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Article: Cardiac Tamponade: A Rare and Insidious Surgical Complication of Hiatal Hernia Repair.

Apel, Roy / Bard, Slava / Naimark, Ari / Menasherov, Nikolai / Wasserberg, Nir / Wiesel, Ory

The Israel Medical Association journal : IMAJ

2024 Volume 26, Issue 4, Page(s) 251–253

MeSH term(s)	Humans ; Cardiac Tamponade/diagnosis ; Cardiac Tamponade/etiology ; Cardiac Tamponade/surgery ; Herniorrhaphy/adverse effects ; Neurosurgical Procedures
Language	English
Publishing date	2024-03-31
Publishing country	Israel
Document type	Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article ; Online: Interval to surgery after neoadjuvant treatment for colorectal cancer.

Wasserberg, Nir

World journal of gastroenterology

2013 Volume 20, Issue 15, Page(s) 4256–4262

Abstract: The current standard treatment of low-lying locally advanced rectal cancer consists of chemoradiation followed by radical surgery. The interval between chemoradiation and surgery varied for many years until the 1999 Lyon R90-01 trial which compared the ... ...

Abstract	The current standard treatment of low-lying locally advanced rectal cancer consists of chemoradiation followed by radical surgery. The interval between chemoradiation and surgery varied for many years until the 1999 Lyon R90-01 trial which compared the effects of a short (2-wk) and long (6-wk) interval. Results showed a better clinical tumor response (71.7% vs 53.1%) and higher rate of positive and pathologic tumor regression (26% vs 10.3%) after the longer interval. Accordingly, a 6-wk interval between chemoradiation and surgery was set to balance the oncological results with the surgical complexity. However, several recent retrospective studies reported that prolonging the interval beyond 8 or even 12 wk may lead to significantly higher rates of tumor downstaging and pathologic complete response. This in turn, according to some reports, may improve overall and disease-free survival, without increasing the surgical difficulty or complications. This work reviews the data on the effect of different intervals, derived mostly from retrospective analyses using a wide variation of treatment protocols. Prospective randomized trials are currently ongoing.
MeSH term(s)	Anal Canal/pathology ; Chemoradiotherapy/methods ; Colorectal Neoplasms/drug therapy ; Colorectal Neoplasms/radiotherapy ; Colorectal Neoplasms/surgery ; Combined Modality Therapy/methods ; Disease-Free Survival ; Humans ; Neoadjuvant Therapy/methods ; Neoplasm Staging ; Preoperative Period ; Prognosis ; Randomized Controlled Trials as Topic ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2013-11-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2185929-2
ISSN	2219-2840 ; 1007-9327
ISSN (online)	2219-2840
ISSN	1007-9327
DOI	10.3748/wjg.v20.i15.4256
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Article ; Online: Escherichia coli Strains from Patients with Inflammatory Bowel Diseases have Disease-specific Genomic Adaptations.

Dubinsky, Vadim / Reshef, Leah / Rabinowitz, Keren / Wasserberg, Nir / Dotan, Iris / Gophna, Uri

Journal of Crohn's & colitis

2022 Volume 16, Issue 10, Page(s) 1584–1597

Abstract: Background and aims: Escherichia coli is over-abundant in the gut microbiome of patients with inflammatory bowel disease [IBD]. Here, we aimed to identify IBD-specific genomic functions of diverse E. coli lineages.: Methods: We investigated E. coli ... ...

Abstract	Background and aims: Escherichia coli is over-abundant in the gut microbiome of patients with inflammatory bowel disease [IBD]. Here, we aimed to identify IBD-specific genomic functions of diverse E. coli lineages. Methods: We investigated E. coli genomes from patients with ulcerative colitis [UC], Crohn's disease [CD] or a pouch, and healthy subjects. The majority of genomes were reconstructed from metagenomic samples, including newly sequenced faecal metagenomes. Clinical metadata were collected. Functional analysis at the gene and mutation level were performed and integrated with IBD phenotypes and biomarkers. Results: Overall, 530 E. coli genomes were analysed. The E. coli B2 lineage was more prevalent in UC compared with other IBD phenotypes. Genomic metabolic capacities varied across E. coli lineages and IBD phenotypes. Host mucin utilisation enzymes were present in a single lineage and depleted in patients with a pouch, whereas those involved in inulin hydrolysis were enriched in patients with a pouch. E. coli strains from patients with UC were twice as likely to encode the genotoxic molecule colibactin than strains from patients with CD or a pouch. Strikingly, patients with a pouch showed the highest inferred E. coli growth rates, even in the presence of antibiotics. Faecal calprotectin did not correlate with the relative abundance of E. coli. Finally, we identified multiple IBD-specific non-synonymous mutations in E. coli genes encoding for bacterial cell envelope components. Conclusions: Comparative genomics indicates that E. coli is a commensal species adapted to the overactive mucosal immune milieu in IBD, rather than causing it. Our results reveal mutations that may lead to attenuated antigenicity in some E. coli strains.
MeSH term(s)	Humans ; Escherichia coli ; Intestinal Mucosa/microbiology ; Escherichia coli Infections/microbiology ; Inflammatory Bowel Diseases/microbiology ; Colitis, Ulcerative/microbiology ; Crohn Disease/microbiology ; Genomics
Language	English
Publishing date	2022-05-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2390120-2
ISSN	1876-4479 ; 1873-9946
ISSN (online)	1876-4479
ISSN	1873-9946
DOI	10.1093/ecco-jcc/jjac071
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Article ; Online: Mesenchymal stem cell therapy for Crohn's perianal fistula-a real-world experience.

White, Ian / Yanai, Henit / Avni, Irit / Slavin, Moran / Naftali, Timna / Tovi, Shifra / Dotan, Iris / Wasserberg, Nir

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2023 Volume 26, Issue 1, Page(s) 102–109

Abstract: Aim: Remission rates of medically and surgically treated complex perianal fistulas in Crohn's disease are low. Recently, trials have demonstrated the potential for long-term remission with local injection of allogeneic adipose-derived mesenchymal stem ... ...

Abstract	Aim: Remission rates of medically and surgically treated complex perianal fistulas in Crohn's disease are low. Recently, trials have demonstrated the potential for long-term remission with local injection of allogeneic adipose-derived mesenchymal stem cells (darvadstrocel). Our aim was to analyse outcomes from our real-world experience with this new treatment. Methods: All patients with Crohn's disease suffering complex perianal fistulas who consecutively underwent administration of darvadstrocel at two centres were followed up and evaluated. Patients were assessed for clinical remission, response, failure, and any complications during follow-up. The results of all patients with a minimum of 3 months' follow-up are presented. Results: Thirty-three patients with Crohn's disease and complex perianal fistulas were included. Of these, 20 (61%) experienced clinical remission that was maintained for a mean follow-up of 14 (3-32) months. A total of 24 of 33 (73%) experienced at least 3 months of clinical remission, with four later having recurrence (3-12 months). Among the remaining nine patients who did not experience clinical remission, two (6%) had partial remission (such as one of two fistulas closing), two (6%) showed signs of response but not remission, and five (15%) showed no signs of healing. The mean time to maintained clinical remission was 6 weeks (range 2 weeks to 6 months), and there were no severe adverse events. Conclusion: In this real-world experience, treatment of Crohn's disease complex perianal fistulas with darvadstrocel had a 61% success rate for maintained clinical remission.
MeSH term(s)	Humans ; Crohn Disease/complications ; Crohn Disease/therapy ; Crohn Disease/diagnosis ; Treatment Outcome ; Mesenchymal Stem Cell Transplantation/adverse effects ; Mesenchymal Stem Cell Transplantation/methods ; Rectal Fistula/etiology ; Rectal Fistula/surgery ; Immunosuppressive Agents ; Mesenchymal Stem Cells
Chemical Substances	Immunosuppressive Agents
Language	English
Publishing date	2023-12-14
Publishing country	England
Document type	Journal Article
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.16830
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Article: Rectal Cancer following Local Excision of Rectal Adenomas with Low-Grade Dysplasia-A Multicenter Study.

Rudnicki, Yaron / Horesh, Nir / Harbi, Assaf / Lubianiker, Barak / Green, Eraan / Raveh, Guy / Slavin, Moran / Segev, Lior / Gilshtein, Haim / Khalifa, Muhammad / Barenboim, Alexander / Wasserberg, Nir / Khaikin, Marat / Tulchinsky, Hagit / Issa, Nidal / Duek, Daniel / Avital, Shmuel / White, Ian

Journal of clinical medicine

2023 Volume 12, Issue 3

Abstract: ... ...

Abstract	Purpose
Language	English
Publishing date	2023-01-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12031032
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Article: Laparoscopic colectomy for colorectal cancer.

Wasserberg, Nir

The Israel Medical Association journal : IMAJ

2010 Volume 12, Issue 9, Page(s) 572–576

Abstract: The laparoscopic approach to the treatment of colon and rectal cancer remains controversial long after it was accepted for benign conditions. Laparoscopic cancer resection should meet appropriate oncologic standards and achieve a long-term oncologic ... ...

Abstract	The laparoscopic approach to the treatment of colon and rectal cancer remains controversial long after it was accepted for benign conditions. Laparoscopic cancer resection should meet appropriate oncologic standards and achieve a long-term oncologic outcome at least equivalent to that of open resection. Several international randomized controlled trials have provided adequate data to ascertain the oncologic quality of laparoscopic colon resection, showing a benefit in short-term outcome over open resection. The use of laparoscopic resection for rectal cancer is awaiting further investigation.
MeSH term(s)	Colectomy ; Colonic Neoplasms/pathology ; Colonic Neoplasms/surgery ; Humans ; Laparoscopy ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery
Language	English
Publishing date	2010-09
Publishing country	Israel
Document type	Journal Article ; Review
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article ; Online: Alteration in Urease-producing Bacteria in the Gut Microbiomes of Patients with Inflammatory Bowel Diseases.

Ryvchin, Ron / Dubinsky, Vadim / Rabinowitz, Keren / Wasserberg, Nir / Dotan, Iris / Gophna, Uri

Journal of Crohn's & colitis

2021 Volume 15, Issue 12, Page(s) 2066–2077

Abstract: Background and aims: Bacterial urease is a major virulence factor of human pathogens, and murine models have shown that it can contribute to the pathogenesis of inflammatory bowel diseases [IBD].: Methods: The distribution of urease-producing ... ...

Abstract	Background and aims: Bacterial urease is a major virulence factor of human pathogens, and murine models have shown that it can contribute to the pathogenesis of inflammatory bowel diseases [IBD]. Methods: The distribution of urease-producing bacteria in IBD was assessed using public faecal metagenomic data from various cohorts, including non-IBD controls [n = 55], patients with Crohn's disease [n = 291] or ulcerative colitis [n = 214], and patients with a pouch [n = 53]. The ureA gene and the taxonomic markers gyrA, rpoB, and recA were used to estimate the percentage of urease producers in each sample. Results: Levels of urease producers in patients with IBD and non-IBD controls were comparable. In non-IBD controls and most IBD patients, urease producers were primarily acetate-producing genera such as Blautia and Ruminococcus. A shift in the type of the dominant urease producers towards Proteobacteria and Bacilli was observed in a subset of all IBD subtypes, which correlated with faecal calprotectin levels in one cohort. Some patients with IBD had no detectable urease producers. In patients with a pouch, the probiotic-associated species Streptococcus thermophilus was more common as a main urease producer than in other IBD phenotypes, and it generally did not co-occur with other Bacilli or with Proteobacteria. Conclusions: Unlike all non-IBD controls, patients with IBD often showed a shift towards Bacilli or Proteobacteria or a complete loss of urease production. Probiotics containing the species S. thermophilus may have a protective effect against colonisation by undesirable urease-producing bacteria in a subset of patients with a pouch.
MeSH term(s)	Case-Control Studies ; Feces/microbiology ; Gastrointestinal Microbiome ; Humans ; Inflammatory Bowel Diseases/microbiology ; Streptococcus/metabolism ; Urease/metabolism
Chemical Substances	Urease (EC 3.5.1.5)
Language	English
Publishing date	2021-06-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2390120-2
ISSN	1876-4479 ; 1873-9946
ISSN (online)	1876-4479
ISSN	1873-9946
DOI	10.1093/ecco-jcc/jjab101
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Article ; Online: High Rates of Incisional Hernia After Laparoscopic Right Colectomy With Midline Extraction Site.

Greemland, Itzhak / Raveh, Guy / Gavrielli, Shlomo / Sadot, Eran / Kashtan, Hanoch / Wasserberg, Nir

Surgical laparoscopy, endoscopy & percutaneous techniques

2021 Volume 31, Issue 6, Page(s) 722–728

Abstract: Background: Laparoscopic surgery aims at reducing wound complications and improving cosmetics, among other advantages. High rates of postoperative ventral hernia (POVH) are observed after laparoscopic-assisted colectomies.: Materials and methods: In ... ...

Abstract	Background: Laparoscopic surgery aims at reducing wound complications and improving cosmetics, among other advantages. High rates of postoperative ventral hernia (POVH) are observed after laparoscopic-assisted colectomies. Materials and methods: In a 2011 to 2016 retrospective study of all patients at Rabin Medical Center, we examined POVH prevalence after right hemicolectomy for neoplasia and correlation to specimen extraction site. We also compared laparoscopic-assisted colectomy to hand-assisted laparoscopic colectomy. Included were patients who had postoperative abdominal computed tomography or magnetic resonance imaging scan as part of their routine oncological follow-up to 6 months postsurgery. Patients were excluded for conversion to laparotomy, and prior abdominal surgeries after right colectomy and before follow-up computed tomography/magnetic resonance imaging scan. Demographic and surgical data were collected from patient electronic records, and scans reviewed for POVH by a designated radiologist. Results: Of 370 patients, 138 (mean age 70.09 y, 58 males) were included: 54 (39.1%) were diagnosed with POVH, 42/72 (58.3%) at midline extraction site, and 12/66 (18.8%) at off-midline extraction sites (P<0.0001). Surgical site infections and patients positive for tumor metastasis were associated with higher POVH rates. Most (74%) POVHs were identified within 18 months postsurgery (P<0.0001). Body mass index, age, sex, diabetes mellitus, smoking, tumor size, lymph nodes positive for metastasis, and hand-assisted laparoscopic colectomy were not associated with POVH prevalence. Conclusion: High rates of radiologically diagnosed POVH were found after laparoscopic-assisted colectomy, with association to midline extraction site, surgical site infections, and positive tumor distant metastasis.
MeSH term(s)	Aged ; Colectomy/adverse effects ; Hernia, Ventral/epidemiology ; Hernia, Ventral/surgery ; Humans ; Incisional Hernia ; Laparoscopy/adverse effects ; Male ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-07-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	1475108-2
ISSN	1534-4908 ; 1530-4515 ; 1051-7200
ISSN (online)	1534-4908
ISSN	1530-4515 ; 1051-7200
DOI	10.1097/SLE.0000000000000977
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Article ; Online: Implantation of an Impedance Sensor for Early Detection of Gastrointestinal Anastomotic Leaks.

Ben-David, Matan / Carmeli, Idan / Orgad, Ran / Nathansohn-Levi, Bar / Yered, Tal / Shor, Erez / Wasserberg, Nir

The Journal of surgical research

2022 Volume 278, Page(s) 49–56

Abstract: Introduction: Accurate early diagnosis of a gastrointestinal anastomotic leak remains a challenge. When an anastomotic leak develops, the electrical properties of the tissue undergoing inflammatory processes change, resulting from the extravasation of ... ...

Abstract	Introduction: Accurate early diagnosis of a gastrointestinal anastomotic leak remains a challenge. When an anastomotic leak develops, the electrical properties of the tissue undergoing inflammatory processes change, resulting from the extravasation of inflammatory fluid and cellular infiltration. The method described here intends to provide a novel early anastomotic leak warning system based upon measurable changes in tissue impedance nearby an acute inflammatory process. Methods: A biodegradable Mg-alloy was compared with a nonabsorbable stainless steel (STS) electrode connected to a wireless recording system for impedance measurement. In vitro measurements were made in physiological solutions and small animal (eight mice) and large animal (eight pigs) models with an anastomotic leak simulated by an open colotomy. Measurements were made at 10 mm intervals from the open colon at baseline and up to 120 min comparing these with a sutured colonic wound and normal tissue. Results: In-vitro biodegradable magnesium electrode impedance evaluation showed good sensitivity to different media due to its environmental corrosion properties. The impedance of an acidic environment (1.06 ± 0.02 kΩ for citric acid) was twice that of phosphate-buffered saline (PBS) (0.64 ± 0.008 kΩ) with a distinction between Normal Saline (0.42 ± 0.013 kΩ) and PBS (0.64 ± 0.008 kΩ). This was in contrast to the performance characteristics of the control STS electrodes, where impedance in an acidic environment was lower than saline or PBS (citric acid:0.76 ± 0.01 kΩ versus PBS: 1.32 ± 0.014 kΩ). In a mouse model simulating an anastomotic leak, there was a significant increase in impedance after 120 min when compared with controls (99.7% increase versus 9.6% increase, respectively; P < 0.02). This effect was confirmed in a pig model when relative impedance measurements of the leak and control groups were compared (1.86 ± 0.46 versus 1.07 ± 0.02, respectively; P < 0.027). Conclusions: Electrophysiological measurement shows diagnostic sensitivity for a gastrointestinal leak with potential clinical utility in the postoperative detection of early intra-abdominal sepsis. Further investigation of biodegradable tissue sensors capable of monitoring an early anastomotic leak is required.
MeSH term(s)	Anastomosis, Surgical/adverse effects ; Anastomotic Leak/diagnosis ; Anastomotic Leak/etiology ; Animals ; Citric Acid ; Early Diagnosis ; Electric Impedance ; Gastrointestinal Diseases ; Mice ; Swine
Chemical Substances	Citric Acid (2968PHW8QP)
Language	English
Publishing date	2022-05-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2022.04.041
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Article ; Online: Rectal Cancer following Local Excision of Rectal Adenomas with Low-Grade Dysplasia—A Multicenter Study

Yaron Rudnicki / Nir Horesh / Assaf Harbi / Barak Lubianiker / Eraan Green / Guy Raveh / Moran Slavin / Lior Segev / Haim Gilshtein / Muhammad Khalifa / Alexander Barenboim / Nir Wasserberg / Marat Khaikin / Hagit Tulchinsky / Nidal Issa / Daniel Duek / Shmuel Avital / Ian White

Journal of Clinical Medicine, Vol 12, Iss 1032, p

2023 Volume 1032

Abstract: Purpose : Rectal polyps with low-grade dysplasia (LGD) can be removed by local excision surgery (LE). It is unclear whether these lesions pose a higher risk for recurrence and cancer development and might warrant an early repeat rectal endoscopy. This ... ...

Abstract	Purpose : Rectal polyps with low-grade dysplasia (LGD) can be removed by local excision surgery (LE). It is unclear whether these lesions pose a higher risk for recurrence and cancer development and might warrant an early repeat rectal endoscopy. This study aims to assess the rectal cancer rate following local excision of LGD rectal lesions. Methods : A retrospective multicenter study including all patients that underwent LE for rectal polyps over a period of 11 years was conducted. Demographic, clinical, and surgical data of patients with LGD werecollected and analyzed. Results : Out of 274 patients that underwent LE of rectal lesions, 81 (30%) had a pathology of LGD. The mean patient age was 65 ± 11 years, and 52 (64%) were male. The mean distance from the anal verge was 7.2 ± 4.3 cm, and the average lesion was 3.2 ± 1.8 cm. Full thickness resection was achieved in 68 patients (84%), and four (5%) had involved margins for LGD. Nine patients (11%) had local recurrence and developed rectal cancer in an average time interval of 19.3 ± 14.5 months, with seven of them (78%) diagnosed less than two years after the initial LE. Seven of the nine patients were treated with another local excision, whilst one had a low anterior resection, and one was treated with radiation. The mean follow-up time was 25.3 ± 22.4 months. Conclusions : Locally resected rectal polyps with LGD may carry a significant risk of recurring and developing cancer within two years. This data suggests patients should have a closer surveillance protocol in place.
Keywords	low-grade dysplasia ; rectal cancer ; rectal polyps ; local excision ; recurrence ; Medicine ; R
Subject code	616
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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