- 17 Kehilat Riga
Tel Aviv, 69400
Israel - 972524261103
- One Anastomosis Gastric Bypass, Bariatric Surgery, Obesity, Mini Gastric Bypass, Laparoscopic Surgery, Laparoscopic Sleeve Gastrectomy, and 26 moreGastric Bypass, Roux-en-y Gastric Bypass, non alcoholic fatty liver disease (NAFLD), Food and Nutrition, Nutrition, Probiotics, Probiotics and Prebiotics, Probiotic Microbiology, Probiotic, Human Microbiome, Gut Microbiome, Microbiome, Human Microbiomes, Stress, Stress Management, Stress (Psychology), Vitamins, Vitamin D, vitamin B12, Body Image, Weight Loss, Body Weight, Weight, Physical Activity, Hiatal hernia, and Laparoscopic Cholecystectomyedit
- My name is Dr. Asnat Raziel and I am the medical director of Assia Bariatric since 2005. Assia Bariatric is a high-vo... moreMy name is Dr. Asnat Raziel and I am the medical director of Assia Bariatric since 2005. Assia Bariatric is a high-volume bariatric center of excellence operating in a private hospital setting in Tel Aviv, Israel.
The center is composed of four fellowship-trained bariatric surgeons, 4 general surgeons, two plastic surgeons, an endocrinologist, a gastroenterologist, two psychologists, two bariatric dietitians, clinical and administrative coordinators, and a dedicated nurse.
I have completed my medical studies in Tel Aviv University, Israel; Served in the Israeli army as a flying surgeon, did a pilot license and then residency in general surgery in Wolfson hospital, Holon, Israel, and two years of fellowship training in bariatric surgery and minimally invasive surgery at the University of Minnesota, Minneapolis, Minnesota, USA, under the directors: Prof. Henry Buchwald and Dr. Sayeed Ikramuddin.
I am the secretary of the Israeli society of metabolic and bariatric surgery. I have presented and published multiple research articles in bariatric surgery.
My current research interest and my publications are in the fields of bariatric surgery, obesity, the multidisciplinary approach to the obese patient, the microbiome, wellbeing, nutrition, stress management, quality of life, comorbidities of obesity, radiology, anesthesia, minimally invasive surgery, and general surgery.
My major research focus is obesity and bariatric surgery and I collaborate with other researchers in my hospital and in other medical centers.
I am a mentor for women surgeons in Israel and I am certified in Mindfulness, Theta Healing, Metheism, Holistic Coaching and use holistic tools in my clinic.
My Big project is called Living Large, and it offers my patients different ways to be supported by 100 different Alternative Medicine therapists to allow a real change in their lifestyle.edit
Background: Extreme obesity leads to increased health risks and perioperative complications. The results of bariatric surgery in patients with super-super obesity (SSO) are presented in this study. Methods: From April 2008 to August 2019,... more
Background: Extreme obesity leads to increased health risks and perioperative complications. The results of bariatric surgery in patients with super-super obesity (SSO) are presented in this study. Methods: From April 2008 to August 2019, 60 patients with super-super obesity underwent bariatric surgery. Their weight loss and outcome were analyzed. The mean follow-up time was 72.25 months. Results: At baseline, the mean age was 41.5 years old, the mean BMI was 63.81 kg/m2, 80% of the patients suffered from co-morbidities, and 23.33% were revisional surgeries. Weight loss continued for up to two years after surgery. The percentage of excess weight lost at two years was 62.27%, from two to five years: 61.48%, from five to 10 years: 36.82% and after ten years it was 31.89% (P<.001). The mean at last follow-up BMI was 45.11 kg/m2 and 48.33% of the patients failed to lose at least 50% of excess weight. Patients with fatty liver, diabetes, sleep apnea and hyperlipidemia had a cure or improvement in more than 70% of the cases. There were 5% complications and two (3.33%) deaths were reported. Conclusion: Bariatric surgery in patients with SSO was feasible and safe. The amount of weight loss achieved was acceptable in the short term but decreased in the long term, almost 50% of the patients failed to decrease excess overweight of 50%. The metabolic effects of bariatric surgery were maintained during the follow-up time despite the increase in weight. However, the third or more revisional bariatric surgery increased the risk of mortality. Trial Registration: Clinicaltrials.gov (number NCT04663425). Funding Statement: There were no sources of support for the work being reported. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The study was approved by the Assuta Helsinki review board (number 2015-073).
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Of special note are neurological complications, which manifest at 3 to 20 months after bariatric surgery and all affect patients experiencing prolonged vomiting. The neurological symptoms include chronic and subacute peripheral... more
Of special note are neurological complications, which manifest at 3 to 20 months after bariatric surgery and all affect patients experiencing prolonged vomiting. The neurological symptoms include chronic and subacute peripheral neuropathy, acute peripheral neuropathy, burning feet, meralgia paresthetica, myotonic syndrome, posterolateral myelopathy, and Wernicke encephalopathy [1]. Since the number of bariatric surgeries is dramatically expanding and the attention to neurological symptoms increasing, more cases of WE1 are reported, though their percentage in the post-surgery population is decreasing. For example, in the United States 8 cases were reported out of 100,000 surgeries in 2002 and 9 cases were published in 2006–2007 among approximately 400,000 surgeries. In southern Europe a combined total of 6 WE cases among 3241 patients undergoing biliopancreatic diversion were reported. A systematic review of the literature [2] was published in 2008. The report [2] describes 84 cases of WE between 1991 and 2008. Gastric bypass or a restrictive procedure had been performed in 80 cases (95%). Admission to hospital for WE occurred within 6 months of surgery in 79 cases (94%). Frequent vomiting was a risk factor in 76 cases (90%) and had lasted for a median of 21 days before admission. Intravenous glucose administration without thiamine was a risk factor in 15 cases (18%). Brain magnetic resonance imaging identified lesions characteristic of WE in 14 of 30 cases (47%).
Research Interests: Surgery, Bariatric Surgery, Nutrition, Obesity, Vitamins, and 14 moreMedicine, Humans, Pubmed, Lead Poisoning, Prognosis, Morbid Obesity, Encephalopathy, Vomiting, Thiamine, Postoperative Complications, Wernicke Encephalopathy, Thiamine deficiency, Sleeve gastrectomy, and Medical and Health Sciences
Research Interests: English language, Medicine, Humans, Length of Stay, Feasibility, and 15 moreRecurrence, Clinical Sciences, Aged, Middle Aged, Inguinal Hernia, Sternum, Hernia Repair, Retrospective Studies, Postoperative Complication, English Language, Abdominal Surgery, Hernia, Coronary artery bypass surgery, Laparoscopy, and Coronary Artery Bypass
Research Interests: Bariatric Surgery, Adolescent, Medicine, Humans, Patient Satisfaction, and 15 moreBody Mass Index, Length of Stay, Gastric banding, Obesity Surgery, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Morbid Obesity, Gastric Bypass, gastric volvulus, Equipment failure, Pulmonary atelectasis, and Hernia Ventral
Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of pyelonephritis rarely seen in children. It is characterized by destruction of the renal parenchyma and invasion of adjacent tissues, mimicking renal tumors. Preoperative... more
Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of pyelonephritis rarely seen in children. It is characterized by destruction of the renal parenchyma and invasion of adjacent tissues, mimicking renal tumors. Preoperative diagnosis is very difficult. Two children with XGP are presented. One underwent nephrectomy and the other drainage of a renal abscess with kidney preservation. Although surgery is considered the only effective treatment, a high index of suspicion and renal biopsy may prevent radical nephrectomy.
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Sleeve gastrectomy (SG) is an established bariatric procedure. However, long-term data on eating and lifestyle behaviors and their effect on weight outcomes are scarce. Therefore, this study aimed to examine these long-term behaviors and... more
Sleeve gastrectomy (SG) is an established bariatric procedure. However, long-term data on eating and lifestyle behaviors and their effect on weight outcomes are scarce. Therefore, this study aimed to examine these long-term behaviors and their associations to weight outcomes following SG. A long-term follow-up study (>5 years post-surgery) of 266 adult patients admitted to a primary SG surgery during 2008–2012 and who participated in a pre-surgery study was conducted. Data on pre-surgery demographics, anthropometrics, and medical status were obtained from the patients’ medical records. Data on long-term health status, anthropometrics, lifestyle and eating habits, eating pathologies, follow-up regime, and satisfaction from the surgery were collected by an interview phone calls according to a structured questionnaire. Data of 169 patients were available before and 7.8±1.0 years post-SG. Their baseline mean age was 41.8±11.3 years, and 71.6% of them were females. The mean post-surgery excess weight loss (EWL) was 53.2±31.2%, and 54.2% had EWL of ≥50%. Eating 3–6 meals per day, not having the urge to eat after dinner, separating liquids from solids, avoiding carbonated beverages, and performing physical activity were related to better weight-loss outcomes (P≤0.026). However, frequent need for eating sweets, binge eating, and feeling guilty or sad after eating were related to worse weight-loss outcomes (P≤0.010). Furthermore, only a minority reported taking a multivitamin and participating in follow-up meetings after more than 1 year since the surgery (≤21.3%). In the long term following SG, approximately half achieved EWL of ≥50%, and physical activity, certain eating patterns, and eating pathologies were related to weight outcomes.
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Background: Recent studies have reported higher postoperative complication rates in patients with severe obesity who undergo bariatric surgery. The extremely obese patient deserves special consideration: significant comorbidities,... more
Background: Recent studies have reported higher postoperative complication rates in patients with severe obesity who undergo bariatric surgery. The extremely obese patient deserves special consideration: significant comorbidities, technical difficulties, and increased postoperative morbidity and mortality are all expected in this patient population. Current data are limited and discrepant on the relationship between patients with class IV obesity (body mass index (BMI) ≥50-59.9 kg/m2), and class V obesity (BMI ≥60 kg/m2). This study compared early postoperative complications (≤30-day) following one-anastomosis gastric bypass (OAGB) morbidity in patients with class III, IV, and V obesity. Methods: Retrospective analysis of perioperative OAGB outcomes in three BMI groups at a high-volume hospital. Operative time, length of stay (LOS), and overall early postoperative complication rates were studied. Complications were ranked by Clavien-Dindo classification (CDC). Results: Between Janua...
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Background The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and... more
Background The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams. Materials and Methods The current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed. Results A total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) (p = 0.032). There was a significant difference in the time int...
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This study aimed to describe nutritional and lifestyle parameters following one-anastomosis gastric bypass (OAGB). A multicenter study among OAGB patients across Israel (n = 277) and Portugal (n = 111) was performed. Patients were... more
This study aimed to describe nutritional and lifestyle parameters following one-anastomosis gastric bypass (OAGB). A multicenter study among OAGB patients across Israel (n = 277) and Portugal (n = 111) was performed. Patients were approached according to the time elapsed since surgery. An online survey with information regarding demographics, anthropometrics, and nutritional and lifestyle aspects was administered in both countries simultaneously. Respondents from Israel (pre-surgery age of 41.6 ± 11.0 years, 75.8% females) and Portugal (pre-surgery age of 45.6 ± 12.3 years, 79.3% females) reported changes in their appetite (≤94.0% and ≤94.6%), changes in their taste (≤51.0 and ≤51.4%), and intolerance to specific foods (i.e., red meat, pasta, bread, and rice). Bariatric surgery-related eating recommendations were generally followed well, but a trend toward lower adherence was evident in groups with longer time elapsed since surgery in both countries. Most respondents from Israel and...
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Page 1. Obesity and Knee Osteoarthritis The Framingham Study David T. Felson, MD, MPH; Jennifer J. Anderson, PhD; Allan Naimark, MD; Alexander M. Walker, MD, DrPH; and Robert F. Meenan, MD, MPH Study Objective ...
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BACKGROUND Bariatric surgery can influence the presentation, diagnosis, and management of gastrointestinal cancers. Esophagogastric (EG) malignancies in patients who have had a prior bariatric procedure have not been fully characterized.... more
BACKGROUND Bariatric surgery can influence the presentation, diagnosis, and management of gastrointestinal cancers. Esophagogastric (EG) malignancies in patients who have had a prior bariatric procedure have not been fully characterized. OBJECTIVE To characterize EG malignancies after bariatric procedures. SETTING University Hospital, United Kingdom. METHODS We performed a retrospective, multicenter observational study of patients with EG malignancies after bariatric surgery to characterize this condition. RESULTS This study includes 170 patients from 75 centers in 25 countries who underwent bariatric procedures between 1985 and 2020. At the time of the bariatric procedure, the mean age was 50.2 ± 10 years, and the mean weight 128.8 ± 28.9 kg. Women composed 57.3% (n = 98) of the population. Most (n = 64) patients underwent a Roux-en-Y gastric bypass (RYGB) followed by adjustable gastric band (AGB; n = 46) and sleeve gastrectomy (SG; n = 43). Time to cancer diagnosis after bariatric surgery was 9.5 ± 7.4 years, and mean weight at diagnosis was 87.4 ± 21.9 kg. The time lag was 5.9 ± 4.1 years after SG compared to 9.4 ± 7.1 years after RYGB and 10.5 ± 5.7 years after AGB. One third of patients presented with metastatic disease. The majority of tumors were adenocarcinoma (82.9%). Approximately 1 in 5 patients underwent palliative treatment from the outset. Time from diagnosis to mortality was under 1 year for most patients who died over the intervening period. CONCLUSION The Oesophago-Gastric Malignancies After Obesity/Bariatric Surgery study presents the largest series to date of patients developing EG malignancies after bariatric surgery and attempts to characterize this condition.
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Objective: To determine the factors that influence bleeding during the course of bariatric surgeries. Background: Bariatric surgery is safe with a low percentage of complications compared with other abdominal surgeries. Bleeding is one of... more
Objective: To determine the factors that influence bleeding during the course of bariatric surgeries. Background: Bariatric surgery is safe with a low percentage of complications compared with other abdominal surgeries. Bleeding is one of the most common complications in surgery for obesity that has the risk of being catastrophic. Methods: The study includes 8,544 cases that underwent bariatric surgery from January 2013 to March 2016 retrospectively, in 4 private institutions. Multiple demographic data were collected: patient characteristics, diseases, medications, surgery type, operative technique, devices, surgeon’s skill, and volume. Results: Bleeding was the most frequent complication that occurred in 122 (1.3%) patients. The Gastric bypass had the highest rate of bleeding (3.05%) of which, 20% were intraoperative bleeding and 80% postoperatively (intra-abdominal in 75%, and intra-luminal in 5%). Simultaneous surgeries, revisional surgeries, stratification of body mass index, st...
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Low postoperative protein intake may represent a modifiable risk factor that leads to fat free mass (FFM) loss postlaparoscopic sleeve gastrectomy (LSG), but data concerning this phenomenon is scarce. To evaluate the association between... more
Low postoperative protein intake may represent a modifiable risk factor that leads to fat free mass (FFM) loss postlaparoscopic sleeve gastrectomy (LSG), but data concerning this phenomenon is scarce. To evaluate the association between daily protein intake and relative FFM loss at 6 (M6) and 12 (M12) months after LSG surgery. Private hospital and university hospital. A prospective cohort study with 12 months follow-up of 77 patients who underwent LSG surgery. Anthropometrics including body composition analysis measured by multifrequency bioelectrical impedance analysis, 3-day food diaries, food intolerance, and habitual physical activity were evaluated at baseline and at M3, M6, and M12. Repeated body composition measurements and food diary were available for 77 patients (45 women) at M6 and for 68 patients at M12. Mean age was 42.7±9.4 years and mean preoperative body mass index was 42.2±4.8 kg/m(2). A protein intake of≥60 g/d was achieved in 13.3%, 32.5% and 39.7% of the study pa...
Research Interests: Bariatric Surgery, Anthropometry, Medicine, Adipose tissue, Humans, and 15 moreFemale, Body Composition, Male, Exercise, Bioelectrical Impedance Analysis, Body Mass Index, Clinical Sciences, Adult, Food Intolerance, Laparoscopy, Postoperative care, Postoperative Complications, Prospective Cohort Study, dr nowzaradan high protein diet, and Gastrectomy
Research Interests: Localization, Evolution, Medicine, Anatomy, Complication, and 15 moreHumans, Female, Male, Length of Stay, Clinical Sciences, Aged, Middle Aged, Hernia, Laparoscopy, Nissen Fundoplication, fundoplication, Hiatal hernia, Cause of death, Intraoperative complications, and Cardiovascular medicine and haematology
IntroductIon: Bariatric and metabolic surgery (BMS) for patients suffering from type 2 diabetes mellitus (T2D) and obesity is now supported by many guidelines. [1,2] This is on the back of high-quality data showing superior efficacy of... more
IntroductIon: Bariatric and metabolic surgery (BMS) for patients suffering from type 2 diabetes mellitus (T2D) and obesity is now supported by many guidelines. [1,2] This is on the back of high-quality data showing superior efficacy of BMS compared to medical management in the treatment of T2D. [3] However, most of these studies are powered to evaluate the efficacy and there is no randomized controlled trial (RCT) in the scientific literature comparing treatment-related or all-cause morbidity and mortality as the primary endpoints. This makes it difficult for patients and health-care practitioners to make a truly informed choice. Introduction: There is a paucity of data in the scientific literature on the morbidity and mortality of bariatric and metabolic surgery (BMS) in individuals suffering from Type 2 diabetes mellitus (T2D). The current study is a secondary analysis of the GENEVA dataset to understand this. Materials and Methods: Logistic regressions were performed to investigate the influence of diabetes on complication rates and procedure selection. Ethical approval was not required. Results: One thousand four hundred and seventy-five of these patients were suffering from T2D at the time of the surgery (416 diet-treated type 2 diabetes), 806 oral agent-treated type 2 diabetes, and 253 insulin-treated type 2 diabetes [ITD]). Six hundred and fifty (44.1%) of these patients underwent laparoscopic sleeve gastrectomy (LSG); 487 (33%) underwent Roux-en-Y gastric bypass; 230 (15.6%) underwent a one anastomosis gastric bypass (OAGB); and 108 (7.3%) underwent some other procedures. The 30-day mortality of BMS in those without T2D was 0.07% (4/5609) as compared to 0.4% (6/1475) and 0.8% (2/253) in those with T2D and ITD, respectively. 7.9% of those with T2D developed a 30-day complication compared to 6.5% without T2D (P = 0.0475). There was an increased risk of complications in patients with ITD on univariate and multivariate analysis. Patients with T2D were significantly less likely to undergo an LSG and significantly more likely to undergo an OAGB. Conclusions: ITD patients undergoing BMS experienced significantly higher 30-day morbidity and mortality. Although LSG was the most common procedure in patients with T2D, these patients were less likely to undergo LSG than patients without T2D.
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Background Age ≥ 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on... more
Background Age ≥ 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort. Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups — patients ≥ 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality. Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 ± 2.5 years, 119.5 ± 24.5 kg, and 43 ± 7 in Group I and 39.8 ± 11.3 years, 117.7±20.4 kg, and 43.7 ± 7 in Group II, respectively. Approximately, 95% of pat...
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Background There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG,... more
Background There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rat...
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Introduction: Weight bias, stigma, and discrimination are common among healthcare professionals. We aimed to evaluate whether an online education module affects weight bias and knowledge about obesity in a private medical center setting.... more
Introduction: Weight bias, stigma, and discrimination are common among healthcare professionals. We aimed to evaluate whether an online education module affects weight bias and knowledge about obesity in a private medical center setting. Methods: An open-label randomized controlled trial was conducted among all employees of a chain of private medical centers in Israel (n = 3,290). Employees who confirmed their consent to participate in the study were randomized into intervention or control (i.e., “no intervention”) arms. The study intervention was an online 15-min educational module that included obesity, weight bias, stigma, and discrimination information. Questionnaires on Anti-Fat Attitudes (AFA), fat-phobia scale (F-scale), and beliefs about the causes of obesity were answered at baseline (i.e., right before the intervention), 7 days, and 30 days post-intervention. Results: A total of 506, 230, and 145 employees responded to the baseline, 7-day, and 30-day post-intervention ques...
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One anastomosis gastric bypass (OAGB) is an emerging bariatric procedure, yet data on its effect on the gastrointestinal tract are lacking. This study sought to evaluate the incidence of small-intestinal bacterial overgrowth (SIBO)... more
One anastomosis gastric bypass (OAGB) is an emerging bariatric procedure, yet data on its effect on the gastrointestinal tract are lacking. This study sought to evaluate the incidence of small-intestinal bacterial overgrowth (SIBO) following OAGB; explore its effect on nutritional, gastrointestinal, and weight outcomes; and assess post-OABG occurrence of pancreatic exocrine insufficiency (PEI) and altered gut microbiota composition. A prospective pilot cohort study of patients who underwent primary-OAGB surgery is here reported. The pre-surgical and 6-months-post-surgery measurements included anthropometrics, glucose breath-tests, biochemical tests, gastrointestinal symptoms, quality-of-life, dietary intake, and fecal sample collection. Thirty-two patients (50% females, 44.5 ± 12.3 years) participated in this study, and 29 attended the 6-month follow-up visit. The mean excess weight loss at 6 months post-OAGB was 67.8 ± 21.2%. The glucose breath-test was negative in all pre-surgery ...
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Background There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The... more
Background There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. Methods We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. Results Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstruct...
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Background The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to... more
Background The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience. Method An international web survey was sent to 197 emergency surgeons with the aim to collect data about emergency surgeons’ experience in the management of patients admitted in the emergency department for acute abdominal pain after bariatric surgery. The survey was conceived as a questionnaire composed by 26 (multiple choice and open) questions and approved by a steering committee. Results One hundred seventeen international emergency surgeons decided to join the project and answered to the web survey with a response rate of 59.39%. Conclusions The aim of this WSES web survey was to ...
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The purpose of this study is to evaluate the results of routine fluoroscopic swallowing study (FSS) imaging 24 h after surgery and computed tomography (CT) on demand based on clinical data, in diagnosing complications after bariatric... more
The purpose of this study is to evaluate the results of routine fluoroscopic swallowing study (FSS) imaging 24 h after surgery and computed tomography (CT) on demand based on clinical data, in diagnosing complications after bariatric surgery. This retrospective study includes 9386 patients that underwent bariatric surgery. A total of 3241 (34.53%) patients underwent FSS imaging following the surgical procedure, and 106 (1.13%) patients underwent CT. Sleeve gastrectomy was performed in 8093 patients (75.81%), gastric bypass was performed in 1281 patients (12%), duodenal switch or biliopancreatic diversion was performed in 12 patients (0.11%), and gastric banding was performed in 1289 patients (12.07%), which were excluded from the study as no imaging modality was used in any of these patients. The sensitivity for FSS was 71.43% and the specificity was 99.85%. An analysis of disease prevalence revealed a value of 0.43% with a positive predictive value of 66.67%. The sensitivity for CT...
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To examine associations of patients' attendance to follow-up meetings with a registered dietitian (RD) and physical exercise practices with weight loss during the 1 year following laparoscopic sleeve gastrectomy (SG). Of 241 patients... more
To examine associations of patients' attendance to follow-up meetings with a registered dietitian (RD) and physical exercise practices with weight loss during the 1 year following laparoscopic sleeve gastrectomy (SG). Of 241 patients with obesity who underwent SG during 2012, 184 (76.3%) participated in a 1-year follow-up telephone interview and had information on number of RD follow-up meetings. Clinical information was available from computerized patient files. Multiple logistic regression analysis, adjusting for propensity score, was computed to reveal factors associated with greater weight loss. The mean %TWL was 31.4 ± 6.1 and the mean number of reported RD meetings during the year following SG was 4.6. The proportion of physically active patients increased by 15% (from 23 to 42) among those who attended at least 3 RD follow-up meetings (n = 123), and by 5% (from 18 to 23) among those who attended fewer than 3 meetings (n = 61) (p = 0.05). Patients conducting physical exerc...
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Although bariatric surgery (BS) is considered safe, concern remains regarding severe post-operative adverse events and mortality. Using a national BS registry, the aim of this study was to assess the incidence, etiologies, and risk... more
Although bariatric surgery (BS) is considered safe, concern remains regarding severe post-operative adverse events and mortality. Using a national BS registry, the aim of this study was to assess the incidence, etiologies, and risk factors for mortality following BS. Prospective data from the National Registry of Bariatric Surgery in Israel (NRBS) including age, gender, BMI, comorbidities, and surgical procedure information were collected for all patients who underwent BS in Israel between June 2013 and June 2016. The primary study outcome was the 3.5-year post-BS mortality rate, obtained by cross-referencing with the Israel population registry. Of the 28,755 patients analyzed (67.3% females, mean age 42.0 ± 12.5 years, and preoperative BMI 42.14 ± 5.21 kg/m), 76% underwent sleeve gastrectomy (SG), 99.1% of the surgeries were performed laparoscopically, and 50.8% of the surgeries were performed in private medical centers. Overall, 95 deaths occurred during the study period (146.9/10...
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In Table 5 the P value for the parameter "More than one chronic disease" is incorrect. The correct value is 0.387, not 0.0387.
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Various definitions for bariatric surgery (BS) success exist, with weight loss and comorbidity resolution outcomes being the most prominent. The study's aim was to compare how various healthcare professionals perceive success in BS. A... more
Various definitions for bariatric surgery (BS) success exist, with weight loss and comorbidity resolution outcomes being the most prominent. The study's aim was to compare how various healthcare professionals perceive success in BS. A 29-item, 10-point Likert scale online survey was distributed via email to Israeli healthcare professionals involved in the different BS aspects using common national professional organizations. These included bariatric surgeons, dietitians, social workers, psychologists, psychiatrists, primary care physicians, gastroenterologists, and nurses. Statement relevancy to BS success was rated. An item was classed as "very important" for BS success if at least 70% of participants rated it 8 or higher in each subgroup. Inter-observer agreement was calculated using kappa statistics. Data on specific occupation, years-in-practice, and major workplace were collected as well. A total of 155 responses was obtained. The majority of respondents were diet...
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Data on vegetarianism and bariatric surgery (BS) are scarce. We herein describe the health and nutritional status of vegetarian patients who plan to undergo BS and propose combined recommendations for vegetarian patients who undergo BS,... more
Data on vegetarianism and bariatric surgery (BS) are scarce. We herein describe the health and nutritional status of vegetarian patients who plan to undergo BS and propose combined recommendations for vegetarian patients who undergo BS, based on our clinical experience and current scientific literature in both nutrition fields. Cross-sectional analysis of a prospectively maintained database of all primary laparoscopic sleeve gastrectomies (LSG) performed at a bariatric center of excellence between January 2014 and November 2016 was carried out querying patients who declared a vegetarian or vegan lifestyle before surgery. Preoperative data collected included demographics, anthropometrics, dietary patterns, supplementation use, physical activity, smoking habits, co-morbidities, and blood tests. Each vegetarian was matched to five different omnivores based on age, gender, and BMI. During the study period, 1470 patients underwent primary LSG surgery (63.7% females). Twenty-one declared ...
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Data on adherence to postoperative lifestyle recommendations by bariatric patients are scarce. Thus, the aim of this study was to evaluate adherence to selected recommendations during the first year following laparoscopic sleeve... more
Data on adherence to postoperative lifestyle recommendations by bariatric patients are scarce. Thus, the aim of this study was to evaluate adherence to selected recommendations during the first year following laparoscopic sleeve gastrectomy (LSG) surgery. A prospective cohort study with 12 months of follow-up on 100 LSG patients was conducted. Data were collected at baseline and at 3 (M3), 6 (M6), and 12 (M12) months post-surgery and included anthropometrics, biochemical tests, food intake, food tolerance, common surgery-related side effects, physical activity (PA), supplementation, and number of follow-up meetings with a dietitian. Data were available for 77 patients (57.1% women, mean age 43.1 ± 9.3 years and preoperative BMI 42.1 ± 4.8 kg/m(2)). Only a minority of the patients adhered to the recommended protein intake ≥60 g/day at all time points (≤40.3%) and ≥6 meetings with a dietitian at M12 (41.6%). Half of the patients performed ≥150 min/week of PA at all time points (≤50.6%...
Research Interests: Bariatric Surgery, Life Style, Diet, Medicine, Prospective studies, and 14 moreHumans, Weight Loss, Female, Male, Patient Compliance, Exercise, Follow-up studies, Obesity Surgery, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Postoperative Period, and Gastrectomy
Hiatal hernia (HH) is common in the bariatric population. Its presence imposes various degrees of difficulty in performing laparoscopic sleeve gastrectomy (LSG). Preoperative upper gastrointestinal evaluation consists of fluoroscopic and... more
Hiatal hernia (HH) is common in the bariatric population. Its presence imposes various degrees of difficulty in performing laparoscopic sleeve gastrectomy (LSG). Preoperative upper gastrointestinal evaluation consists of fluoroscopic and or endoscopic studies OBJECTIVES: To evaluate the efficacy of routine, preoperative barium swallow in identifying HH in patients undergoing LSG, and determine if such foreknowledge changes operative and immediate postoperative course regarding operative time, intraoperative adverse events, and length of hospital stay (LOS). In addition, to quantify HH prevalence in these patients and correlate preoperative patient characteristics with its presence. High-volume bariatric practice in a private hospital in Israel METHODS: Retrospective analysis of prospectively collected data between October 2010 and March 2015: anthropometrics, co-morbidities, previous barium swallow, preoperative HH workup (type and result), operative and immediate postoperative cour...
Research Interests: Bariatric Surgery, Adolescent, Herniorrhaphy, Medicine, Humans, and 15 moreFemale, Male, Length of Stay, Clinical Sciences, Aged, Middle Aged, Adult, Barium, Laparoscopy, Gastroesophageal Reflux, Laparoscopic Sleeve Gastrectomy, Contrast Media, Hiatal hernia, Gastrectomy, and Intraoperative complications
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Research Interests: Bariatric Surgery, Nutrition, Vitamins, Medicine, Israel, and 14 moreHumans, Female, Male, Nutritional Status, Obesity Surgery, Clinical Sciences, Prevalence, Middle Aged, Adult, Public health systems and services research, Cross Sectional Studies, Vitamin D Deficiency, Sleeve gastrectomy, and Gastrectomy
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Assessment of Complications Following Primary Bariatric Surgery According to the Clavien-Dindo Classification - Comparison Between Sleeve Gastrectomy & Gastric Bypass David Goitein 1, Nasser Sakran 2, 3, 4, Amir Szold 2, Asnat Raziel 2 1... more
Assessment of Complications Following Primary Bariatric Surgery According to the Clavien-Dindo Classification - Comparison Between Sleeve Gastrectomy & Gastric Bypass David Goitein 1, Nasser Sakran 2, 3, 4, Amir Szold 2, Asnat Raziel 2 1 Sheba Medical Center, Ramat Gan, Israel 2 Israeli Center for Bariatric Surgery, Tel Aviv, Israel 3 Emek Medical Center, Afula, Israel 4 Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel Introduction: Bariatric surgery is the mainstay treatment for morbid obesity. Common procedure options are laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (GBP). The specific method selected depends on several factors. In contrast with most types of elective surgeries, patient preference has great impact on the procedure choice. The quoted “safety” of the procedure greatly influences this decision. Many surgeons believe LSG to be safer than LRYGBP, and convey this to the patients. This has caused a dramatic shift in pra...
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Laparoscopic Sleeve Gastrectomy in Obese Adolescents Asnat Raziel 1, Nasser Sakran 1, 2, Amir Szold 1, David Goitein 1, 3 1 Assia Medical, Assuta Medical Center, Tel Aviv, Israel. 2 Department of Surgery A, Emek Medical Center, Afula,... more
Laparoscopic Sleeve Gastrectomy in Obese Adolescents Asnat Raziel 1, Nasser Sakran 1, 2, Amir Szold 1, David Goitein 1, 3 1 Assia Medical, Assuta Medical Center, Tel Aviv, Israel. 2 Department of Surgery A, Emek Medical Center, Afula, Israel. Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. 3 Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Background: Laparoscopic Sleeve Gastrectomy (LSG) is gaining credentials as a simple and efficient bariatric procedure with low surgical risk. Surgical treatment for morbid obesity is relatively rare in adolescents; hence few results have been accumulated so far. Herein, we report our data with adolescents after LSG surgery. Methods: Data was prospectively collected regarding adolescent patients undergoing LSG. All patients underwent pre- and post-operative medical and professional evaluations by a multi-disciplinary team. Resul...
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Laparoscopic Roux-Y gastric bypass (LRYGBP) is the gold-standard procedure for the treatment of morbid obesity. It has been reported to be somewhat more efficient and durable than laparoscopic sleeve gastrectomy (LSG). However, it is... more
Laparoscopic Roux-Y gastric bypass (LRYGBP) is the gold-standard procedure for the treatment of morbid obesity. It has been reported to be somewhat more efficient and durable than laparoscopic sleeve gastrectomy (LSG). However, it is considered more invasive and, therefore, more hazardous. There is a lack of unity in complication reporting following bariatric surgery. Thus, there is a possible misconception regarding the relative safety of the two major bariatric procedures performed worldwide. This may have contributed to a shift in practice with LSG gaining momentum "at the expense" of LRYGBP. The aim of this study was to evaluate the relative safety of primary LSG and LRYGBP according to the Clavien-Dindo complication grading system. A total of 2651 and 554 patients underwent primary LSG and LRYGBP, respectively at three high-volume centers. Thirty-day perioperative complications were recorded and graded. Length of hospital stays (LOS) and readmission rates were collect...