John Linn

• NorthShore University HealthSystem

Background Obesity is associated with substantial thromboembolic risk, however, no standard laboratory method exists to stratify risk for post-operative thrombotic events. Our aim is to evaluate preoperative pro-thrombotic biomarkers and thromboelastometry in relationship to clinical VTE stratification in bariatric patients. Methods Preoperative b...

Background There are several surgical options each with their potential for complications, differences in length of procedure, and in meaningful outcomes. This study aims to explore those outcomes after Roux-en-Y Gastric Bypass (RYGB) and Loop Duodenal Switch (LDS). Objective The purpose of this project is to offer a comparative analysis of RYGB a...

Background Hernia repairs are one of the most common general surgery procedures and an essential part of training for general surgery residents. The widespread incorporation of robotic hernia repairs warrants the development of a procedure-specific robotic curriculum to assist novice surgeons in improving technical skills. Objective To evaluate a...

Background Despite excellent surgical outcomes, a minority of qualified patients undergo weight loss surgery. Endoscopic Sleeve Gastroplasty (ESG), an incisionless procedure, has proven to be effective in achieving weight loss and comorbidity improvement. We aim to compare outcomes of ESG to those of Laparoscopic Sleeve Gastrectomy (LSG). Method A...

Purpose Prior investigations regarding the effect of obesity on inguinal hernia repair have been mixed. The aim of our study was to retrospectively compare perioperative outcomes, recurrence rate, and quality of life between obese and non-obese patients undergoing inguinal hernia repair. Methods Patients who underwent inguinal hernia repair by any...

Background Mesh reinforced cruroplasty during laparoscopic paraesophageal hernia repair remains controversial due to wide variation in surgical technique and mesh composition. This study aims to review outcomes and rates of recurrence following laparoscopic paraesophageal hernia repair (LPEHR) with mesh reinforced cruroplasty utilizing absorbable m...

Background: Esophageal dysmotility is a common finding in patients being evaluated for antireflux surgery, although its implication remains unclear. We aimed to evaluate outcomes of patients with esophageal dysmotility after fundoplication. Methods: A retrospective review of a prospective quality-database was performed. All patients who underwen...

Background As flexible endoscopy is increasingly adopted as a minimally invasive approach to surgical challenges, an efficient curriculum is needed to train surgeons in therapeutic endoscopy. We developed a simulation-based approach to teaching endoscopic management of gastrointestinal hemorrhage as part of a modular curriculum, complete with task...

Introduction Compliance is the ability of a hollow organ to dilate and increase volume with an increase in pressure, an accurate representation of food bolus transit through the gastroesophageal junction (GEJ). Impedance planimetry system can calculate compliance (change in volume over pressure) and distensibility (cross-sectional area over pressur...

Background Flexible endoscopy is a valuable tool for the gastrointestinal (GI) surgeon, creating a need for effective and efficient training curricula in therapeutic endoscopic techniques for trainees and practicing providers. Here, we present a simulation-based modular curriculum using an “into the fire” approach with hands-on pre- and post-testin...

Background Simulation using virtual reality (VR) simulators is an important tool in surgical training. VR laparoscopic simulators can provide immediate objective performance assessment without observer evaluation. This study aims to explore the correlation between subjective observer evaluation and VR laparoscopic simulator performance metrics in a...

Background: Previous research has shown that impedance planimetry-based functional lumen imaging probe (FLIP) measurements are associated with patient-reported outcomes after laparoscopic antireflux surgery. We hypothesize that Nissen and Toupet fundoplications have different ideal FLIP profiles, such as distensibility. Study design: A retrospec...

Background The ideal approach to inguinal hernia repair (IHR) after prior pelvic or low abdominal surgery is not agreed upon. We compared safety and outcomes of IHR between open, laparoscopic, and robotic approaches. Methods This retrospective review of a prospective database analyzed demographic, perioperative, and quality of life data for patien...

Background As flexible endoscopy becomes an increasingly valuable minimally invasive approach to surgical challenges, an efficient and comprehensive training curriculum is needed to train surgeons in therapeutic endoscopy. We developed a modular curriculum utilizing a simulation-based, “into the fire” approach to endoscopic foreign body removal for...

IntroductionThe esophagogastric junction (EGJ) is a complex anti-reflux barrier whose integrity relies on both the intrinsic lower esophageal sphincter (LES) and extrinsic crural diaphragm. During hiatal hernia repair, it is unclear whether the crural closure or the fundoplication is more important to restore the anti-reflux barrier. The objective...

Introduction Impedance planimetry with the endoluminal functional lumen imaging probe (FLIP) has been used to measure the gastroesophageal junction (GEJ) tightness, the distensibility index (DI), during anti-reflux surgery. We describe our institutional experience of a tailored fundoplication algorithm utilizing FLIP to select whether patients shou...

Background Numerous studies show changes in functional lumen imaging probe (FLIP) measurements after myotomy during peroral endoscopic myotomy (POEM), but few report on FLIP measurements at follow-up esophagogastroduodenoscopy (EGD). The purpose of this study was to compare perioperative FLIP measurements to those at follow-up EGD. Methods Patient...

Background. There are growing interests from practicing endoscopists to implement the functional lumen imaging probe (FLIP) impedance planimetry system. We present a simulation-based curriculum using an “into the fire” approach with hands-on pre- and post-tests to teach the use of this technology. Methods. The curriculum consists of a series of pre...

Background Simulation is an important tool in surgical training. However, the transferability of skills obtained in the simulation setting to the operating room (OR) is uncertain. This study explores the association between resident simulation performance and OR performance in a laparoscopic cholecystectomy (LC) simulation module. Methods A simula...

Introduction Functional luminal imaging probe (FLIP) use during laparoscopic fundoplication (LF) for gastroesophageal reflux disease is well described. However, there is a lack of data on FLIP measurements during magnetic sphincter augmentation (MSA). This study aims to report our institutional experience in performing FLIP during MSA and to compar...

Introduction This study aims to assess the effect of bariatric surgery on patient-reported outcomes of bowel and bladder function. We hypothesized that bariatric surgery does not worsen bowel and bladder function. Methods and procedures A retrospective review was conducted of a prospectively maintained surgical quality database. We included patien...

Background The endoluminal functional lumen imaging probe (FLIP) can be used to obtain real-time measurements of the diameter (Dmin), cross-sectional area (CSA), and distensibility of the pylorus before and after peroral pyloromyotomy (POP), an emerging endoscopic treatment for delayed gastric emptying. Our study aims to report our single-center ex...

Background There is substantial media and patient interest in the safety of mesh for hernia repair. However, there is a lack of data regarding health-related quality of life (HRQOL) outcomes in patients who undergo inguinal hernia repair (IHR) with mesh. The purpose of this study is report short and long-term postoperative quality of life outcomes...

Background Anti-reflux mucosectomy (ARMS) is a new endoscopic procedure involving a hemi-circumferential endoscopic mucosal resection (EMR) around the gastroesophageal junction. We aim to compare perioperative and quality of life outcomes of patients with reflux who underwent ARMS to a comparable group who underwent laparoscopic Nissen fundoplicati...

Purpose The functional lumen imaging probe provides objective measurements of the gastroesophageal junction during laparoscopic anti-reflux surgery. There is a lack of data on how functional lumen imaging probe measurements change at follow-up. We aim to describe our institutional experience in performing functional lumen imaging probe during posto...

Background Obtaining a clear Critical View of Safety helps prevent bile duct injuries during laparoscopic cholecystectomy, which can be improved with a structured Safe Critical View of Safety curriculum. We aimed to determine whether the improvement in obtaining Critical View of Safety postcurriculum is retained long-term. Methods A safe Critical...

Introduction The Endoluminal Functional Lumen Imaging Probe (Endoflip) can be used to provide objective measurements of the gastroesophageal junction during fundoplication, and recent publications have suggested that this device could improve surgical outcomes. However, the impact of operative variables has not been clearly reported. The aim of thi...

IntroductionPeroral endoscopic myotomy (POEM) is a minimally invasive treatment for achalasia. Considerable evidence demonstrates a high incidence of gastroesophageal reflux disease (GERD) after POEM. The endoluminal functional lumen imaging probe (FLIP) uses impedance planimetry to obtain objective measurements of the gastroesophageal junction. Th...

Background Although peroral endoscopic myotomy (POEM) has emerged as a highly efficacious procedure in the treatment of a variety of esophageal motility disorders, currently no standard pathway for postprocedural care exists. Our study aims to report institutional outcomes in performing POEM as an outpatient procedure with same-day discharge. Addit...

Background Outcomes of incisional hernia repair (IHR) include recurrence and quality of life (QOL). Operative approaches include laparoscopic, open, and robotic approaches. Data regarding comparative QOL outcomes among these repair types are unknown. Our study evaluates quality of life after three approaches to IHR.Study designPatients undergoing o...

IntroductionSpigelian hernias (SH) are rare intraparietal abdominal wall hernias occurring just medial to the semilunar line. Several small series have reported on laparoscopic SH repair and both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approaches have been described. However, there are limited outcome data including bo...

Background The use of mesh in hernia repair has faced intense scrutiny, leading patients to become fearful of its use despite its benefits in reducing hernia recurrence. We report a single institutional experience in performing hernia repair with mesh in terms of hernia-specific outcomes, mesh-related complications and patient-reported quality of l...

Objective Open repair of recurrent inguinal hernias has been shown to result in significantly poorer perioperative outcomes when compared to open primary hernia repair. However, limited data exist comparing primary and recurrent laparoscopic inguinal hernia repair (LIHR). The aim of our study was to compare quality of life and clinical outcomes bet...

Background Peroral endoscopic myotomy (POEM) has previously been shown to be equally if not more expensive than laparoscopic Heller myotomy (LHM). We compare perioperative outcomes and charges between POEM and LHM at a single institution. Methods Outcomes and charge data of 33 patients who underwent LHM and 126 patients who underwent POEM were ana...

Background: Peroral endoscopic pyloromyotomy, or gastric peroral endoscopic myotomy, is a novel endoscopic procedure for the treatment of refractory gastroparesis. We present a simulation-based curriculum using an "into-the-fire" approach with hands-on pre- and post-tests to teach this procedure. Methods: Six, 1-day peroral endoscopic pyloromyot...

Background: Multiple studies have analyzed predictors for chronic pain after open hernia repair. The purpose of this study is to determine which factors predict the development of chronic pain after a laparoscopic inguinal hernia repair. Methods: We identified patients who underwent laparoscopic inguinal hernia repair between 2008 and 2020 at a...

Background: The functional lumen imaging probe is a balloon-based catheter that can be used as a bougie during fundoplication. Our goal was to compare the short-term, quality-of-life outcomes and esophageal-injury rate after fundoplication over a functional lumen imaging probe compared to a traditional bougie. Methods: This is a retrospective re...

Background The study aim is to determine if patients who have undergone endoscopic gastrojejunostomy revision (EGJR) maintain weight loss up to 5 years postoperatively. Methods This is a retrospective review of patients who underwent EGJR with a full-thickness endoscopic suturing device between April 2009 and June 2018. Percent of excess body weig...

Background Each year from 2011 to 2017, fewer than 1% of eligible Americans underwent bariatric surgery to treat obesity and obesity-related comorbidities. Recent studies have suggested that a lack of knowledge within the primary care specialty about the safety and efficacy of bariatric surgery greatly affects referral. This study aimed to analyze...

Background: We provide a comprehensive report of our institution's experience with the endoluminal functional lumen imaging probe (EndoflipTM) impedance planimetry system, a device that can be utilized intra-operatively to objectively evaluate the distensibility of any sphincter of the gastrointestinal tract. We aim to describe the variety of ways...

Background: Subtotal cholecystectomy, where the gallbladder infundibulum is transected to avoid dissecting within the triangle of Calot, has been suggested to conclude laparoscopic cholecystectomy while avoiding common bile duct injury. However, some reports suggest the possibility of recurrent symptoms from a remnant gallbladder. Methods: A ret...

Purpose We report our institution’s experience with endoscopic suturing and hypothesize that it has high technical and clinical success. Methods This is a retrospective review of patients who underwent a procedure with the endoscopic suturing system between April 2010 and March 2019. Definitions of technical and clinical success were established f...

Background The patient presented with symptomatic postprandial biweekly hypoglycemic seizures. Her hypoglycemic episodes were aggravated by stress and also occurred during sleep. She managed these hypoglycemic episodes with an endocrinologist, trying both nutritional and medical management without successful control of her symptoms. An endoscopic g...

Background Postoperative urinary retention (POUR) is a complication of laparoscopic inguinal hernia repair (LIHR). Previous research has identified predictive factors of POUR, such as age and history of benign prostatic hyperplasia (BPH). There is currently limited work on preventative measures. We hypothesize dexamethasone, a steroid, reduces POUR...

Background It remains unclear whether use of self-fixating mesh during laparoscopic inguinal hernia repair (LIHR) impacts postoperative quality of life (QoL). We hypothesize patients receiving self-fixating mesh during totally extraperitoneal (TEP) LIHR will report less pain and improved QoL compared to those receiving non-fixating mesh. Methods A...

Background: For surgery residents, opportunities to systematically learn about surgical equipment are limited. Our facility holds a simulation-based boot camp for incoming, first-year general surgery residents. The aim of this study was to assess the effectiveness of this boot camp at increasing resident confidence and improving technical skills....

Background: Our study aims were to evaluate factors that predict recurrence after open umbilical hernia repair with either mesh or primary closure. Methods: Consecutive patients (n = 1,125) undergoing open umbilical hernia repair from 2009 to 2018 were identified from a prospectively managed, quality database. Kaplan-Meier curves and log-rank te...

Background: For many surgeons, a prior prostatectomy is considered a contraindication to laparoscopic totally extraperitoneal hernia repair. This study aims to evaluate the safety, efficacy, and efficiency of totally extraperitoneal in these patients. Methods: This is a review of a prospectively collected hernia database evaluating patients who...

Background: The purpose was to determine if a standardized video review program for residents improves operative performance. Methods: Participation was offered to surgical residents rotating on a minimally invasive service. Residents were randomized to either the video review group or no video review group. Every participant in the video review...

Background: Obesity has been considered a relative contraindication to peritoneal dialysis (PD). Surprisingly, PD catheter dysfunction rates and longevity have not been studied in the growing obese ESRD population. The aim of this study was to determine the effect of patient weight on PD catheter survival in the three insertion technique categorie...

Background: Despite the popularity of laparoscopic cholecystectomy, rates of common bile duct injury remain higher than previously observed in open cholecystectomy. This retrospective chart review sought to determine the prevalence of, and risk factors for, biliary injury during laparoscopic cholecystectomy within a high-volume healthcare system....

Background: Weight regain after bariatric roux-en-y gastric bypass affects up to 30% of individuals. Revisional surgery is risky, and is typically avoided in favor of dietary and psychological management. Endoscopic gastrojejunostomy revision is a low-morbidity, outpatient procedure that may be more effective than medical management alone for rega...

Background: When considering an asymptomatic inguinal hernia, surgeons must weigh the risks of watchful waiting against the risk of operative complications. Laparoscopy offers the benefit of reduced postoperative pain, which, for appropriate surgical candidates, may strengthen the case for repair. This study compares general and disease-specific q...

Background: The aim of this study is to investigate patient centered quality of life (QOL) outcomes in patients undergoing laparoscopic paraesophageal hernia repair (LPEHR). Study design: We prospectively followed patients who underwent laparoscopic paraesophageal hernia repair between 2009 - 2016. QOL outcomes were measured using Short Form-36...

Purpose: Although many outcomes have been compared between a midline and chevron incision, this is the first study to examine rectus abdominis atrophy after these two types of incisions. Methods: Patients undergoing open pancreaticobiliary surgery between 2007 and 2011 at our single institution were included in this study. Rectus abdominis muscl...

Background Approximately 20–30 % of morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGB) will experience significant weight regain in the years following surgery. Endoscopic gastrojejunal revision (EGJR) has been shown to be a safe, effective and less invasive alternative to revisional surgery, with promising weight loss outcomes. How...

Background: Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient's decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to...

Introduction Primary obesity surgery, endoluminal (POSE) is a promising procedure for weight loss surgery because it is outpatient, is incisionless and has short recovery time. We demonstrate the POSE procedure as a potential option for the bariatric patient. Materials and methods Using an endoluminal camera, we videotaped one of our surgeons perfo...

Objective: To develop and validate a scoring tool capable of accurately predicting which patients with Barrett's esophagus (BE) will progress to dysplasia and/or esophageal adenocarcinoma. Background: Endoscopic therapies have emerged capable of eradicating BE with high efficacy and low complication rates, but which patients should receive treat...

Background: Success of peritoneal dialysis depends on the durability of the peritoneal dialysis catheter, which in turn depends on insertion technique. Catheter-related complications are among the main reasons for peritoneal dialysis failure. Techniques showing evidence of improved catheter function include rectus sheath tunnel, selective omentope...

Background: The lack of long-term data on quality of life after groin hernia repair presents a challenge in setting patients' post-op expectations. This study aimed to describe quality of life outcomes after laparoscopic totally extraperitoneal (TEP) groin hernia repair with a minimum of two-year follow-up. Study design: We prospectively evaluat...

The efficacy of mandatory medically supervised preoperative weight loss (MPWL) prior to bariatric surgery continues to be a controversial topic. The purpose of this observational study was to assess the efficacy of a MPWL program in a single institution, which mandated at least 10 % excess body weight loss before surgery, by comparing outcomes of p...

Background: Surgeon instrument choices are influenced by training, previous experience, and established preferences. This causes variability in the cost of common operations, such as laparoscopic appendectomy. Many surgeons are unaware of the impact that this has on healthcare spending. Objective: We sought to educate surgeons on their instrumen...

To understand whether the elderly (>65 years of age) or octogenarian cohort is at greater risk for poor clinical outcomes after open or laparoscopic inguinal hernia repairs. Beginning in June 2009, all patients presenting to our institution for inguinal hernia repair were asked to participate in a prospective database. Demographics, presenting symp...

Parastomal hernia (PH) is a frequent complication of stoma formation, and recurrence after repair is common. A laparoscopic modified Sugarbaker technique (SB) may decrease the recurrence of PH compared with other methods. A retrospective review, approved by the institutional review board, of patients who underwent PH repair between 2004 and 2014 wa...

The efficacy of mandatory medically supervised preoperative weight loss (MPWL) prior to bariatric surgery continues to be a controversial topic. The purpose of this observational study was to assess the efficacy of a MPWL program in a single institution, which mandated at least 10 % excess body weight loss before surgery, by comparing outcomes of p...

Our aim was to determine the impact of surgeon education regarding disposable supply costs to reduce intraoperative costs for a common procedure such as inguinal hernia repair. At the end of the 2013 fiscal year (FY 13), surgeons in our department were provided with information about the cost of disposable equipment and implants used in common gene...

It is unknown whether acid/reflux control prevents progression in Barrett's esophagus. In this study, we investigate whether medical or surgical control of reflux is associated with a decreased risk of progression to dysplasia/esophageal adenocarcinoma. We retrospectively collected and analyzed data from a cohort of Barrett's esophagus patients par...

Surgeons play a crucial role in the cost efficiency of the operating room through total operative time, use of supplies, and patient outcomes. This study aimed to examine the effect of surgeon education on disposable supply usage during laparoscopic cholecystectomy. Surgeons were educated about the cost of disposable equipments without incentives f...

Background Weight gain after Roux-en-Y gastric bypass occurs in approximately 25 % of cases, and this may contribute to recurrence of comorbid conditions. Currently, adequate treatment strategies for this group of patients are limited. Endoscopic narrowing of the gastrojejunal anastomosis may result in a low-risk, minimally invasive treatment alte...

Inguinal hernia repair is the most common surgery in the world. Health-related quality of life (HRQOL) outcomes are arguably the most important elements of successful repair. This study is aimed to describe short- and long-term quality of life outcomes in patients undergoing laparoscopic inguinal hernia repair. We prospectively followed patients wh...