Pouch Size Research Articles

635. FLEXIBLE ENDOSCOPIC SEPTUM DIVISION FOR ZENKER’S DIVERTICULUM: A SINGLE CENTRE EXPERIENCE

Abstract Background Zenker diverticulum (ZD) is a pseudodiverticulum of the Killian’s triangle and usually affects males in the 6th-9th decade of life. Symptoms include dysphagia, regurgitation, chronic cough, aspiration, halitosis, and weight loss. The treatment of symptomatic ZD is operative and can surgical or endoscopic. Flexible endoscopic septum division is becoming a prominent treatment option for Zenker's diverticulum (ZD). We report our experience with Flexible endoscopic septum division. Methods Data on all consecutive patients that underwent flexible endoscopic treatment for symptomatic Zenker’s diverticulum from February 2021 to December 2023 were retrieved. All patients were diagnosed trough both barium esophagogram and EGDS. All procedures were performed in our centre by the same endoscopist. Dysphagia, regurgitation, and respiratory symptoms severity before the procedure were graded with the Kothari-Haber Scoring System (KH SS). Complications, LOS, symptoms scores and recurrences were recorded. Follow up was performed trough clinical and radiological evaluation. Results 19 patients were included, 16 (84%) men, mean age 77.2 years (53-79). Pre-operative mean symptoms score was 6.1 (4-9). The pre-operative mean pouch size was 4,16 cm (range 2,3-6). Median length of stay was 3 days (2-18). One patient had an oesophageal leak that was managed endoscopically with clip positioning, nasogastric tube, fasting, and antibiotics, with satisfactory long term clinical outcome. No other complications were reported. All patients reported significant symptom improvement, median post-operative symptoms score was 0,3 (0-3). Mild relapsing symptoms were present in two patients (10,5%), at 12 and 35 months. Both patients refused further treatments for recurrence. Conclusions Treatment of ZD with flexible endoscopic septum division is a feasible, safe and effective option with satisfactory long-term results.

Banded Versus Non-banded Sleeve Gastrectomy: A Systematic Review and Meta-Analysis.

Standard bariatric surgeries include biliopancreatic diversion (BPD), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and adjustable gastric banding (AGB). Laparoscopic sleeve gastrectomy (LSG) is currently favored due to safety, efficacy, and shorter operation time. However, previous literature shows 75.6% weight regain post LSG. Introducing Laparoscopic band sleeve gastrectomy (LBSG) to maintain pouch size is proposed to improve outcomes and reduce weight regain. This study aims to compare the safety and efficacy of LSG vs. LBSG in obese patients. A comprehensive search strategy was executed to identify pertinent literature comparing LBSGand LSGin obese patients. Eligible studies underwent independent screening, and pertinent data were systematically extracted. The analysis employed pooled risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous variables, each accompanied by their respective 95% confidence intervals (CI). Our systematic review and meta-analysis included 15 studies encompassing 3929 patients. Regarding body mass index (BMI), at six, 12, and 24 months, no substantial differences were found between LBSG and LSG groups (p < 0.05). Still, at 36 months, LBSG exhibited significantly lower BMI than LSG (MD = -2.07 [-3.84, -0.29], p = 0.02). Excess Weight Loss (EWL) favored LBSG at 12, 24, and 36 months with MD of 3.30 [0.42, 6.18], 4.13 [1.44, 6.81], and 18.43 [9.44, 27.42], p = 0.02, 0.003, < 0.00001, respectively). Operative time did not significantly differ between the procedures (MD = 2.95, 95%CI [-0.06, 5.95], p = 0.05). Resolution of comorbidities, overall complications, post-operative bleeding, reflux, and early complications did not significantly differ between LBSG and LSG. However, LBSG showed higher post-operative regurgitation than LSG (RR = 2.38, 95%CI [1.25, 4.54], p = 0.008).LBSG showed a substantial decrease in BMI at three-year follow-up and higher EWL at one, two, and three years. However, LBSG procedures exhibited a higher incidence of post-operative regurgitation symptoms than LSG. No substantial differences were noted in BMI at six, 12, or 24 months, EWL at six months, operative time, bleeding, reflux, or overall complications.

Analysis of Food Holder Design Parameters based on Fused Deposition Modelling (FDM) using Design of Experiment Method

The limitations of food holders available in local food manufacturer companies make it difficult to produce varieties of the food pouch size. Since each size of the pouch requires a specific size of food holder, therefore, this paper aims to analyze and design of a new food holder for a food pouch with a 500g capacity to be used in the filling machine. The pouch, conveyor, and ball plunger were analyzed to help in designing the food holder. Then, critical criteria were identified such as the food holder’s height, elbow length, and slotting length. After analyzing all the critical criteria, the design of experiment method (DOE) was used to identify significant parameters in designing the food holder. A dry run was done to test the holder, and as a result, it was identified that the food holder height was the most significant criteria, but other criteria also played an important role in the food holder.

Tobacco purchasing in Australia during regular tax increases: findings from the International Tobacco Control Policy Evaluation Project

ObjectiveWe examined Australian tobacco purchasing trends, the average self-reported price paid within each purchase type and the association between type of tobacco product purchased and participant characteristics, including quit intentions,...

Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management

Marginal ulcer (MU) is a potential complication following Roux-en-Y gastric bypass (RYGB), with a mean prevalence of 4.6%. Early identification and prompt intervention are crucial to mitigating further complications. The pathophysiology of MU is complex and involves multiple factors, including smoking, Helicobacter pylori infection, non-steroidal anti-inflammatory drug (NSAID) use, and larger pouch size. Patients with MU may experience acute or chronic abdominal pain. Rarely, they may present with a complication from the ulceration, such as bleeding, perforation, or strictures. Following diagnosis by endoscopy, management of MU typically involves modification of risk factors and medical therapy focused on proton pump inhibitors. In case of complicated ulcers, surgical intervention is often required for the repair of the perforation or resection of the stricture. For recurrent or recalcitrant ulcers, endoscopic coverage of the ulcer bed, resection of the anastomosis, and abdominal or thoracoscopic truncal vagotomy may be considered. This review aims at providing an overview of the etiology, diagnosis, and management of MU after RYGB.

The Impact of the Gastric Pouch and Gastro-Jejunostomy Size after Laparoscopic Roux-En-Y Gastric Bypass - A Prospective, CT-Volumetry Based Study

Abstract Background Some patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) may present with insufficient weight loss or weight regain. Anatomical factors that may lead to failure of LRYGB include the size of the gastric pouch and the diameter of the gastro-jejunostomy. Aims This study explores the gastric pouch size and the size of the gastro-jejunostomy after LRYGB and investigates their impact on weight loss, appetite and quality of life (QoL). Methods Patients undergoing LRYGB in a single centre underwent computed tomography (CT) with oral contrast one day and one year after LRYGB. Volumetry of the gastric pouch and calculation of the size of the gastro-jejunostomy was performed. Appetite was assessed pre-operatively and one year after LRYGB using the Edmonton Appetite Assessment questionnaire. QoL was assessed pre-operatively one year after surgery using the GIQLI and BAROS questionnaires. Results 61 patients were included. Of those, 55 patients (90.2%) underwent CT one year after LRYGB. The mean preoperative Body Mass Index was 40.7±3.97kg/m2. The mean Excess weight loss (%EWL) one year after surgery was 82.1±21.5%. There was no significant change in mean gastric pouch size one day and one year after LYRGB (15.73±11.8cm3 and 14.4±11.5cm3, respectively, p=0.55). The mean size of the gastrojejunostomy increased significantly from 2.63cm2 to 3.60cm2 (p&amp;lt;0.0001). Mean GIQLI and BAROS values improved significantly one year after LRYGB, but no significant changes in the mean Edmonton Appetite Assessment values were found. %EWL and improvement in GIQLI and BAROS values one year after surgery did not correlate with the initial size of the gastric pouch and the increase of the size of the gastro-jejunostomy. Conclusions One year after LRYGB, the size of the gastro-jejunostomy increased significantly, but no difference in the gastric pouch volume was found. Both gastric pouch volume and dilatation of the gastro-jejunostomy did not correlate with weight loss and QoL outcomes.

The impact of gastric pouch size, based on the number of staplers, on the short-term weight outcomes of Roux-en-Y gastric bypass

Introduction No standard of anatomical variables, including stoma size, limb length, pouch size, and volume, has been determined for laparoscopic Roux-en-Y gastric bypass yet. Herein, the authors evaluated the effect of two different techniques for creating the gastric pouch on short-term postoperative weight loss. Methods This retrospective cohort was conducted on patients with a laparoscopic Roux-en-Y gastric bypass history from January 2019 to September 2020. Patients were divided into two groups: in one group, patients’ gastric pouch was made using two 60-mm linear staplers, while in the other group, the gastric pouch was made using three 60-mm linear staplers. Anthropometric data, including weight, height, and BMI, were measured preoperatively and 6 months following surgery. Weight outcomes, such as weight loss, a decrease in BMI, excess weight loss (%EWL), and total weight loss (%TWL), were calculated as short-term weight outcomes. Results Two groups, each containing 50 patients, were included. Patients with smaller pouches (two staplers) had 32.4±9.2 kg weight loss, and those with larger pouches (three staplers) had a 31.42±10.3 kg weight loss. Also, %EWL was 69.7±14.9 and 63.0±20.9, and %TWL was 28.2±6.0 and 26.14±7.5 in patients with two stapler pouches and three stapler pouches, respectively. None of the weight outcome parameters was significantly different between the groups (P>0.05). Conclusion Various studies have been conducted, resulting in different conclusions regarding the effect of the size of the gastric pouch on weight loss. One of the major differences contributing to varying literature studies results is the measurement method used for gastric pouch size. The authors conclude that using two staplers is not a way to achieve a better result. As the best measurement method has not been defined, studies comparing different methods are suggested; here, the aim was to use a more simple and clinical method regarding this issue.

Itraconazole and neutrophil interactions in the immune-inflammatory response of paracoccidioidomycosis using a murine air pouch infection model

Paracoccidioidomycosis (PCM) caused by Paracoccidioides brasiliensis (Pb), is a severe mycosis, prevalent in tropical countries. The presence of polymorphonuclear neutrophils (PMN) in lesions is conspicuous, indicating their central role in innate immunity through the direct killing of Pb and the production of cytokines that activate acquired immunity in the presence of itraconazole (Itra). The toxicity and direct antifungal activity of Itra on Pb in splenocyte co-cultures were evaluated in vitro. Itra showed no toxic effect but marked antifungal activity against Pb. Purified PMN were obtained by the subcutaneous (SC) injection of Pb into mice. Results showed the effect of Itra on the size of the air pouch produced, the cellular population that migrated to the infection site, protein, and mitochondrial metabolism patterns, production of ROS an NO, and the number of cytokines synthesized. Lower doses (3 and 10 mg/kg) of Itra did not affect the cellular profile but led to a lower influx of viable more active PMN, and increased production of ROS and proteins. At a dose of 50 mg/kg the PMN profile remained unchanged along with all other parameters analyzed remained unaltered. Decreases in most cytokine levels were inversely proportional to the Itra concentration. Lower Itra concentrations may elicit activation of the immune response because the combined effects of therapy and immune response are needed, while the higher dose does not require it. Itra also promotes the activation of the cytokines which elicit PMN activation and consequently the resolution of Pb18 infection in the air pouch.

Effect of Pouch Size on Sterilization of Ready-to-Eat (RTE) Bracken Ferns: Numerical Simulation and Texture Evaluation

Bracken fern (Pteridium aquilium, BF) is a widely consumed vegetable. It has the potential to be manufactured as a ready-to-eat (RTE) product as a cooking ingredient and a side dish. The aim of the current study was to develop sterilized BF RTE products and to investigate textural qualities depending on the size of the pouches. The F0-value at the cold point according to pouch size (100, 150, and 200 g) targeted at 15 min was determined through heat transfer simulation using the calibrated heat transfer coefficient. The location of the cold points in the stand-up pouches was moved upward from the bottom of the pouch by increasing the pouch size. The sterilization time for 100, 150, and 200 g was evaluated as 35.0, 41.5, and 47.5 min, respectively. The textural properties measured using the cutting test showed significant differences according to the location in the pouch. The textural degradation of BF in the top part of the pouch was more extensive than that at the bottom due to the smaller dimensions. In addition, the percentage of textural degradation in the top part increased with increasing pouch sizes. The methods introduced in this study can be applied to validate the degree of sterilization and the texture of various stalk vegetables used for ready-to-eat products packed in stand-up pouches.

The impact of gastric pouch size, based on the number of staplers, on the short-term weight outcomes of Roux-en-Y gastric bypass.

No standard of anatomical variables, including stoma size, limb length, pouch size, and volume, has been determined for laparoscopic Roux-en-Y gastric bypass yet. Herein, we evaluated the effect of two different techniques for creating the gastric pouch on short-term postoperative weight loss. This retrospective cohort was conducted on patients with a laparoscopic Roux-en-Y gastric bypass history from January 2019 to September 2020. Patients were divided into two groups: in one group, patients' gastric pouch was made using two 60mm linear staplers, while in the other group, the gastric pouch was made using three 60mm linear staplers. Anthropometric data, including weight, height, and body mass index (BMI), were measured preoperatively and six months following surgery. Weight outcomes, such as weight loss, a decrease in BMI, excess weight loss (%EWL), and total weight loss (%TWL), were calculated as short-term weight outcomes. Two groups, each containing 50 patients, were included. Patients with smaller pouches (two staplers) had 32.4±9.2kg weight loss, and those with larger pouches (three staplers) had a 31.42±10.3kg weight loss. Also, %EWL was 69.7±14.9 and 63.0±20.9, and %TWL was 28.2±6.0 and 26.14±7.5 in patients with two stapler pouches and three stapler pouches, respectively. None of the weight outcome parameters were significantly different between the groups (p-value>0.05). Various studies have been conducted, resulting in different conclusions regarding the effect of the size of the gastric pouch on weight loss. One of the major differences contributing to varying literature studies results is the measurement method used for gastric pouch size. We conclude that using two staplers is not a way to achieve a better result. As the best measurement method has not been defined, studies comparing different methods are suggested; here, the aim was to use a more simple and clinical method regarding this issue.

Large Versus Small Gastric Pouch for Roux-en-Y Gastric Bypass in Individuals With Type 2 Diabetes and a Body Mass Index < 35 kg/m2: Six-Year Outcomes.

BackgroundRoux-en-Y gastric bypass (RYGB) results in extraordinary weight loss and glycemic control outcomes for patients with obesity; however, the effect of gastric pouch size is still unclear, and the reported results are contradictory. Additionally, long-term data on type 2 diabetes (T2D) patients with low body mass index (BMI) are sparse. This study was to assess the effect of 6-year outcomes in Chinese patients with T2D and a BMI < 35 kg/m2 who underwent RYGB with gastric pouches of different sizes.MethodsA retrospective cohort study was performed. There were 42 patients in the large gastric pouch group (L) and 53 patients in the small gastric pouch group (S). Baseline demographic history, pre- and postoperative BMI, waist circumference, and glucose- and lipid metabolism-related indicators were compared.ResultsAssessments were completed in 100%, 100%, 93.6%, and 89.4% of patients at baseline, 1 year, 3 years, and 6 years, respectively. At 6 years, the changes in BMI and fasting plasma glucose were greater in the S group (-4.25 ± 0.51 kg/m2 and -4.58 ± 0.73 mmol/l) than in the L group (-2.06 ± 0.48 kg/m2 and -2.64 ± 0.61 mmol/l). The independent predictors of complete remission of T2D were preoperative BMI and the size of the gastric pouch. A large gastric pouch was associated with a higher risk for marginal ulcers.ConclusionsA small gastric pouch results in better weight loss and glycemic control. High preoperative BMI and a small gastric pouch are associated with better T2D remission rates. A large gastric pouch leads to a higher incidence of marginal ulcers.

Effects of Heterozygous Variants in the Leptin-Melanocortin Pathway on Roux-en-Y Gastric Bypass Outcomes: a 15-Year Case-Control Study.

Heterozygous variants in the leptin-melanocortin pathway are associated with obesity. However, their effect on the long-term outcomes after Roux-en-Y gastric bypass (RYGB) is still unknown. In this matched case-control study, 701 participants from the Mayo Clinic Biobank with a history of RYGB were genotyped. Sixty-three patients had a heterozygous variant in the leptin-melanocortin pathway. After excluding patients with potential confounders, carriers were randomly matched (on sex, age, body mass index [BMI], and years since surgery) with two non-carrier controls. The electronic medical record of carriers and matched non-carriers was reviewed for up to 15years after RYGB. A total of 50 carriers and 100 matched non-carriers with a history of RYGB were included in the study. Seven different genes (LEPR, PCSK1, POMC, SH2B1, SRC1, MC4R, and SIM1) in the leptin-melanocortin pathway were identified. At the time of surgery, the mean age was 50.8 ± 10.6years, BMI 45.6 ± 7.3kg/m2, and 79% women. There were no differences in postoperative years of follow-up, Roux limb length, or gastric pouch size between groups. Fifteen years after RYGB, the percentage of total body weight loss (%TBWL) in carriers was - 16.6 ± 10.7 compared with - 28.7 ± 12.9 in non-carriers (diff = 12.1%; 95% CI, 4.8 to 19.3) and the percentage ofweight regain after maximum weight loss was 52.7 ± 29.7 in carriers compared with 29.8 ± 20.7 in non-carriers (diff = 22.9%; 95% CI, 5.3 to 40.5). The nadir %TBWL was lower - 32.1 ± 8.1 in carriers compared with - 36.8 ± 10.4 in non-carriers (diff = 4.8%; 95% CI 1.8 to 7.8). Carriers of a heterozygous variant in the leptin-melanocortin pathway have a progressive and significant weight regain in the mid- and long-term after RYGB. Genotyping patients experiencing significant weight regain after RYGB could help implement multidisciplinary and individualized weightloss interventions to improve weight maintenance after surgery.

Examining the shape and size of female and male genitalia in snakes using three-dimensional geometric morphometrics

Abstract Quantification of genital variation in males and females can inform our understanding of likely copulatory interactions and evolution of genital diversity. However, no studies have quantified genital shape variation within a single snake species or examined the shape and size of both the vaginal pouch and hemipenes. Here, we examine the shape and size of the genitalia of female and male diamondback water snakes, Nerodia rhombifer, using a three-dimensional automated landmark geometric morphometric approach on models of the lumen of the vaginal pouch and inflated hemipenes, applying these techniques for the first time to the genital shape of vertebrates. Vaginal pouch shape is significantly associated with body size and reproductive status. As females grow larger and become reproductive, the vaginal pouch enlarges, widens and becomes more bifurcated. In reproductive males, the shape of the hemipenes is also significantly associated with body size. As males grow larger, the hemipenes enlarge and widen; their bifurcation becomes more defined and the spines at the base become more prominent. Vaginal pouch and hemipenial centroid size are isometric with respect to body length. The centroid sizes of the hemipenes and vaginal pouch are not significantly different from one another, hence the genitalia match in size. Reproductive females and males covary in the degree of bifurcation and size of their genitalia. We demonstrate the utility of three-dimensional analysis in studies of the shape of soft tissues and advocate its use in future studies of genitalia.

Computed Tomography Assessment of Gastric Band Slippage

Background: The purpose of this study was to develop and validate reliable computed tomography (CT) imaging criteria for the diagnosis of gastric band slippage. Material and Methods: We retrospectively evaluated 67 patients for gastric band slippage using CT. Of these, 14 had surgically proven gastric band slippage (study group), 22 had their gastric bands removed for reasons other than slippage (control group 1), and 31 did not require removal (control group 2). All of the studies were read independently by two radiologists in a blinded fashion. The “O” sign, phi angle, amount of inferior displacement from the esophageal hiatus, and gastric pouch size were used to create CT diagnostic criteria. Standard statistical methods were used. Results: There was good overall interobserver agreement for diagnosis of gastric band slippage using CT diagnostic criteria (kappa = 0.83). Agreement was excellent for the “O” sign (kappa = 0.93) and phi angle (intraclass correlation coefficient = 0.976). The “O” sign, inferior displacement from the hiatus >3.5 cm, and gastric pouch volume >55 cm³ each had 100% positive predictive value. A phi angle <20° or >60° had the highest negative predictive value (NPV) (98%). Of all CT diagnostic criteria, enlarged gastric pouch size was most correlated with band slippage with an AUC of 0.991. Conclusion: All four imaging parameters were useful in evaluating for gastric band slippage on CT, with good interobserver agreement. Of these parameters, enlarged gastric pouch size was most correlated with slippage and abnormal phi angle had the highest NPV.

Why Size Matters: an Evaluation of Gastric Pouch Size in Roux-en-Y Gastric Bypass Using CT Volumetric Analysis and its Effect on Marginal Ulceration

Marginal ulceration (MU) is a common long-term complication following Roux-en-Y gastric bypass (RYGB). The causes of MU after RYGB are multifactorial and include surgical technique of constructing the gastrojejunal anastomosis (GJA). The purpose of this study is to evaluate the relationship between gastric pouch size in RYGB and MU using CT volumetrics. Patients were retrospectively identified who underwent esophagogastroduodenoscopy (EGD) following RYGB at a tertiary care teaching hospital. Measurement of gastric pouch size was performed using 3-D CT software. Standard statistical methods were used, a univariate comparison was performed between MU and non-MU patients followed by a propensity-matched comparison to control for factors known to affect MU, and a propensity-matched subgroup analysis was also performed. In total, 122 patients met criteria, 57 of which had MU on EGD and 65 who did not. The MU group had more smokers and patients with PPI use than the non-MU group, and the mean time from operation to CT scan was 26.6months (range: 0-108months). The MU group had a larger gastric pouch size than the non-MU group (34.1 ± 11.8 versus 20.1 ± 6.8 cm3). When analyzed for matched patient cohorts, this difference remained for the MU group that included smokers and PPI use. When stratified for pouch size, for each 5 cm3 increase in pouch size, patients had 2.4 times odds increase of MU formation. CT volumetric analysis demonstrated that a larger gastric pouch size was associated with MU following RYGB.

Endoscopic therapy of weight regain after bariatric surgery.

Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological, anatomical and metabolic factors. Surgical revision of these patients has significant risks and limited benefits. Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective, safe, less invasive and even reproducible treatment. We herein discuss the indication, selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery. Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.

Detail correction for Gross classification of esophageal atresia based on 434 cases in China.

Detail correction for Gross classification of esophageal atresia based on 434 cases in China.

Cap-Assisted Endoscopic Septotomy of Zenker's Diverticulum: Early and Long-Term Outcomes.

Multiple therapeutic modalities including surgery and rigid and flexible endoscopy have been adopted to manage Zenker's diverticulum (ZD). Minimally invasive flexible endoscopic septotomy (FES) techniques have been increasingly favored over the past 20 years; however, long-term data are still scanty. The aim of this study is to evaluate early and long-term outcomes of FES for naive ZD in a single-center setting. From 2010 to 2017, ZD patients treated with FES were included in a prospectively maintained database (NCT03948438). Those who had already been treated surgically or endoscopically were excluded from the analysis. The Dakkak and Bennett dysphagia scale was used to rate the dysphagia. Persistent complete or near-complete resolution of symptoms (Dakkak and Bennett 0 or 1) was defined as clinical success. Postprocedural adverse events were reported according to ASGE lexicon. Overall, 256 consecutive patients were treated. Mean pouch size was 29.8 ± 11.3 mm. The procedure was successfully completed in all scheduled patients, with an early clinical success of 96.1%. Adverse events occurred in 3.5% (9/256) of patients. Eight of them were mild/moderate with no fatal events, whereas one patient required surgery. Recurrences occurred in 31.3% (80/256) of treated patients after a mean time of 9 ± 3 months and 95% of recurrences were treated by a second FES. At an average follow-up of 5.5 years, 95.3% of patients were asymptomatic after a mean number of 1.3 procedures. FES is a safe and effective treatment modality for patients with ZD. Recurrence rate is significant; however, endoscopic reintervention is associated with long-term relief of dysphagia.

Scalable activated carbon/graphene based supercapacitors with improved capacitance retention at high current densities.

Scalable, highly stable supercapacitor electrodes were developed from the mixture of a tea factory waste based activated carbon (AC) and a low-cost electrochemical exfoliated graphene (EEG). The hybrid electrodes showed notably enhanced stability at high current densities. The AC sample was prepared by chemical method and exposed to a further heat treatment to enhance electrochemical performance. Graphene used in the preparation of hybrid electrodes was obtained by direct electrochemical exfoliation of graphite in an aqueous solution. Detailed structural characterization of AC, EEG, and hybrid material was performed. The original electrochemical performances of AC and EEG were examined in button size cells using an aqueous electrolyte. The hybrid materials were prepared by mixing AC and EEG at different mass percentage ratios, and tested as supercapacitor electrodes under the same conditions. Capacitance stability of the electrodes developed from AC:EEG (70:30) at high currents increased by about 45% compared to the original AC. The highest gravimetric capacitance (110 F/g) was achieved by this hybrid electrode. The hybrid electrode was scaled up to the pouch size and tested using an organic electrolyte. The organic electrolyte was preferred for scaling up due to its wider voltage ranges. The pouch cell had a gravimetric capacitance of 85 F/g and exhibited as good performance as the coin cell in the organic electrolyte.

Transoral Laser-Assisted Diverticulectomy: Swallow Study Results after Complete Endoscopic Pouch Excision for Zenker's Diverticulum.

Transoral endoscopic laser-assisted diverticulotomy (TELD) with diverticulectomy and diverticuloplasty (TELD + DD) for the management of Zenker's diverticulum (ZD) has been utilized by our institution since 2016 in attempts to reduce residual pouch size. This technique involves complete endoscopic pouch excision with partial advancement of mucosal flaps. Our study compares the subjective outcomes, objective outcomes, and complication rates between TELD and TELD + DD. A retrospective cohort study was performed on patients who underwent TELD or TELD + DD by a single surgeon at a tertiary academic center (2013-2019). Videofluoroscopic swallow studies (VFSS) with esophagram, Eating Assessment Tool (EAT-10), Reflux Symptom Index (RSI), and Functional Outcome Swallowing Scale (FOSS) were collected at preoperative and 3 month follow-up visits. A single blinded reviewer recorded height, width, and depth of pre and postoperative pouches with volumetric analysis performed assuming an ellipsoid shape. Comorbidities, complications, postoperative course, and recurrence were recorded. Of the 75 patients that met criteria, 27 underwent TELD + DD and 48 underwent TELD. Eighteen TELD + DD and 37 TELD had both pre and post-operative VFSS. TELD + DD and TELD had a 96 ± 7% and 87 ± 16% reduction in pouch volume, respectively (t-test; P = .01). Complications (TELD + DD 7%, TELD 17%, fisher's exact; P = .31) and final subjective outcomes after adjusting for initial were not significantly different between methods (EAT-10 with TELD + DD ∆ + 1.3, P = .18; RSI ∆ + 1.4, P = .29; FOSS ∆-0.02, P = .91). One short-term recurrence was reported with TELD. Use of TELD + DD is associated with a statistically significantly decreased residual pouch size with no significant difference in short-term subjective outcomes. Complication rates and short-term recurrence rates are comparable. Long-term recurrence rates will require further studies to characterize. Level 3.