Berks County Medical Society Medical Record Fall 2019 - 26

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Every year the Berks County
Medical Society's Pat Sharma
President's Scholarship
recipient has benefited from
the coordination of our
program with the Reading
Hospital's Student Summer
Internship program. Society
members are among the
hospital staff personnel
who act as mentors to
the students as they carry
out substantive research
projects during their
6-week experience. The
hospital internship program
also includes extensive
opportunities for clinical
shadowing and didactic
sessions focused on careers
in medicine. Our programs
share the goal of providing
a valuable experience to
young people pursuing a
career in medicine. The Berks
County Medical Society
is grateful to the Reading
Hospital for its support, and
we are pleased to once again
publish the abstracts of the
research projects carried
out by the Hospital Student
Summer Interns.

26

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www.berkscms.org

Reading Hospital/Tower Health

Student Sum

A Retrospective Review of Robotic
Bariatric Conversions
by Nigel Bowe; Jeffery Emrich, DO; Stephen Myers, MD; Leon Katz, MD;
John Fam, MD; David Tichansky, MD. Section of Bariatric Surgery, Tower
Health Reading Hospital, Reading, Pennsylvania
BACKGROUND: When compared to primary bariatric operations, complication rates have
been reported to be much higher when one type of bariatric operation is converted to another.
The literature primarily details conversion operations performed either laparoscopically or
open. However, it has been observed that complication rates are lower at Tower Health Reading
Hospital when these operations are performed robotically with the da Vinci robot. The da Vinci
robot, with its improved visualization and precision, may help bariatric surgeons decrease the
complication rates of these complex operations.
METHODS: A retrospective patient review at Tower Health Reading Hospital was completed
and included patients from March 2012 to June 2018. There were 110 conversion operations
using the da Vinci robot identified. Information was collected on which operation the patients
were converted to (gastric sleeve, gastric bypass, duodenal switch), what operation they were
converted from (gastric band, gastric sleeve, gastric bypass), reason for conversion (reflux,
weight regain, etc.), complications (anastomotic leak/abscess, anastomotic stricture/obstruction,
bleeding/transfusion, etc.), and complication rates were compared to published series of
conversions performed laparoscopically.
RESULTS: Of the 110 conversions, two patients were excluded leaving 108 patients included in
the study. A retrospective medical literature review for laparoscopic bariatric conversion surgeries
was performed and included articles from Jan 2012-June 2019. Of the literature reviewed,
28 articles (2672 total patients) were included in the study for laparoscopic conversion data
comparison. The four types of conversion surgeries analyzed were adjustable gastric band to
Roux-en-Y gastric bypass, adjustable gastric band to sleeve gastrectomy, sleeve gastrectomy to
Roux-en-Y gastric bypass, and sleeve gastrectomy to biliopancreatic conversion with duodenal
switch. Complication rates at Tower Health Reading Hospital vs. the published literature were
comparable for total leaks/abscess (0.9% vs 2.2%), bleeding/transfusions (0.0% vs 1.4%),
strictures/obstructions (4.6% vs 0.8%), and reoperations (4.6% vs 1.6%).
CONCLUSION: There is a growing trend in bariatric surgery toward conversion surgery,
especially in patients who have had an adjustable gastric band. Complication rates were
similar, and in some instances better, when compared between the robotic cases performed at
Tower Health Reading Hospital and the published literature for laparoscopic cases. We believe
robotic bariatric conversion surgery is feasible with our complication rates when compared to
the laparoscopic conversion surgery data from the medical literature. The robotic approach
may eventually demonstrate superiority as surgical techniques develop and surgeon expertise
progresses. However, further research with larger sample size is needed to provide statistical
significance.
Nigel Bowe is a graduate of the University of Wisconsin - La Crosse and is currently
in the Class of 2022 at Drexel University College of Medicine. His current community
service activities include tutoring low-income 8th grade students at St. James School
in Philadelphia and serving as a Clinic Volunteer and Clinic Coordinator for the
Whosoever Health Outreach Project Clinic in Philadelphia.


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Berks County Medical Society Medical Record Fall 2019

Table of Contents for the Digital Edition of Berks County Medical Society Medical Record Fall 2019

Berks County Medical Society Medical Record Fall 2019 - 1
Berks County Medical Society Medical Record Fall 2019 - 2
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