Research Interests: Hematology, Surgery, Treatment, Treatment Outcome, Medicine, and 15 morePlatelet, Humans, Risk factors, Length of Stay, Retrospective Studies, Risk Factors, Blood Transfusion, Laparoscopy, Platelet Count, Cohort Studies, Splenectomy, Idiopathic thrombocytopenic purpura, Postoperative Complications, Platelet transfusion, and Cardiovascular medicine and haematology
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Many bariatric operations are associated with reduced food tolerance and frequent vomiting, which may cause nutritional deficiencies and influence quality of life. However, the impact of different bariatric procedures on quality of eating... more
Many bariatric operations are associated with reduced food tolerance and frequent vomiting, which may cause nutritional deficiencies and influence quality of life. However, the impact of different bariatric procedures on quality of eating and food tolerance has not yet been studied enough. Two hundred and eighteen participants filled a quality of eating questionnaire, at three different time periods after bariatric operation: short-term (3-6 months, n = 63), medium-term (6-12 months, n = 69) and long-term follow-up (over 12 months, n = 86). The participants underwent the following procedures: 99 patients have had Roux-en-Y gastric bypass (RYGB), 49 laparoscopic gastric banding (LAGB), 56 sleeve gastrectomy (SG), and 14 biliopancreatic diversion with duodenal switch (BPD-DS). At short-term period score achieved for all section of the questionnaire was similar for all operations. The total score of the questionnaire at the medium-term group was 20.27 ± 3.57, 14.47 ± 5.92, 22.27 ± 4.66, and 20.91 ± 3.26 (p < 0.001) and the total score for the long-term group of was 21.56 ± 5.16, 15.5 ± 3.75, 20.45 ± 4.9, and 24.2 ± 2.16 (p < 0.001) for RYGB, LAGB, SG, and BPD-DS, respectively. In a linear regression model we found that LAGB patients had a significantly lower total score compared to all other procedures (p < 0.001). Every 1% of %EWL was associated with a total score decrease in 0.045 points (p = 0.009). Impaired quality of eating and food intolerance is common following many types of bariatric procedures. However, the difficulties diminish as time passes after operation and can be affected by the type of procedure. Patients undergoing LAGB have significantly greater limitations and difficulties to ingest variety of foods.
Research Interests: Bariatric Surgery, Quality of life, Medicine, Humans, Female, and 15 moreMale, Patient Satisfaction, Gastric banding, Obesity Surgery, Eating, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Morbid Obesity, Gastric Bypass, Linear Regression Model, Cross Sectional Studies, Biliopancreatic diversion, and Postoperative Period
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The beneficial effect of bariatric surgery (BS) in type 2 diabetes mellitus patients is well established. Conversely, little is known about the efficacy of BS in type 1 diabetes mellitus (T1DM) patients, despite the increasing prevalence... more
The beneficial effect of bariatric surgery (BS) in type 2 diabetes mellitus patients is well established. Conversely, little is known about the efficacy of BS in type 1 diabetes mellitus (T1DM) patients, despite the increasing prevalence of obesity in this population. A retrospective review was carried out on a prospectively collected bariatric surgery registry of all patients undergoing BS at two university hospitals between 2010 and 2015. Patients with T1DM were identified, and detailed chart reviews were obtained. In this time period, we operated on thirteen patients with T1DM. Eight were female (61.5 %). Median age at time of surgery was 38 ± 8.3 (range 28-53) years. The procedures performed were laparoscopic sleeve gastrectomy (n = 10) and laparoscopic Roux-en-Y gastric bypass (n = 3). On median postoperative follow-up of 24 (range 2.5-51) months, mean body mass index significantly decreased from 39.9 ± 4.1 to 30.1 ± 3.9 kg/m(2) (P < 0.0001) and insulin requirements were significantly reduced from 83.7 ± 40.4 to 45.7 ± 33.1 U/day (P < 0.01). However, there was no significant change in glycemic control assessed by HbA1C (P = 0.2). During the first months following surgery, three patients (21.4 %) experienced diabetic ketoacidosis, and four patients (28.6 %) reported more frequent episodes of hypoglycemia. Bariatric surgery in morbidly obese T1DM patients is an effective method for weight loss, leading to a remarkable improvement in insulin requirements. Larger prospective studies are still needed to confirm these findings, assess long-term effects of BS and better delineate its risk-to-benefit ratio in this growing population of morbidly obese patients with T1DM.
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We designed a study to assess the safety and long-term efficacy of laparoscopic splenectomy (LS) for the treatment of chronic idiopathic thrombocytopenic purpura (ITP). Over a period of 55 months, 104 patients underwent LS for chronic... more
We designed a study to assess the safety and long-term efficacy of laparoscopic splenectomy (LS) for the treatment of chronic idiopathic thrombocytopenic purpura (ITP). Over a period of 55 months, 104 patients underwent LS for chronic ITP. The perioperative course was documented and the long-term follow-up data were recorded. The mean age was 36.9 years (range, 8-83) and 72 patients were female. Patients were operated on with a mean platelet count of 110,000/ml. Fifty-one patients were operated on with a platelet count of < 100,000; 18 of them had a count of < 50,000/ml and 11 had a count of < 10,000/ml. There were no conversions to laparotomy. Bleeding occurred in 14 patients, and five of them received a blood transfusion. The mean operating time was 56.5 min (range, 25-240). There were minor complications in five patients and major complications in three. The mean hospital stay was 2.1 days (range, 0-13). Over a mean follow-up period of 36 months (range, 4-62), all but four patients were available for follow-up. Eighty-four patients are in complete remission. Seven patients are in partial remission, with a platelet count of 50,000-100,000 \ml without medical treatment. Eleven patients did not respond or relapsed following a short initial response; three of them underwent later removal of an accessory spleen, two with partial response. All but two relapses occurred within 70 days of the operation. LS is safe and effective for the treatment of chronic ITP and yields excellent long-term results. Until another form of treatment emerges, LS should be considered the treatment of choice for this disease and recommended to the patient at an early stage of the disease.
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The role of computerized tomography (CT) in evaluating patients with small bowel obstruction (SBO) has been extensively described in the current literature. We report a rare case of SBO related to a surgically proven paracecal hernia,... more
The role of computerized tomography (CT) in evaluating patients with small bowel obstruction (SBO) has been extensively described in the current literature. We report a rare case of SBO related to a surgically proven paracecal hernia, diagnosed on an abdominal CT scan preoperatively.
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Failed sleeve gastrectomy (SG), defined by inadequate weight loss or weight regain, can be treated by a laparoscopic conversion to a biliopancreatic diversion with duodenal switch (DS) or a Roux-en-Y gastric bypass (RYGB). We report the... more
Failed sleeve gastrectomy (SG), defined by inadequate weight loss or weight regain, can be treated by a laparoscopic conversion to a biliopancreatic diversion with duodenal switch (DS) or a Roux-en-Y gastric bypass (RYGB). We report the outcomes of these procedures after SG failure. All patients who underwent DS (n = 9) or RYGB (n = 10) due to inadequate weight loss or weight regain between December 2006 and November 2012 after a failed SG were enrolled. The mean pre-SG weight and body mass index (BMI) for the DS and RYGB patients were 143±36 kg and 51.5±11 kg/m(2) and 120±26 kg and 44.5±5 kg/m(2), respectively. The interval between the SG and the conversion to DS and to RYGB was 27±18 months and 36±17 months, respectively. The operation time and hospital stay were 191±64 minutes and 4.3±2.4 days for DS, and 111±37 minutes and 3.1±1.1 days for RYGB. At reoperation, the weight, BMI and percentage of excess weight loss (%EWL) were 113±22 kg, 43±6 kg/m(2) and 28±16.5% and 107±27.5 kg, 40±5.7 kg/m(2) and 25±12.7% (all P>.05), for the DS and RYGB, respectively. None of the patients were lost to follow-up. The post-DS weight, BMI, and %EWL were 84±19 kg, 30.7±7.4 kg/m(2), and 80±40%. The post-RYGB weight, BMI, and %EWL were 81±21 kg, 30.2±4.8 kg/m(2), and 65.5±34% (all P> .05). DS and RYGB are feasible and effective operations after a failed SG. The DS yields a greater weight loss. The mechanism of failure should guide selection of the second procedure.
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Enhanced-view total extra-peritoneal (eTEP) inguinal hernia repair is a technically demanding procedure with a steep learning curve. Examine the feasibility and effectiveness of an instructor approach to teaching residents how to perform... more
Enhanced-view total extra-peritoneal (eTEP) inguinal hernia repair is a technically demanding procedure with a steep learning curve. Examine the feasibility and effectiveness of an instructor approach to teaching residents how to perform laparoscopic eTEP independently following a dedicated course of individual teaching. Prospective analysis of eTEP procedures performed by residents between March 2018 and September 2020. Six residents dispersed into three groups—Group A: two junior residents, Group B: two mid-level residents and Group C: two senior residents. All residents performed a unilateral IHR comprised of five core steps. Data reviewed for each procedure included the time of each step, total time and autonomy degree as assessment for every step: 1st degree-dependent (physical assistance), 2nd degree-partially dependent (vocal assistance) and 3rd degree-independent. Early and late procedures were divided at 50% of cases. Participants performed 44 procedures (220 steps). Late procedures presented with a significant improvement in all degrees of autonomy (1st degree p = 0.002, 2nd degree p = 0.007 and 3rd degree p < 0.0001) and in every step (Step 1 p = 0.015, Step 2 p = 0.006, Step 3 p < 0.0001, Step 4 p < 0.0001, Step 5 p = 0.002). There was no significant difference in surgery duration between early and late procedures (p = 0.32). At early procedures, junior residents needed significantly higher rates of physical intervention (1st degree) compared to the senior residents (p = 0.004). Conversely, there was no significant difference in 2nd degree of autonomy (p = 0.46), 3rd degree (p = 0.06) and surgery duration (p = 0.16). The last three procedures performed by all participants had no significant difference between the seniority groups in autonomy (1st degree p = 0.1, 2nd degree p = 0.18 and 3rd degree p = 0.1). Dedicated course with an individual instructor's approach is effective in achieving competence, autonomy and confidence in performing eTEP in a short time.
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Background: Microsatellite instability (MSI) is a useful marker of replication errors in neoplasia, resulting from mutations in the mismatch repair (MMR) genes. Nearly all hereditary non-polyposis colorectal cancer (HNPCC) and about 15%... more
Background: Microsatellite instability (MSI) is a useful marker of replication errors in neoplasia, resulting from mutations in the mismatch repair (MMR) genes. Nearly all hereditary non-polyposis colorectal cancer (HNPCC) and about 15% of sporadic colorectal cancers (CRC) exhibit high MSI (MSI-H). The use of the Amsterdam criteria for HNPCC diagnosis may fail to identify many HNPCC cases. Genetic screening of mutations in the MMR genes is laborious, time-consuming, expensive and limited by a low detection rate. Hence, MSI testing is a feasible and cost-effective method to select suspected HNPCC patients for genetic analysis. MSI has not been used routinely or prospectively in the assessment of newly diagnosed CRC. Aims: To prospectively evaluate MSI status in a cohort of patients seen at the Gastrointestinal Oncology Unit of the Tel Aviv Medical Center. Methods: Ninety-eight consecutive patients with colonic or gastric neoplasia were included. Samples from neoplastic and normal mucosa were obtained at the time of diagnostic endoscopy. MSI was determined based on five Bethesda markers using standard polymerase chain reaction procedures. Results: The overall incidence of MSI was 20.4%. MSI-H was detected in 22.2% of CRC, 20% of colonic adenomas and 18.2% of gastric neoplasia. MSI-positive neoplasia tended to display multiple colonic sites, moderate-well differentiated tumors, and a higher rate of familial gastrointestinal neoplasia. Conclusions: MSI may be involved in the early stages of some colorectal tumorigenesis pathways since it may be detected in adenomas. MSI may serve as a cost-effective, reliable and important tool in the selection of HNPCC-suspected families for genetic testing. A small study population, referral bias or ethnic variation might explain the higher MSI rate. It is suggested that, similar to familial adenomatous polyposis, a state of attenuated HNPCC may exist. Hence, the clinical approach in positive patients, and their family members, should be conducted as for families with genetically proven HNPCC.
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Over the last three decades, morbid obesity and its related comorbidities have become a social, medical, and economic burden on healthcare systems and on society alike [1, 2]. Renal transplantation and morbid obesity are closely linked... more
Over the last three decades, morbid obesity and its related comorbidities have become a social, medical, and economic burden on healthcare systems and on society alike [1, 2]. Renal transplantation and morbid obesity are closely linked both by the high prevalence of end-stage renal disease(ESRD) caused by type 2 diabetes mellitus, leading to transplantation, and by immunosuppressive therapy following transplantation. In a review by Friedman et al. of over 85,000 renal transplants, 60% were morbid obese at the time of transplantation and the proportion of obese transplant recipients rose by 116% over 10-year surveillance [3]. Bariatric surgery is the most effective method for weight loss and resolution of obesity-related comorbidities [4, 5]. Although morbid obesity is highly prevalent in renal transplant recipients and candidates, the literature regarding bariatric surgery in this population is scarce and comprised studies treating obesity with sleeve gastrectomy (SG) or Roux-en-Y g...
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Laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently considered the gold standard treatment for morbid obesity. The learning curve for this procedure is about 100 cases, and it is considered the most important factor in decreasing... more
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently considered the gold standard treatment for morbid obesity. The learning curve for this procedure is about 100 cases, and it is considered the most important factor in decreasing complications and mortality. We present our experience and learning curve with LRYGB. The data was collected prospectively. All patients with primary LRYGB between March 2006 and April 2014 were included. Only patients with full data on demographics, length of stay, operating time, and complications were included in the study. Five hundred and eleven patients underwent a LRYGB. Ninety five of them underwent a redo RYGB (conversion), and were excluded. Of the remaining 416 patients, full data was available for 326 and the statistical analysis refers to this group. The complication rate was available for all patients who were included in the study. The mean age and body mass index were 43 years (14-76 years) and 42.8 kg/m2 (34-76) respectively. The mea...
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BackgroundThe increasing prevalence of morbid obesity (MO) results in parallel growth of obesity‐associated liver diseases necessitating liver transplantation (LT).ObjectiveTo examine the feasibility and safety of Roux‐en‐Y gastric bypass... more
BackgroundThe increasing prevalence of morbid obesity (MO) results in parallel growth of obesity‐associated liver diseases necessitating liver transplantation (LT).ObjectiveTo examine the feasibility and safety of Roux‐en‐Y gastric bypass or sleeve gastrectomy in the setting of LT.MethodsThis retrospective chart review included the data on all the MO candidates before and after LT who underwent bariatric surgery (BS) in our institution between 04/2013–09/2016. The reported outcomes were weight change and early and late postoperative complications (mean follow‐up: 43 ± 11.1 months).ResultsEighteen MO peri‐LT patients (10 females, 8 males, average age 48 years) were included in the study. Ten had cirrhosis (mean Model of End‐stage Liver Disease [MELD] score of 12.5 ± 6.42), three underwent concurrent LT and BS (mean MELD score 23.7 ± 0.58), and five had LT (mean of 56 months from LT). The mean percentage of total and excess weight loss was 31% and 81%, respectively. Six of the eight p...
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BACKGROUND AND AIMS Longitudinal assessment of body composition following bariatric surgery allows monitoring of health status. Our aim was to elucidate trends of anthropometric and clinical outcomes 3 years following sleeve gastrectomy... more
BACKGROUND AND AIMS Longitudinal assessment of body composition following bariatric surgery allows monitoring of health status. Our aim was to elucidate trends of anthropometric and clinical outcomes 3 years following sleeve gastrectomy (SG). METHODS A prospective cohort study of 60 patients who underwent SG. Anthropometrics including body composition analysis measured by multi-frequency bioelectrical impedance analysis, blood tests, liver fat content measured by abdominal ultrasound and habitual physical activity were evaluated at baseline and at 6 (M6), 12 (M12), and 36 (M36) months post-surgery. RESULTS Sixty patients (55% women, age 44.7 ± 8.7 years) who completed the entire follow-up were included. Fat mass (FM) was reduced significantly 1 year post-surgery (55.8 ± 11.3 to 26.7 ± 8.3 kg; P < 0.001) and then increased between 1 and 3 years post-operatively, but remained below baseline level (26.7 ± 8.3 to 33.1 ± 11.1 kg; P < 0.001). Fat free mass (FFM) decreased significantly during the first 6 months (64.7 ± 14.3 to 56.9 ± 11.8 kg; P < 0.001), slightly decreased between M6 and M12 and then reached a plateau through M36. Weight loss "failure" (< 50% excess weight loss) was noticed in 5.0% and 28.3% of patients at M12 and M36, respectively. Markers of lipid and glucose metabolism changed thereafter in parallel to the changes observed in FM, with the exception of HDL-C, which increased continuingly from M6 throughout the whole period analyzed (45.0 ± 10.2 to 59.5 ± 15.4 mg/dl; P < 0.001) and HbA1c which continued to decrease between M12 and M36 (5.5 ± 0.4 to 5.3 ± 0.4%; P < 0.001). There were marked within-person variations in trends of anthropometric and clinical parameters during the 3-year follow-up. CONCLUSIONS Weight regain primarily attributed to FM with no further decrease in FFM occurs between 1 and 3 years post-SG. FM increase at mid-term may underlie the recurrence of metabolic risk factors and can govern clinical interventions.
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BACKGROUND Data on the benefits of bariatric surgery for morbid obesity among kidney transplant recipients are scarce. OBJECTIVE To examine the effect of bariatric surgery on graft function and survival and on obesity-related... more
BACKGROUND Data on the benefits of bariatric surgery for morbid obesity among kidney transplant recipients are scarce. OBJECTIVE To examine the effect of bariatric surgery on graft function and survival and on obesity-related co-morbidities. SETTING University hospital. METHODS This case-control study used retrospectively collected data of all kidney recipients who underwent bariatric surgery in our institution between November 2011 and August 2016 (n = 30, 11 females). Nonbariatric operated kidney recipients matched for age, sex, and time elapsed since transplantation served as controls (n = 50, 23 females). Main outcomes were renal function, graft loss events, mortality, and obesity-related co-morbidities. RESULTS The mean follow-up duration was 2.4 ± 1.3 years for both groups. At final follow-up, there was an increase in estimated glomerular filtration rates for the bariatric surgery group, and a decrease for the controls (13.4 ± 19.9 and -3.9 ± 15.8 mL/min/1.73 m2, respectively, P < .001). The chronic kidney disease classification improved in 9 bariatric surgery group patients and in 6 controls (P = .1). Two patients in the bariatric surgery group and 6 controls died. Total death or graft function loss during the follow-up was 6.7% and 16.7%, respectively (P = .3). The total numbers of co-morbidities and medications were lower in the bariatric surgery patients (-.7 and -2, respectively) and higher in the controls (+.3 and +1.1; P < .001) at study closure. CONCLUSIONS There was an improvement in renal function, graft survival, and obesity-related co-morbidities among kidney transplant recipients who underwent bariatric surgery compared with those who did not. These findings support bariatric surgery in this population and warrant prospective studies.
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Morbid obesity is associated with increased graft loss and shortened graft survival in kidney transplant patients. Treating obesity in transplant patients may improve graft outcomes. Laparoscopic sleeve gastrectomy (LSG), an effective... more
Morbid obesity is associated with increased graft loss and shortened graft survival in kidney transplant patients. Treating obesity in transplant patients may improve graft outcomes. Laparoscopic sleeve gastrectomy (LSG), an effective bariatric operation, is relatively unlikely to interfere with absorption of anti-rejection medications. Data on relevant renal function parameters were collected from all LSGs performed on renal transplant patients at our center (n = 10). The procedure was successful in eight patients, with no mortality, graft rejection or dysfunction. The median age and follow-up were 57 years and 14 months, respectively. Seven patients had over 1 year of follow-up. The median preoperative weight and BMI were 119 kg (96-152) and 42 kg/m(2) (37-49), respectively. The median hospital stay was 4 days. The median postoperative weight and BMI at 6 months and 1 year were 86 kg and 31 kg/m(2) and 83 kg and 29 kg/m(2) , respectively. Urinary protein excretion and serum creatinine decreased significantly in all patients (p &lt; 0.05). One patient developed two complications, acute renal failure and sleeve stricture, both of which resolved with treatment. LSG provided effective weight loss in renal transplant patients without adverse effects on graft function and immunosuppression.
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Research Interests: Algorithms, Bariatric Surgery, Adolescent, Medicine, Humans, and 15 moreFemale, Male, Clinical Sciences, Aged, Middle Aged, Adult, Analysis of Variance, Biological markers, Chi Square Distribution, Fluid Therapy, Oliguria, Laparoscopy, Creatinine, Postoperative Complications, and Intraoperative complications
Obesity is a major epidemic in developed countries. It induces or exacerbates hypertension, diabetes mellitus, obstructive sleep apnea, dyslipidemia, and many other disease processes, which cumulatively contribute to premature mortality... more
Obesity is a major epidemic in developed countries. It induces or exacerbates hypertension, diabetes mellitus, obstructive sleep apnea, dyslipidemia, and many other disease processes, which cumulatively contribute to premature mortality on a scale rivaling that of smoking. At present, bariatric surgery is the only therapeutic modality that can produce sustained weight loss and halt or resolve comorbidities. This success results from the ability to perform the operation reliably, usually laparoscopically, with low mortality. The most commonly performed operation is Roux-en-Y gastric bypass. Other bypasses discussed in this review include biliopancreatic diversion with and without duodenal switch. Purely restrictive operations, especially adjustable gastric banding, have a lower risk but are somewhat less effective. We focus on the more controversial aspects of commonly accepted operations, including patient selection, the spectrum and frequency of complications, and the long-term out...
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The surgical risk of transplanted patients is high, and the modified gastrointestinal anatomy after bariatric surgery (BS) may lead to pharmacokinetic alterations in the absorption of immunosuppressive drugs. Data on outcomes of BS and... more
The surgical risk of transplanted patients is high, and the modified gastrointestinal anatomy after bariatric surgery (BS) may lead to pharmacokinetic alterations in the absorption of immunosuppressive drugs. Data on outcomes of BS and the safety and feasibility of maintaining immunosuppression and graft safety among solid organ transplanted patients are scarce. In the current study, weight loss, improvement in comorbidities, and changes in dosage and trough levels of immunosuppression drugs before and after BS were analyzed for all transplanted patients who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in our institution between November 2011 and January 2017. Thirty-four patients (13 females, 21 males, average age 53 years) were included in the study. A successful weight loss (>50% excess weight loss in 28 of them [82%]) was recorded at the last follow-up. Comorbidities improved significantly. Immunosuppressive stability increa...
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RESULTS A total of 443 LSGs were performed. Complete data were available for 241 of the 443 patients (54.4%) at the 1-year follow-up, for 128 of 259 patients (49.4%) at the 3-year follow-up, and for 39 of 56 patients (69.6%) at the 5-year... more
RESULTS A total of 443 LSGs were performed. Complete data were available for 241 of the 443 patients (54.4%) at the 1-year follow-up, for 128 of 259 patients (49.4%) at the 3-year follow-up, and for 39 of 56 patients (69.6%) at the 5-year follow-up. The percentage of excess weight loss was 76.8%, 69.7%, and 56.1%, respectively. Complete remission of diabetes was maintained in 50.7%, 38.2%, and 20.0%, respectively, and remission of hypertension was maintained in 46.3%, 48.0%, and 45.5%, respectively. Changes in high-density lipoprotein cholesterol level (mean [SD] level preoperatively and at 1, 3, and 5 years, 46.7 [15.8], 52.8 [13.6], 56.8 [16.0], and 52.4 [13.8] mg/dL, respectively) and triglyceride level (mean [SD] level preoperatively and at 1, 3, and 5 years, 155.2 [86.1], 106.3 [45.3], 107.2 [53.4], and 126.4 [59.7] mg/dL, respectively) were significant compared with preoperative and postoperative measurements (P < .001). The decrease of low-density lipoprotein cholesterol l...
Research Interests: Risk assessment, Humans, Hyperglycemia, Hypertension, Metabolic diseases, and 15 moreFemale, Male, Hypercholesterolemia, Body Mass Index, Obesity Surgery, Clinical Sciences, Middle Aged, Adult, Time Factors, Retrospective Studies, Risk Assessment, Laparoscopy, Cohort Studies, Postoperative Complications, and Gastrectomy
BACKGROUND Roux-en-Y gastric bypass is currently considered the gold standard surgical option for the treatment of morbid obesity. Open RYGB is associated with a high risk of complications. Laparoscopic RYGB has been shown to reduce... more
BACKGROUND Roux-en-Y gastric bypass is currently considered the gold standard surgical option for the treatment of morbid obesity. Open RYGB is associated with a high risk of complications. Laparoscopic RYGB has been shown to reduce perioperative morbidity and improve recovery. OBJECTIVES To review our experience with laparoscopic RYGB during a 19 month period. METHODS The data were collected prospectively. The study group comprised all patients who underwent laparoscopic RYGB for treatment of morbid obesity as their primary operation between February 2006 and July 2007. The reported outcome included surgical results, weight loss, and improved status of co-morbidities, with follow-up of up to 19 months. RESULTS The mean age of the 50 patients was 36.7 years. Mean body mass index was 44.7 kg/m2 (range 35-76 kg/m2); mean duration of surgery was 171 minutes. There was no conversion to open surgery. The mean length of stay was 4 days (range 2-7 days). Five patients (10%) developed a com...
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Impaired sympathetic/parasympathetic response, expressed by elevated Acetylcholinesterase (AChE) is associated with obesity, metabolic syndrome and inflammation. However, the association between morbid obesity and AChE and the changes in... more
Impaired sympathetic/parasympathetic response, expressed by elevated Acetylcholinesterase (AChE) is associated with obesity, metabolic syndrome and inflammation. However, the association between morbid obesity and AChE and the changes in cholinergic tone following bariatric laparoscopic sleeve gastrectomy (LSG) surgery-induced weight reduction were never analyzed. Two studies are presented; the first (the "apparently healthy cohort") was a cross-sectional study and the second (the "LSG cohort") was a prospective-cohort study with 12 months of follow-up. The "apparently healthy cohort" included 1450 apparently healthy participants who volunteered to the Tel-Aviv Medical Center Inflammation Survey (TAMCIS) during a routine annual checkup visit. The "LSG cohort" included 77 morbid obese patients before and at 3, 6, and 12 months following LSG surgery. Main outcomes included anthropometric measurements, Hemoglobin A1c (HbA1C), serum AChE, insulin ...
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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%...
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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, Adipose tissue, Prospective studies, Humans, and 13 moreFemale, Body Composition, Male, Exercise, Body Mass Index, Clinical Sciences, Adult, Food Intolerance, Laparoscopy, Postoperative care, Postoperative Complications, dr nowzaradan high protein diet, and Gastrectomy
The beneficial effect of bariatric surgery (BS) in type 2 diabetes mellitus patients is well established. Conversely, little is known about the efficacy of BS in type 1 diabetes mellitus (T1DM) patients, despite the increasing prevalence... more
The beneficial effect of bariatric surgery (BS) in type 2 diabetes mellitus patients is well established. Conversely, little is known about the efficacy of BS in type 1 diabetes mellitus (T1DM) patients, despite the increasing prevalence of obesity in this population. A retrospective review was carried out on a prospectively collected bariatric surgery registry of all patients undergoing BS at two university hospitals between 2010 and 2015. Patients with T1DM were identified, and detailed chart reviews were obtained. In this time period, we operated on thirteen patients with T1DM. Eight were female (61.5 %). Median age at time of surgery was 38 ± 8.3 (range 28-53) years. The procedures performed were laparoscopic sleeve gastrectomy (n = 10) and laparoscopic Roux-en-Y gastric bypass (n = 3). On median postoperative follow-up of 24 (range 2.5-51) months, mean body mass index significantly decreased from 39.9 ± 4.1 to 30.1 ± 3.9 kg/m(2) (P &lt; 0.0001) and insulin requirements were significantly reduced from 83.7 ± 40.4 to 45.7 ± 33.1 U/day (P &lt; 0.01). However, there was no significant change in glycemic control assessed by HbA1C (P = 0.2). During the first months following surgery, three patients (21.4 %) experienced diabetic ketoacidosis, and four patients (28.6 %) reported more frequent episodes of hypoglycemia. Bariatric surgery in morbidly obese T1DM patients is an effective method for weight loss, leading to a remarkable improvement in insulin requirements. Larger prospective studies are still needed to confirm these findings, assess long-term effects of BS and better delineate its risk-to-benefit ratio in this growing population of morbidly obese patients with T1DM.
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Developments in laparoscopic surgery have rendered it an efficient tool for many complex surgical procedures. In the last few years, laparoscopic adrenalectomy has become a more viable option for removal of adrenal pathology, with many... more
Developments in laparoscopic surgery have rendered it an efficient tool for many complex surgical procedures. In the last few years, laparoscopic adrenalectomy has become a more viable option for removal of adrenal pathology, with many surgeons preferring it to the conventional open technique. To describe the indications, technique, complications and follow-up of patients undergoing laparoscopic adrenalectomy in our department. The hospital files of 30 patients who underwent the procedure were reviewed. There were 19 females and 11 males with a mean age of 45 years. Indications for surgery differed and included hypersecreting adenoma, pheochromocytoma, suspected malignancy, and incidentaloma. Of the 31 laparoscopic adrenalectomies performed, 11 were right, 18 were left, and 1 was bilateral. The conversion rate to an open procedure was 3%. The mean duration of procedure was 120 minutes. Only one patient required blood transfusion. Complications occurred in 20% of patients, all reversible. There was no mortality. Mean hospitalization duration was 3.4 days and median follow-up 17 months. There were no late complications. All patients operated on for benign diseases are alive. Laparoscopic adrenalectomy appears to be a useful tool for the treatment of a range of adrenal pathologies.