Publications by authors named "Natan Zundel"

Artificial intelligence (AI) is transforming the landscape of medicine, including surgical science and practice. The evolution of AI from rule-based systems to advanced machine learning and deep learning algorithms has opened new avenues for its application in metabolic and bariatric surgery (MBS). AI has the potential to enhance various aspects of MBS, including education and training, decision-making, procedure planning, cost and time efficiency, optimization of surgical techniques, outcome and complication prediction, patient education, and access to care.

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Laparoscopic vertical clip gastroplasty (LVCG) with BariClip is a recent procedure that appears to be safe Gentileschi et al. (Obes Surg 33(1):303-12, 2023). The initial complications reported include erosion, slippage, and gastroesophageal reflux.

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Purpose: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive day procedure that the MERIT randomized controlled trial (RCT) has demonstrated to be an effective and safe method of weight loss versus lifestyle modification alone. We sought to evaluate the cost-effectiveness of ESG from the perspective of a US commercial payer in a cohort of adults with class II and class I obesity with diabetes based on this RCT.

Materials: We used a Markov modelling approach with BMI group health states and an absorbing death state.

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Article Synopsis
  • The study highlights the increasing importance of metabolic and bariatric surgery (MBS) in addressing global obesity, emphasizing the need for rigorous academic and fellowship training for surgeons.
  • A Modified Delphi method involving 89 surgeons from 42 countries was used to establish expert consensus on the necessary criteria for surgeons to obtain privileges for performing MBS, reaching agreement on 29 out of 30 statements.
  • Key consensus points include the requirement for surgeons to hold a general surgery degree, complete a dedicated fellowship, and adhere to defined learning curves for various MBS procedures, alongside maintaining patient data and collaborating in a multidisciplinary team.
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Article Synopsis
  • * A study using a consensus method involved 78 bariatric surgeons globally, who agreed on 54 statements regarding when to use MBS for Class I and II obesity, determining a 70% agreement threshold.
  • * The experts concluded that MBS is cost-effective for Class II obesity and Class I obesity with inadequate weight loss from non-surgical methods, and identified specific surgical options including intra-gastric balloon, endoscopic sleeve gastroplasty, sleeve gastrectomy, Roux-en-Y gastric bypass, and one
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Background: Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality.

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Background: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program evaluates 30-day outcomes of bariatric cases performed in the United States. The Participant Use File in 2020 introduced bowel obstruction (BO). We compared the rates of BO, risk factors, and postoperative outcomes after laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and duodenal switch (DS).

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Article Synopsis
  • Laparoscopic BariClip gastroplasty (LBCG) is a new, reversible weight-loss procedure, but it can lead to complications such as slippage, which the study aims to classify and analyze.
  • A review of 381 LBCG patients revealed a 4.46% incidence of slippage, with symptoms mostly involving vomiting and nausea, and a new classification based on the timing and type of slippage was proposed.
  • The management of slippage cases included removal of the BariClip, repositioning, or conservative treatment, with various displacement types identified via radiological studies.
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Introduction: Laparoscopic BariClip gastroplasty (LBCG) will address a similar tubular restriction than the one achieved with the laparoscopic sleeve gastrectomy (LSG) at the level of the gastric fundus, while maintaining the advantage of simplicity and anatomic preservation. The purpose of the current study was to analyze the risk of slippage and to present the evolving technique by adding gastro-gastric plication of the gastric wall covering the BariClip at those areas where the gastric wall "slips" between the limbs of the clip.

Methods: All patients undergoing LBCG with the evolving technique of gastric plication around the device associated with antral gastroplasty from January 2021 to May 2022 were included in the study group (group A).

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Article Synopsis
  • Sleeve gastrectomy (SG) is the most popular bariatric surgery globally, but there's concern about the necessity for follow-up surgeries due to issues like insufficient weight loss or complications like GERD.
  • A study involving 46 surgeons from 25 countries was conducted to create guidelines for redo-surgeries after SG, achieving consensus on 62 out of 72 statements regarding best practices.
  • Experts emphasized that a multi-disciplinary evaluation is crucial before any redo-surgery, recommending at least 12 months of medical management and suggesting Roux-en Y gastric bypass as an option for certain complications like symptomatic GERD.
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Background: Endoscopic sleeve gastroplasty (ESG) is an endolumenal, organ-sparing therapy for obesity, with wide global adoption. We aimed to explore the efficacy and safety of ESG with lifestyle modifications compared with lifestyle modifications alone.

Methods: We conducted a randomised clinical trial at nine US centres, enrolling individuals aged 21-65 years with class 1 or class 2 obesity and who agreed to comply with lifelong dietary restrictions.

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Background: COVID-19 pandemic varies greatly and has different dynamics in every country, city, and hospital in Latin America. Obesity increases the risk of SARS-CoV-2 infection, and it is one of the independent risk factors for the most severe cases of COVID-19. Currently, the most effective treatment against obesity available is bariatric and metabolic surgery (BMS), which further resolves or improves other independent risk factors like diabetes and hypertension.

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The isolated stricture after the sleeve gastrectomy is one of the possible surgical complications. Previous algorithms have been proposed to address the workup and treatment of sleeve gastrectomy stricture. However, current literature lacks standardization and systematic reviews on this topic.

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Despite the effectiveness of laparoscopic common bile duct (CBD) surgery, no case series details the use and advantages of laparoscopic CBD exploration (LCBDE) without use of intraoperative cholangiography (IOC) in endoscopic retrograde cholangiopancreatography (ERCP) failure. Therefore, we present a case series regarding our success with LCBDE in managing CBD stones (CBDSs) using laparoscopic technique without IOC. We performed a descriptive retrospective observational study.

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Article Synopsis
  • Roux-en-Y gastric bypass is a common bariatric surgery, but about 20% of patients experience weight regain, often due to the enlargement of the anastomosis.
  • A study evaluated the effects of endoscopic argon plasma coagulation (APC) on these enlarged anastomoses compared to standard multidisciplinary management.
  • Results showed that patients treated with APC had significant improvements in weight loss, satiety, and overall quality of life, indicating that APC is a safe and effective option for managing weight regain after surgery.
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  • Over the last decade, the bariatric field has seen developments like laparoscopic vertical clip gastroplasty (LVCG), a reversible procedure that aims to improve weight loss and quality of life without major surgery.
  • A study conducted in the Dominican Republic gathered data from 138 patients who underwent LVCG, focusing on their satisfaction and quality of life post-procedure, which showed significant weight loss and positive outcomes.
  • Results indicated a high participation rate in follow-up assessments, with many patients reporting good to excellent quality of life improvements after the surgery, suggesting LVCG could be a viable option in bariatric treatment.
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Background: Endoscopic approaches exist for targeting weight regain after Roux-en-Y gastric bypass (RYGB), including endoscopic suturing, clipping, and sclerotherapy. Argon plasma coagulation (APC) is a noncontact electrocoagulation method, and when used in RYGB patients, it has shown reduction in the diameter of the gastrojejunal anastomosis.

Objectives: To study the effectiveness of APC for weight regain in terms of weight loss for RYGB patients, from eight bariatric centers.

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Article Synopsis
  • The study aimed to assess the safety of early discharge (ED) following laparoscopic Roux-en-Y gastric bypass (LRYGB) at Montefiore Medical Center by comparing readmitted patients to those who were not.
  • A total of 630 surgeries were reviewed, with 5.1% of patients readmitted within 30 days; those readmitted had a higher BMI and were slightly younger on average.
  • The findings suggest that discharging patients on the first post-operative day is safe, as it does not significantly increase the risk of readmission, supporting the idea of future randomized controlled trials on early discharge practices.
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Background: Endoscopic sutured gastroplasty (ESG) has evolved over time. With the advent of full-thickness endoscopic suturing, an efficient technique for ESG was developed and refined.

Methods: This prospective first-in-man trial started in April 2012 and represents the first use of full-thickness endoscopic suturing for primary obesity therapy.

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Background: Five International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) surveys since 1998 have estimated the volume and type of bariatric surgery being done in constituent member countries. These reports did not include baseline demographic descriptions.

Methods: An IFSO Global Registry pilot project in 2014 demonstrated that it was possible to amalgamate large numbers of individual patient data from different local and national database systems.

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Background And Aims: Many patients who undergo bariatric surgery will experience weight regain and effective strategies are needed to help these patients. A dilated gastrojejunal anastomosis (GJA) has been associated with weight recidivism after Roux-en-Y gastric bypass surgery (RYGB). Endoscopic transoral outlet reduction (TORe) with a full thickness endoscopic suturing device (Overstitch, Apollo Endosurgery, Austin, TX) is a minimally invasive therapeutic option.

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