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| ORAL ABSTRACTS |
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| Year : 2023 | Volume
: 2
| Issue : 1 | Page : 31-37 |
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Oral Abstracts: Abstracts of 20th Annual National Conference of Obesity & Metabolic Surgery Society of India 2023, Mumbai
| Date of Web Publication | 20-Feb-2023 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2949-6705.370081
How to cite this article:
. Oral Abstracts: Abstracts of 20th Annual National Conference of Obesity & Metabolic Surgery Society of India 2023, Mumbai. J Bariatr Surg 2023;2:31-7 |
How to cite this URL:
. Oral Abstracts: Abstracts of 20th Annual National Conference of Obesity & Metabolic Surgery Society of India 2023, Mumbai. J Bariatr Surg [serial online] 2023 [cited 2023 Mar 22];2:31-7. Available from: http://www.jbsonline.org/text.asp?2023/2/1/31/370081 |
| Performing LSG is it Worth or Did You Burn Your Hands? A Retrospective Analysis of 263 Cases | |  |
Apoorv Shrivastava
Department of Surgery, Medanta Hospital, Indore, Madhya Pradesh, India
E-mail: [email protected]
Background: Laparoscopic Sleeve Gastrectomy has been a standard surgical approach to morbid obesity. In recent periods there have reports of GERD, Barrets Esophagus and and weight regain in some studies. This study evaluates 5 year follow up of 263 patients who had undergone LSG from January 2014 till December 2017. The Study is a Single Centre Study.
Objectives: To evaluate the patients outcome for Postoperative Complications, Staple line leaks, Weight Loss at 3 months and 6 Months Weight Regain at 3 years and at 5 Years, Incidence of GERD Clinical and Endoscopic.
Methods: The patients BMI ranged from 36 to 51. All the patients were Non Diabetic. The cases included in the study were in the age group 24 to 62 years. All the patients were operated with standard 5 ports with surgeon standing between the legs. Surgical Stapling was done with Endo GIA Purple in all the patients. Hospital stay ranged from 3 days to 7 days. Patients were followed up to 3 months, 6 months, 3 years and 5 years after surgery.
Results: No major postoperative complications were seen with no staple line leaks. There was a significant excess weight loss at 3 and 6 months with an average of 30 and 71 percent respectively. No staple line leaks were seen. There was a significant weight regain in 5% of the patients in 5 years. Symptomatic reflux was found in 7% which responded to conservative treatment. No case of Barrets or Hiatus Hernia was found.
Conclusion: LSG is an acceptable choice in the Morbidly Obese with comparitively less complications and good weight loss. The incidence of GERD and Barrets Esophagus is very less in our study as compared upto 2 percent in some studies. The weight loss is comparable to other Bariatric procedures such as MGB or RYGB.
| Scientific Weight Management using Whey based High Protein Meal Replacement with Garcinia Cambogia | | |
Arya Singh, Mahendra Narwaria
Departments of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India
E-mail: [email protected]
Background: A high caloric intake and sedentary lifestyle has increased the prevalence of overweight and obese individuals. An observational study was conducted to evaluate the impact of 500 kilocalorie reduction using a high protein meal replacement containing Garcinia cambogia (MR) along with diet and lifestyle interventions.
Methods: The non-surgical scientific weight management plan (SWMP) is defined as a diet and lifestyle intervention with an average 500 kilocalorie reduction using a commercially available high protein whey based meal replacement containing Garcinia cambogia (MR) along with a moderate intensity exercise recommendation for 45-60 minutes every day. About 45 subjects (32 females and 13 males) with a mean weight of 80.5 ±8.2 kg and a BMI of 30.6 ± 3.2 kg/m2, Body fat of 36.6 ± 4.3% and Skeletal muscle of 24.6 ± 3.9% were recruited in the study using purposive sampling. The average caloric intake was in the range of 1700-2000 kilocalorie. The subjects were given an average calorie intake of 1200 ± 240 kcal with one or two meals replaced by MR. About 88% subjects received the MR as a partial or complete replacement of breakfast/morning meal while remaining received as a replacements of dinner. The subjects followed the regimen for 6 months and received a regular follow up every 15-20 days.
Results: The average weight loss seen was 9.9 kg ± 3.2 with an approximate 4-point reduction in the BMI and reduction in body fat % by 8.7% and an increase in skeletal muscle by 1.1%. The weight was sustained in 91% of subjects for a period of 6 months with only 4 subjects showing a regain of 2-3 kg of weight. The subjects also showed an improvement in GI symptoms like gas, constipations or acid reflux.
Conclusion: A whey based high protein meal replacement containing Garcinia cambogia is effective in giving sustainable weight loss observed over a period of 6 month in non-surgical obese/overweight patients.
| Concomitant Bariatric Surgery and Mesh Hernia Repair Surgery – Way Forward | | |
Ashish Vashistha
Department of Surgery, Max Superspeciality Hospital, New Delhi, India
E-mail: [email protected]
Background: Obesity has been consistently associated with a higher incidence of ventral hernia. It is preferable to treat both obesity and hernia in such patients because with weight loss, the risk of recurrence of hernia is reduced. Bariatric surgery offers the best treatment for obesity and its associated and in combination with intraperitoneal onlay mesh repair (IPOM) provides the best treatment in such patients. The bariatric surgical team often faces the dilemma of whether to offer concomitant bariatric surgery with IPOM or a staged procedure in such patients because the safety of a concomitant procedure still creates doubt.
Methods: Retrospective review of 19 patients, who underwent Laparoscopic Sleeve gastrectomy with IPOM at our institute from January 2010 till December 2021 has been analysed.
Results: None of the patients had any complications, patient satisfaction was high, mean hospital stay was 2.5 days amd mean operating time was 103 minutes.
Conclusion: The data analyesed from the study clearly shows that the above mentioned procedures can be combined in the same sitting specially in safe hands.
| Sleeve with Proximal Jejunal Bypass – 3 Year Follow Up Data | | |
D. Thakkar, N. Dukkipati
Department of Bariatrics, Livlife Hospitals, Hyderabad, Telangana, India
E-mail: [email protected]
Background: India has the 3rd largest obese population in the world. Sleeve gastrectomy although the commonest procedure performed alone is not sufficient in patients with morbid obesity to achieve complete and durable weight loss. Laparoscopic Proximal Jejunal Bypass with Sleeve Gastrectomy (LPJB-SG) has shown effective weight loss in such patients in other Asian studies. We present our 3 years data for the same.
Materials and Methods: Patients with morbid obesity who underwent LPJB-SG between June 2018 to July 2022 at a single centre are included in the study. This is an ongoing prospective study on Indian patients. All surgeries consisted of a sleeve gastrectomy with bypassing proximal jejunum about 250–300 cm in length. Intra and post-surgical data were collected and operation time, length of hospital stay (LOS) and early and late complications were documented. BMI and percentage of excess weight loss (%EWL) were assessed at follow-up visits for 3 years. Surgical complications, nutritional deficiencies, improvement of co-morbidities were recorded.
Results: 83 patients underwent LPJB-SG in this study period. Their average age was 37 yrs. Their average weight was 129.9 kg and BMI was 46.45 kg/m2. Their average small bowel length was 750 cms. Average operation time was 2 hrs and length of stay 1 days. Their % EWL was 65.94%. Three year follow up was available for 17 of 27 patients whose % EWL was 67.44%. 2 year follow up % EWL was 66.74%. There were two complications, one SMV thrombosis at 18 days which was managed conservatively and adhesive band obstruction at 3 months which required surgery. One patient was diagnosed with peripheral neuropathy and proximal muscle weakness at 6 months which was managed and reversed completely with B12 supplementation. 5 patients had Type II diabetes at the time of surgery with a diabetic age < 5 yrs. At follow up of 3 years, all 5 had diabetes remission.
Conclusions: LPJB-SG is an effective weight loss procedure. Three year results are promising. Patients with diabetic age < 5 yrs had remission of Diabetes at 3 years. Further long- term data is needed to assess the long-term effectiveness of this procedure.
Keywords: Gastric sleeve, sleeve plus, PJB, gastric bypass, excess weight loss, bariatric surgery
| Bariatric Surgery in Renal Failure Patients Improves Access to Transplantation without Increased Perioperative Risk | | |
Karen D. Bosch, L. Sulutaura, E. Lacea, K. Burton, N. Fernandez-Munoz, P. Sufi, A. Al-Midani1, C. D. Parmar
Department of Surgery, Whittington Hospital, 1Department of Renal Transplantation, Royal Free Hospital, NHS Foundation Trust, London, United Kingdom
E-mail: [email protected]
Background: Renal transplantation is not recommended in patients with BMI >40 as postoperative risks are increased. Bariatric surgery (BS) results in sustained long-term weight-loss. However, renal failure patients are theoretically higher risk candidates.
Objective: We aim to investigate whether renal failure patients who have undergone BS 1) have acceptable outcomes and 2) have better access to transplantation.
Methods: We retrospectively reviewed data from 34 patients with renal failure who were referred for BS between 2013 and 2021. We compared the outcomes of renal failure patients who did (n=19) and did not (n=12) undergo BS. In addition, a group of matched controls (MC) without renal failure were used for further comparison.
Results: Of the 34 patients referred, 19 proceeded with BS (68% female, median age 52, BMI 46.2 ± 1.1 kg/m2), 3 are completing work-up, and 12 did not proceed with surgery (58% female, median age 58, mean BMI 41.5 ± 1.3). The MC group has similar baseline characteristics and type of surgical procedure (74% female, median age 54, BMI 45.9 ± 1.4 kg/m2, 94.7% sleeve gastrectomy). Excess body weight loss (EBWL) was 64.6% ± 5.3% at 1 year in renal failure patients versus 55% ± 7% in MC patients. In the operated group, 11/19 (58%) patients reached their treatment target (6 transplanted, 5 placed on waiting list) versus 2/12 (17%) in unoperated patients (2 transplanted). There was no difference in perioperative complications between renal failure and MC groups. There were 7 deaths in the renal failure groups (5 unoperated; 2 operated, unrelated to surgery) and no deaths in the MC group.
Conclusion: Increased access to renal transplantation is seen after BS in renal failure patients good long-term weight loss is achieved. No evidence of increased perioperative morbidity or mortality is seen. We therefore recommend consideration of bariatric surgery in obese renal failure patients.
| Bariatric Surgery: A New Ray of Hope in Pulmonary Arterial Hypertension | | |
Kona S. Lakshmi Kumari
Department of GI and Minimal Access Surgery, Yashoda Hospital, Somajiguda, Hyderabad, Telangana, India
E-mail: [email protected]
Introduction: Data regarding outcomes of bariatric surgery in patients with pulmonary hypertension is limited Some case reports suggested bariatric surgery improves pulmonary hypertension.
Case Report: A 70 years Lady of height 150 cm weight 116 kgs BMI 45 gives history of gradual weight gain for the past 20 years initially tried exercise and diet control but was unsuccessful. She was having associated symptoms of easy fatiguability, dyspnoea on exertion, pedal edema unable to do daily activities and in a bed bound state Patient also gives history of OSA, Hypertension and severe pulmonary hypertension for which she was on medication Considering above factors of age and pulomonary hypertension evaluated with cardiology consultation and 2D echo revealed Dilated RA/RV. Moderately severe TR/ Severe PAH (RVSP: 85 mm hg) Concentric LVH. No LV RWMA EF 60 %. Grade I diastolic dysfunction UGIE revealed Lax GE junction with non erosive gastritis. Challenging decision of surgery was taken and pre operatively optimised with Bosentan other cardiac support medication and diuretics CPAP support was given. Very low calorie diet was given before taking for surgery with all essential elements and albumin support. Patient was taken up for surgery after 2 weeks of optimisation with continuing pulmonology and cardiology advices. Mini gastric bypass with Gastrojejunostomy performed at 120 cm from DJ flexure performed. With good post op ICU care and Physiotherapy and dietary advises she was discharged after 6 days post procedure in a vitally stable condition Reviews at 2 weeks later 1 month later and 2 months later patient showed dramatic improvement in general condition. Patient was able to move and do small activities and lost about 20 kgs in 40 days post procedure. Her RVSP on 1 month followup improved to 40 mm hg.
Discussion: It gives a new life to morbidly obese patients with associated co morbidities. Here improvement in outcomes such as use of vasodilatory and diuretic medications, need for home oxygen therapy and mean pulmonary arterial pressures, excess body weight loss were reassesed all were improved in present case
Conclusion: Bariatric surgery can be performed without prohibitive complication rates in patients with PH In our experience they achieved significant weight loss and improvement in RVSP.
Keywords: Bariatric surgery, pulmonary hypertension
| Emergent Technology, New Non-Standard and Bariatric Surgery | | |
Mahendra Narwaria, Ankur Sharma
Department of Nutrition and Diabetics, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India
E-mail: [email protected]
Introduction: Loss of endoscopic access to the excluded stomach and biliary tract following a gastric bypass is an identified drawback and there is a felt need to circumvent the problem. Many interventions have been tried to access the excluded stomach including EUS directed transgastric interventions surgical gastrectomy for access.
Aim: Intentional Gastro- Gastric Fistula (GGF) in selected patients with higher predictable need for future endoscopy is an innovative method for addressing the problem.
Materials and Methods: Mini Gastric Bypass (MGB) in a cirrhotic patient with intentional GGF at an anti-gravity position along the cranial end of the vertical staple line, which helped us to have endoscopic access to the excluded stomach and biliary tract post-operatively. Unlike RYGB, MGB has a longer pouch and a wider stoma which results in a lower pressure system owing to reduced food transit time. This alleviates the concern of food passage across the GGF, which leads to undesirable inadequate weight loss and/or weight regain.
Results: Our cirrhotic patient was benefitted with this GGF for endoscopic access to excluded stomach post-operative by avoiding the cumbersome alternatives of Endo USG guided transgastric and Laparoscopic guided access to the excluded stomach.
Conclusion: Intentional GGF constructed in an antigravity position on a low pressure system MGB serves the advantage of access to excluded stomach and biliary tract, probab;y without the risk of trans fistula food passage and weight regain. However, long term follow ups for weight loss in this technique needs to be observed.
| Modified One Anastomosis Loop Gastric Bypass following a RYGB for Better Outcome | | |
Mahendra Narwaria, Ankur Sharma, Arya Singh
Department of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India
E-mail: [email protected]
Introduction: A failed Bariatric procedure is a disappointment to both the patient and the bariatric surgeon. Although the reasons for a failure of a procedure are multifactorial, the surgeon loses as much hope as does the patient if the results after surgery are disappointing. The disappointment rises many folds if this failure is after a second bariatric surgery. Options for weight regain or inadequate weight loss after a Roux en Y (RYGB) includes: Distal RYGB, BPD- DS, Trimming the pouch, with or without a band. Having a patient with a banded RYGB without any significant pouch dilation would leave the 2 options of either having to distalize the JJ anastomosis or to convert to a BPD-DS. Both these procedures carry significant morbidity of protein malnutrition and increased frequency of stool. Induced fat malabsorption after BPD-DS or distal RYGB is supposed to offer some hope for losing weight. However, both these procedures are poorly tolerated by Indian populations. OAGB is not a new procedure for Indian Surgeons and its efficacy has already been proven in various studies. Can OAGB be offered in patients with RYGB?
Aim and Objective: To present out data of Modified One Anastomosis Loop Gastric Bypass (OAGB) following a RYGB with short and medium term follow up and results.
Materials and Methods: A retrospective analysis was done for 9 patients who underwent modified OAGB following a RYGB and following characteristics were noted: Preoperative BMI, comorbidities, original weight before index surgery, time to regain, post-operative follow up with regards to weight loss, change in BMI and resolution of comorbidities.
Results: Modified OAGB following RYGB offers hope for a revision surgery without significant morbidity and is well tolerated.
Conclusion: Modified OAGB following a RYGB can be considered while dealing with patients of RYGB with weight regain. However, long term study needs to be done to observe long term benefits.
Keywords: Biliopabcreatic diversion with duodenal switch, one anastomosis loop gastric bypass, Roux en Y (RYGB)
| Outcomes of Bariatric Surgery in the Geriatric Population (>65 Years) in the Indian Subset of Patients | | |
Vinay Khatri, Manish Khaitan, Riddhish Gadani
KD Hospital, Ahmedabad, Gujarat
E-mail: [email protected]
Background: With the increasing average human lifespan and sedentary lifestyle, there is an increase in obese patients in the geriatric population. Weight loss surgery is not frequently being offered to geriatric population due to the concerns of increased morbidity, mortality and nutritional complications. The purpose of the study was to evaluate the safety and outcome of bariatric surgery in patients >65 years of age.
Methods: A retrospective review of prospectively collected data on post bariatric patients at a single centre from Jan. 2017 to Dec 2019 was used to analyze the weight loss, operative complications and outcome.
Results: The analysis of 1544 patients, 124 (8.03%) patients 65 years and older were identified and were compared with 124 patients matched for type of surgery. Out of 124 patients in each group, 43 (34.6 %) had undergone Roux-en-Y gastric bypass, 29 (23.3%) one anastomosis gastric bypass, and 52 (41.9 %) sleeve gastrectomy. The average age was 68.7 years and 43.5 years in the geriatric and adult groups respectively. Average preoperative weight and BMI were 108.4 kg and 116.2 kg and 46.29 kg/m2 and 41.08 kg/m2 in the geriatric and adult groups respectively The operative outcomes were similar for the 2 groups as determined by the operative time (75 versus 70 minutes), length of stay (52 hours versus 48 days), and 30-day readmission rate (6.0% versus 7.4%). The postoperative complication rates were low in the adult patients compared to 65 years old (bleeding 1.0%, pulmonary 1.5 %, cardiac 1%, wound 0.5%, and 30-day mortality rate 0%). The percentage of excess body weight loss in both the groups at three year follow up were similar.
Conclusion: Bariatric surgery could be an effective and safe treatment modality for patients in Geriatric age group to enhance their quality of life and reduce dependency on others.
| Outcomes Following Reoperative Bariatric Surgery Following Laparoscopic Sleeve Gastrectomy at a Tertiary Care Center | | |
Vitish Singla
Department of Surgical Disciplines, All India Institute of Medical Sciences,
New Delhi, India
E-mail: [email protected]
Introduction: In the midst of pandemic of obesity, the number of bariatric surgeries performed are ever increasing. Some of these patients go on to require revision surgery commonly due to weight regain or reflux. Hereby, we present outcomes following revision bariatric surgery at a tertiary care center.
Methods: Prospectively collected data of all patients undergoing revision bariatric surgery from 2010 until 2021 were analyzed retrospectively. Weight loss, resolution of comorbidities, and complications following revision surgery were evaluated.
Results: Twenty-six patients were included in the study. The mean age was 38.8 (10.8) years. The primary procedure performed was laparoscopic sleeve gastrectomy in all cases. Nine patients underwent RYGB (one banded RYGB) and 14 underwent OAGB (three-banded OAGB). Three patients underwent resleeve. The mean BMI before revision surgery was 42.7 (9.8). It was 32.6 (5.7) kg/m2 and 33.0 (6.1) kg/m2 at 1 and 3 years respectively. Age and pre-revision surgery excess weight correlated with weight loss (r= -0.79 and r=0.99 respectively). Symptomatic reflux developed in one patient each following resleeve and banded RYGB. One patient each developed band erosion with gastro-gastric fistula and band slippage requiring reoperation. Postoperative bleeding occurred in two patients, one requiring endoscopic clip application. One of the patients who underwent conversion to OAGB expired in the postoperative period due to a suspected leak.
Conclusion: Revision bariatric surgery has acceptable weight loss and low complication rates. Band placement in revision cases might lead to a higher complication rate.
Keywords: Reoperative bariatric surgery, revision bariatric surgery, conversion bariatric surgery
| Optimal Length of Biliopancreatic Limb for OAGB | | |
Yarlgadda Krishnamohan
Department of Surgical Gastroenterology, Minimal Access and Bariatric Surgery, CARE Hospitals, Banjara Hills Hyderabad
E-mail: [email protected]
Background: Ideal biliopancreatic limb (BPL) length in bariatric/metabolic procedures to be anastomosed in alimentary continuity remain unclear. This study aims to evaluate different lengths of BPL performed in a series of patients submitted to OAGB and correlate them with excess weight loss (EWL) and diabetic remission.
Patients and Methods: A prospective observational study of 260 consecutive morbidly obese patients undergoing OAGB was performed. BPL length was determined preoperatively depending on Body Mass Index (BMI) and co-morbidities. Remission of comorbidities apart from diabetes and nutritional deficits were recorded at 1, 2 and 5 years after surgery.
Results: 250 patients were included for the purpose of final analysis. BPL length was directly correlated with Units of BMI lost (UBMIL). Established a BMI equivalent to that of 100% EWL and amongst the diabetic patients the results were split equally i.e., 50% showcased complete remission and 50% showcased partial remission. BPL length ranged from 120cms to 200cms depending on the BMI of the patient.
Conclusion: BPL measurement is essential to obtain optimal outcomes after OAGB as per the BMI of the patient, both in terms of excess weight loss and remission/improvement of comorbidities.
| A Case Study on Psychological Reasons of Weight Regain and Revisional Bariatric Surgery among Obsese Patient | | |
Pragna Desai, Naureen Mansuri
Nobesity Bariatric Surgery Center, Ahmedabad, Gujarat, India
E-mail: [email protected]
Background: Obesity is considered to be the leading cause of multiple chronic diseases due to unhealthy lifestyle and problematic eating behavior. Among all the treatments, bariatric surgery is the most effective one for the sustainable outcome but many obese patients fail this procedure too by regaining a significant amount of weight.
Objective: The aim of this study is to identify underlying psychological factors failing the surgery in a short span and seeking revisional bariatric surgery.
Methods: For that case study method used to address and analyze psychological factors leading problematic eating behavior causing weight regain after bariatric surgery and therapeutic intervention to build healthy behavior patterns. The case was taken from Nobesity bariatric surgery center, Ahmedabad, Gujarat. The case was identified using detailed psychological evaluation with the help of detailed history, Beck depression inventory and DSM-V criteria for eating disorder.
Results: Post psychological intervention patient's BDI, BAI score was significantly improved and adapted healthy eating pattern along with healthy coping mechanism to support sustainable weight loss.
Conclusion: Therefore it is proven that unhealthy interpersonal relation is maintaining factor for Binge eating Disorder; along with surgery, Interpersonal therapy and Cognitive behavior therapy gives significant improvement in Obses patient with Eating disorder.
Keywords: Bariatric surgery, binge eating disorder, cognitive therapy, obesity, problematic eating behavior, revision bariatric surgery, weight gain, weight loss surgery
| Preliminary Results of Laparoscopic Sleeve Gastrectomy with Ligamentum Teres Cardiopexy in Preventing Denovo Gerd: A Prospective Study in South Indian Population | | |
X. L. Jayanth Leo, T. Viswanath, S. Saravana Kumar, P. Praveen Raj
Gem Hospital, Chennai
E-mail: [email protected]
Background: Laparoscopic Sleeve Gastrectomy has become most popular and commonest bariatric surgical procedure performed worldwide. In the last decade, it has surpassed the very well-established gold standard procedure Roux-en-Y Gastric Bypass and stood as a stand-alone procedure due to its weight loss effects and potential for comorbid resolution. Though it appears technically easy to perform and has comparable results with other procedures, it is being criticised to be refluxogenic. We aimed at studying how effectively this denovo reflux post sleeve gastrectomy can be prevented/ controlled by adding a sling (ligamentum teres wrap across GE junction) component to the routine surgical steps of this established procedure. Here we present a video of Ligamentum Teres Cardiopexy (LTC) and the surgical techniques in doing it laparoscopically as a part of routinely performed Sleeve Gastrectomy. It prevents/ at least lessens the denovo reflux post operatively with retaining GE junction intra abdominally and thus prevents migration of sleeve.
Materials and Methods: This is a Randomised Controlled Trial with equal allocation of patients undergoing Sleeve Gastrectomy in to two arms (Lap Sleeve Gastrectomy vs Lap Sleeve Gastrectomy with LTC) by closed envelop technique. During 2019-22, patients were enrolled for this study, underwent LSG in a single centre performed by a single surgical team and completed 6 months follow up at least. These were randomised into two groups – 1st group underwent LSG alone (n=38) and the 2nd group underwent LSG combined with LTC (n=36). All the patients were assessed by RDQ score and endoscopy preoperatively as a routine. Patients with significant reflux evident from history, scoring and endoscopy findings (Type C and D Reflux esophagitis) were excluded from the study. At 6 months follow up both the groups were reassessed with RDQ Score and Upper GI Scopy.
Results: After 6 months, patients were assessed with their RDQ scores and endoscopy which were compared to the preoperative scores and endoscopic findings. The overall mean RDQ Score preoperatively in both groups was 12.5±3.5, 15.0 ± 3.6 respectively which dropped to 11 ± 2.8, 8.5 ± 4 post operatively. 6 patients in Non LTC group were symptomatic and needed PPIs for more than 6 months and only 2 in LTC group required PPI for 3 months postoperatively.
Conclusion: Addition of the LTC component to Sleeve Gastrectomy gives an extra benefit in decreasing the incidence of Denovo GERD associated with it. We are doing a similar study incorporating 24 hr pH study and esophageal manometry with long term follow up and larger sample size.
Keywords: De novo GERD, ligamentum teres cardiopexy, reflux disease questionnaire, reflux esophagitis, sleeve gastrectomy
| Long Term Results After Concomitant Approach in Bariatric Surgery with Ventral Hernias: 10 Years Plus Follow Up and Update From Single Centre with 224 Cases | | |
S. Saravana Kumar, T. Viswanath, X. L. Jayanth Leo, P. Praveen Raj
Department of Bariatrics, Gem Hospital, Coimbatore
E-mail: [email protected]
Background: Obesity is known to cause an increase in the risk of abdominal wall hernias (Primary as well as incisional). It has also proven to increase the risk of recurrence after ventral hernia repair attributing to chronically raised intraabdominal pressure. Concomitant approach i.e., combining bariatric surgery and hernia repair with a mesh simultaneously addresses both the problems with decrease in the recurrence rate and provides the advantage of single stage surgery.
Objective: To analyse the long-term results and safety of combining Bariatric surgery and ventral hernia repair with mesh and to assess the mesh infection rates and hernia recurrence.
Methods: It's a retrospective study and all the bariatric patients who underwent concomitant procedure – Bariatric surgery combined with Intraperitoneal Onlay Mesh Repair/ e-TEP (Sleeve, RYGB, OAGB with IPOM/e-TEP) in our centre were included in this study and results were analysed.
Results: A retrospective review of 224 patients who underwent concomitant approach from 2003 till 2021 was done. 146 patients underwent Lap Sleeve Gastrectomy with IPOM/e-TEP (Mean BMI 44.5 ± 5.2 kg/mt2), 74 patients underwent RYGB with IPOM (Mean BMI 46 ± 3.8 kg/mt2) and 4 patients underwent OAGB with IPOM (Mean BMI 54 ± 2.4 kg/mt2). 179 and 45 patients were operated for primary and recurrent hernias respectively. 7 patients underwent e-TEP and 2 underwent Anterior component separation. During follow up, 2 patients presented with recurrence but no mesh infections were evident.
Conclusion: Concomitant approach in bariatric surgery (Sleeve or any types of bypasses) and ventral hernia repair with mesh is safe, feasible and is not associated with increased rates of mesh infection as otherwise feared. It offers single stage solution to this group of patients and addresses chronically raised intraabdominal pressure therefore decreasing the chances of further recurrence. However, this approach should be done in centres which have good experience in both these procedures.
Keywords: Bariatric surgery, concomitant approach, intraperitoneal onlay mesh repair, one anastomosis gastric bypass, recurrent hernia, Roux-en-Y gastric bypass, sleeve gastrectomy, ventral hernia
| Pre-Bariatric Psychological Assessment | | |
S. Christinajoice, T. Viswanath, S. Saravana Kumar, X. L. Jayanth Leo, P. Praveen Raj
Gem Hospital, Coimbatore, India
E-mail: [email protected]
Background: The link between obesity and psychological diseases is very prominent. Since bariatric surgery is emerging as the most effective treatment for obesity, pre operative psychological assessment is gaining importance. Though multiple psychological assessment tools are available, due to their complex and time-consuming nature, using them in daily clinical practice is still challenging. Hence, a simplified pre-bariatric surgery psychological assessment tool is a need for an hour.
Objectives: The aim of this study is to understand the incidence of psychological diseases in morbidly obese seeking Bariatric surgery and to understand the sensitivity of various existing scoring systems and to find a simplified method to use pre-operatively.
Methods: It was a prospective study conducted in a tertiary bariatric surgery center. Informed and oral consents were obtained from all participants. Outpatients were assessed for the presence of psychological conditions and diagnosed based on the criteria mentioned in DSM 5. Existing psychological assessment tools with scoring systems were electronically searched through Pub med, Science direct, clinical key, and Google search engines. Predominantly used tools were selected and patients diagnosed with psychological conditions were assessed by using those tools. The administrative time of each tool was documented. Statistical analysis was done using SPSS version 20.0 (SPSS Inc., IL, USA). The simplified pre-operative assessment method was designed based on the obtained inference.
Results: Among the total population of 185 patients, 109 (59.2 %) and 94 (50.8 %) were diagnosed with anxiety disorder and stress disorder respectively. 80 (43.5%) patients were found to have depression and 73 (39.5%) with personality disorders. Incidence of Eating disorders, substance use disorder, psychosis, bipolar and schizophrenia was in 52(28.5%), 50 (27.3 %), 38(20.7%), 34 (18.9%), and 29(15.8%) patients respectively. The mean BMI of the total population was 43.64 ± 6.8 kg/m2. As a result of an electronic search, we found nearly 28 relevant psychological assessment tools for the above-mentioned psychological conditions. The average administrative time for each tool was 26 ± 5 minutes.
Conclusion: Psychological assessment pre-bariatric surgery is a critical step. The inclusion of a simplified tool in a preliminary evaluation could improve the bariatric surgery outcome.
| Post Bariatric Surgery Psychological Concerns in Indian Setting | | |
Chinmayee Mokal, Madhu Goel, Amrit Nasta, Shravani Bandwalkar,
Ramen Goel
Centre for Metabolic Surgery, Wockhardt Hospital, Mumbai, Maharashtra, India
E-mail: [email protected]
Introduction: Bariatric surgery is an effective tool for patients with morbid obesity to achieve optimum weight loss and improvement of co-morbidities, though its impact on psychological health is not adequately studied.
Objective: We aimed to study the prevalence of psychological concerns post bariatric surgery.
Methodology: Retrospective analysis of prospectively entered database of post bariatric patients was done by a single bariatric psychologist. All bariatric patients who came for psychological consultations from October 2021 to September 2022 were included.
Results: 201 post bariatric patients were referred for psychological consultation. Population included 66 males (32.84%) and 135 females (67.16%). Out of these, 135 (67.16%) patients presented with symptoms of psychological disorders including depression (n=50, 37.04%), anxiety (n=6, 4.44%), panic attack (n=1, 0.74%), mood swings (n=7, 5.19%), psychological hunger (n=17, 12.6%), substance abuse (n=6, 4.44%), stress (n=28, 28.74%), impaired sleep (n=5, 3.7%) multiple diagnosis (n=11, 8.15%), non compliance (n=4, 2.96%) and those with diagnosed psychological conditions (n=42, 31.11%). Overall 482 psychology consultations were performed for these 135 patients.
Conclusion: Post bariatric psychological concerns are relatively high and close supervision and counselling sessions are desirable for healthy recovery.
Keywords: Psychological concerns in bariatrics, Post bariatric psychological assessment, Bariatric Psycological Consultations, Mental health in Bariatric
| Bariatric Surgery App | | |
Raj Palaniappan
Institute of Bariatrics, Apollo Hospitals, Chennai, Tamil Nadu, India
E-mail: [email protected]
Background: Bariatric and Metabolic Surgery is proven to be the only long term solution for the morbidly obese with comorbidities, when all other modalities fail. However, post-operative support is the most challenging period with regards to medical and lifestyle management. Studies prove good post operative support aids in significant improvement of surgical outcome and reduction in weight regain as well. In recent times, mHealth apps have gained significant momentum as they redefine the healthcare ecosystem. Morbid obesity being a metabolic lifestyle disease, will benefit all the more through mHealth by enhancing efficiency, communication & quality of care amenities.
Research: BAROS along with SECURRA has developed an Artificial Intelligence based application platform and app as a potential resource to enhance the bariatric health care professionals' productivity and improve patient's postoperative health outcomes. The platform broadly works on five pillars:
- Clinical reference and diagnostics: They assist bariatric surgeons and associated practitioners with managing the clinical practice and enhance medical environment through IOT.
- Telemedicine: Helps provide virtual patient care by the bariatric team and improving patient engagement allowing immediate access to care anytime anywhere.
- Health management: Aids bariatric patients in real-time assessment of their health conditions such as weight, diabetes, cholesterol, heart rate, and more.
- Wellness & Fitness: Includes nutrition and activity tracking, stress, sleep and other behaviour management that assist individuals to live healthier lives.
- Data management: Integrated with EHR, the platform automatically records valuable patients' information from connected devices.This enables to create a comprehensive profile of each patient for ready retrieval 24x7 with real-time alerts and prescriptions.
Conclusion: The rise of mobile apps in the healthcare industry has been extraordinary. And now we have realised the importance of health apps for bariatric ecosystem to prepare better to deliver multidisciplinary and collaborative health services. Therefore, investing in mobile health would certainly help boost our bariatric practice's reputation and revenue.
| Safety and Efficacy of Sleeve Gastrectomy with Sleeve-Jejunal Bypass: An Advantage over Other Bypass Procedures | | |
Ayushka Ugale, Surendra Ugale
Kirloskar Hospital, Hyderabad
E-mail: [email protected]
Background: The Sleeve Gastrectomy With Sleeve-Jejunal bypass is a single anastomosis Sleeve plus procedure which was introduced as a loop modification of the transit bipartition, continuing with the original idea of maintaining biliary access by avoiding duodenal transection; while creating a functional bypass to achieve weight loss and resolution of the metabolic syndrome.
Objectives: This study was done to evaluate weight loss and control of type 2 diabetes following this procedure.
Methods: The Sleeve Gastrectomy with Sleeve-Jejunal bypass was performed in 39 patients from September 2019 to February 2022 in a single centre. A sleeve gastrectomy is followed by anastomosis of a loop of jejunum (200 cm distal to the DJ flexure) to the antrum. The cohort included 13 male and 26 female patients with a mean age of 40.97 years and mean preoperative BMI of 48.54 kg/m2. 15 patients had type 2 diabetes mellitus. Mean total small bowel length (TSBL) was 660.26 cm; mean common channel (CC) was 465.10 cm. The primary outcome of this study was weight loss and secondary outcome was remission of type 2 diabetes mellitus.
Results: Of the 39 patients who underwent this procedure, 38 reached 6mth follow up, 28 reached 1 yr and 14 followed up after 2 yr. Operative duration was 150-180 min with an average hospital stay of 3-4 days with no postoperative problems. Reduction in BMI was observed from 48.54 to 35.63 kg/m2 at 6 m; 30.8 kg/m2 at 1yr and 28.97 kg/m2 at 2 yr. Mean weight loss was 33.34 kg at 6 m; 47.76 kg at 1 yr and 53.06 kg at 2 yr with a mean %TBWL of 26.39% at 6 m; 36.68% at 1 yr and 40.84% at 2 yr. Remission of diabetes was seen in 11 of 15 patients at 6 m, 12 of 13 at 1 yr and all 10 patients at 2 yr with a mean fall in HbA1c from 6.5 to 5.6 at 6 m; 5.32 at 1 yr and 5.62 at 2 yr. No mortality was seen in this study. 4 patients had complications such as nausea, vomiting, diarrhoea, dumping syndrome, hypoproteinemia and hypoalbuminemia. 1 patient required a partial reversal of the procedure [disconnection of the jejunal bypass while maintaining the sleeve], while the rest were managed conservatively.
Conclusions: This procedure was found to be safe and effective in achieving and maintaining weight loss and diabetes remission. It has the advantage of maintaining biliary access and if required is a simpler reversal compared to other bypass procedures.
| 30-day Morbidity and Mortality of Revisional Bariatric Surgery: An International Multi-Center Collaborative (BROAD) Study | | |
Amrit Nasta, Ramen Goel
Wokhardt Hospital, Mumbai
E-mail: [email protected]
Introduction: Revisional bariatric surgery (RBS) for insufficient weight loss/weight regain or metabolic relapse is increasing worldwide. There is currently no large multinational, prospective data on 30-day morbidity and mortality of RBS. In this study, we aimed to evaluate 30-day morbidity and mortality of RBS in participating centres.
Methods: An international steering group was formed to oversee the study. The steering group members invited bariatric surgeons from around the world to participate in this study through their own personal channels and professional societies. An ethical approval was obtained at the lead centre. Data were collected prospectively on all consecutive RBS patients operated between 15th May 2021 to 31st December 2021. Revisions for complications were excluded.
Results: A total of 65 global centres submitted data on 752 patients. Indications for revision included weight regain in 615(81.8%) patients, inadequate weight loss in 127(16.9%), inadequate diabetes control in 47(6.3%) and diabetes relapse in 27(3.6%). Revisional procedures performed included Roux-en-Y gastric bypass (RYGB) in 44.2% (n=332) patients, One anastomosis gastric bypass (OAGB) in 19.7% (n=148), Sleeve Gastrectomy (SG) in 16.8 % (n=126) and others in 17.15% (n=129) patients. 30-day complications were seen in 82(10.9%) patients. Fifty-two (6.9%) complications were Clavien Dindo grade 3 or higher. Two patients (0.3%) died within 30 days of RBS. Preoperative GERD was found to be significantly associated with 30-day morbidity.
Conclusion: Revisional Bariatric Surgery for insufficient weight loss/ weight regain or metabolic relapse is associated with 10.9% morbidity and 0.3% mortality. The presence of GERD prior to RBS is a significant determinant of morbidity.
Keywords: Revisional bariatric, BROAD study, Revisional bariatric outcomes
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