Professor Nasser Sakran | Bar-Ilan University (original) (raw)
Papers by Professor Nasser Sakran
PubMed, Dec 1, 2019
In the last decade, the number of bariatric surgery procedures increased dramatically in Israel s... more In the last decade, the number of bariatric surgery procedures increased dramatically in Israel similar to what has occurred worldwide. Bariatric surgery procedures have a proven efficacy in the treatment of morbid obesity. However, post-operative complications that involve the gastrointestinal tract may occur. Beyond the importance of early diagnosis and treatment, it is crucial to understand that we may decrease and prevent some of the complications by selecting the bariatric procedure according to the patient's medical background. This review addresses diagnosis, treatment and prevention of gastrointestinal diseases pre- and post-bariatric surgery procedures. Recommended pre-operative diagnostic procedures are listed including the eradication of helicobacter pylori and the protective effect of proton pump inhibitors. We reviewed the effect of specific bariatric procedures on gastroesophageal reflux disease and on intestinal motility. Prevention and treatment of nutritional deficits and metabolic complications are also discussed. Finally, this document was written by a panel of experts representing the attitudes of the Israeli Societies for Metabolic and Bariatric Surgery (ISMBS), Pharmaceutical (PSI), Study of Obesity and the Israeli Gastroenterology and Liver Diseases Association, all endorsed by the Institute for Quality in Medicine of the Israeli Medical Association (IMA).
Surgical Endoscopy and Other Interventional Techniques, Dec 6, 2014
The Israel Medical Association journal : IMAJ, 2018
result is a disturbing prevalence of delayed cholecystectomy [3], and the widespread use of invas... more result is a disturbing prevalence of delayed cholecystectomy [3], and the widespread use of invasive drainage by a cholecystostomy tube, as a temporizing measure, ranging from 25% [4] to 36% in Sakran’s group. This “easy life” for the surgeons, deferring the need to deal with the acute condition in a stressed and busy system, does not come without a price for the patient, the surgeon, and the system. These complications include a longer hospital stay, repeat episodes of acute biliary disease and re-admissions, and more difficult eventual surgery, which is manifested mainly by a higher rate of conversion from laparoscopic to open surgery [5]. In Sakran’s study, increased conversion rate (and its associated higher surgical site infection rate) was found to be the only significant difference between cases in which a cholecystostomy tube was used and in those without a tube, but this is not supported by other studies in which biliary complications were more prevalent in the cholecystost...
Internal Medicine Journal, 2019
Due to the rising prevalence of obesity and type II diabetes mellitus, non‐alcoholic fatty liver ... more Due to the rising prevalence of obesity and type II diabetes mellitus, non‐alcoholic fatty liver disease is becoming the leading cause of chronic liver disease in the Western world. In some patients, simple steatosis can result in non‐alcoholic steatohepatitis which over time can lead to liver cirrhosis and its associated sequelae, including hepatocellular carcinoma. Early identification and management of patients at risk with intensive dietary and lifestyle modification are essential to prevent the development of advanced liver disease and its complications. In this review, we will discuss the epidemiology of non‐alcoholic fatty liver disease, pathogenesis, diagnosis, management and surveillance strategies to offset the morbidity and mortality of this disease, as well as liver and non‐liver‐related complications.
Nutrients, Mar 21, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Obesity Research & Clinical Practice, Jul 1, 2021
Introduction There is a paucity of data in scientific literature on the impact of Coronavirus Dis... more Introduction There is a paucity of data in scientific literature on the impact of Coronavirus Disease 2019 (COVID-19) pandemic on bariatric surgery. The aim of this study was to evaluate the impact of COVID-19 pandemic on Bariatric Surgery globally. Methods We conducted a global online survey of bariatric surgeons between 16/04/20 – 15/05/20. The survey was endorsed by five national bariatric surgery societies and circulated amongst their memberships. Authors also shared the link through their personal networks, email groups, and social media. Results 703 respondents from 77 countries completed the survey. Respondents reported a drop in elective bariatric activity from a median (IQR) of 130 (60-250) procedures in 2019 to a median of 0 (0-2) between16/03/2020 and 15/04/2020 during the pandemic. The corresponding figures for emergency activity were 5 (2-10) and 0 (0-1) respectively. 441 (63%) respondents did not perform any bariatric procedures during this time period. Surgeons reported outcomes of 61 elective bariatric surgical procedures during the pandemic with 13 (21%) needing ventilation and 2 (3.3%) deaths. Of the 13 emergency bariatric procedures reported, 5 (38%) needed ventilation and 4 (31%) died. 90 (13%) surgeons reported having had to perform a bariatric surgical or endoscopic procedure without adequate Personal Protective Equipment. Conclusions COVID-19 pandemic led to a remarkable decline in global elective and emergency bariatric surgery activity at its beginning. Both elective and emergency procedures performed at this stage of the pandemic had considerable morbidity and mortality.
Asian Journal of Surgery, Dec 1, 2022
Obesity Surgery, Jun 8, 2022
Obesity Surgery, Apr 16, 2020
Laparoscopic one anastomosis gastric bypass (OAGB) is gaining ground as a safe and effective oper... more Laparoscopic one anastomosis gastric bypass (OAGB) is gaining ground as a safe and effective operation for morbid obesity [1, 2]. Less than 5% of the patients may require revision surgery, with half of the revisional surgeries due to severe malnutrition and the other half due to bile reflux, ulcer, and/or weight regain (https://www.ifso.com/one-anastomosisgastric-bypass). Nonetheless, OAGB may lead to some difficult to treat complications such as a marginal ulcer (MU). The incidence of MU after OAGB is reported to be around 5.6% [3, 4]. Risk factors for MU include poor tissue perfusion due to tension or ischemia at the anastomosis; the presence of foreign material, such as staples or nonabsorbable suture; excess acid exposure in the gastric pouch due to gastrogastric fistulas; nonsteroidal anti-inflammatory drug use; Helicobacter pylori infection; and smoking [5]. Treatment with a high dose of proton pump inhibitors (PPI) and elimination of risk factors is started first [6], but when conservative treatment fails with an unresolved ulcer, a surgical approach should be considered including conversion to Roux-en-Y gastric bypass (RYGB) [7].
Case Reports in Surgery, 2017
Upside-down stomach is a relatively rare type of a large paraesophageal hernia characterized by t... more Upside-down stomach is a relatively rare type of a large paraesophageal hernia characterized by the migration of the stomach into the posterior mediastinum. Upside-down stomach is prone to severe complications and therefore surgery is recommended even in asymptomatic patients. A 62-year-old male presented with frequent abdominal pain with nausea and vomiting that persisted for one year. The patient was obese with fatty liver and was treated medically for gastroesophageal reflux disease (GERD) for 4 years. On upper gastrointestinal CT study a level-IV paraesophageal hernia was detected with upside-down stomach, and he was referred for elective surgery. Laparoscopic surgery included reduction of the stomach into the abdominal cavity followed by dissection of the paraesophageal membrane and hernia sac. The hiatal defect was closed using a wound closure device and nonabsorbable sutures. The defect closure was reinforced using Physiomesh tucked anteriorly and sutured posteriorly to the diaphragm. Follow-up was uneventful and the patient is free of complaints. The results of this surgical intervention support previous reports that laparoscopic repair with the use of biological mesh in the setting of large paraesophageal hernia should be favorably considered.
World Journal of Surgery, Jul 12, 2023
Background: Recent studies have reported higher postoperative complication rates in patients with... 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 January 2017-December 2021, consecutive patients with obesity class III (n= 2,950), IV (n= 256), and V (n= 23) underwent OAGB. BMI groups were comparable in gender, age, and associated comorbidities. Mean operative time was significantly longer in the higher BMI groups: class III (66.5±25.6 min), IV (70.5±28.7 min), and V (80.0±34.7 min), respectively (p= 0.018); no difference in LOS. In respective BMI classes, ≤30-day complication rates were 3.2%, 3.5%, and 4.3% (p= 0.926). The respective number of patients with CDC grades of 1-2 were 45 (1.5%), 6 (2.3%), and 1 (4.3%), p= 0.500; and in grade ≥3a, 25 (0.8%), 1 (0.4%), 0 (0.0%), p= 0.669. No significant differences in rates of early complications, reoperations, and readmissions were found in revisional patients across BMI groups. There was 0.06% mortality (n= 2 in 3,229), both in BMI class III. Conclusion: OAGB is a safe metabolic bariatric surgery procedure in patients with class III, IV, and V obesity in the perioperative term with comparable ≤30-day morbidity in the three BMI groups.
Surgical laparoscopy, endoscopy & percutaneous techniques, Mar 7, 2023
Background: Crohn's Disease (CD) patients with active penetrating and stricturing disease have a ... more Background: Crohn's Disease (CD) patients with active penetrating and stricturing disease have a high prevalence of malnutrition that has been shown to increase post-operative complications. The effect of 1-3 months of pre-operative exclusive Total Parental Nutrition (TPN) in active CD patients is not well established. We investigated the efficacy of exclusive TPN in active CD patients. Methods: From our IBD Center database (prospectively collected data) we identified all patients with complicated, active CD who were candidates for bowel resection between January 2016 and October 2018. CD location and activity were recorded based on the modified Montreal classification. Inclusion required exclusive preoperative home TPN without additional oral intake for 1-3 months prior to surgery. The Harvey Bradshaw Index (HBI), Body Mass Index (BMI), C-Reactive Protein (CRP) and albumin levels were recorded at baseline and at the end of TPN therapy. Results: Twenty pre-operative CD patients (65% male, 35% female) on exclusive TPN were identified. The mean age of the cohort was 30.75 ± 11.6 years with median disease duration of 8 years (IQR 2.5-11). Mean duration of pre-operative TPN treatment was 73 days (range 24-142 days). Most patients had terminal ileal (35%) or ileocolonic CD (30%), and the stricturing (B2) phenotype was present alone or in combination with other phenotypes in 95% of patients. During TPN therapy, 65% were on stable doses of medication (immunomodulators and/or biologics) and 35% received no medication. All 20 patients had significant clinical improvement in all disease activity indices at the end of preoperative TPN (baseline vs. post TPN): HBI 14.5 vs. 4.0 (p=0.001); BMI 19.2 vs. 19.7 kg/m2 (p=0.017); CRP 57.2 vs. 10.3 mg/L (p=0.001); and albumin 2.7 vs. 3.6 g.dL (p=0.001). Two patients (10%) no longer required bowel resections after completion of exclusive TPN. Conclusion: Exclusive preoperative TPN was associated with weight gain, decreased inflammatory biomarkers, and improved clinical disease activity and nutrition. While the initial results are promising, further studies are needed before a recommendation can be made to use exclusive preoperative TPN for at least 1 month for severe, refractory CD to decrease disease activity and improve nutritional status before elective surgery.
Surgery for Obesity and Related Diseases, Sep 1, 2018
Obesity Surgery, Oct 22, 2022
European Journal of Plastic Surgery, May 5, 2022
Expert Review of Cardiovascular Therapy, Apr 3, 2022
INTRODUCTION Obesity is a chronic disease, which has significant health consequences and is a sta... more INTRODUCTION Obesity is a chronic disease, which has significant health consequences and is a staggering burden to health care systems. Obesity can have harmful effects on the cardiovascular system, including heart failure, hypertension, coronary heart disease, and atrial fibrillation (AF). One of the possible substrates might be epicardial adipose tissue (EAT), which can be the link between AF and obesity. EAT is a fat deposit located between the myocardium and the visceral pericardium. Numerous studies have demonstrated that EAT plays a pivotal role in this relationship regarding atrial fibrillation. AREAS COVERED This review will focus on the role of obesity and the occurrence of atrial fibrillation (AF) and examine the connection between these and epicardial adipose tissue (EAT). The first part of this review will explain the pathophysiology of EAT and its association with the occurrence of AF. Secondly, we will review bariatric and metabolic surgery and its effects on EAT and AF. EXPERT COMMENTARY In this review, the epidemiology, pathophysiology, and treatments methods of AF are explained. Secondly the effects on EAT were elucidated. Due to the complex pathophysiological link between EAT, AF, and obesity, it is still uncertain which treatment strategy is superior.
Current obesity reports, Oct 28, 2021
Purpose of Review Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects o... more Purpose of Review Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future. Recent Findings Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Summary Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.
Obesity Surgery, Oct 18, 2022
PubMed, Dec 1, 2019
In the last decade, the number of bariatric surgery procedures increased dramatically in Israel s... more In the last decade, the number of bariatric surgery procedures increased dramatically in Israel similar to what has occurred worldwide. Bariatric surgery procedures have a proven efficacy in the treatment of morbid obesity. However, post-operative complications that involve the gastrointestinal tract may occur. Beyond the importance of early diagnosis and treatment, it is crucial to understand that we may decrease and prevent some of the complications by selecting the bariatric procedure according to the patient's medical background. This review addresses diagnosis, treatment and prevention of gastrointestinal diseases pre- and post-bariatric surgery procedures. Recommended pre-operative diagnostic procedures are listed including the eradication of helicobacter pylori and the protective effect of proton pump inhibitors. We reviewed the effect of specific bariatric procedures on gastroesophageal reflux disease and on intestinal motility. Prevention and treatment of nutritional deficits and metabolic complications are also discussed. Finally, this document was written by a panel of experts representing the attitudes of the Israeli Societies for Metabolic and Bariatric Surgery (ISMBS), Pharmaceutical (PSI), Study of Obesity and the Israeli Gastroenterology and Liver Diseases Association, all endorsed by the Institute for Quality in Medicine of the Israeli Medical Association (IMA).
Surgical Endoscopy and Other Interventional Techniques, Dec 6, 2014
The Israel Medical Association journal : IMAJ, 2018
result is a disturbing prevalence of delayed cholecystectomy [3], and the widespread use of invas... more result is a disturbing prevalence of delayed cholecystectomy [3], and the widespread use of invasive drainage by a cholecystostomy tube, as a temporizing measure, ranging from 25% [4] to 36% in Sakran’s group. This “easy life” for the surgeons, deferring the need to deal with the acute condition in a stressed and busy system, does not come without a price for the patient, the surgeon, and the system. These complications include a longer hospital stay, repeat episodes of acute biliary disease and re-admissions, and more difficult eventual surgery, which is manifested mainly by a higher rate of conversion from laparoscopic to open surgery [5]. In Sakran’s study, increased conversion rate (and its associated higher surgical site infection rate) was found to be the only significant difference between cases in which a cholecystostomy tube was used and in those without a tube, but this is not supported by other studies in which biliary complications were more prevalent in the cholecystost...
Internal Medicine Journal, 2019
Due to the rising prevalence of obesity and type II diabetes mellitus, non‐alcoholic fatty liver ... more Due to the rising prevalence of obesity and type II diabetes mellitus, non‐alcoholic fatty liver disease is becoming the leading cause of chronic liver disease in the Western world. In some patients, simple steatosis can result in non‐alcoholic steatohepatitis which over time can lead to liver cirrhosis and its associated sequelae, including hepatocellular carcinoma. Early identification and management of patients at risk with intensive dietary and lifestyle modification are essential to prevent the development of advanced liver disease and its complications. In this review, we will discuss the epidemiology of non‐alcoholic fatty liver disease, pathogenesis, diagnosis, management and surveillance strategies to offset the morbidity and mortality of this disease, as well as liver and non‐liver‐related complications.
Nutrients, Mar 21, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Obesity Research & Clinical Practice, Jul 1, 2021
Introduction There is a paucity of data in scientific literature on the impact of Coronavirus Dis... more Introduction There is a paucity of data in scientific literature on the impact of Coronavirus Disease 2019 (COVID-19) pandemic on bariatric surgery. The aim of this study was to evaluate the impact of COVID-19 pandemic on Bariatric Surgery globally. Methods We conducted a global online survey of bariatric surgeons between 16/04/20 – 15/05/20. The survey was endorsed by five national bariatric surgery societies and circulated amongst their memberships. Authors also shared the link through their personal networks, email groups, and social media. Results 703 respondents from 77 countries completed the survey. Respondents reported a drop in elective bariatric activity from a median (IQR) of 130 (60-250) procedures in 2019 to a median of 0 (0-2) between16/03/2020 and 15/04/2020 during the pandemic. The corresponding figures for emergency activity were 5 (2-10) and 0 (0-1) respectively. 441 (63%) respondents did not perform any bariatric procedures during this time period. Surgeons reported outcomes of 61 elective bariatric surgical procedures during the pandemic with 13 (21%) needing ventilation and 2 (3.3%) deaths. Of the 13 emergency bariatric procedures reported, 5 (38%) needed ventilation and 4 (31%) died. 90 (13%) surgeons reported having had to perform a bariatric surgical or endoscopic procedure without adequate Personal Protective Equipment. Conclusions COVID-19 pandemic led to a remarkable decline in global elective and emergency bariatric surgery activity at its beginning. Both elective and emergency procedures performed at this stage of the pandemic had considerable morbidity and mortality.
Asian Journal of Surgery, Dec 1, 2022
Obesity Surgery, Jun 8, 2022
Obesity Surgery, Apr 16, 2020
Laparoscopic one anastomosis gastric bypass (OAGB) is gaining ground as a safe and effective oper... more Laparoscopic one anastomosis gastric bypass (OAGB) is gaining ground as a safe and effective operation for morbid obesity [1, 2]. Less than 5% of the patients may require revision surgery, with half of the revisional surgeries due to severe malnutrition and the other half due to bile reflux, ulcer, and/or weight regain (https://www.ifso.com/one-anastomosisgastric-bypass). Nonetheless, OAGB may lead to some difficult to treat complications such as a marginal ulcer (MU). The incidence of MU after OAGB is reported to be around 5.6% [3, 4]. Risk factors for MU include poor tissue perfusion due to tension or ischemia at the anastomosis; the presence of foreign material, such as staples or nonabsorbable suture; excess acid exposure in the gastric pouch due to gastrogastric fistulas; nonsteroidal anti-inflammatory drug use; Helicobacter pylori infection; and smoking [5]. Treatment with a high dose of proton pump inhibitors (PPI) and elimination of risk factors is started first [6], but when conservative treatment fails with an unresolved ulcer, a surgical approach should be considered including conversion to Roux-en-Y gastric bypass (RYGB) [7].
Case Reports in Surgery, 2017
Upside-down stomach is a relatively rare type of a large paraesophageal hernia characterized by t... more Upside-down stomach is a relatively rare type of a large paraesophageal hernia characterized by the migration of the stomach into the posterior mediastinum. Upside-down stomach is prone to severe complications and therefore surgery is recommended even in asymptomatic patients. A 62-year-old male presented with frequent abdominal pain with nausea and vomiting that persisted for one year. The patient was obese with fatty liver and was treated medically for gastroesophageal reflux disease (GERD) for 4 years. On upper gastrointestinal CT study a level-IV paraesophageal hernia was detected with upside-down stomach, and he was referred for elective surgery. Laparoscopic surgery included reduction of the stomach into the abdominal cavity followed by dissection of the paraesophageal membrane and hernia sac. The hiatal defect was closed using a wound closure device and nonabsorbable sutures. The defect closure was reinforced using Physiomesh tucked anteriorly and sutured posteriorly to the diaphragm. Follow-up was uneventful and the patient is free of complaints. The results of this surgical intervention support previous reports that laparoscopic repair with the use of biological mesh in the setting of large paraesophageal hernia should be favorably considered.
World Journal of Surgery, Jul 12, 2023
Background: Recent studies have reported higher postoperative complication rates in patients with... 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 January 2017-December 2021, consecutive patients with obesity class III (n= 2,950), IV (n= 256), and V (n= 23) underwent OAGB. BMI groups were comparable in gender, age, and associated comorbidities. Mean operative time was significantly longer in the higher BMI groups: class III (66.5±25.6 min), IV (70.5±28.7 min), and V (80.0±34.7 min), respectively (p= 0.018); no difference in LOS. In respective BMI classes, ≤30-day complication rates were 3.2%, 3.5%, and 4.3% (p= 0.926). The respective number of patients with CDC grades of 1-2 were 45 (1.5%), 6 (2.3%), and 1 (4.3%), p= 0.500; and in grade ≥3a, 25 (0.8%), 1 (0.4%), 0 (0.0%), p= 0.669. No significant differences in rates of early complications, reoperations, and readmissions were found in revisional patients across BMI groups. There was 0.06% mortality (n= 2 in 3,229), both in BMI class III. Conclusion: OAGB is a safe metabolic bariatric surgery procedure in patients with class III, IV, and V obesity in the perioperative term with comparable ≤30-day morbidity in the three BMI groups.
Surgical laparoscopy, endoscopy & percutaneous techniques, Mar 7, 2023
Background: Crohn's Disease (CD) patients with active penetrating and stricturing disease have a ... more Background: Crohn's Disease (CD) patients with active penetrating and stricturing disease have a high prevalence of malnutrition that has been shown to increase post-operative complications. The effect of 1-3 months of pre-operative exclusive Total Parental Nutrition (TPN) in active CD patients is not well established. We investigated the efficacy of exclusive TPN in active CD patients. Methods: From our IBD Center database (prospectively collected data) we identified all patients with complicated, active CD who were candidates for bowel resection between January 2016 and October 2018. CD location and activity were recorded based on the modified Montreal classification. Inclusion required exclusive preoperative home TPN without additional oral intake for 1-3 months prior to surgery. The Harvey Bradshaw Index (HBI), Body Mass Index (BMI), C-Reactive Protein (CRP) and albumin levels were recorded at baseline and at the end of TPN therapy. Results: Twenty pre-operative CD patients (65% male, 35% female) on exclusive TPN were identified. The mean age of the cohort was 30.75 ± 11.6 years with median disease duration of 8 years (IQR 2.5-11). Mean duration of pre-operative TPN treatment was 73 days (range 24-142 days). Most patients had terminal ileal (35%) or ileocolonic CD (30%), and the stricturing (B2) phenotype was present alone or in combination with other phenotypes in 95% of patients. During TPN therapy, 65% were on stable doses of medication (immunomodulators and/or biologics) and 35% received no medication. All 20 patients had significant clinical improvement in all disease activity indices at the end of preoperative TPN (baseline vs. post TPN): HBI 14.5 vs. 4.0 (p=0.001); BMI 19.2 vs. 19.7 kg/m2 (p=0.017); CRP 57.2 vs. 10.3 mg/L (p=0.001); and albumin 2.7 vs. 3.6 g.dL (p=0.001). Two patients (10%) no longer required bowel resections after completion of exclusive TPN. Conclusion: Exclusive preoperative TPN was associated with weight gain, decreased inflammatory biomarkers, and improved clinical disease activity and nutrition. While the initial results are promising, further studies are needed before a recommendation can be made to use exclusive preoperative TPN for at least 1 month for severe, refractory CD to decrease disease activity and improve nutritional status before elective surgery.
Surgery for Obesity and Related Diseases, Sep 1, 2018
Obesity Surgery, Oct 22, 2022
European Journal of Plastic Surgery, May 5, 2022
Expert Review of Cardiovascular Therapy, Apr 3, 2022
INTRODUCTION Obesity is a chronic disease, which has significant health consequences and is a sta... more INTRODUCTION Obesity is a chronic disease, which has significant health consequences and is a staggering burden to health care systems. Obesity can have harmful effects on the cardiovascular system, including heart failure, hypertension, coronary heart disease, and atrial fibrillation (AF). One of the possible substrates might be epicardial adipose tissue (EAT), which can be the link between AF and obesity. EAT is a fat deposit located between the myocardium and the visceral pericardium. Numerous studies have demonstrated that EAT plays a pivotal role in this relationship regarding atrial fibrillation. AREAS COVERED This review will focus on the role of obesity and the occurrence of atrial fibrillation (AF) and examine the connection between these and epicardial adipose tissue (EAT). The first part of this review will explain the pathophysiology of EAT and its association with the occurrence of AF. Secondly, we will review bariatric and metabolic surgery and its effects on EAT and AF. EXPERT COMMENTARY In this review, the epidemiology, pathophysiology, and treatments methods of AF are explained. Secondly the effects on EAT were elucidated. Due to the complex pathophysiological link between EAT, AF, and obesity, it is still uncertain which treatment strategy is superior.
Current obesity reports, Oct 28, 2021
Purpose of Review Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects o... more Purpose of Review Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future. Recent Findings Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Summary Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.
Obesity Surgery, Oct 18, 2022