.2-30.0). Final pathology revealed that 80 % (25/30) were positive for metastatic disease and 20 % (5/30) were negative. The positive predictive value of PET in correctly identifying adrenal metastatic disease was 83 % (24 true-positive cases and 5 false-positive cases); there was one false-negative PET. False-positive PET results were not correlated with sex (p = 0.35), age (p = 0.24), or maximum SUV units (p = 0.26). Conclusions: The 20 % false-positive rate for PET-positive adrenalectomies performed for metastatic disease should warrant its inclusion in preoperative counseling to the patient and interaction with the treating oncologist.
    Annals of Surgical Oncology 08/2014; 22(2). DOI:10.1245/s10434-014-4031-9 · 3.93 Impact Factor

  • 19th World Congress of the; 08/2014

  • 19th World Congress of the; 08/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bariatric surgery is the most effective treatment for patients suffering from obesity-related comorbidities. There is little data regarding how patients choose one particular bariatric procedure over another. This study aimed to better define the relationship between preferences of patients considering bariatric surgery and the procedure patients undergo. A bilingual questionnaire was administered to all prospective patients seen between March 1 and August 31, 2012. The questionnaire assessed basic knowledge of bariatric surgery (based on the information seminar) as well as patient preferences of the various outcomes and complications for sleeve gastrectomy, gastric bypass, and gastric banding. One hundred seventy-two patients completed the questionnaire. Fifty-eight percent of patients chose "maximum weight loss" as the most important outcome, and 65 % chose "leak" as the most concerning complication. Subgroup analysis of patients with diabetes revealed that 58 % chose "curing diabetes" as the most important outcome. Nineteen percent of patients were either not sure which procedure they wanted or changed their decision after consultation with the surgeon. The decision to choose one bariatric procedure over another is complex and is based on factors beyond absolute patient preferences. Although maximum weight loss is a commonly reported preference for patients seeking bariatric surgery, patients with diabetes are more focused on diabetes remission. Most patients have already decided which procedure to undergo prior to surgeon consultation. Patients may benefit from shared decision making, which integrates patient values and preferences along with current medical evidence to assist in the complex bariatric surgery selection process.
    Obesity Surgery 05/2014; 24(11). DOI:10.1007/s11695-014-1270-6 · 3.75 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Abnormality in distal lung function may occur in obesity due to reduction in resting lung volume; however, airway inflammation, vascular congestion and/or concomitant intrinsic airway disease may also be present. The goal of this study is to 1) describe the phenotype of lung function in obese subjects utilizing spirometry, plethysmography and oscillometry; and 2) evaluate residual abnormality when the effect of mass loading is removed by voluntary elevation of end expiratory lung volume (EELV) to predicted FRC. 100 non-smoking obese subjects without cardio-pulmonary disease and with normal airflow on spirometry underwent impulse oscillometry (IOS) at baseline and at the elevated EELV. FRC and ERV were reduced (44±22, 62±14% predicted) with normal RV/TLC (29±9%). IOS demonstrated elevated resistance at 20 Hz (R20, 4.65±1.07 cmH2O/L/s); however, specific conductance was normal (0.14±0.04). Resistance at 5-20 Hz (R5-20, 1.86±1.11 cmH2O/L/s) and reactance at 5 Hz (X5, -2.70±1.44 cmH2O/L/s) were abnormal. During elevation of EELV, IOS abnormalities reversed to or towards normal. Residual abnormality in R5-20 was observed in some subjects despite elevation of EELV (1.16±0.8 cmH2O/L/s). R5-20 responded to bronchodilator at baseline but not during elevation of EELV. This study describes the phenotype of lung dysfunction in obesity as reduction in FRC with airway narrowing, distal respiratory dysfunction and bronchodilator responsiveness. When R5-20 normalized during voluntary inflation, mass loading was considered the predominant mechanism. In contrast, when residual abnormality in R5-20 was demonstrable despite return of EELV to predicted FRC, mechanisms for airway dysfunction in addition to mass loading could be invoked.
    PLoS ONE 02/2014; 9(2):e88015. DOI:10.1371/journal.pone.0088015 · 3.23 Impact Factor
  • Source
    Nicole M Hindman · Stella Kang · Manish S Parikh ·
    [Show abstract] [Hide abstract]
    ABSTRACT: The interpretation of images obtained in patients who have recently undergone abdominal or pelvic surgery is challenging, in part because procedures that were previously performed with open surgical techniques are increasingly being performed with minimally invasive (laparoscopic) techniques. Thus, it is important to be familiar with the normal approach used for laparoscopic surgeries. The authors describe the indications for various laparoscopic surgical procedures (eg, cholecystectomy, appendectomy, hernia repair) as well as normal postoperative findings. For example, port site hernias are more commonly encountered in patients with trocar sites greater than 10 mm and occur at classic entry sites (eg, the periumbilical region). Similarly, preperitoneal air can be encountered postoperatively, often secondary to trocar dislodgement during difficult entry or positioning. In addition, intraperitoneal placement of mesh during commonly performed ventral or incisional hernia repairs typically leads to postoperative seroma formation. Familiarity with normal findings after commonly performed laparoscopic surgical procedures in the abdomen and pelvis allows accurate diagnosis of common complications and avoidance of diagnostic pitfalls. © RSNA, 2014.
    Radiographics 01/2014; 34(1):119-38. DOI:10.1148/rg.341125181 · 2.60 Impact Factor
  • Manish Parikh · H. Leon Pachter ·
    [Show abstract] [Hide abstract]
    ABSTRACT: In most elective cases the laparoscopic approach is the ideal technique for splenectomy. The lateral approach (with the patient in lateral decubitus position) is the most common (and reproducible) technique for laparoscopic splenectomy. Certain cases of massive splenomegaly (spleen >25 cm) may require supine position with 45° tilt or hand-assist. It is important to deliver the appropriate vaccines 2 weeks preoperatively and to be in close consultation with the hematologist if the situation warrants. Accessory spleens should always be searched for at the time of initial exploration.
    Chassin's Operative Strategy in General Surgery, 01/2014: pages 883-887; , ISBN: 978-1-4614-1392-9
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved, unemployed patients with severe obesity. A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed. Preoperative patient questionnaires and medical records were reviewed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team. Follow-up data was obtained on all available patients (including those who did not undergo surgery), including weight and employment status. A standardized telephone questionnaire was administered to supplement details regarding employment. Changes in employment status and body weight were determined in both groups. Here, 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team. The vast majority of patients (>80 %) were minorities (primarily Hispanic) and publicly insured. Seventy-two underwent bariatric surgery and 121 did not. Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively (p = 0.043). There was a 10-point body mass index reduction in the surgical group, compared to 1-point reduction in the non-surgical group after one year. Bariatric surgery may improve employment status in an unemployed severely obese patient cohort. Future research in this area should collect detailed prospective data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment.
    Obesity Surgery 12/2013; 24(5). DOI:10.1007/s11695-013-1140-7 · 3.75 Impact Factor
  • Joanna Sesti · Chinonyerem Okoro · Manish Parikh ·

    Journal of the American College of Surgeons 08/2013; 217(2):e13-e15. DOI:10.1016/j.jamcollsurg.2013.04.037 · 5.12 Impact Factor

Publication Stats

890 Citations
250.10 Total Impact Points


  • 2004-2015
    • NYU Langone Medical Center
      • Department of Surgery
      New York, New York, United States
  • 2014
    • Lincoln Hospital
      Bellevue, Washington, United States
  • 2005-2014
    • CUNY Graduate Center
      New York, New York, United States
  • 2009-2012
    • Gracie Square Hospital, New York, NY
      New York, New York, United States
  • 2007-2011
    • New York Presbyterian Hospital
      New York City, New York, United States
  • 2008
    • Weill Cornell Medical College
      • Department of Surgery
      New York, New York, United States
    • Cornell University
      • Department of Surgery
      Итак, New York, United States