Amir Szold
Amir Szold, MD, is a pioneer laparoscopic surgeon, trained in surgery in Jerusalem and Mount Sinai Medical Center, New York. In the late 90’s he was the founder and first president of the Israeli Society of Endoscopic Surgery, and is currently a Board Member, and the Technology Committee Chairman, European Association of Endoscopic Surgeons, and Board Member, Israeli Society of Surgeons.
Dr. Szold is heavily involved in medical innovation. He is the Founder, advisor and board member in multiple medical device start up companies in Israel and Europe, covering fields of 3D vision, robotics, soft tissue replacements, surgical glues, laser technology, smart materials and laparoscopic devices. He is also the Founder and Medical Director of Assia Medical Group in Tel Aviv and the founder and current advisor, of the Physicians for Human Rights volunteer clinic for illegal immigrants and refugees, Tel Aviv, Israel.
Dr. Szold is heavily involved in medical innovation. He is the Founder, advisor and board member in multiple medical device start up companies in Israel and Europe, covering fields of 3D vision, robotics, soft tissue replacements, surgical glues, laser technology, smart materials and laparoscopic devices. He is also the Founder and Medical Director of Assia Medical Group in Tel Aviv and the founder and current advisor, of the Physicians for Human Rights volunteer clinic for illegal immigrants and refugees, Tel Aviv, Israel.
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Papers by Amir Szold
Hiatal hernia (HH) is common in the bariatric population. Its presence imposes various degrees of difficulty in performing laparoscopic sleeve gastrectomy (LSG). Preoperative upper gastrointestinal evaluation consists of fluoroscopic and or endoscopic studies OBJECTIVES: To evaluate the efficacy of routine, preoperative barium swallow in identifying HH in patients undergoing LSG, and determine if such foreknowledge changes operative and immediate postoperative course regarding operative time, intraoperative adverse events, and length of hospital stay (LOS). In addition, to quantify HH prevalence in these patients and correlate preoperative patient characteristics with its presence.
Setting:
High-volume bariatric practice in a private hospital in Israel METHODS: Retrospective analysis of prospectively collected data between October 2010 and March 2015: anthropometrics, co-morbidities, previous barium swallow, preoperative HH workup (type and result), operative and immediate postoperative course.
Results:
Primary LSG was performed in 2417 patients. The overall prevalence of HH was 7.3%. Preoperative diagnosis of gastroesophageal reflux disease and female gender were independent risk factors for HH presence. Operative times were significantly longer when HH was concomitantly repaired but "foreknowledge" thereof did not assist in shortening this time. Looking for an HH that was suggested in preoperative upper gastrointestinal evaluation slightly prolonged surgery. LOS was not changed in a significant fashion by HH presence and repair, whether suspected or incidentally found.
Conclusion:
Routine, pre-LSG barium swallow does not seem to offer an advantage over selective intraoperative hiatal exploration, in the discovery and management of HH. Conversely, when preoperative workup yields a false-positive result, surgery is slightly prolonged.
Hiatal hernia (HH) is common in the bariatric population. Its presence imposes various degrees of difficulty in performing laparoscopic sleeve gastrectomy (LSG). Preoperative upper gastrointestinal evaluation consists of fluoroscopic and or endoscopic studies OBJECTIVES: To evaluate the efficacy of routine, preoperative barium swallow in identifying HH in patients undergoing LSG, and determine if such foreknowledge changes operative and immediate postoperative course regarding operative time, intraoperative adverse events, and length of hospital stay (LOS). In addition, to quantify HH prevalence in these patients and correlate preoperative patient characteristics with its presence.
Setting:
High-volume bariatric practice in a private hospital in Israel METHODS: Retrospective analysis of prospectively collected data between October 2010 and March 2015: anthropometrics, co-morbidities, previous barium swallow, preoperative HH workup (type and result), operative and immediate postoperative course.
Results:
Primary LSG was performed in 2417 patients. The overall prevalence of HH was 7.3%. Preoperative diagnosis of gastroesophageal reflux disease and female gender were independent risk factors for HH presence. Operative times were significantly longer when HH was concomitantly repaired but "foreknowledge" thereof did not assist in shortening this time. Looking for an HH that was suggested in preoperative upper gastrointestinal evaluation slightly prolonged surgery. LOS was not changed in a significant fashion by HH presence and repair, whether suspected or incidentally found.
Conclusion:
Routine, pre-LSG barium swallow does not seem to offer an advantage over selective intraoperative hiatal exploration, in the discovery and management of HH. Conversely, when preoperative workup yields a false-positive result, surgery is slightly prolonged.