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Ghiassi S, Nimeri A, Aleassa EM, Grover BT, Eisenberg D, Carter J. American Society for Metabolic and Bariatric Surgery position statement on one-anastomosis gastric bypass. Surg Obes Relat Dis 2024; 20:319-335. [PMID: 38272786 DOI: 10.1016/j.soard.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/27/2024]
Abstract
The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the society by patients, physicians, society members, hospitals, health insurance payors, and others regarding one-anastomosis gastric bypass as a treatment for obesity and metabolic disease. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement may be revised in the future as more information becomes available.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Abdelrahman Nimeri
- Department of Surgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Essa M Aleassa
- Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Brandon T Grover
- Department of Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Dan Eisenberg
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
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2
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Chao GF, Nadzam G, Cheung M, Duffy A, Ghiassi S, Morton J. Collateral Benefit of Systematic Improvement in Bariatric Surgery Outcomes Following a Single Quality Improvement Project for Bleeding. Obes Surg 2024; 34:1041-1044. [PMID: 38280157 DOI: 10.1007/s11695-023-07037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/08/2023] [Accepted: 12/26/2023] [Indexed: 01/29/2024]
Abstract
The study's aim was not only to use quality improvement system techniques to improve patient care specifically for bleeding but also to track other adverse outcomes. Key drivers were identified and mapped to interventions, namely venous thromboembolism prophylaxis, root cause analysis, indications conference, and operative technique standardization. Bleeding was reduced by 88%, and overall postoperative complications also fell by 63%. A targeted quality improvement project not only was effective in improving outcomes for the specific aim of bleeding but also resulted in improvement for other patient outcomes.
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Affiliation(s)
- Grace F Chao
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520, USA
| | - Geoffrey Nadzam
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520, USA
| | - Maija Cheung
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520, USA
| | - Andrew Duffy
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520, USA
| | - Saber Ghiassi
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520, USA
| | - John Morton
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520, USA.
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Chao GF, Canner J, Hamid S, Ying LD, Ghiassi S, Schwartz JS, Gibbs KE. Outcomes of SADI and OAGB Compared to RYGB from the Metabolic and Bariatric Surgery Quality Improvement Program: The North American Experience. Obes Surg 2024; 34:337-346. [PMID: 38170422 DOI: 10.1007/s11695-023-07019-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Rapid adoption of sleeve gastrectomy (SG) in the last decade aptly reflects the desire of patients and surgeons for alternatives to RYGB and DS. While SG provides good outcomes, other options that address specific patient needs are warranted. Recently approved by ASMBS, SADI, and OAGB have garnered increasing interest due to their single anastomosis technique. METHODS Using the Metabolic and Bariatric Surgery Quality Improvement Program database, we examined laparoscopic and robotic cases from 2018 to 2021 to understand the percentage of primary bariatric surgery cases that are SADI and OAGB. We used coarsened exact matching to match patients who underwent SADI or OAGB to patients who underwent Roux-en-Y gastric bypass (RYGB). We examined outcomes of matched patients using logistic regression. RESULTS Of the 667,979 patients that underwent bariatric-metabolic surgery, 1326 (0.2%) underwent SADI, and 2541 (0.4%) underwent OAGB. SADI was not identified in the database until 2020. In 2020, there were 487 SADI procedures compared to 839 in 2021. From 2018 to 2021, OAGBs went from 149 to 940. Compared with RYGB, SADI was associated with higher rates of anastomotic or staple line leak (OR 2.21 (95% CI 1.08-4.53)) and sepsis (OR 3.62 (95% CI 1.62-8.12)). Compared with RYGB, OAGB was associated with lower rates of gastrointestinal bleeding (OR 0.29 (95% CI 0.12-0.71)) and bowel obstruction (OR 0.10 (95% CI 0.02-0.39)). Of note, there were no differences between these procedures and RYGB for 30-day mortality. CONCLUSION More SADIs and OAGBs are being performed. However, there were higher complication rates associated with the SADI procedure. Further studies will be needed to better understand the key drivers for these outcomes.
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Affiliation(s)
- Grace F Chao
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA.
| | - Joseph Canner
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Safraz Hamid
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Lee D Ying
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Saber Ghiassi
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA
| | | | - Karen E Gibbs
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA
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Ying LD, Chao GF, Canner J, Graetz E, Ghiassi S, Schwartz JS, Zolfaghari EJ, Schneider EB, Gibbs KE. The Degree of Preoperative Hypoalbuminemia Is Associated with Risk of Postoperative Complications in Metabolic and Bariatric Surgery Patients. Obes Surg 2024; 34:51-70. [PMID: 37994997 DOI: 10.1007/s11695-023-06944-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/26/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The incidence and impact of hypoalbuminemia in bariatric surgery patients is poorly characterized. We describe its distribution in laparoscopic sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) patients undergoing primary or revision surgeries and assess its impact on postoperative complications. METHODS The Metabolic and Bariatric Surgery Quality Improvement Program Database (2015 to 2021) was analyzed. Hypoalbuminemia was defined as Severe (< 3 g/dL), Moderate (3 ≤ 3.5 g/dL), Mild (3.5 ≤ 4 g/dL), or Normal (≥ 4 g/dL). Multivariable logistic regression was performed to calculate odds ratios of postoperative complications compared to those with Normal albumin after controlling for procedure, age, gender, race, body mass index, functional status, American Society of Anesthesia class, and operative length. RESULTS A total of 817,310 patients undergoing Primary surgery and 69,938 patients undergoing Revision/Conversion ("Revision") surgery were analyzed. The prevalence of hypoalbuminemia was as follows (Primary, Revision): Severe, 0.3%, 0.6%; Moderate, 5.2%, 6.5%; Mild, 28.3%, 31.4%; Normal, 66.2%, 61.4%. Primary and Revision patients with hypoalbuminemia had a significantly higher prevalence (p < 0.01) of several co-morbidities, including hypertension and insulin-dependent diabetes. Any degree of hypoalbuminemia increased the odds ratio of several complications in Primary and Revision patients, including readmission, intervention, and reoperation. In Primary patients, all levels of hypoalbuminemia also increased the odds ratio of unplanned intubation, intensive care unit admission, and venous thromboembolism requiring therapy. CONCLUSION Over 30% of patients present with hypoalbuminemia. Even mild hypoalbuminemia was associated with an increased rate of several complications including readmission, intervention, and reoperation. Ensuring nutritional optimization, especially prior to revision surgery, may improve outcomes in this challenging population.
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Affiliation(s)
- Lee D Ying
- Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA.
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5
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Stults-Kolehmainen MA, Bond DS, Richardson LA, Herring LY, Mulone B, Garber CE, Morton J, Ghiassi S, Duffy AJ, Balk E, Abolt CJ, Howard MC, Ash GI, Williamson S, Marcon ER, De Los Santos M, Bond S, Huehls J, Alowaish O, Heyman NB, Gualano B. Role of the exercise professional in metabolic and bariatric surgery. Surg Obes Relat Dis 2024; 20:98-108. [PMID: 38238107 DOI: 10.1016/j.soard.2023.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. OBJECTIVES To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? SETTING Clinical and academic exercise settings worldwide. METHODS This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. RESULTS The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and postoperative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". CONCLUSIONS The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.
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Affiliation(s)
- Matthew A Stults-Kolehmainen
- Division of Digestive Health, Center for Weight Management, Yale New Haven Hospital, New Haven, Connecticut; Department of Biobehavioral Sciences, Teachers College - Columbia University, New York, New York.
| | - Dale S Bond
- Departments of Surgery and Research, Hartford Hospital/HealthCare, Hartford, Connecticut
| | | | - Louisa Y Herring
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, England, UK; NIHR Leicester Biomedical Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, England, UK
| | - Bethany Mulone
- Division of Digestive Health, Center for Weight Management, Yale New Haven Hospital, New Haven, Connecticut
| | - Carol Ewing Garber
- Department of Biobehavioral Sciences, Teachers College - Columbia University, New York, New York
| | - John Morton
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Saber Ghiassi
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Andrew J Duffy
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Ethan Balk
- Division of Digestive Health, Center for Weight Management, Yale New Haven Hospital, New Haven, Connecticut; Department of Nutrition and Food Studies, New York University, New York, New York
| | - Charles J Abolt
- Earth and Environmental Sciences Division, Los Alamos National Laboratory, Los Alamos, New Mexico
| | - Matt C Howard
- Department of Marketing & Quantitative Methods, University of South Alabama, Mobile, Alabama
| | - Garrett I Ash
- Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut; Center for Pain, Research, Informatics, Medical Comorbidities and Education Center (PRIME), VA Connecticut Healthcare System, West Haven, Connecticut
| | - Susannah Williamson
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research (WRAIR), Silver Spring, Maryland; Army Educational Outreach Program, Rochester Institute of Technology, Rochester, New York
| | - Emilian Rejane Marcon
- Department of Bariatric Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Melissa De Los Santos
- Department of Biobehavioral Sciences, Teachers College - Columbia University, New York, New York
| | - Samantha Bond
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Janet Huehls
- UMass Memorial Weight Center, UMass Memorial Medical Center, Worchester, Massachusetts
| | - Osama Alowaish
- Department of Biobehavioral Sciences, Teachers College - Columbia University, New York, New York
| | - Nina Brojan Heyman
- Department of Biobehavioral Sciences, Teachers College - Columbia University, New York, New York
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group - Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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Stults-Kolehmainen MA, Bond DS, Richardson LA, Herring LY, Mulone B, Garber CE, Morton J, Ghiassi S, Duffy AJ, Balk E, Abolt CJ, Howard MC, Ash GI, Williamson S, Marcon ER, De Los Santos M, Bond S, Huehls J, Alowaish O, Heyman NB, Gualano B. Role of the exercise professional in metabolic and bariatric surgery. medRxiv 2023:2023.04.20.23288698. [PMID: 37645986 PMCID: PMC10462198 DOI: 10.1101/2023.04.20.23288698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. Objectives To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? Setting Clinical and academic exercise settings worldwide. Methods This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. Results The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being: supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and post-operative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". Conclusions The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.
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Affiliation(s)
- Matthew A. Stults-Kolehmainen
- Center for Weight Management, Division of Digestive Health, Yale New Haven Hospital, New Haven, CT, United States
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Dale S. Bond
- Departments of Surgery and Research, Hartford Hospital/HealthCare, Hartford, CT, United States
| | | | - Louisa Y. Herring
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, England, United Kingdom
- NIHR Leicester Biomedical Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, England, United Kingdom
| | - Bethany Mulone
- Center for Weight Management, Division of Digestive Health, Yale New Haven Hospital, New Haven, CT, United States
| | - Carol Ewing Garber
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - John Morton
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Saber Ghiassi
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Andrew J. Duffy
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Ethan Balk
- Center for Weight Management, Division of Digestive Health, Yale New Haven Hospital, New Haven, CT, United States
- Department of Nutrition and Food Studies, New York University, New York, NY, United States
| | - Charles J. Abolt
- Earth and Environmental Sciences Division, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Matt C. Howard
- Department of Marketing & Quantitative Methods, University of South Alabama, Mobile, AL, United States
| | - Garrett I. Ash
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
- Center for Pain, Research, Informatics, Medical Comorbidities and Education Center (PRIME), VA Connecticut Healthcare System, West Haven, CT, United States
| | - Susannah Williamson
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, United States
- Army Educational Outreach Program, Rochester Institute of Technology, United States
| | - Emilian Rejane Marcon
- Department of Bariatric Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Melissa De Los Santos
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Samantha Bond
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Janet Huehls
- UMass Memorial Weight Center, UMASS Memorial Medical Center, Worchester, MA, United States
| | - Osama Alowaish
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Nina Brojan Heyman
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, School of Medicine, University of São Paulo, São Paulo, Brazil
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Aleassa EM, Papasavas P, Augustin T, Khorgami Z, Benson-Davies S, Ghiassi S, Carter J, Nimeri A. American Society for Metabolic and Bariatric Surgery literature review on the effect of Roux-en-Y gastric bypass limb lengths on outcomes. Surg Obes Relat Dis 2023; 19:755-762. [PMID: 37268517 DOI: 10.1016/j.soard.2023.04.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/02/2023] [Indexed: 06/04/2023]
Abstract
This literature review is issued by the American Society for Metabolic and Bariatric Surgery regarding limb lengths in Roux-en-Y gastric bypass (RYGB) and their effect on metabolic and bariatric outcomes. Limbs in RYGB consist of the alimentary and biliopancreatic limbs and the common channel. Variation of limb lengths in primary RYGB and as a revisional option for weight recurrence after RYGB are described in this review.
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Affiliation(s)
- Essa M Aleassa
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | | | - Toms Augustin
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma
| | - Sue Benson-Davies
- Department of Surgery, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Saber Ghiassi
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, North Carolina
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Ghiassi S. Comments on: Should bariatric surgery be offered to prisoners? Surg Obes Relat Dis 2020; 16:e56. [PMID: 32782119 DOI: 10.1016/j.soard.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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9
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Abstract
PURPOSE OF REVIEW Bariatric surgery is the most effective and durable method for treating obesity. This review highlights the results and safety of bariatric surgery. RECENT FINDINGS The global prevalence of obesity and its related comorbidities including cancer are on the rise. Bariatric surgery has demonstrated more robust and durable weight loss than current medical treatment. Bariatric surgery also reduces significantly the risk of complications associated with obesity comorbidities, such as diabetes and cardiovascular disease, and the risk of mortality in comparison with medical management. Due to accreditation efforts, the safety profile of bariatric surgery is equivalent or superior to many common operations. Obesity is associated with increased all cause morbidity and mortality. The current bariatric procedures produce significant and durable weight loss and reduce the morbidity and mortality associated with obesity-related diseases substantially. The risk/benefit ratio for bariatric surgery is decidedly in favor for the benefit for bariatric surgery.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520, USA.
| | - John M Morton
- Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520, USA
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10
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Alkukhun A, Rezek I, Ghiassi S, Zhang X, Revzin MV. Mesenteric Amyloidosis: Radiologic Imaging with Pathologic Correlation. J Clin Imaging Sci 2020; 10:24. [PMID: 32363086 PMCID: PMC7193195 DOI: 10.25259/jcis_10_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023] Open
Abstract
Amyloidosis is a rare disease that is characterized by abnormal deposition of amyloid proteins in tissues, resulting in local, or systemic disease. When localized, it can present as an amyloidoma. We report a case of mesenteric amyloidosis in an 80-year-old male who was found to have an incidental mesenteric mass that was biopsy-proven to represent non-light chain amyloid tissue.
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Affiliation(s)
- Abedalrazaq Alkukhun
- Departments of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Issa Rezek
- Departments of Surgery, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Saber Ghiassi
- Departments of Surgery, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Xuchen Zhang
- Department of Pathology, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Margarita V Revzin
- Departments of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
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11
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Francis A, Duffy A, Nadzam G, Ghiassi S. A246 High-Grade Small Bowel Obstruction Caused by Adjustable Gastric Band Tubing. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Ghiassi S. Comment on: Operative time as a marker of quality in bariatric surgery. Surg Obes Relat Dis 2019; 15:1120-1121. [PMID: 31427105 DOI: 10.1016/j.soard.2019.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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13
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Ma P, Ghiassi S, Lloyd A, Haddad A, Boone K, DeMaria E, Higa K. Reversal of Roux en Y gastric bypass: largest single institution experience. Surg Obes Relat Dis 2019; 15:1311-1316. [DOI: 10.1016/j.soard.2019.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/30/2019] [Accepted: 05/05/2019] [Indexed: 01/04/2023]
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14
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Ying L, Hubbard M, Ghiassi S, Roberts K, Duffy AJ, Nadzam GS. Intraoperative blood pressure lability in patients requiring blood transfusions after bariatric surgery. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Friedman D, Ghiassi S, Hubbard M, Duffy AJ. Postoperative opioid prescribing practices and evidence-based guidelines in bariatric surgery. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ghiassi S. Comment on: Systematic review and retrospective validation demonstrate prediction models can predict weight loss after bariatric surgery. Surg Obes Relat Dis 2017; 13:1920-1921. [PMID: 29031943 DOI: 10.1016/j.soard.2017.09.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Ying LD, Duffy AJ, Roberts KE, Ghiassi S, Hubbard MO, Nadzam GS. Impact of preoperative wait time due to insurance-mandated medically supervised diets on weight loss after sleeve gastrectomy. Are patients losing momentum? Surg Obes Relat Dis 2017; 13:1584-1589. [DOI: 10.1016/j.soard.2017.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
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Ali M, El Chaar M, Ghiassi S, Rogers AM. American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 2017; 13:1652-1657. [PMID: 29054173 DOI: 10.1016/j.soard.2017.08.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Mohamed Ali
- Department of Surgery, University of California-Davis Medical Center, Sacramento, California
| | - Maher El Chaar
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, the Medical School of Temple University/St Luke's University Health Network, Allentown, Pennsylvania
| | - Saber Ghiassi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Ann M Rogers
- Division of Minimally Invasive and Bariatric Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.
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Eisenberg D, Azagury DE, Ghiassi S, Grover BT, Kim JJ. ASMBS Position Statement on Postprandial Hyperinsulinemic Hypoglycemia after Bariatric Surgery. Surg Obes Relat Dis 2016; 13:371-378. [PMID: 28110984 DOI: 10.1016/j.soard.2016.12.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, Stanford, California; Department of Surgery, Palo Alto VA Health Care System, Palo Alto, California.
| | - Dan E Azagury
- Section of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford, California
| | - Saber Ghiassi
- Yale School of Medicine, New Haven, Connecticut; Department of Surgery, Bridgeport Hospital, Fairfield, Connecticut
| | - Brandon T Grover
- Department of Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Julie J Kim
- Department of General Surgery, Tufts University School of Medicine, Boston, Massachusetts
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Moon C, Ghiassi S, Higa K. Laparoscopic revision of distal Roux-en-Y gastric bypass to duodenal switch for weight loss failure and symptoms. Surg Obes Relat Dis 2015; 11:259-61. [PMID: 25595920 DOI: 10.1016/j.soard.2014.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Cyrus Moon
- Department of Surgery, Delano Regional Medical Center, Delano, California.
| | - Saber Ghiassi
- Advanced Laparoscopic Surgical Associates, Fresno, California; Department of Surgery, University of California San Francisco at Fresno, Fresno, California
| | - Kelvin Higa
- Advanced Laparoscopic Surgical Associates, Fresno, California; Department of Surgery, University of California San Francisco at Fresno, Fresno, California
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Ghiassi S, Morton J, Bellatorre N, Eisenberg D. Short-term medication cost savings for treating hypertension and diabetes after gastric bypass. Surg Obes Relat Dis 2011; 8:269-74. [PMID: 21723203 DOI: 10.1016/j.soard.2011.05.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 02/23/2011] [Accepted: 05/16/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND The cost of medication for the treatment of hypertension and diabetes in the morbidly obese is a significant economic healthcare burden. In the present study, we assessed the effect of gastric bypass surgery on the average annual costs for hypertension and diabetes medication. METHODS A prospective database of gastric bypass patients at the Palo Alto Veterans Affairs Health Care System was reviewed. The preoperative and postoperative medication requirements to treat hypertension and diabetes were identified before surgery and at 1 year postoperatively. Comparisons were made between the annual costs of the antihypertensive and diabetic medications before and after bariatric surgery using the Student paired t test. RESULTS Of 106 patients who had undergone gastric bypass, 90 (85%) had either hypertension or diabetes. Of these 90 patients, 88 (98%) had hypertension and 60 (67%) had diabetes before surgery. Complete remission of hypertension occurred in 44% and remission of diabetes in 80% at 1 year after surgery. The annual cost of medications to treat hypertension was reduced by 65% at 1 year after surgery ($63.52 compared with $20.50, P < .0001). To treat diabetes, the annual medication cost was reduced by 88% at 1 year after gastric bypass surgery ($532.06 compared with $64.58, P < .0001). In the subset of patients with persistent hypertension or diabetes after surgery, the annual cost reduction for antihypertensive medications was 58% ($87.14 versus $36.82, P < .002). The annual cost reduction for diabetic medications was 69% ($1036.60 versus $322.90, P < .02). CONCLUSION Gastric bypass surgery resulted in a significant reduction in the cost of medications to treat hypertension and diabetes in the morbidly obese at 1 year after surgery. These cost savings were also significant in the subset of patients who had persistent hypertension and diabetes after surgery.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
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Bowman JN, Ellozy SH, Ting J, Ghiassi S. Successful repair of popliteal artery pseudoaneurysm after tibial lengthening osteotomy in a 7-year-old boy. Vasc Endovascular Surg 2008; 42:610-4. [PMID: 18621890 DOI: 10.1177/1538574408320023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Popliteal artery injury is a known but rare complication of elective orthopedic procedures. This case report describes the diagnosis and treatment of a popliteal artery pseudoaneurysm and arteriovenous fistula after a tibial lengthening osteotomy in a 7-year-old boy.
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Affiliation(s)
- Jonathan N Bowman
- Department of Vascular Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA.
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Abstract
Internal hernia, the protrusion of a viscus through a peritoneal or mesenteric aperture, is a rare cause of small bowel obstruction. We report the clinical presentation, surgical management, and outcomes of one of the largest series of nonbariatric internal hernias. Ten-year retrospective review of patients at our institution yielded 49 cases of internal hernias. Majority of patients presented with symptoms of acute (75%) or intermittent (22%) small bowel obstruction. While 16% of CT scans were suspicious for internal hernia, in no cases the preoperative diagnosis of internal hernia was made. The most frequent internal hernias were transmesenteric (57.0%) and 34 hernias (69%) were caused by previous surgery. All internal hernias were reduced and the defects were repaired. Compromised bowel was present in 22 cases and 11 patients underwent small bowel resection. The mean postoperative hospitalization was 10.9 days. The overall mortality rate from our series is 2%, and the morbidity rate is 12%. Transmesenteric hernias, as complications of previous surgeries, are the most prevalent internal hernias. Preoperative diagnosis of internal hernia is extremely difficult because of the nonspecific clinical presentation. However, if discovered promptly, internal hernias can be repaired with acceptable morbidity and mortality.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1259, New York, NY 10029, USA
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Ghiassi S, Sun YS, Kim VB, Scott CM, Nifong LW, Rotondo MF, Chitwood WR. Methylene Blue Enhancement of Resuscitation After Refractory Hemorrhagic Shock. ACTA ACUST UNITED AC 2004; 57:515-21. [PMID: 15454796 DOI: 10.1097/01.ta.0000136159.22721.3d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Methylene blue has been used to treat hypovolemic states. This study evaluated prehospital resuscitation after refractory hemorrhagic shock with a combination of methylene blue and limited-volume lactated Ringer's solution. METHODS After blood loss to a mean arterial pressure of 50 mm Hg in canines, refractory hemorrhagic shock was defined as minimal hemodynamic response to phenylephrine. Differential protocols included no treatment (control), methylene blue bolus, limited-volume lactated Ringer's solution, and combined methylene blue/lactated Ringer's solution therapies. Hemodynamic parameters were collected at baseline, during shock, during refractory hemorrhagic shock, and 30, 60, 90, and 120 minutes after treatment. Radiolabeled microspheres were used to measure end-organ perfusion and oxygen delivery. RESULTS Methylene blue/lactated Ringer's resuscitation improved prehospital survival (p < 0.05), mean arterial pressure and cardiac output (p < 0.05), vital end-organ blood flow and oxygen delivery (p < 0.05), and decreased serum lactate levels (p < 0.05), as compared with the methylene blue and lactated Ringer's single therapies. CONCLUSIONS Resuscitation after refractory hemorrhagic shock using a combination of methylene blue and limited-volume lactated Ringer's solution improves prehospital survival and hemodynamic stability and reduces ischemic damage in an acute setting. This form of therapy has been proved useful as a temporizing measure for resuscitation after refractory hemorrhagic shock in a canine model and warrants further study for its application to the hemorrhagic trauma patient.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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Hall JW, Grose JH, Dev MB, Ghiassi S. The effect of masker interaural time delay on the masking level difference in children with history of normal hearing or history of otitis media with effusion. Ear Hear 1998; 19:429-33. [PMID: 9867291 DOI: 10.1097/00003446-199812000-00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the relation between the masking level difference (MLD) and the interaural time delay of the stimulus in children with a history of normal hearing and with a history of otitis media with effusion (OME). DESIGN MLDs for a 500 Hz pure tone presented in a 100 Hz-wide masking noise were determined as a function of the interaural delay of the masker (six interaural delays between -726 microsec and +998 microsec were examined). For the masker with zero interaural delay, the signal was presented either interaurally in-phase or 180 degrees out of phase. For the masker delay conditions, the signal was given the same interaural delay as the masker and then was inverted interaurally. All children had normal audiograms at the time of testing. Ten children had a history of normal hearing and seven children had a history of OME. RESULTS Similar to what has been found previously in adults, children with a history of normal hearing showed the maximum MLD (approximately 16 dB) for an interaural time delay of 0 microsec, with the MLD decreasing as a function of interaural time delay (by as much as 4 to 5 dB for the extreme delays). Children with a history of OME had significantly smaller MLDs than normal for the three smallest interaural delays but did not differ significantly from normal at the three largest interaural delays. CONCLUSIONS The form of the function relating masker interaural time delay to MLD magnitude is adult-like by age 6 yr. The function indicates a binaural advantage for the processing of sound near auditory midline. This advantage is less apparent in children having a history of OME.
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Affiliation(s)
- J W Hall
- Division of Otolaryngology, The University of North Carolina at Chapel Hill, 27599-7070, USA
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