Natan Zundel

• MD
• CEO at Florida International University

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...

Bariatric endoscopy is a developing area that studies the treatment of bariatric surgery complications through minimally invasive endoscopic procedures, and primary obesity therapies. The traditional approach to these complications is surgical, which is associated with significant morbidity and mortality. Endoscopic procedures, such as stent placem...

Anemia has deserved a generous share of the research NIH funds considering its prevalence in the general population and reflecting the detrimental associated socioeconomic impact. Iron and/or vitamin B12 deficiency anemias, which have adverse effects on patients’ quality of life, are commonly observed and often overlooked problems after bariatric s...

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. This study aimed to report on the experience of a single surgical group, analyzing three clinical cas...

Introduction and importance Situs inversus is an anatomical rare condition in which visceral organs are not located in its normal position, with a reversal anatomical orientation. Case presentation We present a case of an 27-year-old male with a Body Mass Index (BMI) of 36.02 Kg/m2, who was programed for a Endoscopic Sleeve Gastroplasty (ESG), in...

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 a...

Purpose With the global epidemic of obesity, the importance of metabolic and bariatric surgery (MBS) is greater than ever before. Performing these surgeries requires academic training and the completion of a dedicated fellowship training program. This study aimed to develop guidelines based on expert consensus using a modified Delphi method to crea...

Obesity is now recognized as a chronic disease associated with a pro-inflammatory state and is often undertreated. It has become a global epidemic, affecting populations worldwide1,2. Metabolic and bariatric surgery (MBS) is considered the most effective treatment option for obesity, which is a chronic, relapsing, and progressive disease3. These su...

Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). 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. The aim of this study was...

Medical tourism refers to the activity of traveling outside one’s hometown or country to receive medical treatment, diagnostic testing, or procedure. In most cases, the purpose is to achieve a more accessible treatment from an economic standpoint; however, it can also be used to receive specialized medical care in places with more experience, resou...

It is clear to all stakeholders involved in the study and treatment of the obesity epidemic that it has exceeded the capacity of response of health systems around the world. Part of the response is bariatric surgery, which has already proven the most effective and durable method to produce significant and enduring weight loss.

Background Obesity in adolescent patients is a public healthcare problem that has rapidly increased over time. Surgical procedures have been proposed as a solution for this pathology, but evidence of bariatric surgery outcomes in adolescent patients is scarce. We aimed to describe the characteristics, experience, and outcomes of our institution's a...

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 bypas...

Introduction Laparoscopic BariClip gastroplasty (LBCG) is a new reversible gastric sleeve-like procedure without gastrectomy proposed to minimize the risk of severe complications. Still one of the possible complications described with LBCG is slippage. The purpose of the current manuscript is to analyze different cases of slippage and propose a cla...

La cirugía bariátrica, al igual que la obesidad, ha tenido un reconocimiento tardío en la comunidad científica. Desde 1996, la Fundación Santa Fe de Bogotá ha contribuido al manejo de la obesidad y al desarrollo de la cirugía bariátrica desde un enfoque multidisciplinario. El abordaje del problema por cirujanos, endocrinólogos, psiquiatras, nutrici...

Duodenal switch has been performed since the early 1980s but only makes up about 1% of bariatric procedures performed in the United States. Initially done open it can now be performed laparoscopically or robotically. It is the most effective operation for excess weight loss and resolution of diabetes and hyperlipidemia however it is also associated...

The rate of revisional surgery has increased with the growing number of primary bariatric surgeries performed worldwide. The incidence of revisional surgery is estimated to be approximately 20% (Mirkin et al. Surg Clin North Am, 101:213–222, 2021). The most common causes for revision include inadequate weight loss and postoperative weight regain. W...

The World Health Organization estimates that around 650 million people worldwide are considered obese. This number is expected to rise significantly over the coming decades due to a sharp rise in childhood obesity from 4% in 1975 to 18% in 2016 [1]. With the increasing prevalence of obesity, bariatric operations are becoming common. The ASMBS estim...

Gastrointestinal leaks are severe complications after bariatric surgery, mainly related to postoperative anastomotic defects with substantial morbidity and mortality. Surgical interventions can be complicated with high morbidity and mortality. Surgical drainage can be indicated when there is peritonitis or perigastric abscess. Conservative manageme...

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...

Sleeve gastrectomy is the bariatric procedure most commonly performed nowadays. Despite its popularity, the way it works hasn’t been explained in its totality. In the past, the mechanisms of action from different bariatric procedures were reduced to either a malabsorptive component, a restrictive one, or a combination of both. Based on that classif...

Objective: This study aimed to survey international experts in metabolic and bariatric surgery (MBS) to improve and consolidate perioperative interventions to prevent gastroesophageal reflux disease (GERD) and marginal ulcers (MU) after MBS. Background: Very important long-term complications after MBS include GERD, Barrett's esophagus, and MU. P...

Background Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic cl...

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...

In diesem Kapitel werden ausführlich die technischen Besonderheiten von drei Adipositasoperationen – Schlauchmagen, Magenbypass und Duodenalswitch sowie unterschiedlichen Varianten der Redo-Chirurgie unter Verwendung minimal invasiver oder roboterassistierter Technik dargestellt. BMI über 60, Thoraxmagen, Z. n. großen viszeralchirurgischen Operatio...

Hematological complications after bariatric surgery can present early on in the postoperative period most commonly as hemorrhage and venous-thrombo-embolism. Hemorrhage is a direct result from the procedure and its incidence has been going down as the procedures and surgical equipment become more efficient. Thrombosis is one of the most feared comp...

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 le...

LaparoscopicLaparoscopicgastric bypassGastric bypass is one of the most frequent bariatric procedures performed in the world. Nowadays, onlySleeve gastrectomysleeve gastrectomyGastrectomy is more used than this technique.

BackgroundCOVID-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 metab...

In the original article the captions for Figs. 1-3 are incorrect.

During the last 20 years, morbid obesity has reached epidemic proportions around the world. More than one in two adults and one in six children are overweight or obese. It is estimated that there are 671 million people who are obese (BMI > 30) in the world.

New technologies arrive every day in the field of bariatrics, since obesity is the late twentieth-century epidemic. The place where traditional bariatric surgery stands is well known, but even though it is a safe approach, it continues to be a surgical intervention with some degree of morbidity. Another issue with such procedures is that less than...

Gastroesophageal reflux disease (GERD) after sleeve gastrectomy is a highly debated topic in the bariatric community. There has been a dramatic increase of sleeve gastrectomies being performed around the world and the somewhat contradictory data published regarding the association between sleeve gastrectomy and GERD.

Background Roux-en-Y gastric bypass is one of the most widely performed bariatric surgeries. However, the relapse of obesity occurs in approximately 20% of patients and enlargement of the anastomosis is one of the factors associated with this relapse. Endoscopic treatment of the anastomosis has been proposed to assist in renewed weight loss. One en...

The use of an intragastric balloon for weight loss commenced in the late 1970s, with experiments on dogs. The prototype was a 250 cc bottle introduced at laparotomy. The evolution of this model over the last four decades from cylindrical to pear to oval, and ultimately a smooth sphere has ‘shaped’ the minimally invasive approach to weight loss. It...

The isolated stricture following the sleeve gastrectomy (SGS) is one of the possible surgical complications. Previous algorithms have been proposed to address the workup and treatment of the SGS. However, current literature lacks standardization and systematic reviews on this topic. This study aims to review all currently available publications and...

Background: 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 wi...

Laparoscopic sleeve gastrectomy (LSG) is not only an accepted stand-alone procedure for morbid obesity, but it has become the most frequently practiced bariatric operation in the world. Its technique is becoming more standardized and adjusted to evidence. The surgical technique practiced by the authors is described and explained.

Currently, obesity is one of the most worrisome diseases of humanity. Bariatric surgery is the gold-standard therapy to address moderate and severe obesity, but it fails to achieve broad acceptance. In this sense, endoluminal alternatives to bariatric surgery are particularly opportune and may entail malabsorptive, evacuation, space-occupying, and...

Background Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. Methods A panel of experts in bariatric metabolic surgery from multiple continents was...

There is no doubt that obesity is an epidemic that affects not only developed but also underdeveloped countries. This “globalization” of the disease has led to the current surgery, as a therapeutic method of this pathology, to evolve in terms of its techniques implemented to patients [1]. Within these evolutions is the single anastomosis gastric by...

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. Ob...

Background Over the last decade, several techniques have emerged and the bariatric trends have changed. A new bariatric procedure that has been proposed is laparoscopic vertical clip gastroplasty (LVCG), which mimics the principle of laparoscopic sleeve gastrectomy, but with a completely reversible mechanism. The introduction of a new procedure in...

Purpose: This study's objective was to describe our experience and evaluate the safety of early discharge (ED) following laparoscopic Roux-en-Y gastric bypass (LRYGB) in a specific patient population. Materials and methods: Patients undergoing LRYGB at Montefiore Medical Center were retrospectively reviewed. Patients readmitted in the first 30 d...

DOI: 10.1007/s00464-018-6121-4 Surg Endosc (2018) 32(Suppl 1): 130 P498 Background: Porcine models have been widely accepted for gastrointestinal surgery studies, due to their similarities to human anatomy, histology and physiology. Devices such as laparoscopic staplers have been widely used in bariatrics and are currently the cornerstone of bariat...

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...

The number of overweight and obese people has been increasing year by year for decades, and the number of surgeries and procedures to control this disease has increased proportionately. Bariatric surgery is the best treatment for advanced cases, but presents a relapse rate of around 20%. In cases of weight recidivism after gastric bypass, endolumen...

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 demonstr...

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 thick...

The surgical treatment of patients with morbid obesity first began in the mid-twentieth century. Its inception was based upon the fundamental principles that malabsorption of food particles and restriction of intake could help obese patients lose significant amounts of weight and resolve their comorbid medical conditions.

The prevalence of laparoscopic vertical sleeve gastrectomy (LSG) for the treatment of morbid obesity has increased markedly over the last decade, and now surpasses gastric bypass surgery in the United States. LSG is a widely accepted operation that has been proven to be safe and effective as a stand-alone primary weight loss procedure. Nevertheless...

INTRODUÇÃO: Obesidade é uma doença crônica que assume características endêmicas no Brasil e no mundo nos últimos anos. Segundo dados da SBCBM, em 2007 cerca de 12,1% da população (15 milhões de pessoas) era obesa. A evolução da doença obesidade está associada a diversas enfermidades como diabetes, hipertensão arterial sistêmica, apnéia obstrutiva d...

BACKGROUND: The Orbera intragastric balloon (IGB) has been approved by the US Food and Drug Administration for use in patients with a body mass index (BMI) between 30 and 40 kg/m2 and is in wide use worldwide as a primary and bridge obesity management tool. The balloon filling volume (BFV) ranges between 400 and 700 mL of saline. Our objective was...

Background and aim: Several bariatric surgery worldwide surveys have been previously published to illustrate the evolution of bariatric surgery in the last decades. The aim of this survey is to report an updated overview of all bariatric procedures performed in 2014.For the first time, a special section on endoluminal techniques was added. Method...

Background: Obesity and its consequences have now reached worldwide pandemic proportions. Among treatments, bariatric interventions are the most effective for weight reduction. Here, we describe the change in anthropometric measurements (AMs) of 615 adult bariatric procedure patients seen in the private practice of a registered dietitian (RD) in B...

Background: Morbid obesity remains one of society's significant medical dilemmas. It is rapidly worsening and expected to affect 35% of the US population by the year 2020. Common current bariatric procedures exist and include, but not limited to, the adjustable gastric band, gastric bypass, and the sleeve gastrectomy. Although beneficial to morbid...

Background: The intragastric balloon (IGB) is an adjunctive treatment for obesity. This meta-analysis aimed to evaluate the efficacy and safety of IGB treatment by reviewing randomized controlled trials (RCTs). Methods: A total of 20 RCTs involving 1195 patients were identified. Weight loss results before and after 3 months were analyzed separat...

Postsurgical fistulas in the GI tract involve the gut and another hollow organ, cavity and even the skin. This complication has tremendous impact on a patient’s health and health care costs, even with improvements in surgical techniques and postsurgical care, the frequency of fistulas have not decreased. There are various classification systems but...

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; Hal...

The refurbished International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) website ( www.ifso.com ) showcases a wealth of high-quality information for bariatric surgery professionals and patients. The website provides free online access to the organisational structure of IFSO and useful information on IFSO-endorsed congresse...

After 15 years, laparoscopic sleeve gastrectomy (LSG) has a firm position as a stand-alone procedure to effectively treat morbid obesity. Low morbidity and mortality have been advocated as advantages over more complex procedures such as laparoscopic Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch or other restrictive pro...

Background and aims: The Orbera Intragastric Balloon (IGB) System has been widely used outside the United States (US) as an effective adjunct to lifestyle modification in the management of mild to moderate obesity. We performed a systematic review and meta-analysis to summarize the out of the US safety and efficacy experience with this IGB system i...

Background: In traditional laparoscopic cholecistectomy, the cystic duct and artery are commonly closed by metallic clips just before their division. Although the placement of these clips for occluding cystic artery and duct can be considered safe, biliary leaks and bleeding may occur especially by its dislodgement. Aim: To report a prospective...

Bariatric surgery is a successful procedure increasingly used for the treatment of obesity with or without the presence of comorbidities. There are several bariatric procedures, which are selected depending on the patient, the recommendation and experience of the physician. Bariatric surgery "per se" generates nutritional deficiencies that must be...

La cirugía bariátrica es un procedimiento exitoso y cada vez más utilizado para el tratamiento de la obesidad con presencia de enfermedades asociadas o sin ella. Existen diferentes tipos de procedimientos los cuales se seleccionan dependiendo del tipo de paciente y de la recomendación y experiencia del médico tratante. La cirugía bariátrica per se...

La cirugía bariátrica es hasta el momento la mejor solución para el problema de obesidad y la diabetes, e incluso, influye en la mejoría de las enfermedades no transmisibles relacionadas con la nutrición. Sin embargo, no está exenta de complicaciones, entre las cuales son frecuentes las metabólicas y nutricionales que, afortunadamente, son predecib...

Many surgeons attempting Laparo-Endoscopic Single Site (LESS) cholecystectomy have found the operation difficult, which is inconsistent with our experience. This article is an attempt to promote a standardized approach that we feel surgeons with laparoscopic skills can perform safely and efficiently. This is a four-trocar approach consistent with t...

Background: Laparoscopic sleeve gastrectomy (LSG) is an emerging surgical approach, but 1 that has seen a surge in popularity because of its perceived technical simplicity, feasibility, and good outcomes. An international expert panel was convened in Coral Gables, Florida on March 25 and 26, 2011, with the purpose of providing best practice guidel...

A novel multi-port (Triport+) and methodology were designed for single port cholecystectomy (SPC) to replicate the principles found in the gold standard 4-port laparoscopic cholecystectomy. We present the first case series utilizing the Triport+, and methodology through a single 15-mm periumbilical fascial incision. The 4 lumen multi-channel port w...

Background New gastric bands have been available for the past 3 years in the United States: Lap-Band AP (LBAP), Realize Band (RB), and Realize Band C (RBC). No RBC data have been previously published. The objective of the present study was to report our experience with 3 newer gastric bands in an experienced, private, U.S. bariatric surgery center.

Bariatric surgery has become more common due to the worldwide obesity epidemic. A shift from open to laparoscopic surgery has occurred in the last 2 decades, because of its advantages. Revisional surgery after bariatric procedures is becoming an important issue, and restrictive procedures account for a large proportion of these interventions. Three...