Chanan Meydan

Background Single anastomosis gastric bypass (SAGB) has been established as a safe and effective bariatric procedure. SAGB has also been suggested as a conversion option from other procedures, but so far not extensively explored in that direction. Methods The study retrospectively reviewed and analyzed 154 consecutive SAGB procedures, including 48 conversion-al SAGB (cSAGB) and 106 primary SAGB (pSAGB). Preoperative physical dimensions and perioperative complications were obtained. Patients were followed 1, 3, and 6 months postoperatively, with weight measurements compared between groups. Results Operative times were longer in the cSAGB group but length of hospital stay was the same for both groups. Sixty-five percent of the cSAGB group had adjustable banding as a primary operation, and 94 % opted for conversion due to insufficient weight loss or regain thereof. Follow-up data availability was 98, 82, and 79 % for the three checkpoints. Three and 6 months postoperatively, cSAGB had inferior mean excess weight loss (EWL) compared to pSAGB, though both groups were successful after 6 months (mean EWL >50 %). Body mass index loss was significantly higher for pSAGB for the first postoperative 3 months. Low complication rates in both groups precluded statistical comparison in that respect. Discussion Initial weight loss after conversional SAGB is inferior to primary SAGB after 6 months. The observed safety of cSAGB is comparable to previous evidence for this procedure in the conversional settings. Conclusion SAGB may be considered as a safe and effective conversional procedure, but not as effective as pSAGB for initial weight loss.

The natural progression of metabolic abnormalities among patients with inherited autoinflammation is unclear. The objective of the study was to assess the cardiometabolic risk of participants with familial Mediterranean fever (FMF). This study included nationwide cross-sectional and longitudinal cohorts. The prevalence of components of the metabolic syndrome at age 17 years was assessed from the medical database of the Israeli Defense Force from 1973 through 1997. Included were 745 males with FMF, 902 healthy male siblings, and a control group of 787,714 participants. A prospective follow-up study traced the incidence of components of the metabolic syndrome to age 45 years among 57 FMF and 1568 control army personnel participants. Body mass index (BMI) and blood pressure (BP) were measured at age 17 years (cross-sectional); lifestyle, anthropometric, and biochemical data were periodically recorded from age 25 years. Abnormal BMI or BP (age 17 y) and Adult Treatment Panel III criteria of the metabolic syndrome were measured. In multivariable regression analysis adjusted for known confounders of obesity, FMF participants had an odds ratio of 0.65 for the occurrence of overweight [95% confidence interval (CI) 0.44-0.96, P = .03] and 0.66 (95% CI 0.48-0.92, P = .012) for hypertension-range BP; their siblings tended to obesity (odds ratio 1.48; 95% CI 1.04-2.11, P = .008). In the follow-up arm, a multivariable analysis adjusted for age, birth year, BMI, education, socioeconomic status, ethnicity, and physical activity yielded hazard ratios of 0.32 (95% CI 0.10-0.82, P = .002) for incident obesity, 0.49 (95% CI 0.25-0.95, P = .037) for incident triglycerides 150 mg/dL or greater, 0.56 (95% CI 0.31-0.98, P = .048) for low-density lipoprotein cholesterol 130 mg/dL or greater, and 2.14 (1.368-3.359, P = .001) for high-density lipoprotein cholesterol less than 40 mg/dL for FMF participants compared with controls. Incident elevated BP was lower among FMF participants (hazard ratio 0.49; 95% CI 0.23-1.00, P = .05), whereas dysglycemia incidence was comparable. FMF is associated with lower rates of most components of the metabolic syndrome compared with normal subjects, unlike other inflammatory conditions.

The aim of the study was to assess the relationship between age of arrival of male pediatric immigrant populations in Israel and their risk for subsequent high-weight morbidity at adolescence. The study analyzed a pooled cross section of 89,744 foreign-born male Jewish study participants, who were born in the former Soviet Union or Ethiopia (1970-1993) and immigrated in childhood to Israel. Each participant's body mass index was measured at approximately 17 years of age. Odds ratios were calculated for obesity and overweight according to age on arrival to Israel. A total of 52,503 Israel-born participants with origins in those same countries were measured at the same age and used as references. A total of 52,258 native Israelis without known immigrating ancestry were also used for comparison. The risk stratification accounted for possible socio-demographic confounders and birth year. Foreign-born immigrants had decreased risk for obesity and overweight relative to Israeli-born immigrants when measured at the age of 17 years. However, those who arrived in Israel during infancy and early childhood (before the age of 3 years) had greater risk for high weight compared with those immigrating during late childhood and adolescence. Although generally protective against obesity and overweight relative to native, these beneficial effects of immigration are diminished for those arriving in early childhood rather than later in adolescence.

The epidemic of obesity has been identified as a major source of morbidity, not just in developed countries but globally, in adults as well as at younger ages. The aims of this study were to describe trends in obesity and overweight in Israeli adolescents and observe temporal changes and association by risk factors. The research analyzed records of 2,148,342 Jewish adolescents, over a span of 44 years and included data for individual body measurements, place of residence, area of origin and education levels. Body mass index (BMI) was measured by professionals, calculated and categorized as overweight or obesity according to age- and gender-specific BMI curves established in recent years. We processed the data in multinomial logistic regression model and calculated odds ratios for various risk factors. Obesity and overweight are on the rise for male and female adolescents born from the mid-1960s onwards, and especially for men from the 1980s onwards. Risk factors for male adolescents include lower socioeconomic status, inferior education levels and Western origins (vs. Asian, African or Israeli origins). Risk modifiers for women were similar, except for African origins, which were associated with increased risk rather than decreased risk. Asian and Israeli origins were protective for both genders, and education was more strongly associated with obesity for women. We recommend stronger preventive efforts directed at adolescents as a whole, and particularly vulnerable groups with lower education levels and poverty, or those with specific geographical origins. Gender disparities are evident and should be considered in these efforts and in further research.

The aim of single incision laparoscopic surgery (SILS) and other types of trans-umbilical procedures (TU) has been to perform operations with minimal or no visible scars. However, in bariatric surgery, they are in particular demanding and the final esthetic advantage is in question given the long-term abdominal skin alteration, or abdominoplasty. We propose an alternative rationale and approach to achieve the minimal scarring concept in bariatric surgery. A retrospective report of a straight forward method using four access ports, where three ports are concealed at either the lower panniculectomy region or the lateral folds of the umbilicus. The technique was performed on a pilot series of 65 female patients who underwent laparoscopic sleeve gastrectomy (LSG). The study sample had a mean age of 40.3 years and a mean BMI of 41.1 ± 4.2 kg/m(2). All procedures were completed laparoscopically. Field ergometry, working angles, and surgeon's convenience were not impaired. Mean operation time was 46 min and mean hospital stay was 2.3 days. Complications were minimal. Postoperative esthetic outcome and the rationale behind port placement were well appreciated by the patients. Performing LSG with the described approach is feasible, safe, and consistent with basic principles of ergometry including correct working triangulation. Esthetic outcome is up to the minimal scarring concept and future body contouring is not hampered.

The natural progression of metabolic abnormalities among patients with inherited autoinflammation is unclear. The objective of the study was to assess the cardiometabolic risk of participants with familial Mediterranean fever (FMF). This study included nationwide cross-sectional and longitudinal cohorts. The prevalence of components of the metabolic syndrome at age 17 years was assessed from the medical database of the Israeli Defense Force from 1973 through 1997. Included were 745 males with FMF, 902 healthy male siblings, and a control group of 787,714 participants. A prospective follow-up study traced the incidence of components of the metabolic syndrome to age 45 years among 57 FMF and 1568 control army personnel participants. Body mass index (BMI) and blood pressure (BP) were measured at age 17 years (cross-sectional); lifestyle, anthropometric, and biochemical data were periodically recorded from age 25 years. Abnormal BMI or BP (age 17 y) and Adult Treatment Panel III criteria of the metabolic syndrome were measured. In multivariable regression analysis adjusted for known confounders of obesity, FMF participants had an odds ratio of 0.65 for the occurrence of overweight [95% confidence interval (CI) 0.44-0.96, P = .03] and 0.66 (95% CI 0.48-0.92, P = .012) for hypertension-range BP; their siblings tended to obesity (odds ratio 1.48; 95% CI 1.04-2.11, P = .008). In the follow-up arm, a multivariable analysis adjusted for age, birth year, BMI, education, socioeconomic status, ethnicity, and physical activity yielded hazard ratios of 0.32 (95% CI 0.10-0.82, P = .002) for incident obesity, 0.49 (95% CI 0.25-0.95, P = .037) for incident triglycerides 150 mg/dL or greater, 0.56 (95% CI 0.31-0.98, P = .048) for low-density lipoprotein cholesterol 130 mg/dL or greater, and 2.14 (1.368-3.359, P = .001) for high-density lipoprotein cholesterol less than 40 mg/dL for FMF participants compared with controls. Incident elevated BP was lower among FMF participants (hazard ratio 0.49; 95% CI 0.23-1.00, P = .05), whereas dysglycemia incidence was comparable. FMF is associated with lower rates of most components of the metabolic syndrome compared with normal subjects, unlike other inflammatory conditions.