Introduction: Bariatric surgery is an accepted treatment worldwide for patients with obesity due to its proven metabolic effects. However, there are variations worldwide in clinical criteria that must be met to qualify for surgery. This study aims to explore globally established practice and opinions on preoperative workup for bariatric surgery. Materials and Methods: A review of literature and international guidelines was performed by a multidisciplinary team and used to develop an online questionnaire survey. This was distributed to bariatric professionals electronically. Results: Two hundred and forty-four bariatric health-care professionals from 224 medical centers across 57 countries completed the survey. The majority of respondents were surgeons (67.2%), and the remainder were other multidisciplinary professionals. Over half of medical centers were public hospitals (50.8%), with most performing over 200 procedures per year (30.3%). Only 68.4% (n = 167) of respondent hospitals used recognized referral guidelines; however, 81.9% felt that there should be written referral criteria (P < 0.001). In 71.3% (n = 172) of respondent units' patients underwent a Medical Weight Management Programme (MWMP) as part of their preparation for surgery. Significant differences were identified worldwide in the criteria used to determine progression to surgery (P < 0.001), time spent in MWMP prior to surgery (P < 0.001), and the roles of members forming the bariatric multidisciplinary team (P = 0.006). Conclusion: This study has identified significant variation in global bariatric surgery practices and highlights the responsibility that societies such as the International Federation for the Surgery of Obesity and Metabolic Disease (IFSO) and the Upper Gastrointestinal Surgery Society have in promoting universal clinical guidelines.

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Correlation between bariatric surgery (BS), weight loss, and alleviation of anxiety symptoms has been assessed frequently. Research indicates a rather positive effect on anxiety symptoms for the first 3 years after surgery. Beyond this time frame, alleviation of symptoms becomes less apparent. The aim of this study was to investigate the connection between anxiety and BS based on the following research question: does BS lead to an alleviation of their anxiety symptoms in adults with morbid obesity and anxiety symptomatology? The basic mechanism underlying this study was a comprehensive literature search in PubMed and PsycINFO, combining search terms for “anxiety” with “bariatric surgery” related terms. The data set resulting from this search was assessed for relevant studies, which were the basis for the following narrative literature review. A set of 30 studies, 24 prospective cohort studies, and 6 literature reviews met inclusion criteria.The studies included 2228 participants (81% female). At baseline, mean age was 41.4 years and mean body mass index (BMI) was 47 kg/m². The mean BMI at the end of the studies was 34 kg/m². Different BS techniques were used for weight loss. A trend for change in anxiety at different time points postsurgery seems to exist. No clear statement can be made about a correlation between weight loss and alleviation of anxiety symptoms. Some studies found a significant correlation between the two parameters for up to 4 years; however, just as many studies found no correlation. The type of weight loss surgery utilized does most likely not determine the effect on anxiety symptoms. BS should not be thought of as a therapy method for anxiety.

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Aim: The aim of this study was to assess the safety and short-term effectiveness of metabolic surgery (MS) in nonobese diabetic patients. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used in this systematic review. The search for evidence was performed in the Medline (PubMed), Embase, Cochrane (CENTRAL), LILACS, and ClinicalTrials.gov databases from the inception to February 2023. The main eligibility criteria were nonobese adults (body mass index [BMI] <30 kg/m²) with type 2 diabetes mellitus (T2DM) undergoing MS. T2DM remission rate, glycemic parameters, and weight loss were measured before and after surgery. Complication rate was also described. Outcomes were aggregated and the quality of evidence was sorted. Heterogeneity was assumed when I² >50%. The random-effects model was used to perform a proportional meta-analysis. Results: Twenty-one studies were included (n = 835). The overall rate of diabetes remission was 50.1% (95% confidence interval [CI] = 43.8%–56.1%; P = 0.993; I² = 92%). The mean reduction of glycated hemoglobin and fasting glucose was 2.42% (95% CI = 1.91%–2.93%; P < 0.00001; I² = 89%) and 70.60 mg/dL, respectively. A drop of 3.34 points (95% CI = 1.59–5.09; P < 0.0002; I² = 95%) was observed in the HOMA-IR, and the mean postprandial glycemia was 123.27 mg/dL. No marked weight loss was observed (−3.80 kg/m² in BMI; 95% CI = 2.70–4.91; P < 0.00001; I² = 95%). There was no postoperative mortality, and the overall postoperative complication rate was about 12%. The certainty of evidence was low or very low. Conclusion: MS could be effective in the surgical approach of nonobese diabetic patients, but further long-term, more robust studies are needed to strengthen the evidence.

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Introduction: Laparoscopic sleeve gastrectomy (LSG) is the commonest bariatric operation being performed in India and worldwide. There are many technical variations that are being practiced. This Delphi consensus was an Obesity and Metabolic Surgery Society of India (OSSI) initiative to standardize the surgical technique of LSG. Methods: Twenty bariatric surgeons were selected as experts based on their years of experience in LSG, overall patient volumes, publications, and the recommendations of the executive committee of OSSI, to vote on 26 statements regarding the surgical steps of LSG. The minimum cutoff for consensus was taken as 70%. Results: The committee achieved a consensus on 19 out of 26 statements in the first round. One question was sent for reconsideration and 3 were resent after modification. Finally, consensus was reached on 22 statements. The consensus was reached regarding the use of preoperative upper gastrointestinal endoscopy. 85.7% agreed on an antral length of 3–5 cm. 85.7% were in favor of dissecting the left crus of the diaphragm completely and 100% agreed on Roux-en y gastric bypass to be the procedure of choice in the presence of medically refractory gastroesophageal reflux disease with hiatus hernia. Most experts agreed that a calibration tube must be used during LSG and the recommended size was between 36 and 40 Fr. Ninety-five percent agreed that care must be taken to avoid narrowing at the incisura and also to stay away from the angle of His. 71.4% did not recommend any kind of staple line reinforcement and 71.4% recommended a postoperative leak test. Conclusion: This Delphi consensus is a step toward improving the quality of surgical outcomes of LSG in India. This document has attempted to establish technical specifications of performing LSG. This will in turn help to maximize the reliability, standardization, and safety of the procedure until more robust studies are published.

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Objective: The objective of the study is to evaluate the effect of very low-calorie diet (VLCD) on postbariatric surgery (BS) patients with weight regain (WR). Methods: This is a prospective, randomized, controlled, interventional clinical trial. The sample selection for the study was performed on the basis of prepared inclusion and exclusion criteria. Structured phone calls were made to all the subjects in which baseline information such as body weight and height were asked through which body mass index (BMI) was calculated to check the eligibility. A sample size of 40 subjects including both males and females with >10% gain of nadir weight after 2 years of BS with a current BMI of ≥30 kg/m^[2] was selected. Two standardized VLCD plans for 4 weeks each were prescribed to them. A close supervision of selected subjects was done regularly through structured weekly calls, outpatient department follow-ups, and support group meets. The statistical analysis was done to find the average weight loss (WL) and change in body fat percentage over 8 weeks. Results: The mean average age of the sample was 45 ± 9.45 years among which 12 were male and 28 were female. The sample size was under the inclusion criteria with >10% WR after 2 years of BS. In this sample, the average total body WL after BS was found to be 47.3 kg. Postoperative average WR in the selected sample was 10.3%. After the follow-up period of 8 weeks of VLCD, an average WL of 3.66 kg (3.76%) along with a body fat percent loss of 2.58% was observed. It was also noted that the WL in the initial weeks was comparatively higher than that in the later weeks. An average WL in the first 4 weeks was 2.36 kg (2.42%) and average WL in the next 4 weeks was 1.32 kg (1.35%). Conclusion: VLCD is effective but long-term effects need to be seen. There have been no such Indian studies before this, and hence, more such studies need to be done.

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