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 Table of Contents  
Year : 2023  |  Volume : 2  |  Issue : 1  |  Page : 38-45

Poster Abstracts: Abstracts of 20th Annual National Conference of Obesity & Metabolic Surgery Society of India 2023, Mumbai

Date of Web Publication20-Feb-2023

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2949-6705.370082

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How to cite this article:
. Poster Abstracts: Abstracts of 20th Annual National Conference of Obesity & Metabolic Surgery Society of India 2023, Mumbai. J Bariatr Surg 2023;2:38-45

How to cite this URL:
. Poster Abstracts: Abstracts of 20th Annual National Conference of Obesity & Metabolic Surgery Society of India 2023, Mumbai. J Bariatr Surg [serial online] 2023 [cited 2023 Sep 29];2:38-45. Available from: http://www.jbsonline.org/text.asp?2023/2/1/38/370082

  Surveillance Endoscopy for Barrett's Esophagitis Following Sleeve Gastrectomy: Is it Required? Top

Arun Kumar, Sai Divya Yadavalli, Vitish Singla, Sandeep Aggarwal

Department of Surgical Disciplines, AIIMS, New Delhi, India

E-mail: [email protected]

Background: Variable incidences (zero to 18.8%) of Barrett's esophagus (BE) have been reported following Sleeve Gastrectomy (SG), however, there is no published data from the Southeast Asian population.

Objectives: To determine the incidence of BE following SG.

Methods: In this cross-sectional observational study, all patients who had undergone SG from 2008 to 2021 and completed a minimum of 1-year follow-up were contacted to participate. Preoperative data was retrieved from a prospectively maintained database. On recruitment, all patients underwent barium swallow and upper gastrointestinal endoscopy (UGIE), and weight parameters and reflux symptoms were recorded.

Results: 104 patients with no preoperative evidence of BE were included. The mean follow-up duration was 5.4 ± 3.1 years. On follow-up endoscopy, Barrett's was suspected in 4 patients but only one (0.96%) had evidence of intestinal metaplasia (IM) without dysplasia. Reflux esophagitis (grade LA-A) resolved in six out of eight patients, while the rates of de novo esophagitis and hiatal hernia (HH) were reported in 27.1% and 24.6%, respectively. On barium swallow, HH and reflux were noted in 15.4% and 42.8%, respectively. The mean Symptom Severity (SS) score increased from 0.6 ± 1.8 to 2.6 ± 5.4 (p = 0.002). The mean body mass index reduced from 44.1 ± 7.1 kg/m2 to 33.6 ± 6.9 kg/m2 (p < 0.0001), however, 25.8% of the patients experienced significant weight regain.

Conclusions: The incidence of BE after SG is low in Southeast Asians. Hence, routine endoscopic surveillance may not be recommended in these patients, solely to diagnose BE.

  Staged versus Concomitant Approach in Patients of Morbid Obesity with a Ventral Hernia: Which Approach to Prefer? Top

Arun Kumar, Sonali Mittal, Jagadeep Azmeera, Sandeep Aggarwal

Department of Surgical Disciplines, AIIMS, New Delhi, India

E-mail: [email protected]

Introduction: Morbid obesity is an important risk factor for ventral hernia and its recurrence. Although controversial, Bariatric surgery (BS) with concomitant ventral hernia repair has been advocated by some authors, while a staged approach in morbidly obese patients has been suggested by others, avoiding the additional morbidity of the concomitant approach.

Objective: To compare the outcomes of the staged vs concomitant approach in patients with a ventral hernia who underwent BS.

Methodology: In this cross-sectional observational study, 64 patients with morbid obesity and ventral hernia underwent BS. Preoperative data were retrieved from a prospectively maintained database of a tertiary care centre from 2014-2022. Patients were assessed (Group A - concomitant ventral hernia repair with BS, Group B - delayed ventral hernia repair) for hernia recurrence rates on follow-up. Data collected include demographics, weight parameters, hernia characteristics, type of repair and incidence of obstruction/strangulation in patients waiting for a staged repair post BS.

Results: Of 64 patients, 52 underwent ventral hernia repair. Of these 52, 36 had a primary ventral hernia and 16 had an incisional hernia. The mean age, BMI, hernial defect size and duration of follow-up post-hernia repair were 45 years, 47.2 kg/m2, 4.3x3.4 cm and 2 years respectively. Seven of the 52 patients underwent concomitant ventral hernia repair due to the presence of obstructive features at presentation and 45 followed a staged approach. None of the patients in group B developed obstructive features while waiting for staged hernia repair. The mean duration at which patients underwent the staged repair post-bariatric surgery was 7 months. Four patients developed recurrences (3 in group A and 1 in group B).

Conclusion: A staged approach in patients of morbid obesity with a ventral hernia may decrease the rate of recurrence while avoiding the associated morbidity of a complex procedure at the time of BS.

  Weight Regain and Inadequate Weight Loss after Obesity Surgery: Associated Factors Top

Arya Singh, Mahendra Narwaria, Prachi Patel

Department of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India

E-mail: [email protected]

Obesity and its associated co-morbidities is pandemic and with scientific developments, many combating therapies are in prevalence. Bariatric Surgery (BS) is considered most effective treatment for morbid obesity. After the surgery however weight regain can occur in 20-30% cases. It has also been observed that some patients do not achieve successful outcomes of weight loss or even if they do so, they are unable to maintain it. Various factors like food choices, Basal metabolism, energy expenditure, lifestyle modifications and hormonal changes are seen to affect the weight status after surgery. This review study depicts factors as well as the mechanism of weight regain post bariatric surgery. It is imperative that weight gain occurs in patients, therefore, more studies are required towards the prevention and care in these subjects.

Keywords: Bariatric surgery, obesity, weight regain

  Ascorbic Acid Deficiency after One Anastomosis Gastric Bypass Surgery Top

Arya Singh, Mahendra Narwaria, Prachi Patel

Department of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India

E-mail: [email protected]

Background: Ascorbic acid (aa) or Vitamin C (Vit C) deficiency is rare but not unusual. Study aims to determine the prevalence of AA deficiency in obese population opting for One Anastomosis Gastric Bypass (OAGB) surgery and also to understand the association of change in body mass index (BMI) on aa after surgery.

Methods: Preoperative plasma aa concentrations were prospectively assessed at 0m, 3m and 6m of surgery. 150 subjects comprised of both male and female in the age group 20- 60 yrs. As per World Health Organisation (WHO), normal level of plasma ascorbate is 0.6 to 2.0 mg/dL and deficiency is below than 0.2 mg/dL (1).

Results: The mean ± standard deviation levels of plasma aa through high performance liquid chromatography was 2.66 ± 1.1 mg/dL preoperatively and 4.41 ± 1.90 mg/dl at 6 m post surgery, which was significantly in range (p=0.00). Also a significant positive correlation was observed between BMI and change in plasma AA level with r -value 0.026.

Conclusion: AA depletion and deficiency is seen rarely but does occur in obese population. The contributing factors included higher BMI, limited intake of fruits and vegetables, and lack of supplements. With correction of weight and co-morbidities, the aa levels also showed a stable and positive level.

Keywords: Obesity surgery, obesity, one anastomosis gastric bypass, vitamin deficiency

  Effect of Aerobic Exercise, Hypocaloric and High Protein Diet on Various Body Components in Class 1 Obese Adult Patients: Observational Cohort Study Top

Arya Singh, Mahendra Narwaria, Prachi Patel

Department of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India

E-mail: [email protected]

Background: People with sarcopenic obesity (SO) are characterized by both low muscle mass (sarcopenia) and high body fat (obesity). They have greater risks of metabolic diseases and physical disability than people with sarcopenia or obesity alone. Calorie restriction in terms of fats and carbohydrate along with a high protein indicates weight loss with solution to muscle loss. Thereby we have conducted this observational study to analyze the effect of aerobic exercise, hypocaloric & high protein diet on various body parameters like body weight, body mass index (BMI) & body component such as fat content & muscle mass.

Materials and Methods:

  • Study site: This observational study was conducted in obesity clinic of Asian Bariatrics Plus Hospital
  • Study design: Observational cohort study
  • Study population: Participants from Adult age group with class1 obesity
  • Study period: 12 weeks period.

Patient who has come to the obesity clinic of Asian Bariatrics Plus Hospital for consultation and fulfilled the inclusion criteria were included into the study. The enrolled participants were advised the treatment protocol as aerobic exercise and hypocaloric high protein diet (as mentioned).

Results and Discussion: This observational study was conducted on 50 subjects age 25 to 51 years lying in class 1 (BMI 30.0 to >30), obesity group who are not suffering from cardiac, liver, Renal & bronchial disease to analyze the effect of aerobic exercise, hypo caloric diet & high protein diet in class 1 adult obese patient from.

In this analysis of combined interventions as aerobic exercise, hypocaloric diet & high protein diet amongst adult obese participants shows statistically significant change in all the body components such as mean body weight, mean body mass index, mean body fat mass & mean skeletal muscle mass.

Conclusion: Results from this study suggest combined interventions as aerobic exercise, hypocaloric diet & high protein diet amongst adult obese participants patient not only help in weight loss but body composition such as body fat, skeletal muscle mass fat mass. However, larger randomized studies are needed to confirm these potential findings.

Keywords: Aerobic exercise, hypocalorie diet, obesity, protein supplements, sarcopenic obesity, weight loss

  Effect of Obesogenic Environment on Child Health Top

Arya Singh, Mahendra Narwaria, Prachi Patel

Department of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India

E-mail: [email protected]

Introduction: Childhood is a distinct age with complex needs because of immense physical and psychological development. Most of the time, the nutritional needs of the children are not adequately met; hence there is a need to provide adequate nutrition to maintain their nutritional status in all age group specially children.

Methodology: A observational cross sectional study was conducted on 100 subjects, aimed at assessing the nutritional status of school going children (8-12 years) attending private and public schools of South Delhi. The sample was selected by purposive random sampling method. A dietary questionnaire previously constructed and tested was administered to collect information on the eating habits, physical activity, barriers affecting healthy food choices and nutritional knowledge. The statistical analysis were done using SPSS version 16.0 statistical analysis software. The values were represented in number (%) and mean ± standard deviation. Chi square test was done to understand the relation between two variables. For all cases, in which a statistical test was conducted, a P < 0.05 was considered to indicate a significant difference.

Results and Discussion: To analyze the nutritional status, anthropometric measurements like height, weight and BMI were taken and were analyzed using WHO growth standards (Z-Score), 2007. Out of 100 subjects 5% were underweight, while 38% were within normal BMI range, 28% were overweight whereas 29% fell under obese category. A positive correlation was found between energy and BMI (p=0.37040). No significant correlation was seen between level of physical activity and overweight/obesity (X 2 =0.127), and the effect of the most preferred beverage intake on overweight and obesity(X 2 =2.98).

Conclusion: Obesogenic environment along with less knowledge about nutritional health aspects there has bee an increasing trend in childhood obesity across the globe. Children and their parents need to be educated regarding balanced dietary habits, food choices and active lifestyle.

  Robotic Mini Gastric Bypass in Super Obese – Technical Tips and Feasibility Top

Ashish Vashistha

Department of Bariatrics, Max Superspeciality Hospital, New Delhi, India

E-mail: [email protected]

Background: Robotic minigastric bypass (RMGB) in super-obese is being performed in our department as one of the common and routine procedure. The study reported here aims to describe the technique and analyse our robotic minigastric bypass casses using da Vinci XI.

Methods: The study includes 20 patients, whose data has been analysed retrospectively having BMI >50 kg/m2. Total operative time, complications, length of hospital stay and ergonomics challenge were analysed. Standard steps for RMGB included inserting a camera port 2 cm above the umbilicus, achieve pneumoperitoneum of 15 mmhg, reverse trendelberg position, placement of nathans liver retractor, then insertion of two hypochondriac ports of 8 mm each, then making a 12 mm port in port of right side of abdomen.

Results: Mean age was 34.4, preoperative mean weight was 126.6 kg, average docking time was 16 mins, mean operative time 73 mins, hospital stay 2.9 days, there were no intraoperative and postoperative complications.

Conclusion: RMGB seems to be safe and effective procedure. Use of robot helps in better ergonomics and thus make surgery easier in superobese patients, hence it should be a procedure of choice especially in superobese.

  Outcome in Serum Albumin Levels after RYGB in Patients Who are Consuming Less Than 30 g Protein Per Day Top

Harsha Jaithalia

K D Hospital, Ahmedabad

E-mail: [email protected]

Background: Severe hypoalbuminemia is one of the complications that may develop after bariatric surgery. It is associated with increased morbidity and mortality and requires timely diagnosis and appropriate treatment to prevent rapid clinical deterioration.

Aim: This five year study was done to observe the changes in serum albumin levels of the patient who underwent RYGB from 2016 to 2020 who were consuming less than 20 gm of dietary protein. The study includes 993 patient.

Methods: In this retrospective study, we conducted an analysis of a database maintained by the high volume center.

Results: The study population included 993 obese patients, 589 (59.3%) females and 404 (40.6%) males. Mean Serum albumin level preoperative was 4.05. Mean albumin level at end of 1 year was 4.22, 3 years was 4.45 and 5 years was 4.78 respectively.

Conclusion: After RYGB surgery the recommended protein intake is 1.1-1.5 gm/kg ideal body weight. Even though our patients consumed less than 30 gms of protein per day, In short limb gastric bypass there was no significant protein malnutrition even in long term.

  Single Anastamotic Sleeve Jejunal Bypass – 6 Year Prospective Study Top

Muvva Sri Harsha

Apollo Institute of Bariatrics, Chennai

E-mail: [email protected]

Background: During 2015-2017, Transit bipartition procedures like SASI (Single anastomosis sleeve ileal bypass) gained popularity and generated lot of interest among the bariatric surgeons as they preserve the continuity to duonenum and small bowel. However Protein malnutrition and excess weight loss after SASI has always been a concern. For this reason, we started offering Transit Bipartition procedure by creating a sleeve and use a smaller a more proximal and smaller Biliopancreatic limb i.e. Single anastomosis sleeve jejunal bypass (SASJ).

Objectives: To study single anastamotic sleeve jejunal bypass (SASJ) as a treatment choice for morbid obesity and compare with existing standard procedures like LSG, RYGB, OAGB. Primary Objective – 1. Weight loss at 1 year, 3 year, 5 year and 6 years – Calculated as % total weight loss. Secondary objective include BMI loss, Co-morbidities resolution and nutrition status

Methods: This is a 5 year prospectively study by collecting data of patients who underwent SASJ in a single centre.

Results: Our study included a total of 72 patients. 5 year follow up data was available for 15 patients, 3 year follow up data for 38 patients and 1 year data for 72 patients. Average Pre-op BMI of our patients is 43+/-10, Average BMI at 1 year, 3 year and 5 years are 26.2 +/-4.2, 26.7+/- 4.5 and 27.1 +/- 4.1 respectively. %TBWL at 1 year, 3 year and 5 year follow up is 37.4 +/-7.6, 39.2+/-12.1 and 39.5 +/-9.3 respectively. Pre-operative average Hba1c is 6.8+/-1.3, Average Hba1c at 1 year, 3 year and 5 year follow up is 5.0+/-0.4, 4.9 +/-0.1 and 4.8+- 0.1 respectively. Significance in resolution of Comorbidities like Diabetes, Dyslipidemia, Hypertension, Obstructive sleep apnea, Infertility, fatty liver and hypothyroidism has been documented. There is no significant malnutrition noticed in our study, except for Vit D deficiencies.

Conclusion: Single Anastomosis Sleeve Jejunal Bypass (SASJ) as a choice of surgery for patients with metabolic syndrome appears to be a promising Bi-partition procedure. %TWBL and Resolution of co-morbidities in our study is comparable other bypass procedures like OAGB & RYGB. There is no significant malnutrition associated with this procedure when compared to more aggressive bypass procedures. Being a bi-partition procedure the natural GI continuity is maintained which makes further endoscopic/interventional biliary procedures feasible. Our study shows promising results and we feel SASJ provides benefits of other malabsorptive procedures like OAGB and RYGB without much nutritional impairment. The Incidence of Weight regain and Inadequate weight loss which are concern after sleeve gastrectomy is not a concern with SASJ. Hence we feel, SASJ is going to be more popular and will prove to be a worthy and an ideal replacement for sleeve gastrectomy.

  Assessing the Status of Nutritional Health Following Single Anastomosis Sleeve Jejunal Top

Maria Guru

Department of Nutrition, Apollo Institute of Bariatrics, Chennai

E-mail: [email protected]

Background: Bariatric Surgery, regardless of its type, is the most effective approach for treating morbid obesity and its related co morbidities if all other modalities fail. However, the biggest concern of any bariatric and metabolic surgery is the post nutritional deficiencies and patient compliance. Though Sleeve gastrectomy is considered to be the safest bet in such scenarios, inadequate weight loss and weight regain is becoming an increasing concern. Single Anastomosis sleeve jejunal (SASJ) bypass, a novel bariatric surgery technique and is considered as an alternative in our department fo the last 6 years as it provides comparable outcome for weight loss and resolution of comorbidites like Gastric bypass with less nutritional deficiencies allowing continuity of normal anatomy as well.

Purpose: The study is aimed at assessing the nutritional status of the most common deficiencies prevalent in post bariatric individuals like Iron, Vitamin B12, D, Calcium and protein along with anthropometric measurements like % excess weight loss (%EWL), Skeletal Muscle mass (SMM) and Body fat Mass (BFM) were also assessed.

Methods: This prospective observational study screened a total of 72 patients who underwent SASJ over a period of 5 years. The supplementation was started from the POST OP day 3 which includes bariatric specific protein (20 gm / day for 6 months) and Multivitamin2 chews over day for 12 months followed by 1 chew based on requirements as per ASMBS Guidelines.Data were compared at baseline, 6 months, 1 year, 3 years and 5 years.

Results: This study included a total of 72 patients. Average Pre-op BMI of our patients is 43+/-10, Average BMI at 1 year, 3 year and 5 years are 26.2 +/-4.2, 26.7+/- 4.5 and 27.1 +/- 4.1 respectively. There was a significant decrease in body fat mass post SASJ in 6 months (54% to 48%), 1 year (48 % to 44) and 3 years (44% to 39%)post which there was a small rise seen, which again dropped (42% to 35%) at 5 years. Average Total protein of our patients pre op was 6.8, average protein at 6 months, 1 year, 3 year and 5 year was 7.3, 7.7, 7.9 and 8.2 respectively. The Iron, Vit d, vit b12 and calcium values were assessed and followed upto 5 years and no significant deficiencies were observed. The overall nutritional scenario improved and was maintained in patients post SASJ with the Barofab provit and Multivitamin supplementation.

Conclusion: In this study, nutritional deficiencies were found to exist in few patients prior surgery, but these levels were much improved post surgery with the supplementation. Iron, calcium, Proteins, Vit b12 and Vit d levels were drastically improved and maintained post the supplementation. Therefore, an adequate nutritional plan and supplementation is necessary to optimize the overall health and nutritional status of patients post SASJ.

  Familial Hyperlipidemia and Metabolic Surgery Top

Mahendra Narwaria, Ankur Sharma, Arya Singh

Department of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India

E-mail: [email protected]

Introduction: Familial Hyperlipidemia is a genetic disorder characterized by high cholesterol levels especially LDL, High incidence of cardiac mortality is noted in these individuals. However, no interventional studies have concluded mortality benefit from cholesterol lowering in these patients. Multiple treatment options are available varying from lifestyle modification to cardiac interventions with favorable outcomes. We have previously reported a case of autosomal recessive hypercholesterolemia who was treated with biliopancreatic Diversion with satisfying results.

Aim and Objective: Our experience with two brothers who were managed with two different surgical procedures owing to unusual intraop findings.

Materials and Methods: Two brothers with familial hypercholesterolemia were planned for Roux en Y Duodeno Jejunal byp[ass, however, one sibling had unusually large mesenteric mass at the proposed site of jejunal transection and hence a Roux en Y cholecysto ileal bypass was done. Their post operatively lipid profile was studied at 3, 6 and 9 months. Both brothers showed significant improvement in their cholesterol levels.

Discussion: Both brothers had significant complications of hyperlipidemia with one having undergone coronary angiography and stenting, while the other had undergone coronary artery bypass for triple vessel coronary artery disease.

Conclusion: Patients with familial hyperlipidemia can be offered surgery as lipid lowering strategy in adjunct to other measures, however long term results of both these procedures need to be studied.

  Quality of Life and Comorbidity Resolution in Geriatric Patients Postdiverted MGB Top

Mahendra Narwaria, Ankur Sharma, Arya Singh

Department of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India

E-mail: [email protected]

Introduction: Morbid obesity together with obesity-related diseases have a negative impact on the overall quality of life (QOL).

Aim: The present study aimed to assess the OQL in geriatric patients post Diverted Mini Gastric Bypass (DMGB) with a focus on weight loss achieved, Comorbidities resolution (Biliary reflux, marginal ulcer, or excessive weight loss leading to improved treatment) and change in lifestyle after surgery.

Materials and Methods: A case series study in which QOL was studied where all patients undergoing bariatric surgery, from the day of surgery were enrolled and followed up for 6 months. Data on QOL was assessed using the Bariatric Analysis and Reporting Outcome System (BAROS) tool, which is based on 3 major areas of weight loss percentage, comorbidity resolution and QOL. The variation in QOL was assessed using the Moorehead Ardeit QOL questionnaire which addresses self-esteem along with daily activities such as physical fitness, social gathering and sexual life, etc. Negative scores were given to complications and re-surgery. All data were entered in MS excel and statistically analyzed using SPSS software.

Results: Patients of age range >60 years were recorded. Based on the BAROS tool overall QOL change was studied in the patients on constant follow up on 6 months after Surgery. By adding a Roux en Y diversion to the MGB-OAGB cases, we saw that along with weight loss the patients recovered of pathologic postoperative biliary reflux and marginal ulcer giving them a comfortable and effective solution to the persistent problem. The patients were nutritionally adequate and the overall eating pattern and quantitative intake improved with time. This indicates that quality of life improves after DMGB.

Conclusion: DMGB appears to be as effective as th eMGB and reduces the incidence of reflux and marginal ulcer. It combines the advantage of MGB with the anti-reflux effect of the RYGB diversion.

  Enhanced Recovery, Safety and Acceptability of Totally Stapled Mini Gastric Bypass Top

Mahendra Narwaria, Ankur Sharma, Arya Singh

Department of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India

E-mail: [email protected]

Introduction: Mini Gastric Bypass is a safe and accepted Bariatric Procedure, yielding good weight loss and metabolic control to patients.

Aim and Objective: Presenting our technique of totally stapled Mini Gastric Bypass- which comes with significant ease of performance and less operative time.

Materials and Methods: A retrospective analysis was done with 100 cases in each arm. Parameters observed on 100 cases of totally stapled MGB are: Operative time, Intraop blood loss, Post-op leaks, Dumping syndrome, Post-op symptomatic dyspepsia (requiring UGI endoscopy study) and Marginal Ulcer. The current technique involved creating a 5 cm stoma with a stapler and subsequent closure of the enterotomy site with another stapler. The above parameters are compared with a retrospective data analysis of 100 cases of MGB performed with our previous technique of creating a pouch-jejunum stoma of 4 cms size with outer seromuscular layer closure with 2-0 surgidac over the stapled pouch-jejunal anastomosis and enterotomy closure with 2-0 polysorb.

Results: Totally stapled MGB patients have significantly less mean operative time. Avoidance of foreign materials along the mucosal side of anastomosis leads to improved tissue healing which translates clinically into reduced marginal ulcerations and reduced symptomatic dyspepsia.

Conclusion: Totally stapled MGB is a good technique for easy, effective and safe procedure.

  Pharmacotherapy for the Management of Obesity Top

Prachi Patel, Mahendra Narwaria1, Arya Singh2

Department of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India

E-mail: [email protected]

Over the past 30 years, both obesity and its associated comorbidities have sharply grown. Obesity, formerly thought to be an issue exclusively in affluent countries, is now a worldwide epidemic. As a result, managing overweight and obesity is extremely expensive throughout the world. This review's goal is to give a general overview of the current alternatives for managing obesity, with a focus on pharmacotherapies. It is widely known how weight loss affects the reduction of risk factors and comorbidities associated with obesity. Despite the fact that thorough lifestyle adjustment is recommended by established clinical guidelines to promote weight loss, many individuals do not benefit from lifestyle therapies and may not be candidates for bariatric surgery. Pharmacotherapy may be an effective treatment for these people. Many pharmacotherapies, including phentermine, are recommended for short-term usage and do not need to result in clinically significant weight loss (i.e., less than 5%) in order to be effective. The FDA has so far approved five drugs for long-term weight management: orlistat, lorcaserin, phentermine/topiramate, naltrexone/bupropion, and liraglutide. These medications have demonstrated effectiveness in helping patients lose weight that is clinically significant and in enhancing cardiometabolic parameters. By customizing these pharmacotherapies depending on patient needs, comorbidities, and associated drug safety issues, healthcare professionals can lessen the obesity epidemic.

  Effect of Bariatric Surgery on Thyroid Function in Obese Patients: A Systematic Review and Meta-Analysis Top

Prachi Patel, Mahendra Narwaria1, Arya Singh2

Department of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India

E-mail: [email protected]

With regard to the impact of bariatric surgery on Thyroid function in obese patients, our goal was to conduct a Review to see the effect of Bariatric Surgery on the levels and fuctions of Thyroid Hormones. Clinical studies were looked for in the Elsevier, PubMed, EMBASE, and Central databases. Data were combined, and subgroup and sensitivity analyses were carried out when appropriate and practical. 24 publications were consequently included in the review. TSH, FT3, and T3 levels were found to significantly decline after bariatric surgery. Postoperatively, the levels of FT4, T4, and rT3 did not significantly change. Additionally, bariatric surgery improved overt and subclinical hypothyroidism by lowering the thyroid hormone levels and requirements after surgery. In conclusion, TSH, FT3, and T3 levels should drop after bariatric surgery. Non-significant changes in T4, FT4, and rT3 levels are also expected.

  Why Strict Follow Up Post Bariatric Surgery is Mandatory Top

Vishakha Merude, Prashant Salvi, P. M. Thapar, Akash Dehankar, Aisha Aga

Jupiter Hospital, Thane

E-mail: [email protected]

The worldwide obesity rate continues to grow and it is a significant issue for individuals and the healthcare system. According to the WHO data, obesity affects about 13% of the world's adult population. Bariatric surgery (BS) is the most effective treatment strategy that results in significant and sustained long term weight loss. Micronutrient deficiency is common in obesity despite of surplus weight and high calorie intake. Further exacerbation is often seen after BS due to resultant dietary restrictions and physiological and anatomical alterations.

Objectives: To assess deficiency post BS and treat them accordingly.

Methods: A retrospective analysis of patients undergoing BS for morbid obesity at Jupiter Hospital from September 2020 to October 2022.

Inclusion criteria's:

1) Body Mass Index ≥ 40 kg/m2 or ≥ 35 kg/m2 with obesity related co-morbidities

2) Age group 18-65 years.

A multidisciplinary team was set up including a surgeon, cardiologist, chest physician, physiotherapist, endocrinologist; anesthetic, bariatric dietician and psychiatrist. All surgical procedures were performed with a minimally invasive approach by the trained surgeon, including Sleeve Gastrectomy, MGB/OAGB, RYGB and revision BS. After discharge a personalized diet and post-operative follow up schedule was provided to all patients. Patients were followed up on OPD basis; medical visits were scheduled at 1, 3, 6, and 12 months n first year, and then every 12 months.

Results: Fifty patients fulfilling the criteria were included in the study, of which 39 were female and 11 male. 38 patients underwent SG, 2 RYGB, 8 MGB/OAGB, 1 Revision LAP Band to SG, 1 Revision SG to OAGB respectively. Post BS we observed 20% hair loss between 3-6 month,20% thiamine deficiency,10% dislike to taste of water,constipation post BS-10%.

Conclusion: BS is widely considered the most reliable therapeutic strategy which results in significant and sustainable weight loss, improvement of obesity related comorbidities and prolonged survival. Patients who undergo BS required intensive post-operative follow up in order to treat the deficiencies earlier and maximize the weight loss.

  To Study the Impact of Preoperative Weight Loss Attempts on Post-Bariatric Weight Loss Outcomes Top

Shivangi Bhaskar

Nobesity Bariatric Surgery Center, Ahmedabad, Gujarat, India

E-mail: [email protected]

Background: Bariatric surgery is considered as one of the most effective treatments for morbid obesity. However the results post-bariatric surgery are different amongst patients, that depends on the number of factors preoperative and postoperative which may influence the weight loss process. For instance previous weight loss attempts, age, gender, comorbidities, socio-cultural environment, etc.

Aim: To study the impact of preoperative weight loss attempts on post-bariatric weight loss outcomes.

Methods: A total of 92 samples were taken from the Nobesity Bariatric surgery center. The sample is divided into two categories, 1) Patients with previous weight loss attempts (n=54), 2) Patient with no weight loss attempts (n=38). The mean and t-test are used to compare the total loss from excess body weight between both groups for the duration of one year.

Results: Based on statistical analysis, it is observed that the post-bariatric weight loss outcome to reach the target was significantly better than patients with no previous weight loss attempt.

Conclusion: Hence, preoperative weight loss attempts have a significant impact on post-bariatric weight loss outcomes.

Keywords: Preoperative weight loss attempt, weight loss surgery

  Post Bariatric Weight Loss with Muscle Loss – Are They Correlating with Patient Complaints? Top

Nikita Sanjay Singh

Obesity Bariatric Surgery Center, Ahmedabad, Gujarat, India

E-mail: [email protected]

Background: Bariatric surgery acts as an important lifestyle intervention like a therapy for weight related comorbidities, weight loss, healthy body composition & improving quality of life. Patients are happy with the weight loss during the initial phase, as they reach towards their target weight, the complaints related to weakness become more frequent.

Objective: To identify the reason for this problem the current study aims to find out the correlation between weight loss & muscle loss with patient complaints.

Methods: A Total 47 patients were taken as a sample for this study & divided into two groups: with & without complaints. The data was collected from NObesity Bariatric Surgery Centre, Ahmedabad. The correlation method is used to analyze body fat mass, skeletal muscle mass, Albumin, percent of excess weight reduction of patients.

Results: After the data analysis, it is clearly observed that there is negative correlation between patient complaints & body composition. Moreover, patients who are in regular compliance adhering to recommended physical activity & daily protein as per ASMBS, exhibit minimum complaint with healthy body composition.

Conclusion: Hence the poor body composition can lead to various complaints after bariatric surgery.

Keywords: Albumin, bariatric surgery, body composition, fat mass, skeletal muscle, weakness

  Post Bariatric Long Term Adherence to Supplements, Challenges and Management Top

Dharti Kachhadiya

K D Hospital, Ahmedabad

E-mail: [email protected]

Background: In India obesity is rising health concern due to modernized faulty food habits, technophile world, sedentary lifestyle. For long term sustain weight loss people opt bariatric surgery. Bariatric surgeries are being performed in India more than 2 decades. After sleeve gastrectomy, MGB and RYGB is the most commonly performed procedures in India respectively. Obese people are deficient in certain vitamins and minerals due to obesity and stick to vegetarianism. This deficiency can be exaggerated in long run after malabsorptive procedures due to non adherence to supplements as per the ASMBS recommendation.

Aim: Study aims the long term adherence to multivitamin supplements at high volume centre and its impact on nutritional parameters in comparison with those patients who didn't take supplements.

Methods: Total number of patients operated in the year of 2015, 2016 and 2017 were taken as sample to evaluate their adherence towards multivitamin, for the data analysis mean difference T test was used.

Results: There is mean difference in nutritional parameters between those who take supplements and did not take supplements.

Conclusion: This study concludes that to avoid the deficiencies and related problems, long term adherence to supplements and follow up is advisable.

  Outcomes of Enhanced Recovery after Surgery Versus Standard Pathway: Post Laparoscopic RYGB – A Randomised Control Trial Top

S. Prabhakaran, T. Viswanath, Christina Joice, S. Saravana Kumar, X. L. Jayanth Leo, P. Praveen Raj

E-mail: [email protected]

Background: ERAS pathway has been implicated in various surgical disciplines and in wide variety of patient groups with its benefits very well established. We have published our own data in studying the outcomes of ERAS Pathway in patients undergoing Sleeve Gastrectomy. In this study we have aimed at studying the advantages of ERAS pathway in 84 consecutive cases who underwent LRYGB at our centre.

Methods: This is a prospective randomised control trial involving 84 consecutive cases of LRYGB. 42 patients were flown post operatively in standard pathway and equal number in ERAS pathway chosen by closed envelop technique. Primary outcome was duration of hospitalisation and secondary outcomes involved differences in pain control, need for analgesia, early ambulation, oral intake, also complication rates and readmissions.

Results: Compared to standard pathway, patients in ERAS pathway had lesser mean hospital stay (1 day vs 2 days, p=0.038). Patients in ERAS pathway received TAP block (Transversus Abdominis Plane block) per operatively. The pain scores and need for analgesics was also significantly low in ERAS group compared to Standard pathway arm (p=0.001). Patients in ERAS group were ambulated early than those in standard pathway group. There were 2 cases in ERAS pathway readmitted with nausea/ vomiting. However, both patients settled with conservative measures and stayed for one and half days each at readmission (Statistically insignificant). One patient had bleed postop in ERAS pathway and hence was excluded from the study. No re admissions in standard pathway.

Conclusion: After LRYGB, ERAS pathway shortens length of hospital stay (LOH) and hastens recovery, also lessens the duration of post op pain with decreased need for analgesics.

Keywords: Enhanced recovery after surgery pathway, laparoscopic Roux-en-Y gastric bypass, standard pathway, transversus abdominis plane block

  Common Nutritional Deficiencies in Weight Loss Surgery Top

Prachi Patel, Arya Singh1, Mahendra Narwaria2

Department of Nutrition, Asian Bariatrics Plus Hospital, Ahmedabad, Gujarat, India

E-mail: [email protected]

Bariatric Surgery for long term treatment of obesity and its associated comorbidities may lead to reduced food intake, suboptimal dietary quality, altered digestion and absorption and non-adherence to supplementation contribute to risk of vitamin deficiency.

Aim: To assess the vitamin deficiencies of patients who have undergone Bariatric Surgery.

Methodology: Cross sectional Study with purposive selection of patients who had undergone Bariatric Surgery at Asian Bariatric Plus Hospital, Ahmedabad. Data were elicited on various biochemical parameters and dietary intakes pre and post operative and analyzed statistically.

Results: Of the 103 patients who underwent Laparoscopic Sleeve Gastrectomy (LSG) or Gastric Bypass (GB) Surgery, 59 were males and 44 were females with age range of 25-60 years. The subjects were studied for a year on biochemical parameters (Vitamin D, Vitamin B12, serum protein, serum albumin levels, serum globulin levels, albumin: globulin ratio) and diet (via 24 hr recall) for both preoperative phase and post-operatively over a year. 3 monthly follow ups were done where the patients were under strict dietary assistance and nutritional supplements. They were subjected to a 2 month early post operative diet (starting from 600 kcal- 1000 kcal diet and further as per requirement bringing to 1500 kcal diet) that varied in consistency and gradually the calorie was maintained as per the weight loss and patients need. The average protein level variation in LSG in a ayera was marginal being -0.04 g/dl whereas in GB the variation was -0.54 g/dl. Albumin levels showed a fall (LSG= 1.07 & GB= 2.27 g/dl) Further, the variation was also marginally observed in various nutrients like Vitamin D (LSG = +37, GB= +44 mcg/ml) & Vitamin B12 (LSG= +56, GB= +63 mcg/ml).

Conclusion: Based on the result, it was shown that although optimal supplementation regimens are not yet defined for the Indian population, most deficiencies currently can be prevented or treated by consistent and appropriate supplementation.

  Assessment of Macronutrients Post Bariatric Surgery Top

Shravani Bandwalkar, Madhu Goel1, Amrit Nasta1, Chinmayee Mokal1, Ramen Goel1

Centre for Metabolic Surgery, Wockhardt Hospital, Agripada, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: Bariatric surgery is an effective method to tackle obesity and related comorbidities. A well-structured bariatric diet helps in enhanced weight loss and better quality of life.

Objective: To assess the macronutrient consumption over the span of 1 year post bariatric surgery.

Methodology: Out of 79 operated patients 38 patients (Male: 17, Female: 21) 24-hour recall was available which was used to calculate macronutrient intake over various time lines. 21 underwent sleeve gastrectomy, 15 Roux-en-Y gastric bypass and 2 one Anastomosis gastric bypass. Patients were categorized into 4 groups depending upon the duration of follow up post-surgery. Group A (1 month): n=12; Group B (3 months): n=14; Group C (6 months): n=7; Group D (1 year): n=5.

Results: In Group A, mean protein intake was 61.4+14.3 gms, mean carbohydrate 52.2+21.19 gms, mean fat 13+6.4 gms. Group B, mean protein intake was 70+ 17.76, mean carbohydrate 66.38 + 23.58 gms, mean fat 12.7 +5.07 g. Group C, mean protein: 71.57 + 13.64, mean carbohydrate 68.85 + 25.58 g, mean fat 21.34 + 11.74 g. Group D, mean protein: 65.4 + 26 25, mean carbohydrate 119.4 + 32 g, mean fats 28.8 + 15 gms. Total mean protein intake was 66 g (Expected range: 60-80g), mean carbohydrate 76.5 g which is 40% of total energy intake (expected range 35-48 %) and mean fat 19 g which is 23% of total energy intake (expected range 37-42%).

Conclusion: In our patients, the intake of protein and carbohydrate is adequate at various timelines and according to the nutritional recommendations of American Society for Nutrition, 2017.


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