Chaya Schweiger

Publications (9)22.06 Total impact

• Article: Intervertebral disc height changes after weight reduction in morbidly obese patients and its effect on quality of life and radicular and low back pain.

  Zvi Lidar, Eyal Behrbalk, Gilad J Regev, Khalil Salame, Ory Keynan, Chaya Schweiger, Liat Appelbaum, Yair Levy, Andrei Keidar
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  ABSTRACT: STUDY DESIGN.: Prospective study in a morbidly obese population after bariatric surgery. OBJECTIVE.: To document the effect of significant weight reduction on intervertebral disc space height, axial back pain, radicular leg pain, and quality of life. SUMMARY OF BACKGROUND DATA.: Low back pain is a common complaint in obese patients, and weight loss is found to improve low back pain and quality of life. The mechanism by which obesity causes low back pain is not fully understood.On acute axial loading and offloading, intervertebral disc changes its height; there are no data on intervertebral disc height changes after significant weight reduction. METHODS.: Thirty morbidly obese adults who underwent bariatric surgery for weight reduction were enrolled in the study. Disc space height was measured before and 1 year after surgery. Visual analogue scale was used to evaluate axial and radicular pain. The 36-Item Short Form Health Survey and Moorehead-Ardelt questionnaires were used to evaluate changes in quality of life. RESULTS.: Body weight decreased at 1 year after surgery from an average of 119.6 ± 20.7 kg to 82.9 ± 14.0 kg corresponding to an average reduction in body mass index of 42.8 ± 4.8 kg/m to 29.7 ± 3.4 kg/m (P < 0.001).The L4-L5 disc space height increased from 6 ± 1.3 mm, presurgery to 8 ± 1.5 mm 1 year postsurgery (P < 0.001).Both axial and radicular back pain decreased markedly after surgery (P < 0.001). Patients' Moorehead-Ardelt score significantly improved after surgery (P < 0.001). Although the 36-Item Short Form Health Survey score did not show any statistically significant improvement after surgery, the physical component of the questionnaire showed a positive trend for improvement.No correlation was noted between the amount of weight reduction and the increment in disc space height or back pain improvement. CONCLUSION.: Bariatric surgery, resulting in significant weight reduction, was associated with a significant decrease in low back and radicular pain as well as a marked increase in the L4-L5 intervertebral disc height.Reduction in body weight after bariatric surgery in morbidly obese patients is associated with a significant radiographical increase in the L4-L5 disc space height as well as a significant clinical improvement in axial back and radicular leg pain.
  Spine 05/2012; 37(23):1947-52. · 2.08 Impact Factor
• Article: [Nutritional deficiencies in bariatric surgery patients: prevention, diagnosis and treatment].

  Chaya Schweiger, Andrei Keidar
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  ABSTRACT: The number of people suffering from surgery and obesity in the western world is constantly growing. In 1997 the World Health Organization (WHO) defined obesity as a plague and one of greatest public health hazards of our time. The National Institution of Health (NIH) declared that surgery is the only long-term solution for obesity. Today there are four different types of bariatric surgery. Each variation has different implications on the nutritional status of bariatric surgery patients. Bariatric surgery candidates are at risk of developing vitamin and mineral nutritional deficiencies in the post-operative stage, due to vomiting, decrease in food intake, food intolerance, diminution of gastric secretions and bypass of absorption area. It is easier and more efficient to treat nutritional deficiencies in the preoperative stage. Therefore, preoperative detection and correction are crucial. Blood tests before surgery to detect and treat nutritional deficiencies are crucial. In the postoperative period, blood tests should be conducted every 3 months in the first year after operation, every six months in the second year and annually thereafter. Multivitamin is recommended to prevent nutritional deficiencies in all bariatric surgery patients. Furthermore, iron, calcium, Vitamin D and B12 are additionally recommended for Roux-en-Y Gastric Bypass patients. Patients with Biliopancreatic diversion and Duodenal Switch should also take fat soluble vitamins.
  Harefuah 11/2010; 149(11):715-20, 748.
• Article: Effect of different bariatric operations on food tolerance and quality of eating.

  Chaya Schweiger, Ram Weiss, Andrei Keidar
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  ABSTRACT: Many bariatric operations are associated with reduced food tolerance and frequent vomiting, which may cause nutritional deficiencies and influence quality of life. However, the impact of different bariatric procedures on quality of eating and food tolerance has not yet been studied enough. Two hundred and eighteen participants filled a quality of eating questionnaire, at three different time periods after bariatric operation: short-term (3-6 months, n = 63), medium-term (6-12 months, n = 69) and long-term follow-up (over 12 months, n = 86). The participants underwent the following procedures: 99 patients have had Roux-en-Y gastric bypass (RYGB), 49 laparoscopic gastric banding (LAGB), 56 sleeve gastrectomy (SG), and 14 biliopancreatic diversion with duodenal switch (BPD-DS). At short-term period score achieved for all section of the questionnaire was similar for all operations. The total score of the questionnaire at the medium-term group was 20.27 ± 3.57, 14.47 ± 5.92, 22.27 ± 4.66, and 20.91 ± 3.26 (p < 0.001) and the total score for the long-term group of was 21.56 ± 5.16, 15.5 ± 3.75, 20.45 ± 4.9, and 24.2 ± 2.16 (p < 0.001) for RYGB, LAGB, SG, and BPD-DS, respectively. In a linear regression model we found that LAGB patients had a significantly lower total score compared to all other procedures (p < 0.001). Every 1% of %EWL was associated with a total score decrease in 0.045 points (p = 0.009). Impaired quality of eating and food intolerance is common following many types of bariatric procedures. However, the difficulties diminish as time passes after operation and can be affected by the type of procedure. Patients undergoing LAGB have significantly greater limitations and difficulties to ingest variety of foods.
  Obesity Surgery 10/2010; 20(10):1393-9. · 3.29 Impact Factor
• Article: [New insight into old disease: potential treatment of type 2 diabetes mellitus by bariatric surgery].

  Andrei Keidar, Chaya Schweiger, Itamar Raz
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  ABSTRACT: The incidence of type 2 diabetes mellitus is rising. It presently affects more than 150 million people worldwide, and 7.5% of the population of Europe suffer from this disease. This is partially explained by an increase in the prevalence of obesity. Less than 10% of the diabetic patients achieve appropriate control of their illness. For over a decade, it has been observed that the resolution of type 2 diabetes is an additional outcome of surgical treatment of morbid obesity. Moreover, it has unequivocally been shown that, postoperatively, diabetes-related morbidity and mortality have significantly declined. This improvement in diabetes control is long lasting, and was well documented postoperatively for at least 16 years. Two procedures, the Roux-en-Y gastric bypass (RYGB) and the biliopancreatic diversion (BPD), are more effective treatments for diabetes than other procedures. They are followed by normalization of concentrations of plasma glucose, insulin and glycosylated hemoglobin in 80-100% of morbidly obese patients. Studies have shown that results return to euglycemia and normal insulin levels occur within days after surgery, long before any significant weight loss occurs. This fact suggests that weight loss alone is not a sufficient explanation for this improvement. Other possible mechanisms effective in this phenomenon are decreased food intake, partial malabsorption of nutrients, and anatomical alteration of the gastrointestinal tract, that incites changes in the incretin system, which in turn, affect glucose balance. Better understanding of those mechanisms may lead to the discovery of new treatment modalities for diabetes and obesity.
  Harefuah 02/2010; 149(2):95-8, 124.
• Source

  Available from: Aniceto Baltasar

  Article: Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux.

  Andrei Keidar, Liat Appelbaum, Chaya Schweiger, Ram Elazary, Aniceto Baltasar
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  ABSTRACT: Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure, and it can be done as an isolated LSG or in conjunction with biliopancreatic diversion bypass/duodenal switch (laparoscopic duodenal switch; LDS). Gastroesophageal reflux after LSG has been described, but the mechanism is unknown and the treatment in the severest cases has not been discussed. We describe a cohort of patients who have underwent an LSG or LDS, and have suffered from a severe postoperative gastroesophageal motility disorder and/or reflux, report on their treatment, and discuss possible underlying mechanisms. Seven hundred and six patients underwent an LSG by two of the authors (AK, AB). Sixty nine patients underwent laparoscopic sleeve gastrectomy in Hadassah Medical Center, Jerusalem, Israel (January, 2006 and December 2008; 55 isolated LSG, 14 with LDS), and 637 (212 isolated LSG, 425 LDS) in Clinica San Jorge and Alcoy Hospital in Alcoy, Spain, (January 2002 and November 2008). Of them, eight patients who has suffered from a gastroesophageal dysmotility and reflux disease postoperatively and needed a specific treatment besides regular proton pump inhibitors (PPIs) were identified (1.1%). A combination of dilated upper part of the sleeve with a relative narrowing of the midstomach, without complete obstruction, was common to all eight patients who suffered from a severe gastroesophageal dysmotility and reflux. The sleeve volume, the bougie size, and the starting point of the antral resection do not seem to have an effect in this complication. Operative treatment was needed in only one case out of eight; in the rest of the patients, medical modalities were successful. More knowledge is required to understand the underlying mechanisms.
  Obesity Surgery 12/2009; 20(2):140-7. · 3.29 Impact Factor
• Source

  Available from: tapuz.co.il

  Article: Nutritional deficiencies in bariatric surgery candidates.

  Chaya Schweiger, Ram Weiss, Elliot Berry, Andrei Keidar
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  ABSTRACT: To assess the prevalence of nutritional deficiencies amongst people who suffer from morbid obesity and are candidates for bariatric surgery and to evaluate the relations between pre-operative nutritional deficiencies and demographic data and co-morbidities. Preoperative blood tests of 114 patients (83 women and 31 men) were collected. The blood tests included plasma chemistry (including albumin, total protein, iron, ferritin, vitamin B12, folic acid, parathyroid hormone (PTH), calcium, and phosphorous) and a blood count (for hemoglobin and mean corpuscular volume (MCV)). Demographic and socio-economic details were collected from all patients. Mean age, weight, and BMI of the patients were 38 years (15-77), 122.9 kg (87-250), and 44.3 kg/m(2) (35.3-74.9), respectively. The prevalence of pre-operative nutritional deficiencies were: 35% for iron, 24% for folic acid, 24% for ferritin, 3.6% for vitamin B12, 2% for phosphorous, and 0.9% for calcium, Hb and MCV level was low in 19%. High levels of PTH were found among 39% of the patients. No hypoalbuminemia was encountered. Low iron was more common in females relative to men (40.8 vs.14.3%, p = 0.04) as well as ferritin levels (31.8 vs. 0%, p = 0.001). Men showed a greater prevalence of anemia (35.5% and 12% respectively, p = 0.01) relative to women. Patients with BMI > 50 kg/m(2) were at greater risk for low folic acid (OR = 14.57, 95% CI:1.4-151.34). Patients with high income were less likely to have iron deficiency (OR = 0.19, 95% CI:0.038-0.971). A high prevalence of nutritional deficiencies was found amongst bariatric surgery candidates suffering from morbid obesity.
  Obesity Surgery 10/2009; 20(2):193-7. · 3.29 Impact Factor
• Source

  Available from: PubMed Central

  Article: Short-term dynamics and metabolic impact of abdominal fat depots after bariatric surgery.

  Ram Weiss, Liat Appelbaum, Chaya Schweiger, Idit Matot, Naama Constantini, Alon Idan, Noam Shussman, Jacob Sosna, Andrei Keidar
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  ABSTRACT: Bariatric surgery is gaining acceptance as an efficient treatment modality for obese patients. Mechanistic explanations regarding the effects of bariatric surgery on body composition and fat distribution are still limited. Intra-abdominal and subcutaneous fat depots were evaluated using computed tomography in 27 obese patients prior to and 6 months following bariatric surgery. Associations with anthropometric and clinical changes were evaluated. Excess weight loss 6 months following surgery was 47% in male and 42.6% in female subjects. Visceral fat and subcutaneous fat were reduced by 35% and 32%, respectively, in both sexes, thus the visceral-to-subcutaneous fat ratio remained stable. The strongest relation between absolute and relative changes in visceral and subcutaneous fat was demonstrated for the excess weight loss following the operations (r approximately 0.6-0.7), and these relations were strengthened further following adjustments for sex, baseline BMI, and fat mass. Changes in waist circumference and fat mass had no relation to changes in abdominal fat depots. All participants met the criteria of the metabolic syndrome at baseline, and 18 lost the diagnosis on follow-up. A lower baseline visceral-to-subcutaneous fat ratio (0.43 +/- 0.15 vs. 0.61 +/- 0.21, P = 0.02) was associated with clinical resolution of metabolic syndrome parameters. The ratio between visceral and subcutaneous abdominal fat remains fairly constant 6 months following bariatric procedures regardless of sex, procedure performed, or presence of metabolic complications. A lower baseline visceral-to-abdominal fat ratio is associated with improvement in metabolic parameters.
  Diabetes care 08/2009; 32(10):1910-5. · 8.09 Impact Factor
• Source

  Available from: ima.org.il

  Article: Laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity: experience with 50 patients.

  Abed Khalaileh, Idit Matot, Chaya Schweiger, Liat Appelbaum, Ram Elazary, Andrei Keidar
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  ABSTRACT: Roux-en-Y gastric bypass is currently considered the gold standard surgical option for the treatment of morbid obesity. Open RYGB is associated with a high risk of complications. Laparoscopic RYGB has been shown to reduce perioperative morbidity and improve recovery. To review our experience with laparoscopic RYGB during a 19 month period. The data were collected prospectively. The study group comprised all patients who underwent laparoscopic RYGB for treatment of morbid obesity as their primary operation between February 2006 and July 2007. The reported outcome included surgical results, weight loss, and improved status of co-morbidities, with follow-up of up to 19 months. The mean age of the 50 patients was 36.7 years. Mean body mass index was 44.7 kg/m2 (range 35-76 kg/m2); mean duration of surgery was 171 minutes. There was no conversion to open surgery. The mean length of stay was 4 days (range 2-7 days). Five patients (10%) developed a complication, but none of them required early reoperation and there were no deaths. Mean follow-up was 7 months (range 40 days-19 months). The excess body weight loss was 55% and 61% at 6 and 12 months respectively. Diabetes resolved completely or significantly improved in all five patients with this condition, as did hypertension in eight patients out of nine. Laparoscopic RYGB is feasible and safe. The results in terms of weight loss and correction of co-morbidities are comparable to other previously published studies. However, only surgeons with experience in advanced laparoscopic as well as bariatric surgery should attempt this procedure.
  The Israel Medical Association journal: IMAJ 06/2008; 10(5):350-3. · 1.02 Impact Factor
• Article: Bariatric surgery for high risk patients: first staged laparoscopic biliopancreatic diversion with duodenal switch for severe obesity.

  Andrei Keidar, Nahum Begleibter, Abed Chalaila, Ram Elazary, Chaya Schweiger, Avraham Rivkind
  The Israel Medical Association journal: IMAJ 09/2007; 9(8):616-7. · 1.02 Impact Factor