8635 W. 3rd. Street, Suite 880W Los Angeles CA 90048
Mission Statement
Surgery Group of Los Angeles Research Foundation is dedicated to the prevention and the elimination of disabling and life-threatening illnesses through clinical research and education.
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Research Publications
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Ongoing Studies
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Research Interns
The Surgery Group of Los Angeles Research Foundation currently has ten ongoing longitudinal studies:
Does caffeine intake from coffee enhance bowel recovery after colorectal surgery (Coffee-1)
GeneFx Colon Field Experience Survey (GeneFx-1)
Anal Fistula Plug in Crohn’s patients: A Meta Analysis (Crohn’s Fistula-1)
Acute diverticulitis in transplant patients (Diverticulitis-1)
Fecalization as predictor of treatment algorithm for small bowel obstruction (Fecalization-I)
Prospective Outcome Based Robotic Colorectal Surgery Registry (Robot-1)
A Comparison of Ultrasound Guided Transversus Abdominis Plane Nerve Block Technique Versus Laparoscopic Transversus Abdominis Plane Nerve Block Technique Versus No Block on Postoperative Opioid Consumption after Major Colorectal Surgery (Nerve Block-1).
Is Sacral Nerve Stimulation an effective treatment for chronic pelvic pain and constipation (Stimulator-1)
Presentation, evaluation and treatment of colonic diverticulitis complicated by liver abscesses – Meta Analysis (Abscesses-1)
Total versus hand assisted laparoscopic right colectomy – Short term outcomes (Colectomy-I)
For information about enrollment in one of our research projects please contact us at: (310) 289-1518
Does caffeine intake from coffee enhance bowel recovery after colorectal surgery (Caffeine-1)
The effects of coffee have been shown to act as a colonic stimulant. Caffeinated coffee stimulates colonic activity, most notably in the transverse/descending colon, in magnitude similar to a meal, 60% stronger than water, and 23% stronger than decaffeinated coffee. [1]Moreover, the consumption of both water and caffeine causes a decrease in the rectal sensory threshold for the desire to defecate, while anal sphincter pressure after caffeine intake is significantly higher than after water intake. This may result in an earlier desire to defecate. Coffee has also been shown to have an effect on defecation by increasing rectal tone by 45% (measured with a barostat) thirty minutes after consumption.
Study’s primary objective: To determine if the use of coffee in the postoperative period will reduce time to recovery of GI function by at least one day in patients undergoing elective colorectal operations. (This will be assessed by twice daily interview of patients as to whether they have passed flatus or had a bowel movement)
Study’s secondary objective: To determine if the use of coffee in the postoperative period will reduce hospital length of stay by at least one day, and to also evaluate the tolerance of solid food, which will help determine postoperative ileus and rates of vomiting/nasogastric tube (re)insertion, and other perioperative morbidities such as an anastomotic leak, wound infection, and intra-abdominal abscesses in patients undergoing elective colorectal operations.
GeneFx Colon Field Experience Survey
GeneFx-Colon is a 634-transcript DNA microarray based signature developed for Stage II colon cancer using FFPE specimens. The assay identifies patients at higher risk of recurrence following surgery within 5 years. This test is not to be used independently for purposes of medical diagnosis, prognosis, or as the basis for making therapeutic decisions, but may be used in conjunction with other recognized tools.
We wish to conduct a research survey where we will be asking our physicians how the test results are being utilized vs traditional histo-factors to determine recurrence risk and treat/not treat.
Study’s primary objective: To determine if the use of coffee in the postoperative period will reduce time to recovery of GI function by at least one day in patients undergoing elective colorectal operations. (This will be assessed by twice daily interview of patients as to whether they have passed flatus or had a bowel movement)
Study’s secondary objective: To determine if the use of coffee in the postoperative period will reduce hospital length of stay by at least one day, and to also evaluate the tolerance of solid food, which will help determine postoperative ileus and rates of vomiting/nasogastric tube (re)insertion, and other perioperative morbidities such as an anastomotic leak, wound infection, and intra-abdominal abscesses in patients undergoing elective colorectal operations.
Crohn’s-1
Treatment of fistula-in-ano in the setting of Crohn’s disease is challenging. Given limited treatment option, surgeons have used anal fistula plug. Nevertheless, data regarding its efficacy is lacking.
Objective: To review, consolidate, and analyze the findings of studies investigating the efficacy of anal fistula plugs (AFPs) in treating Crohn’s anal fistula.
Data Sources: A literature review was conducted via PUBMED, EMBASE, MEDLINE, SCOPUS and COCHRANE LIBRARY for the period 1995-2014.
Study Selection: Articles were selected if the studies included AFP in treatment of fistula-in-ano in Crohn’s patients. Randomized/non-randomized, controlled/uncontrolled clinical trials, prospective observational studies and retrospective case studies were included. Abstracts, case reports, letters, comments, conference proceedings and non-English language studies were excluded.
Intervention(s): Anal fistula plug insertion was performed.Main Outcome Measures: The primary outcome measured was clinical healing of the fistula.
We wish to conduct a research survey where we will be asking our physicians how the test results are being utilized vs traditional histo-factors to determine recurrence risk and treat/not treat.
Study’s primary objective: To determine if the use of coffee in the postoperative period will reduce time to recovery of GI function by at least one day in patients undergoing elective colorectal operations. (This will be assessed by twice daily interview of patients as to whether they have passed flatus or had a bowel movement)
Study’s secondary objective: To determine if the use of coffee in the postoperative period will reduce hospital length of stay by at least one day, and to also evaluate the tolerance of solid food, which will help determine postoperative ileus and rates of vomiting/nasogastric tube (re)insertion, and other perioperative morbidities such as an anastomotic leak, wound infection, and intra-abdominal abscesses in patients undergoing elective colorectal operations.
Acute diverticulitis in transplant patients
Our immune system fights for us day in and day out, allowing us to stay healthy. However if an individual has some condition or takes certain medications to make their immune weak, it causes him or her to be more prone to infections, inflammation, and many other conditions. One such affliction is called diverticulitis. Diverticulitis is the inflammation of a bud, or diverticula, that forms on the small intestine. Diverticula are thought to form primarily because of low fiber diets. When one of these pouches becomes inflamed, the condition is called diverticulitis.
Our immune system fights for us day in and day out, allowing us to stay healthy. However if an individual has some condition or takes certain medications to make their immune weak, it causes him or her to be more prone to infections, inflammation, and many other conditions. One such affliction is called diverticulitis. Diverticulitis is the inflammation of a bud, or diverticula, that forms on the small intestine. Diverticula are thought to form primarily because of low fiber diets. When one of these pouches becomes inflamed, the condition is called diverticulitis.
Fecalization as predictor of treatment algorithm for small bowel obstruction (Fecalization-1)
The small intestine is an important part of digestive track that takes in all the nutrients from the food we eat, so what happens when it gets blocked? How do we know how much it’s blocked, where it’s blocked and what’s the best way to treat it? In order to properly diagnose these obstructions known as “small bowel obstructions”, imaging technology such as CAT scans are used to get a visual on what’s inside the small intestine. These scanned images often contain characteristic signs that can give a physician vital information on the obstruction if their value as a sign is thoroughly understood. These signs are confirmed as indicative after researching their occurrence and value in relation to observed small bowel obstructions.
Our goal is to assess these signs by examining CT scans of previous patients to see if there is a connection between certain signs on, the obstruction found and the treatment needed. In particular, we are examining what is known as the “small bowel feces sign” or “focalization” to see its potential as a predictor of treatment. We hope to shed more light on this sign in the efforts to make a diagnosis and medical intervention more efficient and effective.
Prospective Outcome Based Robotic Colorectal Surgery Registry (Robot-1)
Summary: We seek to develop a robotic colorectal surgery specific data registry with collection of core variables. This data, collected by attending surgeons will include preoperative, intraoperative, and postoperative variables including those specific to Robotic surgery.
Description of Problem/Background: Prospective, outcome based database collection and analysis is scarce if not lacking in robotic colorectal surgery. While there have been robotic publications on robotic colorectal cases, most focus on rectal operations and/or are plagued by faulty design and biases. Most regional and national databases are collected and maintained by nurses or administrative staff interfering with the accuracy of the data and credence of its value.
Purpose, Hypothesis, and Methods of Research: Given the ever growing number of robotic colorectal cases performed, we feel that there is a need for prospectively gathered, surgeon centered, thorough registry focusing on wide array of robotic colorectal operations. We look to gather information about patient demographics, preoperative comorbidities, intraoperative variables, and anesthesia related factors. In addition, we included several colorectal specific factors such as steroid and immunomodulator use in patients with inflammatory bowel disease, type of bowel preparation, type and method of anastomosis and formation of stoma. Robot specific variables will be of focus. These will include: generation of robot, number of arms used, robotic time, use of vessel sealer or stapler, use of I Spy, intracorporial versus extracorporeal anastomosis, conversion to laparoscopic or open operation, etc. Postoperative complications will be categorized as major surgical, minor surgical, major medical, and minor medical. All data will be collected by attending surgeons and analyzed prospectively. Data collected will be reviewed and analyzed to determine which preoperative or intraoperative events/factors are contributors to development of postoperative complications. This will allow us to optimize or eliminate those factors in order to improve outcome. The data will also help to shed light on the benefits of robotic surgery in these cases, demonstrate length of learning curve and ultimately result in efficient robotic colorectal surgery with maximal reduction in complications.
Our goal is to assess these signs by examining CT scans of previous patients to see if there is a connection between certain signs on, the obstruction found and the treatment needed. In particular, we are examining what is known as the “small bowel feces sign” or “focalization” to see its potential as a predictor of treatment. We hope to shed more light on this sign in the efforts to make a diagnosis and medical intervention more efficient and effective.
A Comparison of Ultrasound Guided Transversus Abdominis Plane Nerve Block Technique Versus Laparoscopic Transversus Abdominis Plane Nerve Block Technique Versus No Block on Postoperative Opioid Consumption after Major Colorectal Surgery (Nerve Block-1)
Postoperative pain can pose significant challenges in the postoperative recovery of patients undergoing major colorectal surgery. Traditionally, opioids have played an important role in treating postoperative pain. It is well established that opioids are highly effective in relieving pain; however, opioids are associated with numerous side effects that include nausea, vomiting, constipation, ileus, bladder dysfunction, respiratory depression, pruritus, drowsiness, sedation, and allergic reaction. These opioid side effects, which range in severity, can significantly interfere with discharge home following colorectal surgery. (1) Significant interest exists in the use of local anesthetic based regional anesthesia techniques as a means to extend the analgesic window for patients undergoing colorectal surgery (2). Specifically, the use of the TAP block as an adjunct in postoperative pain control has been widely reported in the anesthesia and colorectal surgery literature (2,3). Historically, the block was performed in a blind fashion with relative success and presently the block is typically performed either with ultrasound guidance or laparoscopic visualization (2,3). While the TAP block has shown to be effective in post-operative pain control, the techniques used to place the block have not formally been compared.
We are purposing a prospective, single-blinded, randomized study of patients undergoing major colorectal surgery to compare TAP block under ultrasound guidance versus laparoscopic visualization versus no TAP block. We hypothesize that laparoscopic-guided TAP block is non-inferior to ultrasound-guided TAP block with respect to perioperative pain control and either technique is superior to no TAP. In addition, we will measure procedural time, any adverse events related to the block, overall postoperative analgesic requirement, analgesic dura
Is Sacral Nerve Stimulation an effective treatment for chronic pelvic pain and constipation (Stimulator-1)
Study the efficacy of Sacral Nerve Stimulation in alleviating chronic pelvic pain and chronic constipation. Patients with chronic pelvic pain and/or constipation that are intractable to conservative, medical management, or biofeedback therapy will be enrolled in the study. The severity of their constipation and/or chronic pain will be evaluated by a scoring system before and after the procedure. The procedure will follow the same routine steps used for implantation of the interim device for fecal and urinary incontinence. There will be no sham or control group.
Presentation, evaluation and treatment of colonic diverticulitis complicated by liver abscesses – Meta Analysis (Abscesses-1)
Evaluate all available literature on patients presenting with colonic diverticulitis that is complicated by liver abscesses. This will be a comprehensive review of demographic, clinical presentation, laboratory and imaging work up, medical and surgical management and ultimate outcome.
We are purposing a prospective, single-blinded, randomized study of patients undergoing major colorectal surgery to compare TAP block under ultrasound guidance versus laparoscopic visualization versus no TAP block. We hypothesize that laparoscopic-guided TAP block is non-inferior to ultrasound-guided TAP block with respect to perioperative pain control and either technique is superior to no TAP. In addition, we will measure procedural time, any adverse events related to the block, overall postoperative analgesic requirement, analgesic dura
Total versus hand assisted laparoscopic right colectomy – Short term outcomes (Colectomy-I)
Compare complication rates, 30 day outcome and oncological outcome between patients with right sided colon cancer undergoing resection with 2 different laparoscopic methods: Hand assisted laparoscopy versus pure laparoscopic technique.