Dan Eisenberg

All Publications

• A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration. Journal of general internal medicine Funk, L. M., Gunnar, W., Dominitz, J. A., Eisenberg, D., Frayne, S., Maggard-Gibbons, M., Kalarchian, M. A., Livingston, E., Sanchez, V., Smith, B. R., WEIDENBACHER, H., Maciejewski, M. L. 2017

  Abstract

  In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA's capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.

  View details for DOI 10.1007/s11606-016-3951-4

  View details for PubMedID 28271434

• ASMBS Position Statement on Postprandial Hyperinsulinemic H ypoglycemia after Bariatric Surgery SURGERY FOR OBESITY AND RELATED DISEASES Eisenberg, D., Azagury, D. E., Ghiassi, S., Grover, B. T., Kim, J. J. 2017; 13 (3): 371-378

  View details for DOI 10.1016/j.soard.2016.12.005

  View details for Web of Science ID 000398016500001

• Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center. Surgery for obesity and related diseases Eisenberg, D., Lohnberg, J. A., Kubat, E. P., Bates, C. C., Greenberg, L. M., Frayne, S. M. 2016

  Abstract

  Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers.To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management.This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey.Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m(2) (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively).The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts.

  View details for DOI 10.1016/j.soard.2016.11.007

  View details for PubMedID 28089437

• Osteoarthritis in veterans undergoing bariatric surgery is associated with decreased excess weight loss: 5-year outcomes. Surgery for obesity and related diseases Kubat, E., Giori, N. J., Hwa, K., Eisenberg, D. 2016; 12 (7): 1426-1430

  Abstract

  Obesity exacerbates pre-existing musculoskeletal disease and joint pain. This may limit physical activity in obese individuals.We sought to identify the disease burden and impact of osteoarthritis of the lumbar back, hip, knee, and ankle in veterans undergoing bariatric surgery.Veterans Affairs medical center.Retrospective review of a prospective bariatric database of operations performed at a single Veterans Affairs medical center. Patients with osteoarthritis of the lumbar spine, hip, knee, or ankle were identified and diagnosis confirmed by electronic health record review of prior radiographic reports. Analysis was performed using χ(2) test for continuous variables. Student's t test and one-way analysis of variance were used to compare qualitative variables.Of 254 bariatric surgical patients, 83.9% had preoperative musculoskeletal pain before bariatric surgery and 59.1% had a confirmed diagnosis of osteoarthritis of the lumbar spine, hips, knees, and/or ankles. Follow-up rate was 97.4%, 85.4%, and 82.6% at 1, 3, and 5 years respectively. Of patients with osteoarthritis, 58.6% had knee involvement and 46% had multiple sites involved. In the cohort without osteoarthritis, percent excess body mass index loss was 66.9% at 1 year versus 58.5% in the cohort with osteoarthritis (P = .009), 66.1% versus 51.9% (P = .001) at 3 years, and 64.3% versus 50.1% (P = .002) after 5 years. Percent total weight loss was 28.4% versus 25.2%, 28.0% versus 22.8%, and 27.1% versus 22.4%, respectively, at 1, 3, and 5 years.Osteoarthritis is common among veterans undergoing bariatric surgery. It is associated with significantly less weight loss compared to veterans who do not have osteoarthritis, up to 5 years after bariatric surgery.

  View details for DOI 10.1016/j.soard.2016.02.012

  View details for PubMedID 27260653

• Chemerin Activation in Human Obesity OBESITY Chang, S., Eisenberg, D., Zhao, L., Adams, C., Leib, R., Morser, J., Leung, L. 2016; 24 (7): 1522-1529

  Abstract

  Chemerin is an inflammatory adipokine, whose activity is regulated by successive proteolytic cleavages at its C-terminus. It is secreted as an inactive precursor (chem163S); cleavage at Lys158 converts it to chem158K with modest activity. Chem157S is the most potent form and chem155A is inactive. The aim of this study was to determine if chemerin was activated in samples from patients with obesity.Using specific ELISAs for different chemerin forms and a pan-chemerin ELISA, chemerin forms in human obesity were characterized.Plasma chemerin from patients with obesity (BMI 44.3 ± 1.3 kg/m(2) , n = 29) was significantly higher than in lean controls (BMI 20.9 ± 0.7 kg/m(2) , n = 10) (160 ± 11 vs. 76.2 ± 5.5 ng/mL, respectively, P < 0.0001). This increase in chemerin was due to increased previously unattributed chemerin, with further C-terminal truncation demonstrated by mass spectrometry, accounting for ∼35% of total plasma chemerin. Chemerin forms in adipose tissue showed a different profile, with minimal chem163S and significant levels of chem157S. Chem155A was present in omental but not in subcutaneous adipose tissue. Unattributed chemerin forms were undetectable in adipose tissue.Chemerin is activated in adipose tissue of subjects with obesity, and further C-terminal processing occurs during the disposition of chemerin from adipose tissue, resulting in substantial levels of novel degraded forms in plasma that correlate with obesity.

  View details for DOI 10.1002/oby.21534

  View details for Web of Science ID 000379303200017

  View details for PubMedID 27222113

• American Society for Metabolic and Bariatric Surgery position statement on accreditation of bariatric surgery centers endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons. Surgery for obesity and related diseases DeMaria, E. J., El Chaar, M., Rogers, A. M., Eisenberg, D., Kallies, K. J., Kothari, S. N. 2016; 12 (5): 946-954

  View details for DOI 10.1016/j.soard.2016.04.020

  View details for PubMedID 27317595

• Urgent and Elective Robotic Single-Site Cholecystectomy: Analysis and Learning Curve of 150 Consecutive Cases JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Kubat, E., Hansen, N., Nguyen, H., Wren, S. M., Eisenberg, D. 2016; 26 (3): 185-191

  View details for DOI 10.1089/lap.2015.0528

  View details for Web of Science ID 000372455000005

• American Society for Metabolic and Bariatric Surgery position statement on long-term survival benefit after metabolic and bariatric surgery SURGERY FOR OBESITY AND RELATED DISEASES Kim, J., Eisenberg, D., Azagury, D., Rogers, A., Campos, G. M. 2016; 12 (3): 453-459

  Abstract

  The following position statement has been issued by the American Society for Metabolic and Bariatric Surgery in response to numerous inquiries made to the Society by patients, physicians, society members, hospitals, health insurance payors, the media, and others regarding the benefit of metabolic and bariatric surgery on long-term survival. An overview of the current available published peer-reviewed scientific evidence is presented.

  View details for DOI 10.1016/j.soard.2015.11.021

  View details for Web of Science ID 000376223300001

  View details for PubMedID 26944548

• ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management SURGERY FOR OBESITY AND RELATED DISEASES Kim, J., Azagury, D., Eisenberg, D., DeMaria, E., Campos, G. M. 2015; 11 (4): 739-748

  View details for DOI 10.1016/j.soard.2015.05.001

  View details for Web of Science ID 000359329500001

  View details for PubMedID 26071849

• Standardized outcomes reporting in metabolic and bariatric surgery. Surgery for obesity and related diseases Brethauer, S. A., Kim, J., El Chaar, M., Papasavas, P., Eisenberg, D., Rogers, A., Ballem, N., Kligman, M., Kothari, S. 2015; 11 (3): 489-506

  View details for DOI 10.1016/j.soard.2015.02.003

  View details for PubMedID 26093765

• Standardized Outcomes Reporting in Metabolic and Bariatric Surgery OBESITY SURGERY Brethauer, S. A., Kim, J., El Chaar, M., Papasavas, P., Eisenberg, D., Rogers, A., Ballem, N., Kligman, M., Kothari, S. 2015; 25 (4): 587-606

  View details for DOI 10.1007/s11695-015-1645-3

  View details for Web of Science ID 000351771500001

  View details for PubMedID 25802064

• Telephone Follow-Up by a Midlevel Provider After Laparoscopic Inguinal Hernia Repair Instead of Face-to-Face Clinic Visit JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS Eisenberg, D., Hwa, K., Wren, S. M. 2015; 19 (1)

  View details for DOI 10.4293/JSLS.2014.00205

  View details for Web of Science ID 000368472200018

• Preoperative Change in 6-Minute Walk Distance Correlates With Early Weight Loss After Sleeve Gastrectomy JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS Hansen, N., Hardin, E., Bates, C., Bellatorre, N., Eisenberg, D. 2014; 18 (3)

  Abstract

  The 6-minute walk test (6MWT) is an objective preoperative measure of functional capacity and response to intervention in patients with heart or lung disease. In bariatric surgery, there has been no reliable preoperative measure predictive of postoperative success. Here we investigated the impact of bariatric surgery on changes in distance traveled in the 6MWT (the 6MWD) and whether preoperative changes in 6MWD correlated with weight change after surgery.This is a retrospective study of consecutive patients in which the 6MWT was performed before and after laparoscopic sleeve gastrectomy for weight loss. 6MWD and total weight were measured. Pearson correlation was used to determine association between variables.Of 100 patients who underwent laparoscopic sleeve gastrectomy, 31 patients had a preoperative 6MWT. Thirty patients (97%) were available for follow-up after surgery. Percentage of excess weight loss was 45.7% over an average of 7 months after surgery. There was a weak correlation between the postoperative weight loss and the change in preoperative and postoperative 6MWD (r = 0.28; P = .13). In a subset of patients who demonstrated a change in distance traveled in 2 separate preoperative 6MWD measurements (average 18.5% increase in distance), there was a strong correlation with postoperative weight loss (r = 0.82; P = .02).A demonstrated increase in 6MWD before surgery correlates strongly with early postoperative weight loss after laparoscopic sleeve gastrectomy. A multidisciplinary team that includes a physical therapist is useful in preparing bariatric patients for surgery.

  View details for DOI 10.4293/JSLS.2014.00383

  View details for Web of Science ID 000348437400070

  View details for PubMedID 25392673

• Innovation in Safety, and Safety in Innovation JAMA SURGERY Eisenberg, D., Wren, S. M. 2014; 149 (1): 7-9

  View details for DOI 10.1001/jamasurg.2013.5112

  View details for Web of Science ID 000330117300002

  View details for PubMedID 24352512

• Comparison of robotic and laparoendoscopic single-site surgery systems in a suturing and knot tying task SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Eisenberg, D., Vidovszky, T. J., Lau, J., Guiroy, B., Rivas, H. 2013; 27 (9): 3182-3186

  Abstract

  BACKGROUND: Laparoendoscopic single-site (LESS) surgery has been established for various procedures. Shortcomings of LESS surgery include loss of triangulation, instrument collisions, and poor ergonomics, making advanced laparoscopic tasks especially challenging. We compared a LESS system with a robotic single-site surgery platform in performance of a suturing and knot-tying task under clinically simulated conditions. METHODS: Each of five volunteer minimally invasive surgeons was tasked with suturing a 5 cm longitudinal enterotomy in porcine small intestine with square knots at either end, using a laparoendoscopic or da Vinci robotic single-site surgery platform, within a 20 min time limit. A saline leak test was then performed. Each surgeon performed the task twice using each system. The time to completion of the task and presence of a leak were noted. Fisher's exact test was used to compare the overall completion rate within the defined time limit, and a Wilcoxon rank test was used to compare the specific times to complete the task. A p value of <0.05 was considered significant. RESULTS: All surgeons were able to complete the task on the first try within 20 min using the robot system; 60 % of surgeons were able to complete it after two attempts using the LESS surgery system. Time to completion using the robot system was significantly shorter than the time using the standard LESS system (p < 0.0001). There were no leaks after closure with the robot system; the leak rate following the standard LESS system was 90 %. CONCLUSIONS: Surgeons demonstrated significantly better suturing and knot-tying capabilities using the robot single-site system compared to a standard LESS system. The robotic system has the potential to expand single-site surgery to more complex tasks.

  View details for DOI 10.1007/s00464-013-2874-y

  View details for Web of Science ID 000323621500016

  View details for PubMedID 23443484

• Biologic sealants: the next great thing in gastrointestinal surgery? journal of surgical research Eisenberg, D. 2013; 182 (1): 30-31

  View details for DOI 10.1016/j.jss.2012.03.002

  View details for PubMedID 22464395

• Sleeve Gastrectomy as a Stand-alone Bariatric Operation for Severe, Morbid, and Super Obesity JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS Eisenberg, D., Bellatorre, A., Bellatorre, N. 2013; 17 (1): 63-67

  Abstract

  The laparoscopic sleeve gastrectomy (LSG) is emerging as an effective bariatric operation and is especially attractive in high-risk populations. In this study we examine the efficacy of LSG as a stand-alone operation in the veteran population.This is a retrospective review of consecutive patients who underwent LSG as a stand-alone procedure at the Palo Alto Veterans Affairs medical center with a minimum 12-month follow-up.Of 205 patients undergoing bariatric surgery, 71 patients had a sleeve gastrectomy, 40 of whom had the operation performed at least 12 months previously. Thirty-six (90%) were available for 1-year follow-up, with a mean follow-up duration of 22 months (range: 12-42), a mean body mass index of 48.3 kg/m(2), and an 83% male population. Mean percent excess weight loss was 61% at an average of 22 months, with no significant difference between severely obese, morbidly obese, and super obese cohorts. Diabetes remission was seen in 56% of patients, hypertension remission in 51.6%, and obstructive sleep apnea remission in 46.4%, and gastroesophageal reflux disease improved or did not change in 83%. Medication use significantly decreased after surgery.LSG is safe and effective as a stand-alone bariatric operation in the high-risk veteran population. It is effective in severely obese, morbidly obese, and super obese patients. LSG induces remission or improvement in comorbidities of nearly all patients, translating to a decrease in medication use.

  View details for DOI 10.4293/108680812X13517013317077

  View details for Web of Science ID 000323043700009

  View details for PubMedID 23743373

• A prior history of substance abuse in veterans undergoing bariatric surgery. Journal of obesity Tedesco, M., Hua, W. Q., Lohnberg, J. A., Bellatorre, N., Eisenberg, D. 2013; 2013: 740312-?

  Abstract

  The rates of obesity and substance abuse are high among US veterans.To examine weight loss and substance abuse rates following bariatric surgery in veterans with a history of substance abuse (SA).A prospective database of consecutive bariatric operations was reviewed. Data for SA patients were compared to patients without a substance abuse history (NA). Behavioral medicine staff followed patients throughout the pre- and postoperative courses.Of 205 bariatric surgery patients, there were 74 (36.1%) SA patients. The mean preoperative body mass index (BMI) was 46.2 ± 8.1 kg/m², and percent excess weight loss at 12 months was 71.8%, 58.0%, and 33.5% for Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic gastric banding, respectively, not significantly different than the NA group (P = 0.15, 0.75, 0.96). Postoperative substance abuse in SA and NA patients was 8.1% and 1.5%, respectively (P = 0.234).A prior history of substance abuse is common in veterans undergoing bariatric surgery; weight loss results are comparable to the general veteran bariatric cohort. Rates of substance abuse are low postoperatively, but higher in patients without a prior history of substance abuse. Close multidisciplinary followup throughout the postoperative course is likely to be integral to the patient's success.

  View details for DOI 10.1155/2013/740312

  View details for PubMedID 23840947

• Concurrent Laparoscopic Morgagni Hernia Repair and Sleeve Gastrectomy JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Chiou, G., Tedesco, M., Eisenberg, D. 2012; 22 (10): 999-1002

  Abstract

  The Morgagni-type anterior diaphragmatic hernia is a congenital defect that is a very uncommon hernia presenting in an adult. Surgical repair is usually recommended upon diagnosis and often requires synthetic mesh for a durable, tension-free repair. The use of synthetic mesh concurrently with several of bariatric operations is controversial owing to the potential for mesh infection. In this report we describe a laparoscopic repair of a symptomatic Morgagni hernia with synthetic mesh, concurrently with sleeve gastrectomy, in a morbidly obese man. The patient was a 58-year-old man with a body mass index of 48 kg/m(2) and associated co-morbid conditions that included obstructive sleep apnea, hypertension, hyperlipidemia, impaired fasting glucose, and osteoarthritis. He was diagnosed with Morgagni hernia with exertional dyspnia. He underwent concurrent laparoscopic Morgagni hernia repair with mesh and sleeve gastrectomy. At 2 months after surgery the patient was doing well and tolerating solid foods, and his percentage excess weight loss was 35%. He was exercising regularly and had no exertional dyspnea. Laparoscopy is an attractive approach to performing multiple intra-abdominal procedures concurrently. The Morgagni hernia repair with mesh can be performed safely and effectively using a laparoscopic approach. This can be performed concurrently with bariatric surgery in the morbidly obese.

  View details for DOI 10.1089/lap.2012.0293

  View details for Web of Science ID 000312379900012

  View details for PubMedID 23067069

• Portal Vein Thrombosis Following Laparoscopic Sleeve Gastrectomy for Morbid Obesity JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS Rosenberg, J. M., Tedesco, M., Yao, D. C., Eisenberg, D. 2012; 16 (4): 639-643

  Abstract

  Portal vein thrombosis has been documented after laparoscopic general surgery and has been uncommonly observed after laparoscopic bariatric surgery. Among bariatric operations, the sleeve gastrectomy is being performed with ever-increasing frequency. Here we report the case of a man who presented with portal vein thrombosis after laparoscopic sleeve gastrectomy.A 41-y-old man underwent an uneventful laparoscopic sleeve gastrectomy for the treatment of morbid obesity, and presented on postoperative day 10 with nonfocal abdominal pain, nausea, vomiting, and leukocytosis. Computed tomography revealed portal vein thrombosis, which was found in the setting of Clostridium difficile colitis.Portal vein thrombosis may be identified with increasing frequency as the number of laparoscopic bariatric operations continues to increase. A high index of suspicion is necessary to diagnose this rare, but potentially lethal, complication.

  View details for DOI 10.4293/108680812X13517013316636

  View details for Web of Science ID 000314201800023

  View details for PubMedID 23484577

• Surgical Site Infections: Time to Modify the Wound Classification System? JOURNAL OF SURGICAL RESEARCH Eisenberg, D. 2012; 175 (1): 54-55

  View details for DOI 10.1016/j.jss.2011.07.025

  View details for Web of Science ID 000303472500016

  View details for PubMedID 21920549

• Short-term medication cost savings for treating hypertension and diabetes after gastric bypass SURGERY FOR OBESITY AND RELATED DISEASES Ghiassi, S., Morton, J., Bellatorre, N., Eisenberg, D. 2012; 8 (3): 269-274

  Abstract

  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.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.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).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.

  View details for DOI 10.1016/j.soard.2011.05.009

  View details for Web of Science ID 000304520900005

  View details for PubMedID 21723203

• Preoperative finding of gastric neuroendocrine tumor (gastric carcinoid) in a patient evaluated for bariatric surgery. Surgery for obesity and related diseases Perryman, S., Kaltenbach, T., Eisenberg, D. 2011; 7 (5): e18-20

  View details for DOI 10.1016/j.soard.2010.11.005

  View details for PubMedID 21233025

• Early postoperative outcomes and medication cost savings after laparoscopic sleeve gastrectomy in morbidly obese patients with type 2 diabetes. Journal of obesity Slater, B. J., Bellatorre, N., Eisenberg, D. 2011; 2011: 350523-?

  Abstract

  Background. We investigated the effect of laparoscopic sleeve gastrectomy (LSG) on morbidly obese diabetics and examined the short-term impact of LSG on diabetic medication cost. Methods. A prospective database of consecutive bariatric patients was reviewed. Morbidly obese patients with type 2 diabetes who underwent LSG were included in the study. Age, gender, body mass index (BMI), diabetic medication use, glucose, insulin, and HbA1c levels were documented preoperatively, and at 2 weeks, 2 months, 6 months, and 12 months postoperatively. Insulin resistance was estimated using the homeostatic model assessment (HOMA). Use and cost of diabetic medications were followed. Results. Of 178 patients, 22 were diabetics who underwent LSG. Diabetes remission was observed in 62% of patients within 2 months and in 75% of patients within 12 months. HOMA-IR improved after only two weeks following surgery (16.5 versus 6.6, P < 0.001). Average number of diabetic medications decreased from 2.2 to <1, within 2 weeks after surgery; corresponding to a diabetes medication cost savings of 80%, 91%, 99%, and 99.7% after 2 weeks, 2 months, 6 months, and 12 months, respectively. Conclusion. Morbidly obese patients with diabetes who undergo LSG have high rates of diabetes remission early after surgery. This translates to a significant medication cost savings.

  View details for DOI 10.1155/2011/350523

  View details for PubMedID 22187636

• Use of a flexible robotic transgastric natural orifice translumenal endoscopic surgery (NOTES) platform in a cadaver to test access, navigation, maneuverability, and stability SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Eisenberg, D., Storne, E., Belson, A. 2010; 24 (9): 2323-2323

  Abstract

  The advancement of natural orifice translumenal endoscopic surgery (NOTES) depends on the availability of a suitable platform. A 2008 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) Working Group identified access, navigation, maneuverability, and stability to withstand instrument forces as the essential requirements for a successful NOTES platform [1]. No single NOTES platform can adequately achieve all four of these key capabilities. In this study, the authors tested a novel flexible endoscopic robotic platform in a cadaver to determine how it performs with respect to these specific requirements.A highly maneuverable multichannel flexible robotic endoscopic platform developed for NOTES was used transgastrically in an adult cadaver to test the platform's ability to reach multiple intraabdominal targets. The device was under the control of the surgeon throughout the test. The surgeon was blinded to a control laparoscopic view. At each target organ, the platform was maneuvered via a joystick to provide different camera views and tool access orientation appropriate for the surgical tasks of each procedure. Standard endoscopic tools were used in the platform's two working channels to demonstrate the platform's ability to withstand the forces generated during tissue manipulation and clipping.The platform reached each target organ site without difficulty, relying on the endoscopic view only. The platform's unique ability to maintain stability in two- and three-dimensional space resisted forces exerted by tools in the tool channels used for tissue manipulation and clipping. Endoscopic visualization allowed the surgeon to reposition the platform easily to gain a different camera view or tool access orientation about an organ (see video in Supplementary material).The authors demonstrated that the four capabilities identified by NOSCAR can be provided by the flexible robotic endoscopic platform. These essential capabilities for the clinical implementation of NOTES were addressed specifically by this platform. The provision of these capabilities in a single device may further the advancement and adoption of NOTES.

  View details for DOI 10.1007/s00464-010-0905-5

  View details for Web of Science ID 000281776400043

  View details for PubMedID 20174943

• Post-traumatic stress disorder (PTSD) is not a contraindication to gastric bypass in veterans with morbid obesity SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Ikossi, D. G., Maldonado, J. R., Hernandez-Boussard, T., Eisenberg, D. 2010; 24 (8): 1892-1897

  Abstract

  The veteran population is routinely screened for post-traumatic stress disorder (PTSD). The prevalence of obesity in this population continues to increase. We examined whether weight loss outcomes in veterans with PTSD is comparable to results in veterans who do not suffer from PTSD, after gastric bypass. We also examined the effect of bariatric surgery on PTSD symptoms.This retrospective review of prospective data compares veterans with and without PTSD who underwent laparoscopic gastric bypass. Differences between the means of age, initial BMI, and percent excess weight loss were compared between the groups using a Student's t test. Pearson's chi(2) was used to evaluate the relationship between a diagnosis of PTSD, major depressive disorder (MDD), and other Axis I psychiatric disorders. A similar analysis was done to assess for a relationship between PTSD and obesity-related comorbidities, including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, and GERD.We identified 24 patients who had gastric bypass and a diagnosis of PTSD before surgery and compared them to those without PTSD. Both groups had a similar mean age and initial BMI. There was no significant difference between the percent excess weight lost after 1 year follow-up between the PTSD group (66%) and the non-PTSD group (72%) (p = 0.102). In assessing comorbid conditions, we found a significant association between the diagnosis of PTSD and MDD (p = 0.002), PTSD and other Axis I disorders (p = 0.004), and PTSD and GERD (p = 0.002). However, we saw no significant association between PTSD and DM (p = 0.977), HTN (p = 0.332), and obstructive sleep apnea (OSA) (p = 0.676). The severity of PTSD symptoms fluctuated in the postoperative period.Veterans with PTSD have comparable weight loss to those without PTSD after gastric bypass. In addition, surgery does not seem to have an adverse effect on PTSD symptoms, although PTSD symptomatology tends to fluctuate over time. Further study in this patient population is warranted.

  View details for DOI 10.1007/s00464-009-0866-8

  View details for Web of Science ID 000279488400015

  View details for PubMedID 20063014

• Does Preoperative Weight Change Predict Postoperative Weight Loss after Laparoscopic Roux-en-Y Gastric Bypass in the Short Term? Journal of obesity Eisenberg, D., Duffy, A. J., Bell, R. L. 2010; 2010

  Abstract

  Background. Many institutions mandate preoperative weight loss prior to bariatric surgery. This study examines the correlation between preoperative weight change and postoperative success following laparoscopic Roux-en-Y gastric bypass. Methods. We retrospectively studied the correlation between change in BMI before surgery and change in BMI postoperatively, using linear regression analyses and one-way ANOVA, in 256 consecutive gastric bypass patients with 1-year followup. Results. Of 256 patients, 125 lost weight preoperatively (mean -1.7% BMI), while 131 maintained or gained weight (mean +1.2% BMI). Postoperatively, there was no significant difference in percent BMI loss between the two groups (34.6% and 34.5%). The percent change in BMI preoperatively did not predict postoperative BMI change after 1 year (P = n.s.). Conclusions. Our study did not show any correlation between preoperative weight change and postoperative weight loss after Roux-en-Y gastric bypass. Therefore, we do not believe that potential patients should be denied bariatric surgery on the basis of their inability to lose weight preoperatively.

  View details for DOI 10.1155/2010/907097

  View details for PubMedID 20798850

• Video Self-Assessment Augments Development of Videoscopic Suturing Skill JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Jamshidi, R., LaMasters, T., Eisenberg, D., Duh, Q., Curet, M. 2009; 209 (5): 622-625

  Abstract

  Development of surgical skills on inanimate models has been popularized by efforts to improve patient safety and efficiency of resident training. We evaluated whether surgical residents' acquisition of videoscopic suturing skill is accelerated by reviewing video of their own previous practice session.Fourteen residents from two general surgery training programs received didactic instruction on laparoscopy. Attempts at suturing and knotting were then timed and recorded for each subject, and half of them were provided a video of their attempts to review. After 7 to 10 days, repeat attempts were timed and recorded. Knots were mechanically tested, and videos were reviewed in blinded fashion.Baseline characteristics were similar between the two groups. Both groups demonstrated improvement of videoscopic suturing efficiency and quality. On a 27-point scale, suturing and knot quality scores improved by an average of 11.6 (SD 3.9) in the video review group and 2.3 (SD 6.0) in the control group (p = 0.007). Times to complete the tasks were reduced by 30.3% (SD 11%) in the video review group and 3.1% (SD 32%) in the control group (p = 0.075). Eighty-six percent of video review subjects found the videos useful, and 86% of control subjects believed that videos would have been useful.Development of videoscopic suturing skill is augmented by independent review of earlier attempts. Knot quality and technique are improved, with a trend toward increased speed. This minimal-cost method of enhancing skill training for junior residents parallels the effectiveness of video review in fields such as aviation and athletics.

  View details for DOI 10.1016/j.jamcollsurg.2009.07.024

  View details for Web of Science ID 000271876400011

  View details for PubMedID 19854403

• Management of Median Arcuate Ligament Syndrome: A New Paradigm ANNALS OF VASCULAR SURGERY Duffy, A. J., Panait, L., Eisenberg, D., Bell, R. L., Roberts, K. E., Sumpio, B. 2009; 23 (6): 778-784

  Abstract

  Median arcuate ligament (MAL) syndrome is an anatomic and clinical entity characterized by extrinsic compression on the celiac axis, which leads to postprandial epigastric pain, vomiting, and weight loss. Although characterized a few decades ago, the existence of this syndrome is still challenged by several authors. We reviewed the management of MAL syndrome, with special emphasis on the minimally invasive approaches. We also report the first case of successful combination of minimally invasive surgery and endovascular therapy in the treatment of this syndrome. A PubMed search was carried out to identify articles in English from 1963 to 2008 using the keywords "median arcuate ligament syndrome" and "celiac artery compression syndrome." Additional articles were identified by a manual search of the references from the key articles. All clinical and experimental studies that contained material applicable to the topic were considered. Classic treatment of the condition is represented by open MAL release. However, permanent changes in the celiac artery wall lead to poor long-term outcomes, and associated complex vascular procedures have been employed. Laparoscopic treatment of MAL syndrome was reported in five cases. All patients had resolution of symptoms, but long-term follow-up is not available. Laparoscopic release of arcuate ligament syndrome with intraoperative duplex ultrasound may be used in patients with symptoms suggestive of the diagnosis. In patients with persistent celiac flow abnormalities noted on duplex ultrasound or postoperative imaging, celiac angioplasty and stenting are advocated. If this option is not available or does not relieve symptoms, vascular reconstruction should be employed.

  View details for DOI 10.1016/j.avsg.2008.11.005

  View details for Web of Science ID 000271259800011

  View details for PubMedID 19128929

• Intraoperative Endoscopy: A Requisite Tool for Laparoscopic Resection of Unusual Gastrointestinal Lesions-A Case Series JOURNAL OF SURGICAL RESEARCH Eisenberg, D., Bell, R. 2009; 155 (2): 318-320

  Abstract

  Laparoscopy is increasingly becoming a preferred approach to surgery of the gastrointestinal tract. Proper localization of small benign tumors is essential for precise non-anatomical excisions and remains difficult with the laparoscopic approach due to the greatly diminished tactile feedback.Between July 2006 and June 2007, 4 patients underwent resection of benign small gastrointestinal lesions. All resections were performed laparoscopically, with intraoperative endoscopy, using picture-in-picture display of both views on a single monitor.All 4 cases were completed laparoscopically. Three involved gastric lesions and 1 involved a cecal lesion. Adequacy of resection was confirmed grossly by real-time intraoperative endoscopy and microscopically by histology. Gastric lesions included pancreatic heterotopia, a gastrointestinal stromal tumor, and a Dieulafoy's lesion. The cecal lesion was a granular cell tumor. Operative times ranged from 57 min to 110 min (mean 91 min), and the average postoperative length of hospital stay was 3.5 d.Real-time intraoperative endoscopy with picture-in-picture viewing is a powerful surgical tool allowing for simultaneous intra- and extra-luminal views. Thus, endoscopic guidance allows for even the most subtle lesions to be identified and precisely excised. In addition, the adequacy of the laparoscopic procedure can be evaluated in real time, allowing for immediate adjustments or revisions to be made when needed. The endoscopic view allows for hemostasis to be ensured, and for precise anatomical excisions to be performed, especially in cases requiring the preservation of the pylorus or ileocecal valve. Larger series are needed to further establish the efficacy of this surgical approach.

  View details for DOI 10.1016/j.jss.2008.06.046

  View details for Web of Science ID 000269332300021

  View details for PubMedID 19482295

• Male Patients Above Age 60 have as Good Outcomes as Male Patients 50-59 Years Old at 1-Year Follow-up After Bariatric Surgery OBESITY SURGERY Wool, D., Bellatorre, N., Wren, S., Eisenberg, D. 2009; 19 (1): 18-21

  Abstract

  It is estimated that 25% of Americans older than 60 years are obese. Male gender and advanced age are indicators of increased risk for bariatric surgery. Good results have been shown in patients older than 50, but nearly all published studies include a large majority of females, and few include patients >60 years old. In this study, we examined the results of males over 60 years old.We reviewed a prospective database of 107 consecutive patients who underwent bariatric surgery between April 2002 and June 2007 at the Palo Alto VA. Of these, 60 patients were males older than 50 and available for follow-up 12 months postoperatively. There were 47 males 50-59 years old (group I) and 13 males older than 60 years (group II). Data were analyzed using Student's t test.Mean preoperative body mass index was similar in both groups (49.4 vs. 47.5 kg/m(2); p = 0.468). Length of hospital stay was similar (3.2 vs. 3.5 days; p = 0.678), but early morbidity was higher in group II patients (30.8% vs. 8.5%; p = 0.037). Morbidity included urinary tract infection, cardiac arrhythmias, and early bowel obstruction. Excess weight loss after 1 year was not significantly different (63.6% vs. 60.6%; p = 0.565). Diabetes resolution or improvement was seen in 87% of group I patients and 90% of group II patients.Despite a higher early morbidity rate, obese males >/=60 years old perform as well as male patients 50-59 years old with respect to excess weight loss, mortality, length of stay, and improvement of diabetes, at 1 year postoperatively.

  View details for DOI 10.1007/s11695-008-9734-1

  View details for Web of Science ID 000262281700004

  View details for PubMedID 18855082

• The growing problem of obesity in the older population: is surgery an option? Aging Health Eisenberg D 2009; 5 (3): 291-300
• Cholecystectomy in situs inversus totalis: laparoscopic approach. Case report and review of the literature International Medical Case Reports Journal Eisenberg, D. 2009; 2: 27-29
• Does preoperative weight change predict postoperative weight loss after laparoscopic Roux-en-Y gastric bypass in the short term? Journal of Obesity Eisenberg D, Duffy AJ, Bell RL 2009
• Laparoscopic treatment of subxiphoid incisional hernias in cardiac transplant patients JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS Eisenberg, D., Popescu, W. M., Duffy, A. J., Bell, R. L. 2008; 12 (3): 262-266

  Abstract

  Symptomatic subxiphoid incisional hernias present difficult surgical problems, especially in immuno-suppressed cardiac transplant patients. Here, we describe the laparoscopic repair of subxiphoid incisional hernias in patients with a history of cardiac transplantation.Four patients with subxiphoid hernias who had previously undergone heart transplantation were identified from a prospective database. Each underwent a laparoscopic repair with mesh implantation.Three patients had a previous open repair. The mean age was 62.5 years, an average of 64.3 months after transplantation. At the time of surgery, all patients were immunosuppressed, and each had a subxiphoid, poststernotomy incisional hernia. Gore dual mesh was used in 2 patients, while Parietex mesh was used in 2. Mean operative time was 122 minutes, and all were completed laparoscopically. The mean length of stay was 6.5 days, and the mean defect size was 286.25 cm(2). There was a significant correlation between hernia size and length of stay (P=0.037). Postoperatively, one patient (25%) developed pulmonary edema, and 1 patient (25%) had a prolonged ileus.Symptomatic subxiphoid incisional hernias are a challenging surgical problem in patients with a history of sternotomy. Laparoscopic repair is safe and effective in immunosuppressed patients who have previously undergone cardiac transplantation.

  View details for Web of Science ID 000258833000008

  View details for PubMedID 18765049

• Design, Management, and Critical Evaluation of a Surgical Basic/Clinical Science Curriculum: The Role of an Educational Chief Resident J Surg Educ Gregg SC, Eisenberg D, Duffy AJ, Longo WE 2008; 65 (1): 36-42
• Virtual Three-Dimensional Computed Tomography Evaluation of the Gastric Pouch Following Laparoscopic Roux-Y Gastric Bypass Obes Surg Alva S, Eisenberg D, Duffy A, Roberts K, Israel G, Bell R 2008; 18 (4): 364-366
• A new modality to evaluate the gastric remnant after Roux-en-Y gastric bypass Surg Obes Relat Dis Alva S, Eisenberg D, Duffy A, Roberts K, Israel G, Bell R 2008; 4 (1): 46-49
• Update on obesity surgery World J Gastroenterol Eisenberg D, Duffy AJ, Bell RL 2006; 12 (20): 3196-3203
• Metabolic consequences of bariatric surgery J Clin Gastroenterol Lynch RJ, Eisenberg D, Bell RL 2006; 40 (8): 659-668
• Laparoscopic ventral hernia repair using a two 5-mm port technique J Soc Lap Surg Abir F, Eisenberg D, Bell R 2005; 9 (1): 94-96
• A survivin gene signature predicts aggressive tumor behavior Cancer Research Salz W, Eisenberg D, Plescia J, Garlick DS, Weiss RM, Wu XR, Sun TT, Altieri DC 2005; 65 (9): 3531-3534
• The impact of bariatric surgery on severely obese patients with diabetes Diabetes Spectrum Eisenberg D, Bell RL 2003; 16 (4): 240-245
• Caenorhabditis elegans embryos contain only one major species of Ro RNP RNA Van Horn DJ, Eisenberg D, O'Brien CA, Wolin SL 1995; 1 (3): 293-303