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4. The Civil Liability for Self-Driving Cars in Austria

Author

Zehetner, Jörg, Cetin, Merve, Holzer, Angelika, Comandè, Giovanni, Series Editor, Ebers, Martin, Series Editor, Zou, Mimi, Series Editor, Steege, Hans, editor, Caggiano, Ilaria Amelia, editor, Gaeta, Maria Cristina, editor, and von Bodungen, Benjamin, editor

Published
2024
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7. Counter-regulatory responses to postprandial hypoglycaemia in patients with post-bariatric hypoglycaemia vs surgical and non-surgical control individuals

Author

Tripyla, Afroditi, Herzig, David, Reverter-Branchat, Gemma, Pavan, Jacopo, Schiavon, Michele, Eugster, Philippe J., Grouzmann, Eric, Nakas, Christos T., Sauvinet, Valérie, Meiller, Laure, Zehetner, Joerg, Giachino, Daniel, Nett, Philipp, Gawinecka, Joanna, Del Favero, Simone, Thomas, Andreas, Thevis, Mario, Dalla Man, Chiara, and Bally, Lia

Published
2023
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14. Management of paraesophageal hiatus hernia

Author

Gerdes, Stephan, Schoppmann, Sebastian F, Bonavina, Luigi, Boyle, Nicholas, Mueller-Stich, Beat P, Gutschow, Christian A, Gisbertz, Suzanne Sarah, Kockerling, Ferdinand, Lehmann, Thorsten G, Lorenz, Dietmar, Granderath, Frank Alexander, Rosati, Riccardo, Wullstein, Christoph, Lundell, Lars, Cheong, Edward, Nafteux, Philippe, Olmi, Stefano, Monig, Stefan, Biebl, Matthias, Leers, Jessica, Zehetner, Joerg, Kristo, Ivan, Berrisford, Richard George, Skrobic, Ognjan M, Simic, Aleksandar P, Pera, Manuel, Grimminger, Peter Philipp, Gockel, Ines, Zarras, Konstantinos, Nieuwenhuijs, Vincent Bernard, Gossage, James A, Henegouwen, Mark I van Berge, Stein, Hubert J, Markar, Sheraz R, Hueting, Willem Eduard, Targarona, Eduardo M, Johansson, Jan, Macaulay, Graeme D, Wijnhoven, Bas PL, Benedix, Frank, Attwood, Stephen E, Hoelscher, Arnulf Heinrich, Priego, Pablo, Fuchs, Karl-Hermann, Luyer, Misha DP, Griffiths, Ewen A, Sovik, Torgeir Thorson, Theodorou, Dimitrios, Sgromo, Bruno, Salo, Jarmo A, Singhal, Rishi, Thorell, Anders, Zaninotto, Giovanni, Itenc, Marko, D'journo, Xavier Benoit, Fullarton, Grant M, Horbach, Thomas, Surgery, CCA - Cancer Treatment and Quality of Life, CCA - Cancer biology and immunology, CCA - Imaging and biomarkers, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, and CCA - Cancer Treatment and quality of life

Subjects
REPAIR, MESH, Hiatus hernia, Mesh, Science & Technology, Fundoplication, Surgical technique, GUIDELINES, Paraesophageal hernia, REFLUX, Surgery, Delphi survey, RECURRENCE, Life Sciences & Biomedicine
Abstract

Aims There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology. Methods We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as “recommended” or “discouraged” if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled “acceptable” (neither recommended nor discouraged). Results Seventy-two surgeons with a median (IQR) experience of 23 (14–30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15–36) and 40 (28–60) pHH-surgeries, respectively. After Delphi round 2, “recommended” strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified “discouraged” strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were “acceptable”. Conclusions This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.

Published
2023
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24. Contributors

Author

Abbas, Abbas E., primary, Adams, David B., additional, Aggarwal, Piyush, additional, Ahmed, Bestoun H., additional, Albanese, Craig, additional, Albert, Matthew R., additional, Ali, Abubaker, additional, Alicuben, Evan, additional, Allaix, Marco E., additional, Altman, Ashley, additional, Ando, Hisami, additional, Andolfi, Ciro, additional, Annamalai, Alagappan, additional, Asare, Elliot A., additional, Asti, Emanuele, additional, Auchincloss, Hugh G., additional, Babic, Benjamin, additional, Baker, Talia B., additional, Ball, Chad G., additional, Barbetta, Arianna, additional, Barlow, John M., additional, Barr, Justin, additional, Barreto, Juan Camilo, additional, Barry, Linda, additional, Beal, Eliza W., additional, Beard, Kristin Wilson, additional, Beck, David E., additional, Behrns, Kevin E., additional, Bellevue, Oliver C., additional, Bellorin-Marin, Omar E., additional, Bergman, Jacques, additional, Berry, James, additional, Besselink, Marc G.H., additional, Bharucha, Adil E., additional, Bilchik, Anton J., additional, Bildzukewicz, Nikolai A., additional, Bingham, Jason, additional, Birnbaum, Elisa, additional, Black, Sylvester M., additional, Blackmon, Shanda H., additional, Bleier, Joshua I.S., additional, Bodzin, Adam S., additional, Boland, C. Richard, additional, Bolton, John, additional, Bolton, Nathan, additional, Bonavina, Luigi, additional, Bonds, Morgan, additional, Bouwense, Stefan A.W., additional, Boys, Joshua A., additional, Bravo-Infante, Raquel, additional, Bremner, Ross M., additional, Brenner, Bruce M., additional, Brown, Shaun R., additional, Callery, Mark P., additional, Cameron, John L., additional, Camilleri, Michael, additional, Campbell, Jacob, additional, Cassim, Riaz, additional, Castillo-Angeles, Manuel, additional, Cauley, Christy, additional, Cavaness, Keith M., additional, Cerfolio, Robert J., additional, Champagne, Bradley J., additional, Chandrasoma, Parakrama, additional, Chang, Alex L., additional, Chapman, Christopher G., additional, Chapman, William C., additional, Cheek, Susannah, additional, Chen, Harvey S., additional, Cho, Clifford S., additional, Choi, Eric T., additional, Choi, Eugene A., additional, Chojnacki, Karen A., additional, Choti, Michael A., additional, Christie, Ian, additional, Chua, Heidi, additional, Church, James M., additional, Cioffi, Jessica L., additional, Clark, Susannah, additional, Clavien, Pierre-Alain, additional, Cloud, Adam, additional, Colavita, Paul D., additional, Colquhoun, Steven D., additional, Conway, William, additional, Cools-Lartigue, Jonathan, additional, Coosemans, Willy, additional, Cornwell, Edward E., additional, Costantini, Mario, additional, Coyle, Yvonne, additional, Craig, Daniel A., additional, Croome, Kristopher P., additional, Cullen, Joseph J., additional, D'Andrea, Anthony P., additional, Dassopoulos, Themistocles, additional, Davila, Marta L., additional, Davila, Raquel E., additional, DeMeester, Steven R., additional, DeMeester, Tom R., additional, Dempsey, Daniel T., additional, dePrisco, Gregory, additional, Depypere, Lieven, additional, Dietz, David W., additional, Dillhoff, Mary E., additional, DiNorcia, Joseph, additional, Doane, Stephen M., additional, Dogeas, Epameinondas, additional, Dozois, Eric J., additional, Dumon, Kristoffel, additional, Dunn, Stephen P., additional, Dunst, Christy M., additional, Dussel, John N., additional, Dyer, Matthew, additional, Efron, Jonathan, additional, El-Gohary, Yousef, additional, Lakis, Mustapha El, additional, Ellison, E. Christopher, additional, Ellsmere, James, additional, Essani, Rahila, additional, Evans, Douglas B., additional, Fang, Sandy H., additional, Fasen, Geoffrey, additional, Fernando, Hiran C., additional, Ferri, Lorenzo, additional, Fichera, Alessandro, additional, Finck, Christine, additional, Fisher, Oliver M., additional, Fleshman, James W., additional, Fong, Yuman, additional, Foreman, Michael L., additional, Francone, Todd D., additional, Franko, Edward R., additional, French, Daniel, additional, Fuchs, Hans Friedrich, additional, Fuchs, Karl Hermann, additional, Funaki, Brian, additional, Funk, Geoffrey A., additional, Fusco, Joseph, additional, Gaitonde, Shrawan G., additional, Gajjar, Aakash H., additional, Garcia-Aguilar, Julio, additional, Gearhart, Susan, additional, Geller, David A., additional, Ghobadi, Comeron, additional, Gilbert, Sebastien, additional, Giles, David, additional, Gillaspie, Erin, additional, Girotti, Micah, additional, Gittes, George K., additional, Goodman, Michael D., additional, Gooszen, Hein G., additional, Gores, Gregory J., additional, Griffin, James F., additional, Griffin, S. Michael, additional, Grimm, Leander, additional, Grochola, L.F., additional, Habib, Fahim, additional, Hanks, John B., additional, Harris, James E., additional, Hartwig, Matthew G., additional, Hassan, Imran, additional, Hedrick, Traci L., additional, Hicks, Terry C., additional, Hodin, Richard, additional, Hofstetter, Wayne L., additional, Hogg, Melissa, additional, Hu, Yue-Yung, additional, Hungness, Eric S., additional, Hunt, Steven R., additional, Huseynova, Khumara, additional, Hyman, Neil H., additional, Iannitti, David A., additional, Indes, Jeffrey, additional, Jenkins, Megan, additional, Jensen, Todd, additional, Jeziorczak, Paul M., additional, Jilani, Danial, additional, Jiménez-Toscano, Marta, additional, Jobe, Blair A., additional, Johnston, Lily E., additional, Kahrilas, Peter J., additional, Kalady, Matthew F., additional, Kassira, Noor, additional, Katkhouda, Namir, additional, Katz, Philip O., additional, Keller, Deborah S., additional, Kelley, Matthew P., additional, Kennedy, Gregory D., additional, Kent, Tara Sotsky, additional, Kia, Leila, additional, Kibbe, Melina R., additional, Kim, John, additional, King, Alice, additional, Kiran, Ravi P., additional, Kirton, Orlando C., additional, Klein, Andrew, additional, Klein, Eric N., additional, Kohn, Geoffrey P., additional, Kovell, Robert Caleb, additional, Kozol, Robert, additional, Lacy, Antonio M., additional, Ladner, Daniela P., additional, Lagarde, S.M., additional, Laituri, Carrie A., additional, Landmann, Alessandra, additional, Lee, Janet T., additional, Lee, Lawrence L., additional, Leinicke, Jennifer A., additional, Lerut, Toni, additional, Levi, David M., additional, Li, Chao, additional, Liang, Yu, additional, Lichliter, Andrew H., additional, Lichliter, Warren E., additional, Lightner, Amy L., additional, Lile, Deacon J., additional, Lillemoe, Keith D., additional, Lin, Jules, additional, Lin, Shu S., additional, Lipham, John C., additional, Litle, Virginia R., additional, Lodhia, Nayna A., additional, Longo, Walter E., additional, Lord, Reginald V.N., additional, Louie, Brian E., additional, Low, Donald E., additional, Lowe, Val J., additional, Luc, Jessica G.Y., additional, Luketich, James D., additional, Ma, Yanling, additional, MacCarty, Robert L., additional, MacDonald, Blair, additional, Madoff, Robert D., additional, Magge, Deepa, additional, Maheshwari, Anurag, additional, Mahmoud, Najjia N., additional, Mahvi, David A., additional, Mahvi, David M., additional, Mak, Grace Z., additional, Mansfield, Sara A., additional, Manzano, Maricarmen, additional, Maron, David J., additional, Mathew, Melvy S., additional, Mathis, Kellie L., additional, Matthews, Jeffrey B., additional, McFadden, David W., additional, Merchea, Amit, additional, Messaris, Evangelos, additional, Miller, Daniel L., additional, Miller, Heidi J., additional, Millis, J. Michael, additional, Mittal, Sumeet K., additional, Molena, Daniela, additional, Montgomery, Stephanie C., additional, Moore, Ryan, additional, Morgan, Katherine A., additional, Mortenson, Melinda M., additional, Mulholland, Michael W., additional, Mulvihill, Michael S., additional, Mutch, Matthew, additional, Nafteux, Philippe Robert, additional, Nagaraju, Arun, additional, Nagorney, David M., additional, Nathan, Hari, additional, Natoli, Karen R., additional, Navuluri, Rakesh, additional, Nissen, Nicholas N., additional, Nobel, Tamar B., additional, Noordman, B.J., additional, Norton, Jeffrey A., additional, Novitsky, Yuri W., additional, Nussbaum, Michael S., additional, Nyberg, Scott L., additional, Oelschlager, Brant K., additional, Oh, Daniel S., additional, Otero-Piñeiro, Ana, additional, Oto, Aytekin, additional, Pachter, H. Leon, additional, Paidas, Charles N., additional, Palazzo, Francesco, additional, Paniccia, Alessandro, additional, Papaconstantinou, Harry T., additional, Pappas, Theodore N., additional, Pappou, Emmanouil P., additional, Parikh, Manish, additional, Paruch, Jennifer L., additional, Patel, Asish D., additional, Patel, Mikin, additional, Patti, Marco G., additional, Paulson, Emily Carter, additional, Pawlik, Timothy M., additional, Payne, Isaac, additional, Pemberton, John H., additional, Pendola, Michael, additional, Perez, Alexander, additional, Pernar, Luise I.M., additional, Peters, Walter R., additional, Petrowsky, Henrik, additional, Peyre, Christian G., additional, Phillips, Alexander W., additional, Pillai, Lashmikumar, additional, Plummer, Joseph M., additional, Pointer, David T., additional, Poruk, Katherine E., additional, Posner, Mitchell C., additional, Postier, Russell, additional, Prachand, Vivek N., additional, Pritts, Timothy A., additional, Quatrino, Gregory, additional, Ranka, Sagar, additional, Rattner, David W., additional, Reavis, Kevin M., additional, Reddy, Vikram B., additional, Remzi, Feza H., additional, Ricciardi, Rocco, additional, Rice, Thomas W., additional, Richman, Aaron, additional, Rider, Paul, additional, Roberts, John Paul, additional, Roberts, Patricia L., additional, Roggin, Kevin K., additional, Roll, Garrett Richard, additional, Rona, Kais, additional, Rosen, Charles B., additional, Ross, Samuel Wade, additional, Roth, J. Scott, additional, Rushing, Amy P., additional, Safar, Bashar, additional, Saldinger, Pierre F., additional, Samakar, Kamran, additional, Sandhu, Kulmeet K., additional, Schaheen, Lara W., additional, Schirmer, Bruce, additional, Schneider, Andrew, additional, Schulick, Richard D., additional, Schwab, Ben, additional, Scurci, Stephanie, additional, Senagore, Anthony, additional, Shah, Adil A., additional, Shah, Shimul A., additional, Shames, Brian, additional, Shanmugan, Skandan, additional, Shapiro, David S., additional, Silviera, Matthew, additional, Slakey, Douglas P., additional, Sloan, Joshua, additional, Smallwood, Nathan, additional, Smith, Shane P., additional, Smithers, B. Mark, additional, Smoot, Rory L., additional, Soares, Kevin C., additional, Soffer, Edy, additional, Solomina, Julia, additional, Soper, Nathaniel J., additional, Spechler, Stuart Jon, additional, Sridhar, Praveen, additional, Steele, Scott R., additional, Sternbach, Joel M., additional, Stevenson, Christina E., additional, Strong, Scott A., additional, Sucandy, Iswanto, additional, Sundaram, Magesh, additional, Sundaresan, Sudhir, additional, Swanstrom, Lee L., additional, Sylla, Patricia, additional, Takada, Tadahiro, additional, Talbot, Ethan, additional, Tam, Vernissia, additional, Tamm, Eric P., additional, Tatarian, Talar, additional, Tavakkoli, Ali, additional, Te, Helen S., additional, Teitelbaum, Ezra N., additional, Ternent, Charles A., additional, Thompson, Jon S., additional, Thomson, Iain, additional, Thorson, Alan G., additional, Thorson, Chad M., additional, Totten, Crystal F., additional, Truty, Mark J., additional, Tsai, Susan, additional, Tseng, Jennifer, additional, Tullius, Tom, additional, Tzakis, Andreas G., additional, van Lanschot, J.J.B., additional, van Santvoort, Hjalmar C., additional, Van Veer, Hans, additional, Vega, Jorge A., additional, Velanovich, Vic, additional, Vogler, Sarah A., additional, Wang, Huamin, additional, Ward, Mark A., additional, Warner, Brad W., additional, Warner, Susanne G., additional, Watson, Thomas J., additional, Waxman, Irving, additional, Webster-Lake, Carissa, additional, Wei, Benjamin, additional, Weiser, Martin R., additional, Wells, Dennis, additional, Wells, Katerina, additional, Welton, Mark Lane, additional, Wen, Yuxiang, additional, Wendling, Mark R., additional, Wesson, Hadley K.H., additional, Wexner, Steven D., additional, White, Rebekah R., additional, Whitlow, Charles B., additional, Wijnhoven, B.P.L., additional, Wilkes, Justin, additional, Wilson, Rickesha L., additional, Witkowski, Piotr, additional, Wolfgang, Christopher L., additional, Worrell, Stephanie G., additional, Yang, Jian, additional, Yeo, Charles J., additional, Yeung, Ching, additional, Yung, Evan E., additional, Zafar, Syed Nabeel, additional, Zaninotto, Giovanni, additional, Zeh, Herbert, additional, Zehetner, Joerg, additional, Zenilman, Michael E., additional, Zimmerman, Pamela, additional, and Zuccaro, Gregory, additional

Published
2019
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25. Management of paraesophageal hiatus hernia:recommendations following a European expert Delphi consensus

Author

Gerdes, Stephan, Schoppmann, Sebastian F., Bonavina, Luigi, Boyle, Nicholas, Müller-Stich, Beat P., Gutschow, Christian A., Gisbertz, Suzanne Sarah, Köckerling, Ferdinand, Lehmann, Thorsten G., Lorenz, Dietmar, Granderath, Frank Alexander, Rosati, Riccardo, Wullstein, Christoph, Lundell, Lars, Cheong, Edward, Nafteux, Philippe, Olmi, Stefano, Mönig, Stefan, Biebl, Matthias, Leers, Jessica, Zehetner, Joerg, Kristo, Ivan, Berrisford, Richard George, Skrobić, Ognjan M., Simić, Aleksandar P., Pera, Manuel, Grimminger, Peter Philipp, Gockel, Ines, Zarras, Konstantinos, Nieuwenhuijs, Vincent Bernard, Gossage, James A., van Berge Henegouwen, Mark i., Stein, Hubert J., Markar, Sheraz R., Hueting, Willem Eduard, Targarona, Eduardo M., Johansson, Jan, Macaulay, Graeme D., Wijnhoven, Bas P.L., Benedix, Frank, Attwood, Stephen E., Hölscher, Arnulf Heinrich, Priego, Pablo, Fuchs, Karl Hermann, Luyer, Misha D.P., Griffiths, Ewen A., Søvik, Torgeir Thorson, Theodorou, Dimitrios, Sgromo, Bruno, Salo, Jarmo A., Gerdes, Stephan, Schoppmann, Sebastian F., Bonavina, Luigi, Boyle, Nicholas, Müller-Stich, Beat P., Gutschow, Christian A., Gisbertz, Suzanne Sarah, Köckerling, Ferdinand, Lehmann, Thorsten G., Lorenz, Dietmar, Granderath, Frank Alexander, Rosati, Riccardo, Wullstein, Christoph, Lundell, Lars, Cheong, Edward, Nafteux, Philippe, Olmi, Stefano, Mönig, Stefan, Biebl, Matthias, Leers, Jessica, Zehetner, Joerg, Kristo, Ivan, Berrisford, Richard George, Skrobić, Ognjan M., Simić, Aleksandar P., Pera, Manuel, Grimminger, Peter Philipp, Gockel, Ines, Zarras, Konstantinos, Nieuwenhuijs, Vincent Bernard, Gossage, James A., van Berge Henegouwen, Mark i., Stein, Hubert J., Markar, Sheraz R., Hueting, Willem Eduard, Targarona, Eduardo M., Johansson, Jan, Macaulay, Graeme D., Wijnhoven, Bas P.L., Benedix, Frank, Attwood, Stephen E., Hölscher, Arnulf Heinrich, Priego, Pablo, Fuchs, Karl Hermann, Luyer, Misha D.P., Griffiths, Ewen A., Søvik, Torgeir Thorson, Theodorou, Dimitrios, Sgromo, Bruno, and Salo, Jarmo A.

Abstract

Aims: There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology. Methods: We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as “recommended” or “discouraged” if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled “acceptable” (neither recommended nor discouraged). Results: Seventy-two surgeons with a median (IQR) experience of 23 (14–30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15–36) and 40 (28–60) pHH-surgeries, respectively. After Delphi round 2, “recommended” strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified “discouraged” strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were “acceptable”. Conclusions: This multina

Published
2023

26. Counter-regulatory responses to postprandial hypoglycaemia in patients with post-bariatric hypoglycaemia vs surgical and non-surgical control individuals

Author

Tripyla, Afroditi; https://orcid.org/0000-0002-6096-0009, Herzig, David; https://orcid.org/0000-0003-1028-9445, Reverter-Branchat, Gemma; https://orcid.org/0000-0003-1902-9973, Pavan, Jacopo; https://orcid.org/0000-0002-0602-6565, Schiavon, Michele; https://orcid.org/0000-0003-0590-2399, Eugster, Philippe J; https://orcid.org/0000-0002-0197-6318, Grouzmann, Eric; https://orcid.org/0000-0002-3224-2536, Nakas, Christos T; https://orcid.org/0000-0003-4155-722X, Sauvinet, Valérie; https://orcid.org/0000-0002-6273-9498, Meiller, Laure; https://orcid.org/0000-0002-9702-8899, Zehetner, Joerg; https://orcid.org/0000-0001-6530-8012, Giachino, Daniel; https://orcid.org/0000-0002-2071-1091, Nett, Philipp; https://orcid.org/0000-0002-6847-9092, Gawinecka, Joanna; https://orcid.org/0000-0003-3859-0934, Del Favero, Simone; https://orcid.org/0000-0002-8214-2752, Thomas, Andreas; https://orcid.org/0000-0003-1199-0743, Thevis, Mario; https://orcid.org/0000-0002-1535-6451, Dalla Man, Chiara; https://orcid.org/0000-0002-4908-0596, Bally, Lia; https://orcid.org/0000-0003-1993-7672, Tripyla, Afroditi; https://orcid.org/0000-0002-6096-0009, Herzig, David; https://orcid.org/0000-0003-1028-9445, Reverter-Branchat, Gemma; https://orcid.org/0000-0003-1902-9973, Pavan, Jacopo; https://orcid.org/0000-0002-0602-6565, Schiavon, Michele; https://orcid.org/0000-0003-0590-2399, Eugster, Philippe J; https://orcid.org/0000-0002-0197-6318, Grouzmann, Eric; https://orcid.org/0000-0002-3224-2536, Nakas, Christos T; https://orcid.org/0000-0003-4155-722X, Sauvinet, Valérie; https://orcid.org/0000-0002-6273-9498, Meiller, Laure; https://orcid.org/0000-0002-9702-8899, Zehetner, Joerg; https://orcid.org/0000-0001-6530-8012, Giachino, Daniel; https://orcid.org/0000-0002-2071-1091, Nett, Philipp; https://orcid.org/0000-0002-6847-9092, Gawinecka, Joanna; https://orcid.org/0000-0003-3859-0934, Del Favero, Simone; https://orcid.org/0000-0002-8214-2752, Thomas, Andreas; https://orcid.org/0000-0003-1199-0743, Thevis, Mario; https://orcid.org/0000-0002-1535-6451, Dalla Man, Chiara; https://orcid.org/0000-0002-4908-0596, and Bally, Lia; https://orcid.org/0000-0003-1993-7672

Abstract

Aims/hypothesis Post-bariatric hypoglycaemia is an increasingly recognised complication of bariatric surgery, manifesting particularly after Roux-en-Y gastric bypass. While hyperinsulinaemia is an established pathophysiological feature, the role of counter-regulation remains unclear. We aimed to assess counter-regulatory hormones and glucose fluxes during insulin-induced postprandial hypoglycaemia in patients with post-bariatric hypoglycaemia after Roux-en-Y gastric bypass vs surgical and non-surgical control individuals. Methods In this case–control study, 32 adults belonging to four groups with comparable age, sex and BMI (patients with post-bariatric hypoglycaemia, Roux-en-Y gastric bypass, sleeve gastrectomy and non-surgical control individuals) underwent a postprandial hypoglycaemic clamp in our clinical research unit to reach the glycaemic target of 2.5 mmol/l 150–170 min after ingesting 15 g of glucose. Glucose fluxes were assessed during the postprandial and hypoglycaemic period using a dual-tracer approach. The primary outcome was the incremental AUC of glucagon during hypoglycaemia. Catecholamines, cortisol, growth hormone, pancreatic polypeptide and endogenous glucose production were also analysed during hypoglycaemia. Results The rate of glucose appearance after oral administration, as well as the rates of total glucose appearance and glucose disappearance, were higher in both Roux-en-Y gastric bypass groups vs the non-surgical control group in the early postprandial period (all p<0.05). During hypoglycaemia, glucagon exposure was significantly lower in all surgical groups vs the non-surgical control group (all p<0.01). Pancreatic polypeptide levels were significantly lower in patients with post-bariatric hypoglycaemia vs the non-surgical control group (median [IQR]: 24.7 [10.9, 38.7] pmol/l vs 238.7 [186.3, 288.9] pmol/l) (p=0.005). Other hormonal responses to hypoglycaemia and endogenous glucose production did not significantly differ between the group

Published
2023

28. Esophageal and gastric malignancies after bariatric surgery: a retrospective global study

Author

Chetan Parmar, Roxanna Zakeri, Mohamed Abouelazayem, Thomas H. Shin, Ali Aminian, Tala Mahmoud, Barham K. Abu Dayyeh, Melissa Y. Wee, Laura Fischer, Freek Daams, Kamal Mahawar, Carlos Sosa Gallardo, Cataldo Agustin, Fernando Wright, Ignacio Fuente, Miguel Carbajo, Patricio Cal, Jacob Chisholm, Lilian Kow, Michael H.L. Tan, Philip Gan, Sivakumar Gananadha, Daniel M. Felsenreich, Gerhard Prager, Chris Matthys, Jacques M. Himpens, Marc A.M.R.M. Focquet, Almino Ramos, Manoel Galvano Nato, Thiago Vidal, Amin Andalib, Aya Siblini, Lorenzo Ferri, Lina Abdarabo, Yehonatan Nevo, Radu Pescarus, Wah Yang, Hosam Hamed, Arnaud Liagre, Damien Bergeat, De Montrichard Marie, Francesco Martini, François Regis, Laurent Genser, Mehdi Skalli, Marius Nedelcu, Milan Smejkal, Radwan Kassir, Regenet Nicolas, Christine Stier, Dan-Sebastian Nedelcut, Grigorios Christodoulidis, Amar Vennapusa, Mohammad Kermansaravi, Asnat Raziel, Nasser Sakran, Alberto Oldani, Cristian Eugeniu Boru, Fouzia Mécheri, Francesca Ciccarese, Giovanni Carlo Cesana, Mario Musella, Matteo Uccelli, Mirto Foletto, Pasquale Auricchio, Stefano Olmi, Yosuke Seki, Anne Kasteleijn, Gerhard Van 'T Hof, Jan A. Apers, Judith W.H. Hart, Justin S.L. Van De Sande, Marijn Takkenberg, Pierre B.G.M. Feskens, Rob Snoekx, Victor D. Plat, Jorunn Sandvik, Piotr Kalinowski, Celso Nabais, Ahmed Z. Al-Bahrani, Mohammad Al Zoubi, Carla Bettonica, Javier Osorio, Javier Tejedor-Tejada, Lourdes M. Sanz, Marta Cuadrado, Rajesh Gianchandani Moorjani, Fringeli Yannick, Michel Suter, Yves Borbély, Zehetner Joerg, Juan S. Barajas-Gamboa, Matthew Kroh, Aaron P. Kisiel, Anna Kamocka, Arul Immanuel, Bruno Sgromo, Bussa Gopinath, David Khoo, Samrat Mukherjee, Dimitrios Pournaras, Tim Underwood, Ewen A. Griffiths, Glenn V. Miller, Helen Jaretzke, Jan Dmitrewski, Martin S. Wadley, Ragad Al-Housni, Richard S. Gillies, Rishi Singhal, Shaun R. Preston, Steven John Robinson, William J. Hawkins, Marco Adamo, Mohamed El Kalaawy, James Gossage, Christopher B. Crawford, Veeravich Jaruvongvanich, Parmar, C., Zakeri, R., Abouelazayem, M., Shin, T. H., Aminian, A., Mahmoud, T., Abu Dayyeh, B. K., Wee, M. Y., Fischer, L., Daams, F., Mahawar, K., Gallardo, C. S., Agustin, C., Wright, F., Fuente, I., Carbajo, M., Cal, P., Chisholm, J., Kow, L., Tan, M. H. L., Gan, P., Gananadha, S., Felsenreich, D. M., Prager, G., Matthys, C., Himpens, J. M., Focquet, M. A. M. R. M., Ramos, A., Nato, M. G., Vidal, T., Andalib, A., Siblini, A., Ferri, L., Abdarabo, L., Nevo, Y., Pescarus, R., Yang, W., Hamed, H., Liagre, A., Bergeat, D., Marie, D. M., Martini, F., Regis, F., Genser, L., Skalli, M., Nedelcu, M., Smejkal, M., Kassir, R., Nicolas, R., Stier, C., Nedelcut, D. -S., Christodoulidis, G., Vennapusa, A., Kermansaravi, M., Raziel, A., Sakran, N., Oldani, A., Boru, C. E., Mecheri, F., Ciccarese, F., Cesana, G. C., Musella, M., Uccelli, M., Foletto, M., Auricchio, P., Olmi, S., Seki, Y., Kasteleijn, A., Van 'T Hof, G., Apers, J. A., Hart, J. W. H., Van De Sande, J. S. L., Takkenberg, M., Feskens, P. B. G. M., Snoekx, R., Plat, V. D., Sandvik, J., Kalinowski, P., Nabais, C., Al-Bahrani, A. Z., Al Zoubi, M., Bettonica, C., Osorio, J., Tejedor-Tejada, J., Sanz, L. M., Cuadrado, M., Moorjani, R. G., Yannick, F., Suter, M., Borbely, Y., Joerg, Z., Barajas-Gamboa, J. S., Kroh, M., Kisiel, A. P., Kamocka, A., Immanuel, A., Sgromo, B., Gopinath, B., Khoo, D., Mukherjee, S., Pournaras, D., Underwood, T., Griffiths, E. A., Miller, G. V., Jaretzke, H., Dmitrewski, J., Wadley, M. S., Al-Housni, R., Gillies, R. S., Singhal, R., Preston, S. R., Robinson, S. J., Hawkins, W. J., Adamo, M., El Kalaawy, M., Gossage, J., Crawford, C. B., Jaruvongvanich, V., Surgery, CCA - Cancer Treatment and quality of life, Amsterdam Gastroenterology Endocrinology Metabolism, and Plastic, Reconstructive and Hand Surgery

Subjects
Adult, obesity, Sleeve gastrectomy, medicine.medical_specialty, Palliative treatment, bariatric surgery, esophageal cancer, esophagogastric cancer, gtastric cancer, metabolic surgery, adult, female, gastrectomy, humans, middle aged, retrospective studies, treatment outcome, gastric bypass, morbid, stomach neoplasms, medicine.medical_treatment, Esophageal cancer, Esophagogastric cancer, Population, Gastric Bypass, Bariatric Surgery, Gastrectomy, Stomach Neoplasms, medicine, Humans, In patient, Adjustable gastric band, education, Retrospective Studies, Bariatric surgery, education.field_of_study, business.industry, Cancer, Middle Aged, medicine.disease, Obesity, Obesity, Morbid, Surgery, Treatment Outcome, Adenocarcinoma, Female, Metabolic surgery, Gastric cancer, business
Abstract

Background Bariatric surgery can influence the presentation, diagnosis, and management of gastrointestinal cancers. Oesophago-Gastric (OG) malignancies in patients who have had a prior bariatric procedure have not been fully characterised. Objective To characterise OG malignancies after bariatric procedures. Setting University Hospital, United Kingdom. Methods We performed a retrospective, multi-centre observational study of patients with OG malignancies after bariatric surgery to characterise this condition. Results This study includes 170 patients from 75 centres in 25 countries who underwent bariatric procedures between 1985 and 2020. At the time of the bariatric procedure, the mean age was 50.2 ± 10 years and the mean weight 128.8 ± 28.9 kg. Females comprised 57.3% (n=98) of the population. Most (n=64) patients underwent a Roux-en-Y Gastric Bypass (RYGB) followed by Adjustable Gastric Band (AGB) (n = 46) and Sleeve Gastrectomy (SG) (n = 43). Time to cancer diagnosis after bariatric surgery was 9.5 ± 7.4 years and mean weight at diagnosis was 87.4 ± 21.9 kg. The time lag was 5.9 ± 4.1 years after SG compared to 9.4 ± 7.1 years after RYGB and 10.5 ± 5.7 years after AGB. One-third of patients presented with metastatic disease. The majority of tumours were adenocarcinoma (82.9%). Approximately 1 in 5 patients underwent palliative treatment from the outset. Time from diagnosis to mortality was under one year for most patients who died over the intervening period. Conclusions The OGMOS (Oesophago-Gastric Malignancies after Obesity/ Bariatric Surgery) study presents the largest series to date of patients developing OG malignancies after bariatric surgery and attempts to characterise this condition.

Published
2022
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31. Effect of gastric ischemic conditioning prior to esophagectomy: systematic review and meta-analysis.

Author

Aiolfi, Alberto, Bona, Davide, Bonitta, Gianluca, Bonavina, Luigi, Cayre, Luigi, Gutschow, Christian A., Lipham, John, Manara, Michele, Popa, Călin, Rausa, Emanuele, Schlanger, Diana, Schoppmann, Sebastian, Simić, Aleksandar, Sozzi, Andrea, and Zehetner, Joerg

Abstract

Ischemia at the anastomotic site is thought to be a protagonist in the development of anastomosis-related complications while different strategies to overcome this problem have been reported. Gastric ischemic conditioning (GIC) prior to esophagectomy has been described with this intent. Evaluate the effect of GIC on anastomotic complications after esophagectomy. Scopus, Web of Science, MEDLINE, and PubMed were investigated up to March 31st, 2023. We considered articles that appraised short-term outcomes after GIC vs. no GIC in patients undergoing esophagectomy. Anastomotic leak (AL), anastomotic stricture (AS), and gastric conduit necrosis (GCN) were primary outcomes. Risk ratio (RR) and standardized mean difference (SMD) were used as pooled effect size measures, whereas 95% confidence intervals (95% CIs) were used to calculate related inference. Fourteen studies (1760 patients) were included. Of those, 732 (41.6%) underwent GIC, while 1028 (58.4%) underwent one-step esophagectomy. Compared with no GIC, GIC was related to a reduced RR for AL (R RR = 0.63; 95% CI 0.47–0.86; p < 0.01) and AS (RR = 0.51; 95% CI 0.29–0.91; p = 0.02), whereas no differences were found for GCN (RR = 0.56; 95% CI 0.19–1.61; p = 0.28). Postoperative pneumonia (RR = 1.09; p = 0.99), overall complications (RR = 0.87; p = 0.19), operative time (SMD − 0.58; p = 0.07), hospital stay (SMD 0.66; p = 0.09), and 30-day mortality (RR = 0.69; p = 0.22) were comparable. GIC prior to esophagectomy seems associated with a reduced risk for AL and AS. Further studies are necessary to identify the subset of patients who can benefit from this procedure, the optimal technique, and the timing of GIC prior to esophagectomy. [ABSTRACT FROM AUTHOR]

Published
2023
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32. Cholecystolithiasis – Update 2006

Author

Zehetner, Jörg, Shamiyeh, Andreas, Wayand, Wolfgang, Neugebauer, E.A.M., editor, Sauerland, S., editor, Fingerhut, A., editor, Millat, B., editor, and Buess, G., editor

Published
2006
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39. 159-OR: Endocrine and Metabolic Counterregulation to Standardized Postprandial Hypoglycemia after Bariatric Surgery

Author

TRIPYLA, AFRODITI, primary, HERZIG, DAVID, additional, BRANCHAT, GEMMA REVERTER, additional, PAVAN, JACOPO, additional, SCHIAVON, MICHELE, additional, EUGSTER, PHILIPPE J., additional, GROUZMANN, ERIC, additional, NAKAS, CHRISTOS T., additional, VALÉRIE, SAUVINET, additional, ZEHETNER, JOERG, additional, GIACHINO, DANIEL, additional, DEL FAVERO, SIMONE, additional, THOMAS, ANDREAS, additional, THEVIS, MARIO, additional, MAN, CHIARA DALLA, additional, and BALLY, LIA, additional

Published
2022
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