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1. Effect of BMI on safety of bariatric surgery during the COVID-19 pandemic, procedure choice, and safety protocols - An analysis from the GENEVA Study

Author

Rishi Singhal, Islam Omar, Brijesh Madhok, Christian Ludwig, Abd A. Tahrani, Kamal Mahawar, Michał Pędziwiatr, Piotr Major, Piotr Zarzycki, Athanasios Pantelis, Dimitris P. Lapatsanis, Georgios Stravodimos, Chris Matthys, Marc Focquet, Wouter Vleeschouwers, Antonio G. Spaventa, Carlos Zerrweck, Antonio Vitiello, Giovanna Berardi, Mario Musella, Alberto Sanchez-Meza, Felipe J. Cantu, Fernando Mora, Marco A. Cantu, Abhishek Katakwar, D. Nageshwar Reddy, Haitham Elmaleh, Mohammad Hassan, Abdelrahman Elghandour, Mohey Elbanna, Ahmed Osman, Athar Khan, Laurent Layani, Nalini Kiran, Andrey Velikorechin, Maria Solovyeva, Hamid Melali, Shahab Shahabi, Ashish Agrawal, Apoorv Shrivastava, Ankur Sharma, Bhavya Narwaria, Mahendra Narwaria, Asnat Raziel, Nasser Sakran, Sergio Susmallian, Levent Karagöz, Murat Akbaba, Salih Zeki Pişkin, Ahmet Ziya Balta, Zafer Senol, Emilio Manno, Michele Giuseppe Iovino, Mohamed Qassem, Sebastián Arana-Garza, Heitor P. Povoas, Marcos Leão Vilas-Boas, Alan Li, Basil J. Ammori, Hany Balamoun, Mohammed Salman, Amrit Manik Nasta, Ramen Goel, Hugo Sánchez-Aguilar, Miguel F. Herrera, Adel Abou-Mrad, Lucie Cloix, Guilherme Silva Mazzini, Leonardo Kristem, Andre Lazaro, Jose Campos, Joaquín Bernardo, Jesús González, Carlos Trindade, Octávio Viveiros, Rui Ribeiro, David Goitein, David Hazzan, Lior Segev, Tamar Beck, Hernán Reyes, Jerónimo Monterrubio, Paulina García, Marine Benois, Radwan Kassir, Alessandro Contine, Moustafa Elshafei, Sueleyman Aktas, Sylvia Weiner, Till Heidsieck, Luis Level, Silvia Pinango, Patricia Martinez Ortega, Rafael Moncada, Victor Valenti, Ivan Vlahović, Zdenko Boras, Arnaud Liagre, Francesco Martini, Gildas Juglard, Manish Motwani, Sukhvinder Singh Saggu, Hazem Al Momani, Luis Adolfo Aceves López, María Angelina Contreras Cortez, Rodrigo Aceves Zavala, Christine D'Haese, Ivo Kempeneers, Jacques Himpens, Andrea Lazzati, Luca Paolino, Sarah Bathaei, Abdulkadir Bedirli, Aydın Yavuz, Çağrı Büyükkasap, Safa Özaydın, Andrzej Kwiatkowski, Katarzyna Bartosiak, Maciej Walędziak, Antonella Santonicola, Luigi Angrisani, Paola Iovino, Rossella Palma, Angelo Iossa, Cristian Eugeniu Boru, Francesco De Angelis, Gianfranco Silecchia, Abdulzahra Hussain, Srivinasan Balchandra, Izaskun Balciscueta Coltell, Javier Lorenzo Pérez, Ashok Bohra, Altaf K. Awan, Paul C. Leeder, Sherif Awad, Waleed Al-Khyatt, Ashraf Shoma, Hosam Elghadban, Sameh Ghareeb, Bryan Mathews, Marina Kurian, Andreas Larentzakis, Gavriella Zoi Vrakopoulou, Konstantinos Albanopoulos, Ahemt Bozdag, Azmi Lale, Cuneyt Kirkil, Mursid Dincer, Ahmad Bashir, Ashraf Haddad, Leen Abu Hijleh, Bruno Zilberstein, Danilo Dallago de Marchi, Willy Petrini Souza, Carl Magnus Brodén, Hjörtur Gislason, Kamran Shah, Antonio Ambrosi, Giovanna Pavone, Nicola Tartaglia, S. Lakshmi Kumari Kona, K. Kalyan, Cesar Ernesto Guevara Perez, Miguel Alberto Forero Botero, Adrian Covic, Daniel Timofte, Madalina Maxim, Dashti Faraj, Larissa Tseng, Ronald Liem, Gürdal Ören, Evren Dilektasli, Ilker Yalcin, Hudhaifa AlMukhtar, Mohammed Al Hadad, Rasmi Mohan, Naresh Arora, Digvijaysingh Bedi, Claire Rives-Lange, Jean-Marc Chevallier, Tigran Poghosyan, Hugues Sebbag, Lamia Zinaï, Saadi Khaldi, Charles Mauchien, Davide Mazza, Georgiana Dinescu, Bernardo Rea, Fernando Pérez-Galaz, Luis Zavala, Anais Besa, Anna Curell, Jose M. Balibrea, Carlos Vaz, Luis Galindo, Nelson Silva, José Luis Estrada Caballero, Sergio Ortiz Sebastian, João Caetano Dallegrave Marchesini, Ricardo Arcanjo da Fonseca Pereira, Wagner Herbert Sobottka, Felipe Eduardo Fiolo, Matias Turchi, Antonio Claudio Jamel Coelho, Andre Luis Zacaron, André Barbosa, Reynaldo Quinino, Gabriel Menaldi, Nicolás Paleari, Pedro Martinez-Duartez, Gabriel Martínez de Aragon Ramírez de Esparza, Valentin Sierra Esteban, Antonio Torres, Jose Luis Garcia-Galocha, Miguel Josa, Jose Manuel Pacheco-Garcia, Maria Angeles Mayo-Ossorio, Pradeep Chowbey, Vandana Soni, Hercio Azevedo de Vasconcelos Cunha, Michel Victor Castilho, Rafael Meneguzzi Alves Ferreira, Thiago Alvim Barreiro, Alexandros Charalabopoulos, Elias Sdralis, Spyridon Davakis, Benoit Bomans, Giovanni Dapri, Koenraad Van Belle, Mazen Takieddine, Pol Vaneukem, Esma Seda Akalın Karaca, Fatih Can Karaca, Aziz Sumer, Caghan Peksen, Osman Anil Savas, Elias Chousleb, Fahad Elmokayed, Islam Fakhereldin, Hany Mohamed Aboshanab, Talal Swelium, Ahmad Gudal, Lamees Gamloo, Ayushka Ugale, Surendra Ugale, Clara Boeker, Christian Reetz, Ibrahim Ali Hakami, Julian Mall, Andreas Alexandrou, Efstratia Baili, Zsolt Bodnar, Almantas Maleckas, Rita Gudaityte, Cem Emir Guldogan, Emre Gundogdu, Mehmet Mahir Ozmen, Deepti Thakkar, Nandakishore Dukkipati, Poonam Shashank Shah, Shashank Subhashchandra Shah, Simran Shashank Shah, Md Tanveer Adil, Periyathambi Jambulingam, Ravikrishna Mamidanna, Douglas Whitelaw, Vigyan Jain, Deepa Kizhakke Veetil, Randeep Wadhawan, Max Torres, Tabata Tinoco, Wouter Leclercq, Marleen Romeijn, Kelly van de Pas, Ali K. Alkhazraji, Safwan A. Taha, Murat Ustun, Taner Yigit, Aatif Inam, Muhammad Burhanulhaq, Abdolreza Pazouki, Foolad Eghbali, Mohammad Kermansaravi, Amir Hosein Davarpanah Jazi, Mohsen Mahmoudieh, Neda Mogharehabed, Gregory Tsiotos, Konstantinos Stamou, Francisco J Barrera Rodriguez, Marco A. Rojas Navarro, Omar MOhamed Torres, Sergio Lopez Martinez, Elda Rocio Maltos Tamez, Gustavo A. Millan Cornejo, Jose Eduardo Garcia Flores, Diya Aldeen Mohammed, Mohamad Hayssam Elfawal, Asim Shabbir, Kim Guowei, Jimmy By So, Elif Tuğçe Kaplan, Mehmet Kaplan, Tuğba Kaplan, DangTuan Pham, Gurteshwar Rana, Mojdeh Kappus, Riddish Gadani, Manish Kahitan, Koshish Pokharel, Alan Osborne, Dimitri Pournaras, James Hewes, Errichetta Napolitano, Sonja Chiappetta, Vincenzo Bottino, Evelyn Dorado, Axel Schoettler, Daniel Gaertner, Katharina Fedtke, Francisco Aguilar-Espinosa, Saul Aceves-Lozano, Alessandro Balani, Carlo Nagliati, Damiano Pennisi, Andrea Rizzi, Francesco Frattini, Diego Foschi, Laura Benuzzi, Chirag Parikh, Harshil Shah, Enrico Pinotti, Mauro Montuori, Vincenzo Borrelli, Jerome Dargent, Catalin A Copaescu, Ionut Hutopila, Bogdan Smeu, Bart Witteman, Eric Hazebroek, Laura Deden, Laura Heusschen, Sietske Okkema, Theo Aufenacker, Willem den Hengst, Wouter Vening, Yonta van der Burgh, Ahmad Ghazal, Hamza Ibrahim, Mourad Niazi, Bilal Alkhaffaf, Mohammad Altarawni, Giovanni Carlo Cesana, Marco Anselmino, Matteo Uccelli, Stefano Olmi, Christine Stier, Tahsin Akmanlar, Thomas Sonnenberg, Uwe Schieferbein, Alejandro Marcolini, Diego Awruch, Marco Vicentin, Eduardo Lemos de Souza Bastos, Samuel Azenha Gregorio, Anmol Ahuja, Tarun Mittal, Roel Bolckmans, Tom Wiggins, Clément Baratte, Judith Aron Wisnewsky, Laurent Genser, Lynn Chong, Lillian Taylor, Salena Ward, Michael W. Hi, Helen Heneghan, Naomi Fearon, Andreas Plamper, Karl Rheinwalt, Justin Geoghegan, Kin Cheung Ng, Krzysztof Kaseja, Maciej Kotowski, Tarig A. Samarkandy, Adolfo Leyva-Alvizo, Lourdes Corzo-Culebro, Cunchuan Wang, Wah Yang, Zhiyong Dong, Manel Riera, Rajesh Jain, Hosam Hamed, Mohammed Said, Katia Zarzar, Manuel Garcia, Ahmet Gökhan Türkçapar, Ozan Şen, Edoardo Baldini, Luigi Conti, Cacio Wietzycoski, Eduardo Lopes, Tadeja Pintar, Jure Salobir, Cengiz Aydin, Semra Demirli Atici, Anıl Ergin, Huseyin Ciyiltepe, Mehmet Abdussamet Bozkurt, Mehmet Celal Kizilkaya, Nezihe Berrin Dodur Onalan, Mariana Nabila Binti Ahmad Zuber, Wei Jin Wong, Amador Garcia, Laura Vidal, Marc Beisani, Jorge Pasquier, Ramon Vilallonga, Sharad Sharma, Chetan Parmar, Lyndcie Lee, Pratik Sufi, Hüseyin Sinan, and Mehmet Saydam

Subjects
obesity, Endocrinology, Diabetes and Metabolism, bariatric surgery, resuming elective surgery, laparoscopy, body mass index, BMI, covid-19, metabolic surgery, obesity surgery, pandemic, Sars-Cov-2, female, gastrectomy, humans, male, pandemics, retrospective studies, treatment outcome, weight loss, gastric bypass, Resuming Elective surgery, Obesity, Morbid, Bariatric surgery, Nutrition and Dietetics, Pandemic, Manchester Cancer Research Centre, SARS-CoV-2, ResearchInstitutes_Networks_Beacons/mcrc, COVID-19, Obesity, Morbid, Obesity surgery, Metabolic surgery, Body Mass Index, Female, Gastrectomy, Humans, Male, Pandemics, Retrospective Studies, Treatment Outcome, Weight Loss, Bariatric Surgery, Gastric Bypass, Laparoscopy
Abstract

Background: It has been suggested that patients with a Body Mass Index (BMI) of > 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI - Group I (BMI60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 ± 24.4 Kgs and 43.03 ± 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively. The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion: The 30-day mortality rate was significantly higher in patients with BMI > 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection.

Published
2022

2. Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

Author

Singhal, Rishi, Omar, Islam, Madhok, Brijesh, Rajeev, Yashasvi, Graham, Yitka, Tahrani, Abd A, Ludwig, Christian, Wiggins, Tom, Mahawar, Kamal, Michał, Pędziwiatr, Piotr, Major, Piotr, Zarzycki, Athanasios, Pantelis, Dimitris, P Lapatsanis, Georgios, Stravodimos, Chris, Matthys, Marc, Focquet, Wouter, Vleeschouwers, Antonio, G Spaventa, Carlos, Zerrweck, Antonio, Vitiello, Giovanna, Berardi, Mario, Musella, Alberto, Sanchez-Meza, Felipe, J Cantu Jr, Fernando, Mora, Marco, A Cantu, Abhishek, Katakwar, D Nageshwar Reddy, Haitham, Elmaleh, Mohammad, Hassan, Abdelrahman, Elghandour, Mohey, Elbanna, Ahmed, Osman, Athar, Khan, Laurent, Layani, Nalini, Kiran, Andrey, Velikorechin, Maria, Solovyeva, Hamid, Melali, Shahab, Shahabi, Ashish, Agrawal, Apoorv, Shrivastava, Ankur, Sharma, Bhavya, Narwaria, Mahendra, Narwaria, Asnat, Raziel, Nasser, Sakran, Sergio, Susmallian, Levent, Karagöz, Murat, Akbaba, Salih Zeki Pişkin, Ahmet Ziya Balta, Zafer, Senol, Emilio, Manno, Michele Giuseppe Iovino, Mohamed, Qassem, Sebastián, Arana-Garza, Heitor, P Povoas, Marcos Leão Vilas-Boas, Alan, Li, Basil, J Ammori, Hany, Balamoun, Mohammed, Salman, Amrit Manik Nasta, Ramen, Goel, Hugo, Sánchez-Aguilar, Miguel, F Herrera, Adel, Abou-Mrad, Lucie, Cloix, Guilherme Silva Mazzini, Leonardo, Kristem, Andre, Lazaro, Jose, Campos, Joaquín, Bernardo, Jesús, González, Carlos, Trindade, Octávio, Viveiros, Rui, Ribeiro, David, Goitein, David, Hazzan, Lior, Segev, Tamar, Beck, Hernán, Reyes, Jerónimo, Monterrubio, Paulina, García, Marine, Benois, Radwan, Kassir, Alessandro, Contine, Moustafa, Elshafei, Sueleyman, Aktas, Sylvia, Weiner, Till, Heidsieck, Luis, Level, Silvia, Pinango, Patricia Martinez Ortega, Rafael, Moncada, Victor, Valenti, Ivan, Vlahović, Zdenko, Boras, Arnaud, Liagre, Francesco, Martini, Gildas, Juglard, Manish, Motwani, Sukhvinder Singh Saggu, Hazem Al Momani, Luis Adolfo Aceves López, María Angelina Contreras Cortez, Rodrigo Aceves Zavala, Christine, D'Haese, Ivo, Kempeneers, Jacques, Himpens, Andrea, Lazzati, Luca, Paolino, Sarah, Bathaei, Abdulkadir, Bedirli, Aydın, Yavuz, Çağrı, Büyükkasap, Safa, Özaydın, Andrzej, Kwiatkowski, Katarzyna, Bartosiak, Maciej, Walędziak, Santonicola, Antonella, Luigi, Angrisani, Iovino, Paola, Rossella, Palma, Angelo, Iossa, Cristian Eugeniu Boru, Francesco De Angelis, Gianfranco, Silecchia, Abdulzahra, Hussain, Srivinasan, Balchandra, Izaskun Balciscueta Coltell, Javier Lorenzo Pérez, Ashok, Bohra, Altaf, K Awan, Brijesh, Madhok, Paul, C Leeder, Sherif, Awad, Waleed, Al-Khyatt, Ashraf, Shoma, Hosam, Elghadban, Sameh, Ghareeb, Bryan, Mathews, Marina, Kurian, Andreas, Larentzakis, Gavriella Zoi Vrakopoulou, Konstantinos, Albanopoulos, Ahemt, Bozdag, Azmi, Lale, Cuneyt, Kirkil, Mursid, Dincer, Ahmad, Bashir, Ashraf, Haddad, Leen Abu Hijleh, Bruno, Zilberstein, Danilo Dallago de Marchi, Willy Petrini Souza, Carl Magnus Brodén, Hjörtur, Gislason, Kamran, Shah, Antonio, Ambrosi, Giovanna, Pavone, Nicola, Tartaglia, S Lakshmi Kumari Kona, Kalyan, K, Cesar Ernesto Guevara Perez, Miguel Alberto Forero Botero, Adrian, Covic, Daniel, Timofte, Madalina, Maxim, Dashti, Faraj, Larissa, Tseng, Ronald, Liem, Gürdal, Ören, Evren, Dilektasli, Ilker, Yalcin, Hudhaifa, Almukhtar, Mohammed Al Hadad, Rasmi, Mohan, Naresh, Arora, Digvijaysingh, Bedi, Claire, Rives-Lange, Jean-Marc, Chevallier, Tigran, Poghosyan, Hugues, Sebbag, Lamia, Zinaï, Saadi, Khaldi, Charles, Mauchien, Davide, Mazza, Georgiana, Dinescu, Bernardo, Rea, Fernando, Pérez-Galaz, Luis, Zavala, Anais, Besa, Anna, Curell, Jose, M Balibrea, Carlos, Vaz, Luis, Galindo, Nelson, Silva, José Luis Estrada Caballero, Sergio Ortiz Sebastian, João Caetano Dallegrave Marchesini, Ricardo Arcanjo da Fonseca Pereira, Wagner Herbert Sobottka, Felipe Eduardo Fiolo, Matias, Turchi, Antonio Claudio Jamel Coelho, Andre Luis Zacaron, André, Barbosa, Reynaldo, Quinino, Gabriel, Menaldi, Nicolás, Paleari, Pedro, Martinez-Duartez, Gabriel Martínez de Aragon Ramírez de Esparza, Valentin Sierra Esteban, Antonio, Torres, Jose Luis Garcia-Galocha, Miguel, Josa, Jose Manuel Pacheco-Garcia, Maria Angeles Mayo-Ossorio, Pradeep, Chowbey, Vandana, Soni, Hercio Azevedo de Vasconcelos Cunha, Michel Victor Castilho, Rafael Meneguzzi Alves Ferreira, Thiago Alvim Barreiro, Alexandros, Charalabopoulos, Elias, Sdralis, Spyridon, Davakis, Benoit, Bomans, Giovanni, Dapri, Koenraad Van Belle, Mazentakieddine, Pol, Vaneukem, Esma Seda Akalın Karaca, Fatih Can Karaca, Aziz, Sumer, Caghan, Peksen, Osman Anil Savas, Elias, Chousleb, Fahad, Elmokayed, Islam, Fakhereldin, Hany Mohamed Aboshanab, Talal, Swelium, Ahmad, Gudal, Lamees, Gamloo, Ayushka, Ugale, Surendra, Ugale, Clara, Boeker, Christian, Reetz, Ibrahim Ali Hakami, Julian, Mall, Andreas, Alexandrou, Efstratia, Baili, Zsolt, Bodnar, Almantas, Maleckas, Rita, Gudaityte, Cem Emir Guldogan, Emre, Gundogdu, Mehmet Mahir Ozmen, Deepti, Thakkar, Nandakishore, Dukkipati, Poonam Shashank Shah, Shashank Subhashchandra Shah, Simran Shashank Shah, Md Tanveer Adil, Periyathambi, Jambulingam, Ravikrishna, Mamidanna, Douglas, Whitelaw, Vigyan, Jain, Deepa Kizhakke Veetil, Randeep, Wadhawan, Max, Torres, Tabata, Tinoco, Wouter, Leclercq, Marleen, Romeijn, Kelly van de Pas, Ali, K Alkhazraji, Safwan, A Taha, Murat, Ustun, Taner, Yigit, Aatif, Inam, Muhammad, Burhanulhaq, Abdolreza, Pazouki, Foolad, Eghbali, Mohammad, Kermansaravi, Amir Hosein Davarpanah Jazi, Mohsen, Mahmoudieh, Neda, Mogharehabed, Gregory, Tsiotos, Konstantinos, Stamou, Francisco, J Barrera Rodriguez, Marco, A Rojas Navarro, Omar MOhamed Torres, Sergio Lopez Martinez, Elda Rocio Maltos Tamez, Gustavo, A Millan Cornejo, Jose Eduardo Garcia Flores, Diya Aldeen Mohammed, Mohamad Hayssam Elfawal, Asim, Shabbir, Kim, Guowei, Jimmy By So, Elif Tuğçe Kaplan, Mehmet, Kaplan, Tuğba, Kaplan, Dangtuan, Pham, Gurteshwar, Rana, Mojdeh, Kappus, Riddish, Gadani, Manish, Kahitan, Koshish, Pokharel, Alan, Osborne, Dimitri, Pournaras, James, Hewes, Errichetta, Napolitano, Sonja, Chiappetta, Vincenzo, Bottino, Evelyn, Dorado, Axel, Schoettler, Daniel, Gaertner, Katharina, Fedtke, Francisco, Aguilar-Espinosa, Saul, Aceves-Lozano, Alessandro, Balani, Carlo, Nagliati, Damiano, Pennisi, Andrea, Rizzi, Francesco, Frattini, Diego, Foschi, Laura, Benuzzi, Chirag, Parikh, Harshil, Shah, Enrico, Pinotti, Mauro, Montuori, Vincenzo, Borrelli, Jerome, Dargent, Catalin, A Copaescu, Ionut, Hutopila, Bogdan, Smeu, Bart, Witteman, Eric, Hazebroek, Laura, Deden, Laura, Heusschen, Sietske, Okkema, Theo, Aufenacker, Willem den Hengst, Wouter, Vening, Yonta van der Burgh, Ahmad, Ghazal, Hamza, Ibrahim, Mourad, Niazi, Bilal, Alkhaffaf, Mohammad, Altarawni, Giovanni Carlo Cesana, Marco, Anselmino, Matteo, Uccelli, Stefano, Olmi, Christine, Stier, Tahsin, Akmanlar, Thomas, Sonnenberg, Uwe, Schieferbein, Alejandro, Marcolini, Diego, Awruch, Marco, Vicentin, Eduardo Lemos de Souza Bastos, Samuel Azenha Gregorio, Anmol, Ahuja, Tarun, Mittal, Roel, Bolckmans, Tom, Wiggins, Clément, Baratte, Judith Aron Wisnewsky, Laurent, Genser, Lynn, Chong, Lillian, Taylor, Salena, Ward, Michael, W Hi, Helen, Heneghan, Naomi, Fearon, Andreas, Plamper, Karl, Rheinwalt, Justin, Geoghegan, Kin Cheung Ng, Krzysztof, Kaseja, Maciej, Kotowski, Tarig, A Samarkandy, Adolfo, Leyva-Alvizo, Lourdes, Corzo-Culebro, Cunchuan, Wang, Wah, Yang, Zhiyong, Dong, Manel, Riera, Rajesh, Jain, Hosam, Hamed, Mohammed, Said, Katia, Zarzar, Manuel, Garcia, Ahmet Gökhan Türkçapar, Ozan, Şen, Edoardo, Baldini, Luigi, Conti, Cacio, Wietzycoski, Eduardo, Lopes, Tadeja, Pintar, Jure, Salobir, Cengiz, Aydin, Semra Demirli Atici, Anıl, Ergin, Huseyin, Ciyiltepe, Mehmet Abdussamet Bozkurt, Mehmet Celal Kizilkaya, Nezihe Berrin Dodur Onalan, Mariana Nabila Binti Ahmad Zuber, Wei Jin Wong, Amador, Garcia, Laura, Vidal, Marc, Beisani, Jorge, Pasquier, Ramon, Vilallonga, Sharad, Sharma, Chetan, Parmar, Lyndcie, Lee, Pratik, Sufi, Hüseyin, Sinan, and Mehmet, Saydam

Subjects
Nutrition and Dietetics, Manchester Cancer Research Centre, SARS-CoV-2, ResearchInstitutes_Networks_Beacons/mcrc, Endocrinology, Diabetes and Metabolism, obesity, older patients, resuming elective surgery, metabolic surgery, Resuming elective surgery, Bariatric Surgery, COVID-19, Metabolic surgery, Obesity, Older patients, Aged, Humans, Pandemics, Postoperative Complications, Prospective Studies, Obesity, Morbid, Surgery, Morbid
Abstract

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 patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I (11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups. Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those ≥ 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups. Graphical abstract

Published
2022

3. Surgical Therapy for GERD

Author

Natan Zundel, Ariel Shuchleib, and Elias Chousleb

Subjects
medicine.medical_specialty, business.industry, Reflux, Disease, medicine.disease, Asymptomatic, digestive system diseases, Surgical therapy, medicine.anatomical_structure, GERD, medicine, Adenocarcinoma, Presentation (obstetrics), medicine.symptom, Esophagus, business, Intensive care medicine
Abstract

The presentation of gastroesophageal reflux ranges from asymptomatic patients to incapacitating symptoms and can even promote the development of adenocarcinoma of the esophagus. In order to understand the correct management of gastroesophageal reflux disease (GERD), it is important to understand the anatomical and pathophysiological changes that lead to its development.

Published
2021

6. Management of Post-Bariatric Surgery Emergencies

Author

Elias Chousleb and Alberto Chousleb

Subjects
medicine.medical_specialty, Post bariatric surgery, business.industry, General surgery, Gastroenterology, Psychological intervention, Bariatric Surgery, Middle Aged, Obesity, Morbid, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, 030220 oncology & carcinogenesis, Emergency medicine, Humans, Medicine, Female, 030211 gastroenterology & hepatology, Surgery, Emergencies, business
Abstract

Management of post-bariatric surgery emergencies is common practice in the USA and the world. Due to the popularity and widespread use of bariatric procedures to treat obesity and its comorbidities, emergency physicians and general surgeons will be challenged with the treatment of short- and long-term complications of bariatric procedures. In this article, we evaluate the most common long-term complications of the most commonly performed bariatric interventions.

Published
2017

8. Balancing Complications and Metabolic Benefit

Author

Elias Chousleb, Soni Chousleb, and Natan Zundel

Subjects
medicine.medical_specialty, Laparoscopic sleeve gastrectomy, business.industry, Gastric bypass, Excess weight, nutritional and metabolic diseases, medicine.disease, Surgery, Morbid obesity, Diabetes mellitus, medicine, Adjustable gastric band, business, Diabetes obesity, Biliopancreatic Diversion
Abstract

Bariatric surgery emerged as an effective way to treat morbid obesity, and it was rapidly recognized to have the capability to improve diabetes mellitus type 2 (T2DM), reduce cardiovascular events, and improve survival (Buchwald et al. Am J Med 122: 248, 2009; Sjostromk et al. JAMA 307: 56–65, 2012; Adams et al. N Engl J Med 357: 741–752, 2007; Halperin and Goldfine. Curr Opin Endocrinol Diabetes Obesity 20: 98–105, 2013). It has been suggested that 84 % of the patients with diabetes will undergo long-term remission after RYGB (Jurowich et al. Obes Surg 22: 1521–1526, 2012). The bariatric procedures most commonly performed are Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric band (LAGB), laparoscopic sleeve gastrectomy (LSG), and biliopancreatic diversion (BPD), each with different magnitude in the excess weight loss, but with sustainable long-term results compared with medical group alone.

Published
2016

9. Reasons and Operative Outcomes After Reversal of Gastric Bypass and Jejunoileal Bypass

Author

Sheetal Patel, Samuel Szomstein, Elias Chousleb, and Raul J. Rosenthal

Subjects
Adult, Male, Reoperation, Leak, medicine.medical_specialty, Gastroplasty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Gastric bypass, Jejunoileal bypass, MEDLINE, Risk Assessment, Postoperative Complications, Jejunoileal Bypass, Laparotomy, medicine, Humans, Renal Insufficiency, Stomach Ulcer, Treatment Failure, Aged, Retrospective Studies, Nutrition and Dietetics, business.industry, Malnutrition, Retrospective cohort study, Perioperative, Middle Aged, Intestinal necrosis, Obesity, Morbid, Surgery, Feasibility Studies, Female, business, Follow-Up Studies
Abstract

Limited information is available regarding reversal of gastric bypass. While reversal will lead to weight regain and return of comorbid conditions, procedure reversal is sometimes necessary due to complications. The decision to reverse versus revise is difficult; currently, there are no established guidelines. The objective was to review one center's experience with reversals of gastric bypass and jejunoileal bypass procedures and identify potential indications as well as technical feasibility and short-term outcomes. A retrospective review of a prospectively collected database from 1999 to 2010 was conducted; 12 patients who underwent reversal of non-banding bariatric procedures were included. There was no major perioperative morbidity in elective patients; one patient whose reversal was part of a second-look operation had massive intestinal necrosis. There was one (8.3 %) non-procedure-related postoperative death. No leaks were identified in any of the reversals. Leak rates were compared with other revisional procedures such as reversals, revisions, and conversions, with no statistical significance regarding leak rates between all three groups; however, revisions and conversions were performed via open or laparoscopic approach, while reversals were performed exclusively via open approach. Reversals of bariatric (non-banding) procedures, either combined or purely malabsorptive, are technically challenging. Indications remain poorly defined. In our experience, short gut syndrome, renal failure, marginal ulceration, and malnutrition were the most common indications for reversal, differing from previously published data. Indications can depend on patient and surgeon preferences, but primarily on surgeon experience and type of complications. Based on this initial experience, these operations can be performed using the open approach with good outcomes.

Published
2012

10. Laparoscopic Roux-en-Y Duodenojejunal Bypass for Superior Mesenteric Artery Syndrome

Author

Sheetal Patel, Elias Chousleb, Samuel Szomstein, Jihui Li, Jesus E. Hidalgo, and Raul J. Rosenthal

Subjects
Male, medicine.medical_specialty, Adolescent, Duodenum, Superior Mesenteric Artery Syndrome, business.industry, Treatment options, Anastomosis, Roux-en-Y, Middle Aged, Anastomosis, medicine.disease, Roux-en-Y anastomosis, Surgery, Young Adult, Jejunum, Weight Loss, Feasibility Studies, Humans, Medicine, Female, Laparoscopy, business, Superior mesenteric artery syndrome
Abstract

Introduction Superior mesenteric artery syndrome is a clearly defined and uncommon medical condition. Surgical intervention is needed for failed long-term medical management. Material and methods We report a series of 3 cases, a 17-year-old woman, a 23-year-old man, and a 50-year-old woman that were successfully treated by Roux-en-Y duodenojejunal bypass using a laparoscopic approach. Technique A 5-trocar laparoscopic approach was used for the surgery. A 75 cm long Roux limb was used in all cases. Results The postoperative period was unremarkable and symptoms of obstruction subsided in all 3 cases. Conclusions Laparoscopic duodenojejunal bypass seems to be a feasible and safe treatment option for superior mesenteric artery syndrome.

Published
2011

11. History of the Development of Metabolic/Bariatric Surgery

Author

Jaime A. Rodriguez, James Patrick O’Leary, and Elias Chousleb

Subjects
medicine.medical_specialty, Laparoscopic sleeve gastrectomy, Sleeve gastrectomy, business.industry, General surgery, medicine.medical_treatment, Metabolic surgery, Cosmesis, Morbid obesity, Weight loss, Medicine, medicine.symptom, Surgical treatment, business, Insurance coverage
Abstract

The surgical treatment of morbid obesity and the numerous medical conditions associated with obesity has evolved over the past 58 years since the first operation specifically designed to create weight loss was performed and reported. Many different procedures and innumerable variations of procedures have since come and gone. The transition to laparoscopic procedures has dramatically improved recovery time, discomfort, cosmesis, and many complications. Lessons learned during the evolution of bariatric and metabolic surgery are important to remember in order to continue to improve safety and efficacy.

Published
2014

12. Laparoscopic Management of Intestinal Obstruction

Author

Samuel Shuchleib, Elias Chousleb, and Alberto Chousleb

Subjects
Laparoscopic surgery, medicine.medical_specialty, business.industry, General surgery, medicine.medical_treatment, Tissue Adhesions, Laparoscopic adhesiolysis, medicine, Humans, Laparoscopy, Surgery, Chronic abdominal pain, business, Intestinal Obstruction, Minimally invasive procedures
Abstract

Laparoscopic adhesiolysis is a valuable tool for the surgeon performing complex minimally invasive procedures. It can be used for the management of intestinal obstruction and chronic abdominal pain syndromes. It is also an essential skill when performing laparoscopic surgery on patients who had prior abdominal operations. The use of laparoscopy for patients with an intestinal obstruction was once considered an absolute contraindication. With the advancement in optics and increasing experience, more and more surgeons are turning to laparoscopy as a useful diagnostic and therapeutic tool in more complex situations.

Published
2010

14. Treatment of Hemorrhoids by Infrared Thermocoagulation

Author

Soni Chousleb, Elias Chousleb, and Philip F. Caushaj

Subjects
medicine.medical_specialty, Hemorrhoids, business.industry, medicine.medical_treatment, Bipolar diathermy, medicine, Internal Hemorrhoid, business, medicine.disease, Rubber band ligation, Surgery
Published
2009

15. Hernias internas

Author

Raul Rosenthal and Elias Chousleb

Abstract

La mayoria de las hernias intraperitoneales derivan de variantes anatomicas que habitualmente estan presentes en el momento de nacer ( fig. 88-1 ). Las hernias que se desarrollan secundariamente a alteraciones en la rotacion intestinal normal durante el desarrollo embriologico presentan sacos. Por lo general, estos tipos de hernias son paraduodenales o mesocolicas. Las hernias que se desarrollan a traves de defectos en el mesenterio o el peritoneo carecen de sacos. Estos tipos de hernias incluyen las que tienen lugar a traves del orificio epiploico, los defectos congenitos en el mesenterio del intestino delgado y grueso y, con menor frecuencia, defectos en los ligamentos anchos del utero.

Published
2006

16. Myasthenia gravis improvement after laparoscopic Roux-en-Y gastric bypass

Author

Lester Carrodeguas, Flavia Soto, Guillermo Higa, David Podkameni, Elias Chousleb, Eduardo Locatelli, Natan Zundel, Samuel Szomstein, Priscila Antozzi, Alexander Villares, Emmanuel Lo Menzo, Fernando Arias, Raul J. Rosenthal, and Colleen Kennedy

Subjects
medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Population, Gastric Bypass, Anastomosis, Risk Assessment, Severity of Illness Index, Perioperative Care, Body Mass Index, Weight loss, Severity of illness, Myasthenia Gravis, Weight Loss, medicine, Humans, education, education.field_of_study, Nutrition and Dietetics, business.industry, Anastomosis, Roux-en-Y, Middle Aged, medicine.disease, Roux-en-Y anastomosis, Obesity, Myasthenia gravis, Surgery, Obesity, Morbid, Treatment Outcome, Female, Laparoscopy, medicine.symptom, business, Body mass index, Follow-Up Studies
Abstract

Many diseases in the obese population have been found to improve after weight loss. A 56-year-old female with a long history of myasthenia gravis (MG) and morbid obesity is reported. Preoperatively, she presented with a BMI of 46.5 kg/m2, and was on three medications and IV immunoglobulin every 5 weeks. After the surgical procedure, she improved and required less medication. Because MG and morbid obesity require careful perioperative management in order to avoid complications, a multidisciplinary approach is recommended.

Published
2005

17. [Actual status of laparoscopic cholecystectomy]

Author

Elias, Chousleb Mizrahi, Alberto, Chousleb Kalach, and Samuel, Shuchleib Chaba

Subjects
Clinical Trials as Topic, Postoperative Complications, Treatment Outcome, Cholecystectomy, Laparoscopic, Cholecystitis, Humans
Abstract

Since the first laparoscopic cholecystectomy in 1988, the management of gall-bladder disease has changed importantly. This technique was rapidly popularized in the U.S. as well as in Europe. Multiple studies have proved its feasibility, safeness and great advantages.Analyze usefulness and recent advances of endoscopic surgery in the management of gallbladder disease.We did a review of the recent medical literature to determine the actual status of laparoscopic cholecystectomy.Laparoscopic cholecystectomy is the most common surgical procedure performed in the digestive tract. During the year 2001, 1,100,000 cholecystectomies were done in the U.S., 85% were done laparoscopically. In Mexico cholecystectomy in government hospitals is done laparoscopically in 50% of the cases, while in private hospitals it reaches 90%. There are multiple prospective controlled studies showing superiority of laparoscopic cholecystectomy in times of recovery, costs, return to normal activity, pain, morbidity, esthetics among other advantages.Laparoscopic cholecystectomy is the gold standard for the treatment of the great majority of cases of gallbladder disease, nevertheless in developing countries open cholecystectomy is still done frequently.

Published
2005

18. [Bile duct laparoscopic exploration]

Author

Samuel, Shuchleib Chaba, Elias, Chousleb Mizrahi, Alejandro, Mondragón Sánchez, and Alberto, Chousleb Kalach

Subjects
Biliary Tract Surgical Procedures, Clinical Trials as Topic, Postoperative Complications, Treatment Outcome, Bile Ducts, Extrahepatic, Humans, Laparoscopy
Abstract

The use of ERCP with endoscopic esphincterotomy (ES) for the management of choledocholithiasis has replaced almost completely common bile duct exploration in the era of laparoscopic cholecystectomy. Once the procedure is completed it is followed by laparoscopic cholecystectomy in the same hospitalization. During the last few years, the development of new technology and equipment with possibilities of minimal invasive procedures and diagnosis, as well as the ongoing surgical skills has allowed surgeons to solve the problem of choledocholithiasis in one minimal invasive procedure, decreasing effectively morbidity with a high success rate, changing again ERCP with ES as a complement and not as a substitute for surgery. Nevertheless the initial step in the use of these techniques require of a special technical support and what is most important capacitation to achieve the desire objectives. Transcystic technique seems to be the most promising and choledochotomy with primary closure in cases that cannot be solved with the transcystic approach. Regardless of the approach the surgeon must be familiar with both and increasingly with the use of the endoscope in order to provide patients with advantages of minimal invasive surgery and all its advantages. We also discuss our series of 81 patients operated on with laparoscopic surgery with a high rate of success, low morbidity and mortality.

Published
2005

19. Laparoscopic removal of gastric band after early gastric erosion: case report and review of the literature

Author

Raul J. Rosenthal, David Podkameni, Samuel Szomstein, Natan Zundel, Flavia Soto, Elias Chousleb, Guillermo Higa, and Emanuele Lomenzo

Subjects
Adult, Male, Reoperation, medicine.medical_specialty, Gastroplasty, Gastric banding, Gastrointestinal reflux, Gastric erosion, Morbid obesity, Postoperative Complications, Foreign-Body Migration, medicine, Humans, Laparoscopy, medicine.diagnostic_test, business.industry, Stomach, digestive, oral, and skin physiology, Prostheses and Implants, medicine.disease, digestive system diseases, Surgery, Gastric lumen, Obesity, Morbid, Prosthesis Failure, Gastric band, medicine.anatomical_structure, Treatment Outcome, Gastric Mucosa, Fluoroscopy, Gastroesophageal Reflux, business, Tomography, X-Ray Computed, Follow-Up Studies
Abstract

Laparoscopic gastric banding is a popular method for treating morbid obesity. One of the most serious complications is band erosion into the gastric lumen. We present the case of a patient who underwent gastric banding and presented with symptoms of gastrointestinal reflux and mild-to-moderate hypertension, fever, and pain. UGI revealed stomach wall erosion and partial migration of the band into the gastric lumen. The band was laparoscopically removed without any further complications. Migration after laparoscopic gastric banding must be immediately addressed to prevent infection. Close monitoring of the band location during adjustments as well as a high index of suspicion is necessary.

Published
2005

20. Routine abdominal drains after laparoscopic Roux-en-Y gastric bypass: a retrospective review of 593 patients

Author

Elias Chousleb, Natan Zundel, Fernando Arias, Emanuele Lomenzo, Alexander Villares, Guillermo Higa, Flavia Soto, Colleen Kennedy, David Podkameni, Priscila Antozzi, Samuel Szomstein, and Raul J. Rosenthal

Subjects
Suction (medicine), Male, medicine.medical_specialty, Resuscitation, Pulmonary Atelectasis, Endocrinology, Diabetes and Metabolism, Blood Loss, Surgical, Gastric Bypass, Hematocrit, medicine, Humans, Laparoscopy, Retrospective Studies, Nutrition and Dietetics, medicine.diagnostic_test, business.industry, Medical record, Retrospective cohort study, Middle Aged, Roux-en-Y anastomosis, Surgery, Parenteral nutrition, Drainage, Female, business
Abstract

Background: The authors reviewed the benefits of routine placement of closed drains in the peritoneal cavity following laparoscopic Roux-en-Y gastric bypass (LRYGBP). The purpose of the study was to determine whether routine closed abdominal drainage provides diagnostic and therapeutic advantages in the presence of complications such as bleeding and leaks. Materials and Methods: The medical records of 593 consecutive patients who had undergone LRYGBP from July 2001 through May 2003 were retrospectively reviewed. In all cases, antecolic antegastric LRYGBP was performed. Two 19-Fr Blake closed suction drains were left in place, one at the gastrojejunostomy and the other at the jejunojejunostomy. The incidence of bleeding and leaks was reviewed, and the utility of the drains relative to diagnosis and management was evaluated. Results: Bleeding presented in 24 patients (4.4%); in 8, the diagnosis was based on increased sanguinous output from the drain and decreased hematocrit. None of the patients with intraabdominal bleeding required reoperation. Of the 10 patients (1.68%) who presented with leaks, the diagnosis was made within 48 hours postoperatively in 5 patients (50%), based on the characteristics of the drain output. Nonoperative management with drainage and total parenteral nutrition was accomplished in 5 (50%) of the 10 patients with leaks. There was no mortality in the series. Conclusion: The routine use of abdominal drains after LRYGBP appears to be beneficial. Drains allowed early diagnosis of complications and in most cases, the successful treatment of leaks. When bleeding is suspected or documented, appropriate volume replacement therapy is mandatory to maintain adequate hemodynamic parameters. Drain output may orient the surgeon to take preventive measures such as discontinuing anticoagulation and early fluid resuscitation. In this series, in most cases the bleeding spontaneously stopped and no further surgical management was required.

Published
2004

23. SHF-09: Reasons for reversal and outcomes after reversal of gastric bypass for morbid obesity

Author

Elias Chousleb, Jayne Lieb, Raul J. Rosenthal, and Samuel Szomstein

Subjects
medicine.medical_specialty, business.industry, Gastric bypass, medicine.disease, Surgery, Morbid obesity, Fasting glucose, Exact test, Weight loss, Diabetes mellitus, medicine, Statistical analysis, Hypoglycemic drugs, medicine.symptom, business
Abstract

data base (7F, mean age 457y, BMI 518 kg/m 2 , HbA1c: 8.31%). 16 LRYGB Obese Diabetics with similar pre-operative features (Group2), were identified (7F; mean age 458y; BMI 484 kg/m2, HbA1c: 8.51%). LRGBP alimentary limb was 150 cm and bilio-pancreatic limb was 50 cm from Treitz ligament. SG vertical transection was calibrated on a 40F oro-gastric bougie. Data were analyzed at 15 days, 6 months, 1 year according weight loss and diabetes resolution (fasting glucose 126 mg/dl without hypoglycemic drugs). Data were reported as meanSD, statistical analysis was by Fisher’s exact test (p0.05 was significant). Results: Group1 and Group2 BMI were comparable at 15 days: 467 and 445 kg/m2, respectively (p0,479). BMI was significantly lower in Group2 (354 and 325 kg/m 2 ) vs. Group 1 (426 and 385 kg/m 2 ) at 6 months and 1 year respectively (P0.02). Diabetes resolution occurred in 66, 77and 77% of Group1 patients and in 94, 100, 94% of Group2 at 15 days, 6 months and 1 year, respectively (pns). Conclusion: In spite of its statistically significant inferiority regarding weight loss in comparison with LRYGB, SG is equally effective for the diabetes resolution.

Published
2010

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