Journal of the American College of Surgeons
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Anastomotic conversions and revisions remain crucial in addressing complications or sub-optimal outcomes following primary bariatric procedures. Preoperative malnutrition, proxied by hypoalbuminemia, has traditionally been considered a risk factor for postoperative morbidity. This study investigates the validity of this association in revisional and conversion metabolic/bariatric surgery (MBS). ⋯ Following adjustment for confounding patient factors, hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications such as leak, reoperation, or re-intervention after revisional and anastomotic conversion MBS, although there maybe increase in SSI and readmission rates.
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Idiopathic subglottic stenosis (iSGS) is a rare fibrotic disease of the proximal airway affecting adult Caucasian women nearly exclusively. Life-threatening ventilatory obstruction occurs secondary to pernicious subglottic mucosal scar. Disease rarity and wide geographic patient distribution has previously limited substantive mechanistic investigation into iSGS pathogenesis. ⋯ Our novel data support an iSGS disease model where epithelial alterations facilitate microbiome displacement, dysregulated immune activation, and localized fibrosis. Overall, these results refine our understanding of iSGS and implicate shared pathogenic mechanisms with distal airway fibrotic diseases.