Daniel J Gagné's research while affiliated with Temple University and other places
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Publications (62)
Cervical esophagogastric anastomotic disruption following transhiatal esophagectomy (THE) is a significant problem. Gastric tip ischemia is a primary cause of anastomotic failure. We examined gastric tip blood flow when laparoscopic "ischemic preconditioning" was attempted by selectively ligating the short gastric (SG) vessels or both the left and...
Although vertical banded gastroplasty (VBG) was endorsed by the 1991 National Institutes of Health Consensus Conference for the treatment of morbid obesity, it has largely been abandoned owing to the poor long-term weight loss and band-related complications. The objective of the present study was to review the outcomes of patients who had undergone...
Selection of candidates for surgical fellowships has traditionally been based on subjective evaluations by the program directors and references from previous positions. The introduction of well-validated objective methods of assessment has allowed us to evaluate candidates' technical skills and base the selection process on objective, reliable, and...
Obesity is a risk factor for cancer and is associated with increased mortality from a number of malignancies. We describe our experience with bariatric surgery patients with a history of malignancy and review the safety and outcomes of bariatric surgery in patients with a history of cancer.
We performed a retrospective review of prospectively colle...
Immunocompromised patients are at high risk of medical complications. Immunosuppression might be a relative contraindication to bariatric surgery. We describe our experience with immunosuppressed patients undergoing bariatric surgery and review the safety, efficacy, results, and outcomes.
We performed a retrospective review of prospectively collect...
Previous studies have reported a high prevalence of Helicobacter pylori infection in patients undergoing Roux-en-Y gastric bypass (RYGB) and a greater incidence of anastomotic ulcer in patients positive for H. pylori, leading to recommendations for routine preoperative screening. Our hypotheses were that the prevalence of H. pylori in patients unde...
Laparoscopic splenectomy has become the surgical procedure of choice for various diseases of the spleen. Portal vein thrombosis (PVT) after splenectomy occurs in 0.5% to 22% of patients. Symptoms are nonspecific and include fever, abdominal pain, and epigastric distress. Risk factors for PVT after splenectomy include underlying hematologic disorder...
Thrombotic thrombocytopenic purpura (TTP) is an uncommon disorder characterized by a pentad of microangiopathic hemolytic anemia, thrombocytopenia, renal dysfunction, fever, and a fluctuating neurologic syndrome. Splenectomy is performed for patients who are refractory to plasma therapy and for relapsing TTP. We describe a case of a patient who die...
Severe obesity can be associated with significant alterations in normal cardiopulmonary physiology. The pathophysiologic effects of obesity on a patient's pulmonary function are multiple and complex. The impact of obesity on morbidity and mortality are often underestimated. Bariatric surgery has been shown to be the most effective modality of relia...
Access and endoscopic evaluation of the bypassed stomach is difficult after laparoscopic Roux-en-Y gastric bypass. We propose a minimally invasive technique to access the bypassed stomach after Roux-en-Y gastric bypass for endoscopic diagnosis and treatment.
First, we established carbon dioxide pneumoperitoneum to a pressure of 12-15 mm Hg. Next, 1...
The bypassed portion of the stomach is difficult to access and evaluate after Roux-en-Y gastric bypass. Access to the excluded stomach may be needed for nutritional support or decompression owing to acute distension and obstruction. We report our experience with percutaneous, computed tomography (CT)-guided gastrostomy tube placement into the gastr...
Gastric diverticula are extremely rare and may be congenital or acquired. Postgastrectomy formation of gastric diverticula has been attributed to outpouching through the weakened wall of the stomach. When symptomatic, gastric diverticula may cause pain, nausea, dysphagia, and vomiting. Gastric diverticula may also be associated with ectopic mucosa,...
Lumbar peritoneal and ventriculoperitoneal shunts are widely used for the treatment of hydrocephalus. In the past, the abdominal portion of these procedures required laparotomy. With the advent of minimally invasive techniques, laparoscopically assisted placement of the distal catheter has been tried.
We performed 10 shunt procedures (3 lumbar peri...
Management of the gallbladder in patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP) is controversial. We reviewed our experience in patients undergoing LRYGBP without routine gallbladder screening.
The data of 644 patients who underwent LRYGBP at our institution were analyzed. Preoperative ultrasonography was routinely obtained earl...
Roux-en-Y gastric bypass (RYGBP) is the most commonly performed operation for the treatment of morbid obesity in the USA. Complications related to the jejuno-jejunal (J-J) anastomosis include postoperative leak, staple-line bleeding and obstruction. We present 3 cases of perforation at the J-J anastomosis occurring more than 30 days after surgery....
Purpose: Although vertical banded gastroplasty (VBG) was endorsed
by the 1991 National Institutes of Health Consensus Conference
for the treatment of morbid obesity, it has largely been
abandoned owing to the poor long-term results. We present our
experience with laparoscopic revision of failed VBG to Roux-en-Y
gastric bypass (RYGBP).
Methods: Retr...
This study was undertaken to determine the safety and efficacy of reoperative laparoscopic fundoplication for patients with failed fundoplication.
Thirty-nine of 612 consecutive patients who had undergone fundoplication underwent laparoscopic reoperative fundoplication for recurrent symptoms, persistent dysphagia, or gas bloat. An additional 15 pat...
Bariatric surgery in patients >50 years has been controversial. We investigated the safety and efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients >55 years of age.
Prospective data on 71 patients (54 females and 17 males) undergoing LRYGBP were reviewed. The patients were followed for a mean of 17 months (range 2-35 months).
The...
Gastrointestinal obstructive complications after laparoscopic Roux-en-Y gastric bypass (LRYGBP) are not uncommon. Their usual causes are strictures, internal hernias and adhesions. Superior mesenteric artery (SMA) syndrome is a rare disorder caused by compression of the third portion of the duodenum by the SMA that can occur after rapid weight loss...
Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been very effective in managing a broad range of morbid obesity-related co-morbidities. We report a beneficial effect of LRYGBP that has not been previously observed.
Between December 1999 and September 2002, 224 patients underwent LRYGBP. Preoperative assessment for hypothyroidism and follow-up da...
The prevalence of irritable bowel syndrome (IBS) is higher among subjects with gastroesophageal reflux disease (GERD). This study aimed to assess the effect of IBS on the postoperative outcome of antireflux surgery.
For this study, 102 patients who underwent laparoscopic fundoplication were screened preoperatively for IBS with the Rome II criteria....
The effect of prior nonoperative treatment, type of fundoplication, and surgical approach on quality of life after minimally invasive Heller myotomy (MIHM) for achalasia in not known. MIHM for achalasia was performed in 105 patients (primary 102; redo 3). Sixty-five patients had prior nonoperative treatment (dilations in 41; botulinum toxin injecti...
Access to the bypassed stomach is difficult following laparoscopic Roux-en-Y gastric bypass (LRYGBP). The bypassed stomach is not readily available for endoscopic or radiographic evaluation. Diagnosis and treatment of peptic ulcer disease and its complications in the excluded stomach becomes difficult. We present a case of perforation in the bypass...
Purpose: Emergency cholecystectomy under general anesthesia has been associated with high morbidity and mortality in critically ill patients. Percutaneus cholecystostomy was advocated as preferred treatment in high surgical risk patients.
The American Journal of Gastroenterology (2003) 98, S59; doi:10.1111/j.1572-0241.2003.07906.x
Spilled gallstones have emerged as a new issue in the era of laparoscopic cholecystectomy. We treated a 77-year-old woman who underwent laparoscopic cholecystectomy. Subsequently, a right flank abscess developed. During the cholecystectomy, the gallbladder was perforated and stones were spilled. After a failed attempt to drain the abscess percutane...
Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a popular operation for morbid obesity. Early complications can be treated successfully with a laparoscopic approach. We reviewed our experience with laparoscopic re-exploration in the early postoperative period.
The initial 85 patients who underwent LRYGBP by two surgeons at a training hospital wer...
The diagnosis of acute abdominal conditions in the critically ill patient remains difficult. The goal of this study is to demonstrate the use of bedside minilaparoscopy as a diagnostic aid in the intensive care unit (ICU) in patients with possible intra-abdominal catastrophic condition.
Between February 1998 and May 1999, intensive care patients wi...
The American Journal of Gastroenterology (2000) 95, 2467; doi:10.1111/j.1572-0241.2000.02551.x
Purpose: Rectal prolapse is a relatively common problem that usually affects an elderly and debilitated population. Symptoms are usually bothersome and socially disabling.
Citations
... Moreover, non-obese T1DM patients have an increased risk of obesity due to the anabolic effects of insulin and due to their frequent use of simple sugars for hypoglycemic episodes [6]. However, the medical literature which describes BS in T1DM patients is limited to few case series and scattered case reports, with conflicting results (Table 1) [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. ...
... Les suites postopératoires étaient simples avec une bonne évolution et un recul de 8 mois sans récidive de la masse ni de la douleur Discussion L'endométriose périnéale est une entité rare. Liang rapporte une série de 6 cas [1]; Robert Akbari rapporte deux cas [2]. Cette pathologie est l'apanage de la femme en période d´activité génitale, ses signes révélateurs sont variables. ...
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... Prior studies have described laparoscopic gastrectomy and Roux-en-Y gastric bypass in the setting of IM [4][5][6]. In these studies, the authors emphasize that surgeons need to be aware of this anatomic variant in advance and know how to handle it intraoperatively [5] as the operation requires visualization of the duodenojejunal angle and identification of the ligament Treitz before dividing the stomach and performing the Roux-en-Y or other reconstruction. ...
... The likely explanation for a reduced AL is a better vascular/oxygen supply to the anastomotic site induced by preoperative GIC. This is indirectly supported by previous studies using Doppler flowmetry, fluorescence microscopy, hyperspectral imaging, and angiography [7,12,13,53]. Histological changes with neoangiogenesis, increased microvessels count, and RR risk ratio, 95% CI confidence interval vessel hypertrophy have also been reported [44]. Similarly, a possible explanation for reduced AS may be an increased preservation of the muscularis propria layer and decreased collagen deposition, with reduced fibrosis at the anastomotic site [19]. ...
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... For the open conversions, a short-term (30-day) complication rate of 6.5% is found while for the laparoscopic conversions in two studies a complication rate of 19% is found [10][11][12]. The study with the largest cohort is a recent study comprised of 321 patients, which included 48 VBG conversions [13]. ...
... The presence of bile in the gastric pouch has been recently recognized as a possible cause of post-operative pain and dysphagia in patients who have had RYGB, and thus explains the gastric pouch cancer following RYGB [61,62]. We believe that retrograde peristalsis in RYGB patients has a role in this; however, studies regarding motility abnormalities in RYGB patients are needed. ...
... 14,15 If a high suspicion persists with inconclusive imaging, a low threshold to perform diagnostic and operative laparoscopy is advisable to reduce morbidity and mortality. 16,17 After reviewing the pathophysiology of Petersen's Hernia, many Obstetricians typically do not emphasize intra-abdominal pathology as primary differentials aside from those stated above. It is important to take a thorough surgical history for gravid patients who present with abdominal pain regardless of trimester and take into consideration possible complications of previous abdominal surgery, including bariatric surgery. ...
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... The increasing prevalence of biologic modifiers and monoclonal antibody therapy must be reflected to represent the modern cohort of patients. While there is substantial short-term data supporting the utilization of bariatric surgery in this patient population, the field is lacking evidence regarding long-term complications and weight loss efficacy [15,16]. We hypothesize that bariatric surgery provides stable weight loss with minimal complications in patients requiring long-term immunosuppression. ...
... Unexpected intraoperative discoveries of tumors suspicious for malignancy seem to be rare. Gagné et al. found only two cases in the retrospective analysis of their cohort of 1566 patients [23]. Considering the alarming cancer risk profile of bariatric patients, a question is if the implementation of a routine abdominal CT or MRI in the preoperative workup would be advisable. ...
... Eight studies report consequential validity evidence relevant to the use of the LapSim in assessment of skill or competence [12,13,17,33,38,42,48,52]. Four studies report procedures for generating pass/fail benchmarks, summarised in Table 8. ...
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