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  1. Article ; Online: Artificial Intelligence in Surgery: The Future is Now.

    Guni, Ahmad / Varma, Piyush / Zhang, Joe / Fehervari, Matyas / Ashrafian, Hutan

    European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes

    2024  

    Abstract: Background Clinical Artificial intelligence (AI) has reached a critical inflection point. Advances in algorithmic science and increased understanding of operational considerations in AI deployment are opening the door to widespread clinical pathway ... ...

    Abstract Background Clinical Artificial intelligence (AI) has reached a critical inflection point. Advances in algorithmic science and increased understanding of operational considerations in AI deployment are opening the door to widespread clinical pathway transformation. For surgery in particular, the application of machine learning algorithms in fields such as computer vision and operative robotics are poised to radically change how we screen, diagnose, risk-stratify, treat and follow-up patients, in both pre- and post-operative stages, and within operating theatres. Summary In this paper, we summarise the current landscape of existing and emerging integrations within complex surgical care pathways. We investigate effective methods for practical use of AI throughout the patient pathway, from early screening and accurate diagnosis to intraoperative robotics, post-operative monitoring and follow-up. Horizon scanning of AI technologies in surgery is used to identify novel innovations that can enhance surgical practice today, with potential for paradigm shifts across core domains of surgical practice in the future. Any AI-driven future must be built on responsible and ethical usage, reinforced by effective oversight of data governance, and of risks to patient safety in deployment. Implementation is additionally bound to considerations of usability and pathway feasibility, and the need for robust healthcare technology assessment and evidence generation. While these factors are traditionally seen as barriers to translating AI into practice, we discuss how holistic implementation practices can create a solid foundation for scaling AI across pathways. Key Messages The next decade will see rapid translation of experimental development into real-world impact. AI will require evolution of work practices, but will also enhance patient safety, enhance surgical quality outcomes, and provide significant value for surgeons and health systems. Surgical practice has always sat on a bedrock of technological innovation. For those that follow this tradition, the future of AI in surgery starts now.
    Language English
    Publishing date 2024-01-22
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 205700-1
    ISSN 1421-9921 ; 0014-312X
    ISSN (online) 1421-9921
    ISSN 0014-312X
    DOI 10.1159/000536393
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  2. Article ; Online: Influence of ventilatory parameters on the concentration of exhaled volatile organic compounds in mechanically ventilated patients.

    Romano, Andrea / Fehervari, Matyas / Boshier, Piers R

    The Analyst

    2023  Volume 148, Issue 17, Page(s) 4020–4029

    Abstract: Analysis of volatile organic compounds (VOC) within exhaled breath is subject to numerous sources of methodological and physiological variability. Whilst breathing pattern is expected to influence the concentrations of selected exhaled VOCs, it remains ... ...

    Abstract Analysis of volatile organic compounds (VOC) within exhaled breath is subject to numerous sources of methodological and physiological variability. Whilst breathing pattern is expected to influence the concentrations of selected exhaled VOCs, it remains challenging to investigate respiratory rate and depth accurately in awake subjects. Online breath sampling was performed in 20 mechanically ventilated patients using proton transfer reaction time-of-flight mass spectrometry (PTR-ToF-MS). The effect of variation in respiratory rate (RR) and tidal volume (TV) on the VOC release profiles was examined. A panel of nineteen VOCs were selected, including isoprene, acetone, propofol, volatile aldehydes, acids and phenols. Variation in RR had the greatest influence on exhaled isoprene levels, with maximum and average concentrations being inversely correlated with RR. Variations in RR had a statistically significant impact on acetone, C3-C7 linear aldehydes and acetic acid. In comparison, phenols (including propofol), C8-C10 aldehydes and C3-C6 carboxylic acids were not influenced by RR. Isoprene was the only compound to be influenced by variation in TV. These findings, obtained under controlled conditions, provide useful guidelines for the optimisation of breath sampling protocols to be applied on awake patients.
    MeSH term(s) Humans ; Volatile Organic Compounds/analysis ; Respiration, Artificial ; Acetone/analysis ; Propofol ; Breath Tests/methods ; Aldehydes ; Phenols
    Chemical Substances Volatile Organic Compounds ; isoprene (0A62964IBU) ; Acetone (1364PS73AF) ; Propofol (YI7VU623SF) ; Aldehydes ; Phenols
    Language English
    Publishing date 2023-08-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 210747-8
    ISSN 1364-5528 ; 0003-2654
    ISSN (online) 1364-5528
    ISSN 0003-2654
    DOI 10.1039/d3an00786c
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    Zs.A 2423: Show issues Location:
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  3. Article ; Online: Bone health following paediatric and adolescent bariatric surgery: a systematic review and meta-analysis.

    Mitra, Anuja Tulip / Das, Bibek / Sarraf, Khalid Maher / Ford-Adams, Martha / Fehervari, Matyas / Ashrafian, Hutan

    EClinicalMedicine

    2024  Volume 69, Page(s) 102462

    Abstract: Background: Childhood obesity is a pressing health crisis of epidemic proportions. Bariatric surgery (BS) is an effective weight loss solution however its role in the paediatric population is contentious owing to the paucity of weight specific and ... ...

    Abstract Background: Childhood obesity is a pressing health crisis of epidemic proportions. Bariatric surgery (BS) is an effective weight loss solution however its role in the paediatric population is contentious owing to the paucity of weight specific and generalised health outcomes. This systematic review and meta-analysis aimed to assess the impact of paediatric BS on bone health.
    Methods: This prospectively registered systematic review (PROSPERO ID: CRD42023432035) was performed in accordance with PRISMA guidelines. We searched MEDLINE (1946-1928 September 2023), EMBASE (1947-1928 September 2023) via the Ovid platform, and the Cochrane Review Library to identify scientific publications reporting bone outcome measures in patients under the age of 18 years who underwent BS. Meta-analysis was undertaken on post-operative weight and bone parameters in paediatric patients following BS. Outcomes were reported as weighted or standardized mean difference with 95 percent confidence intervals. Subgroup analysis by intervention, quality scoring and risk of bias were assessed.
    Findings: Twelve studies with 681 patients across 5 countries (mean age 17 ± 0.57 years) were included. The quality of included studies was rated as high and there was substantial between-study heterogeneity for most factors included in the meta-analysis (
    Interpretation: BS effectively reduces weight in paediatric patients, but RYGB and SG may have adverse effects on bone health in the medium term. It is crucial to monitor and support bone health through appropriate nutritional supplementation and judicious follow-up. Long-term data is needed to fully understand the clinical implications of these findings on bone outcomes.
    Funding: Medical Research Council (MRC), United Kingdom.
    Language English
    Publishing date 2024-02-02
    Publishing country England
    Document type Journal Article
    ISSN 2589-5370
    ISSN (online) 2589-5370
    DOI 10.1016/j.eclinm.2024.102462
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  4. Article ; Online: Medicolegal Cases in Bariatric Surgery in the United Kingdom.

    Fehervari, Matyas / Fadel, Michael G / Reddy, Marcus / Khan, Omar A

    Current obesity reports

    2023  Volume 12, Issue 3, Page(s) 355–364

    Abstract: Purpose of review: To evaluate the current state of bariatric medicolegal activity and explore the reasons of litigation in bariatric surgery. The underlying legal principles in bariatric medicolegal cases and most frequent pitfalls will also be ... ...

    Abstract Purpose of review: To evaluate the current state of bariatric medicolegal activity and explore the reasons of litigation in bariatric surgery. The underlying legal principles in bariatric medicolegal cases and most frequent pitfalls will also be discussed.
    Recent findings: There is a growing number of litigations in bariatric surgery, particularly relating to complications and long waiting lists for bariatric surgery within the public-funded health systems. The main issues are related to consent, lack of follow-up, delayed identification of complications and lack of appropriate emergency management of complications, involving bariatric surgeons, clinicians, general practitioners and multidisciplinary team members. Appropriate multidisciplinary involvement pre- and postoperatively and robust follow-up protocols can help to mitigate the risks. Bariatric surgery requires a unique paradigm with a multidisciplinary approach both pre- and postoperatively to improve the long-term functional outcomes of patients. There is a rising incidence of medicolegal claims following bariatric surgery. The underlying reasons for this are multifactorial including an increase in the volume of surgery, high patient expectations, the incidence of long-term postoperative complications and the requirement of long-term follow-up.
    MeSH term(s) Humans ; Malpractice ; Bariatric Surgery/adverse effects ; Postoperative Complications/etiology ; United Kingdom
    Language English
    Publishing date 2023-06-02
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2162-4968
    ISSN (online) 2162-4968
    DOI 10.1007/s13679-023-00508-1
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  5. Article ; Online: Unusual cause of intraoperative haemorrhage: a lesson for patient counselling.

    Alghazawi, Laith Omar Khalaf / Holtermann Entwistle, Olivia / Fehervari, Matyas / Spalding, Duncan

    BMJ case reports

    2022  Volume 15, Issue 6

    Abstract: Hepatocellular carcinoma (HCC) is a well-known malignant neoplasm of the liver associated with spontaneous haemorrhage in 3%-15% of cases. This complication is life threatening and has a mortality rate of 33%-100%. Despite the frequency and severity of ... ...

    Abstract Hepatocellular carcinoma (HCC) is a well-known malignant neoplasm of the liver associated with spontaneous haemorrhage in 3%-15% of cases. This complication is life threatening and has a mortality rate of 33%-100%. Despite the frequency and severity of spontaneous haemorrhage, the importance of patient education about this complication has not been highlighted before. There is currently no information available on the NHS UK website, and no publications have addressed the effect of patient education. We present this case report describing a patient who developed classical symptoms of haemorrhage the day before her elective HCC resection, but was unaware of its importance, and thus did not seek medical attention. She was subsequently found to have a large volume haemoperitoneum, anaemia and a ruptured HCC intraoperatively. This case illustrates the significant importance of counselled regarding the symptoms and risk of spontaneous rupture of HCC to prompt early presentation to medical services.
    MeSH term(s) Blood Loss, Surgical ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/surgery ; Counseling ; Female ; Hemoperitoneum/etiology ; Hepatectomy ; Humans ; Liver Neoplasms/pathology ; Rupture, Spontaneous/surgery
    Language English
    Publishing date 2022-06-09
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2021-247951
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  6. Article ; Online: The effects of bariatric surgery on cardiac function: a systematic review and meta-analysis.

    Sargsyan, Narek / Chen, Jun Yu / Aggarwal, Ravi / Fadel, Michael G / Fehervari, Matyas / Ashrafian, Hutan

    International journal of obesity (2005)

    2023  Volume 48, Issue 2, Page(s) 166–176

    Abstract: Introduction: Obesity is associated with alterations in cardiac structure and haemodynamics leading to cardiovascular mortality and morbidity. Culminating evidence suggests improvement of cardiac structure and function following bariatric surgery.: ... ...

    Abstract Introduction: Obesity is associated with alterations in cardiac structure and haemodynamics leading to cardiovascular mortality and morbidity. Culminating evidence suggests improvement of cardiac structure and function following bariatric surgery.
    Objective: To evaluate the effect of bariatric surgery on cardiac structure and function in patients before and after bariatric surgery.
    Methods: Systematic review and meta-analysis of studies reporting pre- and postoperative cardiac structure and function parameters on cardiac imaging in patients undergoing bariatric surgery.
    Results: Eighty studies of 3332 patients were included. Bariatric surgery is associated with a statistically significant improvement in cardiac geometry and function including a decrease of 12.2% (95% CI 0.096-0.149; p < 0.001) in left ventricular (LV) mass index, an increase of 0.155 (95% CI 0.106-0.205; p < 0.001) in E/A ratio, a decrease of 2.012 mm (95% CI 1.356-2.699; p < 0.001) in left atrial diameter, a decrease of 1.16 mm (95% CI 0.62-1.69; p < 0.001) in LV diastolic dimension, and an increase of 1.636% (95% CI 0.706-2.566; p < 0.001) in LV ejection fraction after surgery.
    Conclusion: Bariatric surgery led to reverse remodelling and improvement in cardiac geometry and function driven by metabolic and haemodynamic factors.
    MeSH term(s) Humans ; Obesity, Morbid ; Heart ; Bariatric Surgery/methods ; Obesity ; Ventricular Function, Left
    Language English
    Publishing date 2023-11-25
    Publishing country England
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 752409-2
    ISSN 1476-5497 ; 0307-0565
    ISSN (online) 1476-5497
    ISSN 0307-0565
    DOI 10.1038/s41366-023-01412-3
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    Zs.A 1325: Show issues Location:
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  7. Article ; Online: Gastrojejunostomy Closure Technique and Risk of Leak: an Evaluation in Ex Vivo Porcine Models.

    Das, Bibek / Ledesma, Frances / Ashrafian, Hutan / Reddy, Marcus / Khan, Omar A / Fehervari, Matyas

    Obesity surgery

    2023  Volume 33, Issue 3, Page(s) 978–981

    Abstract: Introduction: Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric operations worldwide. Leaks following RYGB are rare, but the consequences can be devastating. Although most leaks occur at the gastrojejunostomy (GJ) ... ...

    Abstract Introduction: Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric operations worldwide. Leaks following RYGB are rare, but the consequences can be devastating. Although most leaks occur at the gastrojejunostomy (GJ) anastomosis, there is a lack of data on modifiable technical factors that can reduce the risk of leaks. Therefore, we evaluated whether the leak pressure of a GJ linear stapled anastomosis is dependent on the closure technique.
    Methods: Two expert surgeons constructed gastric pouches and GJ anastomoses on ex vivo porcine models in a laparoscopic simulator using 30-mm and 45-mm endoscopic staplers. The GJ anastomosis was closed using either a single layer suture, double layer suture or stapler. The endpoints were leak pressure to air insufflation, measured by two independent observers, site of leak and internal circumference of the GJ anastomosis.
    Results: In total, 30 GJ anastomoses were constructed (30 mm, n = 15; 45 mm, n = 15). The GJ anastomosis was closed using single layer (n = 9), double layer (n = 9) and stapled techniques (n = 12). Inter-observer agreement was high. Stapled and double layer closures were more resilient than a single layer closure, with 75% (9/12) stapled closures remaining intact at < 70 mmHg. GJ stoma circumference was lower using a 30-mm stapler (64.8 mm vs 80.2 mm; p < 0.05) but independent of closure technique. The most common leak site was the corner of the closure (67%).
    Conclusion: In summary, the GJ anastomosis closure technique may be a modifiable factor to prevent anastomotic leak.
    MeSH term(s) Animals ; Swine ; Gastric Bypass/methods ; Obesity, Morbid/surgery ; Anastomosis, Roux-en-Y ; Stomach/surgery ; Laparoscopy/methods ; Anastomotic Leak/prevention & control ; Anastomotic Leak/surgery
    Language English
    Publishing date 2023-01-26
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1070827-3
    ISSN 1708-0428 ; 0960-8923
    ISSN (online) 1708-0428
    ISSN 0960-8923
    DOI 10.1007/s11695-023-06470-0
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    Zs.A 3381: Show issues Location:
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  8. Article ; Online: Outcomes of One-Anastomosis Gastric Bypass Conversion to Roux-en-Y Gastric Bypass for Severe Obesity: A Systematic Review and Meta-analysis.

    Sargsyan, Narek / Das, Bibek / Robb, Henry / Namgoong, Christopher / Ali, Iihan / Ashrafian, Hutan / Humadi, Samer / Mitra, Anuja / Fehervari, Matyas

    Obesity surgery

    2024  Volume 34, Issue 3, Page(s) 976–984

    Abstract: One-anastomosis gastric bypass (OAGB) is an effective procedure to treat severe obesity. However, conversion to Roux-en-Y gastric bypass (RYGB) is increasing. We therefore conducted a systematic review to determine the safety and efficacy associated with ...

    Abstract One-anastomosis gastric bypass (OAGB) is an effective procedure to treat severe obesity. However, conversion to Roux-en-Y gastric bypass (RYGB) is increasing. We therefore conducted a systematic review to determine the safety and efficacy associated with OAGB-RYGB conversion. A systematic search was conducted by three independent reviewers using Medline, Embase, and the Cochrane library following PRISMA guidelines. Six studies including 134 patients were selected who were undergoing OAGB-RYGB conversion. The most common indications were reflux (47.8%), malnutrition (31.3%), and inadequate weight loss (8.2%). Study outcomes demonstrated 100% resolution of bile reflux. Overall, there was medium-term weight gain of 0.61 BMI. OAGB to RYGB conversion leads to resolution of reflux symptoms. However, it is associated with weight regain, albeit this may be acceptable to patients to treat biliary reflux.
    MeSH term(s) Humans ; Gastric Bypass/methods ; Obesity, Morbid/surgery ; Anastomosis, Roux-en-Y ; Weight Gain ; Gastroesophageal Reflux/surgery ; Bile Reflux/surgery ; Retrospective Studies
    Language English
    Publishing date 2024-01-20
    Publishing country United States
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 1070827-3
    ISSN 1708-0428 ; 0960-8923
    ISSN (online) 1708-0428
    ISSN 0960-8923
    DOI 10.1007/s11695-023-07050-y
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  9. Article ; Online: Vagal Nerve Therapy in the Management of Obesity: A Systematic Review and Meta-Analysis.

    Fadel, Michael G / Fehervari, Matyas / Das, Bibek / Soleimani-Nouri, Payam / Ashrafian, Hutan

    European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes

    2023  Volume 64, Issue 4, Page(s) 365–375

    Abstract: Introduction: The vagus nerve has an important role in satiety, metabolism, and autonomic control in upper gastrointestinal function. However, the role and effects of vagal nerve therapy on weight loss remain controversial. This systematic review and ... ...

    Abstract Introduction: The vagus nerve has an important role in satiety, metabolism, and autonomic control in upper gastrointestinal function. However, the role and effects of vagal nerve therapy on weight loss remain controversial. This systematic review and meta-analysis assessed the effects of vagal nerve therapy on weight loss, body mass index (BMI), and obesity-related conditions.
    Methods: MEDLINE, EMBASE, and CINAHL databases were searched for studies up to April 2022 that reported on percentage excess weight loss (%EWL) or BMI at 12 months or remission of obesity-related conditions following vagal nerve therapy from January 2000 to April 2022. Weighted mean difference (WMD) was calculated, meta-analysis was performed using random-effects models, and between-study heterogeneity was assessed.
    Results: Fifteen studies, of which nine were randomised controlled trials, of 1,447 patients were included. Vagal nerve therapy led to some improvement in %EWL (WMD 17.19%; 95% confidence interval [CI]: 10.94-23.44; p < 0.001) and BMI (WMD -2.24 kg/m2; 95% CI: -4.07 to -0.42; p = 0.016). There was a general improvement found in HbA1c following vagal nerve therapy when compared to no treatment given. No major complications were reported.
    Conclusions: Vagal nerve therapy can safely result in a mild-to-moderate improvement in weight loss. However, further clinical trials are required to confirm these results and investigate the possibility of the long-term benefit of vagal nerve therapy as a dual therapy combined with standard surgical bariatric interventions.
    MeSH term(s) Humans ; Obesity/therapy ; Vagus Nerve ; Weight Loss ; Body Mass Index ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2023-08-04
    Publishing country Switzerland
    Document type Meta-Analysis ; Systematic Review
    ZDB-ID 205700-1
    ISSN 1421-9921 ; 0014-312X
    ISSN (online) 1421-9921
    ISSN 0014-312X
    DOI 10.1159/000533358
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  10. Article ; Online: Medium-Term Weight Loss and Remission of Comorbidities Following Endoscopic Sleeve Gastroplasty: a Systematic Review and Meta-analysis.

    Fehervari, Matyas / Fadel, Michael G / Alghazawi, Laith Omar Khalaf / Das, Bibek / Rodríguez-Luna, María Rita / Perretta, Silvana / Wan, Andrew / Ashrafian, Hutan

    Obesity surgery

    2023  Volume 33, Issue 11, Page(s) 3527–3538

    Abstract: This systematic review and meta-analysis aimed to determine the short- and medium-term weight loss outcomes and comorbidity resolution following endoscopic sleeve gastroplasty. Our search identified 35 relevant studies containing data from 7525 patients. ...

    Abstract This systematic review and meta-analysis aimed to determine the short- and medium-term weight loss outcomes and comorbidity resolution following endoscopic sleeve gastroplasty. Our search identified 35 relevant studies containing data from 7525 patients. Overall, pooled short-term (12 months) total weight loss (TWL) was 16.2% (95% CI 13.1-19.4%) in 23 studies (n = 5659). Pooled medium-term TWL was 15.4% (95% CI 13.7-17.2%) in 10 studies (n = 4040). Diabetes resolution was 55.4% (95% CI 46-64%), hypertension resolution was 62.8% (95% CI 43-82%), dyslipidaemia resolution was 56.3% (95% CI 49-63%), and obstructive sleep apnoea resolution was 51.7% (95% CI 16.2-87.3%) in four studies (n = 480). This pooled analysis demonstrates that ESG can induce durable weight loss and resolution of obesity-associated comorbidities in patients with moderate obesity.
    MeSH term(s) Humans ; Gastroplasty ; Obesity, Morbid/surgery ; Obesity/surgery ; Comorbidity ; Weight Loss ; Treatment Outcome
    Language English
    Publishing date 2023-09-13
    Publishing country United States
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 1070827-3
    ISSN 1708-0428 ; 0960-8923
    ISSN (online) 1708-0428
    ISSN 0960-8923
    DOI 10.1007/s11695-023-06778-x
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