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Kow L, Magdy M. Obituary for Ken Loi (7/7/69-28/10/23). Obes Surg 2024; 34:1393-1394. [PMID: 38446359 PMCID: PMC11031468 DOI: 10.1007/s11695-024-07092-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 03/07/2024]
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Brown WA, Liem R, Al-Sabah S, Anvari M, Boza C, Cohen RV, Ghaferi A, Våge V, Himpens J, Kow L, Morton J, Musella M, Pattou F, Sakran N, Clapp B, Prager G, Shikora S. Metabolic Bariatric Surgery Across the IFSO Chapters: Key Insights on the Baseline Patient Demographics, Procedure Types, and Mortality from the Eighth IFSO Global Registry Report. Obes Surg 2024; 34:1764-1777. [PMID: 38592648 PMCID: PMC11031475 DOI: 10.1007/s11695-024-07196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION The International Federation for Surgery for Obesity and Metabolic Disorders (IFSO) Global Registry aims to provide descriptive data about the caseload and penetrance of surgery for metabolic disease and obesity in member countries. The data presented in this report represent the key findings of the eighth report of the IFSO Global Registry. METHODS All existing Metabolic and Bariatric Surgery (MBS) registries known to IFSO were invited to contribute to the eighth report. Aggregated data was provided by each MBS registry to the team at the Australia and New Zealand Bariatric Surgery Registry (ANZBSR) and was securely stored on a Redcap™ database housed at Monash University, Melbourne, Australia. Data was checked for completeness and analyzed by the IFSO Global Registry Committee. Prior to the finalization of the report, all graphs were circulated to contributors and to the global registry committee of IFSO to ensure data accuracy. RESULTS Data was received from 24 national and 2 regional registries, providing information on 502,150 procedures. The most performed primary MBS procedure was sleeve gastrectomy, whereas the most performed revisional MBS procedure was Roux-en-Y gastric bypass. Asian countries reported people with lower BMI undergoing MBS along with higher rates of diabetes. Mortality was a rare event. CONCLUSION Registries enable meaningful comparisons between countries on the demographics, characteristics, operation types and approaches, and trends in MBS procedures. Reported outcomes can be seen as flags of potential issues or relationships that could be studied in more detail in specific research studies.
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Affiliation(s)
- Wendy A Brown
- Department of Surgery, Australia and New Zealand Bariatric Surgery Registry, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia.
| | - Ronald Liem
- Dutch Audit for the Treatment of Obesity, Heerlen, Netherlands
| | - Salman Al-Sabah
- Department of Surgery, Kuwait University (Kuwait Bariatric Surgery Registry), Kuwait, Kuwait
| | | | - Camilo Boza
- Bariatric Surgery Center, Clinica MEDS (Chilean Bariatric Surgery Registry), Santiago, Chile
| | - Ricardo V Cohen
- The Center for the treatment of Obesity and Diabetes - COD Hospital Oswaldo Cruz (Brazilian Registry), Sao Paulo, Brazil
| | - Amir Ghaferi
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Villy Våge
- Scandinavian Obesity Surgery Registry Norway (SOReg-N), Helse Bergen Health Trust, Bergen, Norway
| | | | - Lilian Kow
- Department GI Surgery, Flinders University South Australia (Australian and New Zealand Bariatric Surgery Registry), Adelaide, Australia
| | - John Morton
- Yale School of Medicine (MBSAQIP- Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project), New Haven, CT, USA
| | - Mario Musella
- Advanced Biomedical Sciences Department (Italian Registry), Naples "Federico II" University, Naples, Italy
| | - Francois Pattou
- University of Lille, Integrated Center for Obesity, CHU Lille, Inserm,, Institut Pasteur Lille (SOFFCO-MM Registry), Lille, France
| | - Nasser Sakran
- Department of General Surgery, Holy Family Hospital, Nazareth, Israel
- The Azrieli Faculty of Medicine Safed, Bar-Ilan University (Israelian Registry), Ramat Gan, Israel
| | - Benjamin Clapp
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79902, USA
| | - Gerhard Prager
- Universitätsklinik Für Allgemeinchirurgie, Vienna, Austria
| | - Scott Shikora
- Department of Surgery, Division of Gastrointestinal and General Surgery, Brigham and Women's Hospital, Harvard Medical School (MBSAQIP), Boston, MA, USA
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Kermansaravi M, Shahmiri SS, Kow L, Gawdat K, Abbas SI, Aly A, Bashir A, Bhandari M, Haddad A, ElFawal MH, Inam A, Kasama K, Kim SH, Kular KS, Lakdawala M, Layani LA, Lee WJ, Pazouki A, Prasad A, Safadi B, Wang C, Yang W, Adib R, Jazi AHD, Shabbir A. Technical Variations and Considerations around OAGB in IFSO-APC and IFSO-MENAC Chapters, an Expert Survey. Obes Surg 2024:10.1007/s11695-024-07239-9. [PMID: 38662251 DOI: 10.1007/s11695-024-07239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE This study aimed to evaluate the technical variations of one-anastomosis gastric bypass (OAGB) among IFSO-APC and MENAC experts. BACKGROUND The multitude of technical variations and patient selection challenges among metabolic and bariatric surgeons worldwide necessitates a heightened awareness of these issues. Understanding different perspectives and viewpoints can empower surgeons performing OAGB to adapt their techniques, leading to improved outcomes and reduced complications. METHODS The scientific team of IFSO-APC, consisting of skilled bariatric and metabolic surgeons specializing in OAGB, conducted a confidential online survey. The survey aimed to assess technical variations and considerations related to OAGB within the IFSO-APC and IFSO-MENAC chapters. A total of 85 OAGB experts participated in the survey, providing their responses through a 35-question online format. The survey took place from January 1, 2024, to February 15, 2024. RESULTS Most experts do not perform OAGB for children and adolescents younger than 18 years. Most experts create the gastric pouch over a 36-40-F bougie and prefer to create a gastrojejunostomy, at the posterior wall of the gastric pouch. An anti-reflux suture during OAGB is performed in all patients by 51.8% of experts. Most experts set a common limb length of > 4 m in revisional and conversional OAGBs to prevent nutritional complications. CONCLUSION The ongoing debate among metabolic and bariatric surgeons regarding the technical variations and patient selection in OAGB remains a significant point of discussion. This survey demonstrated the variations in technical aspects and patient selection for OAGB among MBS surgeons in the IFSO-APC and IFSO-MENAC chapters. Standardizing the OAGB technique is crucial to ensure optimal safety and efficacy in this procedure.
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Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Shahab Shahabi Shahmiri
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Khaled Gawdat
- Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Ahmad Aly
- Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia
- University of Melbourne, Melbourne, Australia
| | - Ahmad Bashir
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
| | | | - Ashraf Haddad
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
| | | | - Atif Inam
- Metabolic, Thoracic & General Surgery Unit III, Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Sang Hyun Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | | | | | | | - Wei-Jei Lee
- Medical Weight Loss Center, China Medical University Hsinchu Hospital, Zhubei, Taiwan
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Reza Adib
- The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Amir Hossein Davarpanah Jazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Asim Shabbir
- National University of Singapore, Singapore, Singapore
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Angrisani L, Santonicola A, Iovino P, Palma R, Kow L, Prager G, Ramos A, Shikora S. IFSO Worldwide Survey 2020-2021: Current Trends for Bariatric and Metabolic Procedures. Obes Surg 2024; 34:1075-1085. [PMID: 38438667 PMCID: PMC11026210 DOI: 10.1007/s11695-024-07118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE This IFSO survey aims to describe the current trends of metabolic and bariatric surgery (MBS) reporting on the number and types of surgical and endoluminal procedures performed in 2020 and 2021, in the world and within each IFSO chapter. METHODS All national societies belonging to IFSO were asked to complete the survey form. The number and types of procedures performed (surgical and endoluminal interventions) from 2020 to 2021 were documented. A special section focused on the impact of COVID-19, the existence of national protocols for MBS, the use of telemedicine, and any mortality related to MBS. A trend analysis of the data, both worldwide and within each IFSO chapter, was also performed for the period between 2018 and 2021. RESULTS Fifty-seven of the 74 (77%) IFSO national societies submitted the survey. Twenty-four of the 57 (42.1%) reported data from their national registries. The total number of surgical and endoluminal procedures performed in 2020 was 507,806 and in 2021 was 598,834. Sleeve gastrectomy (SG) remained the most performed bariatric procedure. Thirty national societies (52%) had regional protocols for MBS during COVID-19, 61.4% supported the use of telemedicine, and only 47.3% collected data on mortality after MBS in 2020. These percentages did not significantly change in 2021 (p > 0.05). CONCLUSIONS The number of MBS markedly decreased worldwide during 2020. Although there was a positive trend in 2021, it did not reach the values obtained before the COVID-19 pandemic. SG continued to be the most performed operation. Adjustable gastric banding (AGB) continues to decrease worldwide.
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Affiliation(s)
- Luigi Angrisani
- Public Health Department - School of Medicine, "Federico II" University of Naples, Naples, Italy.
| | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Rossella Palma
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Lilian Kow
- Flinders University, Adelaide, South Australia
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Almino Ramos
- Gastro-Obeso-Center Institute, Sao Paulo, Brazil
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Kovoor JG, Nematzadeh N, Ataie S, Thomas B, Short R, Davey A, Goodrich A, Shrestha T, Gupta AK, Stretton B, Bacchi S, Marshall-Webb M, Kaeppeli R, Navidi M, Liyanage C, Maddern GJ, Barreto SG, Kow L, Padbury RT. Understanding the length of hospital stay after general surgery using a prospectively maintained local database. Surgery 2024:S0039-6060(24)00070-9. [PMID: 38508918 DOI: 10.1016/j.surg.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, South Australia, Australia; The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Flinders Medical Centre, Adelaide, South Australia, Australia; Ballarat Base Hospital, Victoria, Australia.
| | | | - Sara Ataie
- Flinders University, Adelaide, South Australia, Australia
| | - Bev Thomas
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Rachel Short
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Amy Davey
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Angie Goodrich
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | | | | | - Brandon Stretton
- University of Adelaide, South Australia, Australia; The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia
| | - Stephen Bacchi
- Flinders University, Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia; Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Matthew Marshall-Webb
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia; Box Hill Hospital, Melbourne, Victoria, Australia
| | - Reto Kaeppeli
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Maziar Navidi
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | | | - Guy J Maddern
- University of Adelaide, South Australia, Australia; The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - S George Barreto
- Flinders Medical Centre, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia
| | - Lilian Kow
- Flinders Medical Centre, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia
| | - Robert T Padbury
- Flinders Medical Centre, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia
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Ponce de Leon-Ballesteros G, Pouwels S, Romero-Velez G, Aminian A, Angrisani L, Bhandari M, Brown W, Copaescu C, De Luca M, Fobi M, Ghanem OM, Hasenberg T, Herrera MF, Herrera-Kok JH, Himpens J, Kow L, Kroh M, Kurian M, Musella M, Narwaria M, Noel P, Pantoja JP, Ponce J, Prager G, Ramos A, Ribeiro R, Ruiz-Ucar E, Salminen P, Shikora S, Small P, Stier C, Taha S, Taskin EH, Torres A, Vaz C, Vilallonga R, Verboonen S, Zerrweck C, Zundel N, Parmar C. Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m 2): a Modified Delphi Study. Obes Surg 2024; 34:790-813. [PMID: 38238640 DOI: 10.1007/s11695-023-06990-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology. METHODS A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts' votes was achieved. RESULTS A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations. CONCLUSION This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population.
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Affiliation(s)
- Guillermo Ponce de Leon-Ballesteros
- Department of Surgery, Hospital Angeles Morelia, Morelia, Postal: 331, Int. B-502, Av. Montaña Monarca, Montaña Monarca, 58350, Morelia, Michoacan, Mexico.
| | - Sjaak Pouwels
- Department of General, Abdominal Surgery and Coloproctology, Helios St. Elisabeth Hospital, Oberhausen, NRW, Germany
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | | | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luigi Angrisani
- Department of Public Health, Federico II" University of Naples, Naples, Italy
| | | | - Wendy Brown
- Department of Surgery, Monash University, Melbourne, Australia
| | - Catalin Copaescu
- Department of Surgery, Ponderas Academic Hospital, Bucharest, Romania
| | | | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Till Hasenberg
- Helios Obesity Center West, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Miguel F Herrera
- Clinic for Nutrition and Obesity, The American British Cowdray Medical Center Observatorio, Mexico City, Mexico
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Johnn H Herrera-Kok
- Department of General and Digestive Surgery, University Hospital of Leon, Leon, Spain
| | - Jacques Himpens
- Bariatric Surgery Unit, Delta CHIREC Hospital, Brussels, Belgium
| | - Lilian Kow
- Flinders Medical Centre, Adelaide, Australia
| | - Matthew Kroh
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Mario Musella
- Advanced Biomedical Sciences Department, "Federico II" University of Naples, Naples, Italy
| | | | - Patrick Noel
- Clinique Bouchard, ELSAN, Marseille, France
- Emirates Specialty Hospital, DHCC, Dubai, UAE
| | - Juan P Pantoja
- Department of Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jaime Ponce
- CHI Memorial Hospital Chattanooga, Chattanooga, TN, USA
| | - Gerhard Prager
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Rui Ribeiro
- Department of General Surgery, Hospital Lusiadas Amadora, Amadora, Portugal
| | - Elena Ruiz-Ucar
- Department of Bariatric and Endocrine Surgery, Fuenlabrada University Hospital, Madrid, Spain
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Scott Shikora
- Department of Surgery, Division of Gastrointestinal and General Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter Small
- Directorate of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Christine Stier
- Department of Interdisciplinary Endoscopy and Visceral Surgery, University Hospital Mannheim, Mannheim, Germany
| | - Safwan Taha
- Bariatric and Metabolic Surgery Center, Mediclinic Hospital Airport Road, Abu Dhabi, UAE
| | - Eren Halit Taskin
- Department of Surgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Antonio Torres
- General and Digestive Surgery Service, Department of Surgery, Hospital Clínico San Carlos, Complutense University Medical School, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain
| | - Carlos Vaz
- Obesity and Metabolic Surgery Unit, Hospital CUF Tejo, Lisbon, Portugal
| | - Ramon Vilallonga
- Department of Surgery, Enodcrine-Metabolic and Bariatric Surgery Unit, Vall Hebron Barcelona Hospital Campus, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Carlos Zerrweck
- The American British Cowdray Medical Center Santa Fe, Mexico City, Mexico
| | - Natan Zundel
- Department of Surgery, University of Buffalo, Buffalo, NY, USA
| | - Chetan Parmar
- Department of Surgery, The Whittington Hospital NHS Trust, London, UK
- Apollo Hospitals Educational and Research Foundation, Hyderabad, India
- University College London, London, UK
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7
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Kermansaravi M, Chiappetta S, Parmar C, Shikora SA, Prager G, LaMasters T, Ponce J, Kow L, Nimeri A, Kothari SN, Aarts E, Abbas SI, Aly A, Aminian A, Bashir A, Behrens E, Billy H, Carbajo MA, Clapp B, Chevallier JM, Cohen RV, Dargent J, Dillemans B, Faria SL, Neto MG, Garneau PY, Gawdat K, Haddad A, ElFawal MH, Higa K, Himpens J, Husain F, Hutter MM, Kasama K, Kassir R, Khan A, Khoursheed M, Kroh M, Kurian MS, Lee WJ, Loi K, Mahawar K, McBride CL, Almomani H, Melissas J, Miller K, Misra M, Musella M, Northup CJ, O'Kane M, Papasavas PK, Palermo M, Peterson RM, Peterli R, Poggi L, Pratt JSA, Alqahtani A, Ramos AC, Rheinwalt K, Ribeiro R, Rogers AM, Safadi B, Salminen P, Santoro S, Sann N, Scott JD, Shabbir A, Sogg S, Stenberg E, Suter M, Torres A, Ugale S, Vilallonga R, Wang C, Weiner R, Zundel N, Angrisani L, De Luca M. Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus. Sci Rep 2024; 14:3445. [PMID: 38341469 PMCID: PMC10858961 DOI: 10.1038/s41598-024-54141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/08/2024] [Indexed: 02/12/2024] Open
Abstract
Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m2. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.
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Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat-e Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Sonja Chiappetta
- Department of General and Laparoscopic Surgery, Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy.
| | | | - Scott A Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | | | - Teresa LaMasters
- Unitypoint Clinic Weight Loss Specialists, West Des Moines, IA, USA
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN, USA
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Abdelrahman Nimeri
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Shanu N Kothari
- Prisma Health, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Edo Aarts
- WeightWorks Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | | | - Ahmad Aly
- Austin and Repatriation Medical Centre, University of Melbourne, Heidelberg, VIC, Australia
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmad Bashir
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Amman, Jordan
| | | | - Helmuth Billy
- Ventura Advanced Surgical Associates, Ventura, CA, USA
| | - Miguel A Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
| | - Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | | | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paolo, Brazil
| | | | - Bruno Dillemans
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - Silvia L Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Pierre Y Garneau
- Division of Bariatric Surgery, CIUSSS-NIM, Montreal, Canada
- Department of Surgery, Université de Montréal, Montréal, Canada
| | - Khaled Gawdat
- Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ashraf Haddad
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Amman, Jordan
| | | | - Kelvin Higa
- Fresno Heart and Surgical Hospital, UCSF Fresno, Fresno, CA, USA
| | - Jaques Himpens
- Bariatric Surgery Unit, Delta Chirec Hospital, Brussels, Belgium
| | - Farah Husain
- University of Arizona College of Medicine, Phoenix, USA
| | - Matthew M Hutter
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Amir Khan
- Walsall Healthcare NHS Trust, Walsall, UK
| | | | - Matthew Kroh
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marina S Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Wei-Jei Lee
- Medical Weight Loss Center, China Medical University Shinchu Hospital, Zhubei City, Taiwan
| | - Ken Loi
- Director of St George Surgery, Sydney, Australia
| | - Kamal Mahawar
- South Tyneside and Sunderland Foundation NHS Trust, Sunderland, UK
| | | | | | - John Melissas
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece
| | - Karl Miller
- Diakonissen Wehrle Private Hospital, Salzburg, Austria
| | | | - Mario Musella
- Advanced Biomedical Sciences Department, Federico II" University, Naples, Italy
| | | | - Mary O'Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Pavlos K Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, USA
| | - Mariano Palermo
- Department of Surgery, Centro CIEN-Diagnomed, University of Buenos Aires, Buenos Aires, Argentina
| | - Richard M Peterson
- Department of General and Minimally Invasive Surgery, UT Health San Antonio, San Antonio, TX, USA
| | - Ralph Peterli
- Department of Visceral Surgery, Clarunis, University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Luis Poggi
- Department of Surgery Clinica Anglo Americana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Janey S A Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA
| | - Aayad Alqahtani
- New You Medical Center, King Saud University, Obesity Chair, Riyadh, Saudi Arabia
| | - Almino C Ramos
- Medical Director of Gastro-Obeso-Center, Institute for Metabolic Optimization, Sao Paulo, Brazil
| | - Karl Rheinwalt
- Department of Bariatric, Metabolic, and Plastic Surgery, St. Franziskus Hospital, Cologne, Germany
| | - Rui Ribeiro
- Centro Multidisciplinar Do Tratamento da Obesidade, Hospital Lusíadas Amadora e Lisbon, Amadora, Portugal
| | - Ann M Rogers
- Department of Surgery - Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Paulina Salminen
- Division of Digestive Surgery and Urology, Department of Digestive Surgery, Turku University Hospital, Turku, Finland
| | - Sergio Santoro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-900, Brazil
| | - Nathaniel Sann
- Advanced Surgical Partners of Virginia, Richmond, VA, USA
| | - John D Scott
- Division of Bariatric and Minimal Access Surgery, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Asim Shabbir
- National University of Singapore, Singapore, Singapore
| | - Stephanie Sogg
- Massachusetts General Hospital Weight Center, Boston, MA, USA
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Antonio Torres
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Calle del Prof Martín Lagos, S/N, 28040, Madrid, Spain
| | - Surendra Ugale
- Kirloskar and Virinchi Hospitals, Hyderabad, Telangana, India
| | - Ramon Vilallonga
- Endocrine, Bariatric, and Metabolic Surgery Department, Universitary Hospital Vall Hebron, Barcelona, Spain
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Rudolf Weiner
- Bariatric Surgery Unit, Sana Clinic Offenbach, Offenbach, Germany
| | - Natan Zundel
- Department of Surgery, University of Buffalo, Buffalo, NY, USA
| | - Luigi Angrisani
- Department of Public Health, Federico II University of Naples, Naples, Italy
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8
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Giudicelli G, Gero D, Romulo L, Chirumamilla V, Iranmanesh P, Owen CK, Bauerle W, Garcia A, Lucas L, Mehdorn AS, Pandey D, Almuttawa A, Cabral F, Tiwari A, Lambert V, Pascotto B, De Meyere C, Yahyaoui M, Haist T, Scheffel O, Robert M, Nuytens F, Azagra S, Kow L, Prasad A, Vaz C, Vix M, Bindal V, Beckmann JH, Soussi D, Vilallonga R, El Chaar M, Wilson EB, Ahmad A, Teixeira A, Hagen ME, Toso C, Clavien PA, Puhan M, Bueter M, Jung MK. Global benchmarks in primary robotic bariatric surgery redefine quality standards for Roux-en-Y gastric bypass and sleeve gastrectomy. Br J Surg 2024; 111:znad374. [PMID: 37981863 PMCID: PMC10771137 DOI: 10.1093/bjs/znad374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/26/2023] [Accepted: 10/21/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Whether the benefits of the robotic platform in bariatric surgery translate into superior surgical outcomes remains unclear. The aim of this retrospective study was to establish the 'best possible' outcomes for robotic bariatric surgery and compare them with the established laparoscopic benchmarks. METHODS Benchmark cut-offs were established for consecutive primary robotic bariatric surgery patients of 17 centres across four continents (13 expert centres and 4 learning phase centres) using the 75th percentile of the median outcome values until 90 days after surgery. The benchmark patients had no previous laparotomy, diabetes, sleep apnoea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI greater than 50 kg/m2, or age greater than 65 years. RESULTS A total of 9097 patients were included, who were mainly female (75.5%) and who had a mean(s.d.) age of 44.7(11.5) years and a mean(s.d.) baseline BMI of 44.6(7.7) kg/m2. In expert centres, 13.74% of the 3020 patients who underwent primary robotic Roux-en-Y gastric bypass and 5.9% of the 4078 patients who underwent primary robotic sleeve gastrectomy presented with greater than or equal to one complication within 90 postoperative days. No patient died and 1.1% of patients had adverse events related to the robotic platform. When compared with laparoscopic benchmarks, robotic Roux-en-Y gastric bypass had lower benchmark cut-offs for hospital stay, postoperative bleeding, and marginal ulceration, but the duration of the operation was 42 min longer. For most surgical outcomes, robotic sleeve gastrectomy outperformed laparoscopic sleeve gastrectomy with a comparable duration of the operation. In robotic learning phase centres, outcomes were within the established benchmarks only for low-risk robotic Roux-en-Y gastric bypass. CONCLUSION The newly established benchmarks suggest that robotic bariatric surgery may enhance surgical safety compared with laparoscopic bariatric surgery; however, the duration of the operation for robotic Roux-en-Y gastric bypass is longer.
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Affiliation(s)
- Guillaume Giudicelli
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lind Romulo
- Department of Surgery, Orlando Health, University of Central Florida, Orlando, Florida, USA
| | - Vasu Chirumamilla
- Bariatric and Robotic Center of Excellence, Mather Northwell Hospital Health, Port Jefferson, New York, USA
| | - Pouya Iranmanesh
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Christopher K Owen
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Wayne Bauerle
- Department of Surgery, Division of Bariatric Surgery, St. Luke’s University Health Network, Bethlehem, Pennsylvania, USA
| | - Amador Garcia
- Endocrine-Metabolic and Bariatric Unit, Robotic Surgery, Vall Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lisa Lucas
- Department of Endocrine and Digestive Surgery, University Hospital of Poitiers, Poitiers, France
| | - Anne-Sophie Mehdorn
- Department of General, Abdominal, Thoracic, Transplantation and Paediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
- Kurt Semm Centre for Laparoscopic and Robot Assisted Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Dhananjay Pandey
- Institute of Minimal Access, Bariatric and Robotic Surgery, Max Super Speciality Hospital, Delhi NCR, India
| | - Abdullah Almuttawa
- Department of Endocrine and Digestive Surgery, Strasbourg University Hospital – IRCAD, Strasbourg, France
- Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Abhishek Tiwari
- Department of Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Virginia Lambert
- Adelaide Bariatric Centre, Department of Surgery, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Beniamino Pascotto
- General and Minimally Invasive (Laparoscopic and Robotic) Surgery Department, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | | | - Marouan Yahyaoui
- Department of Digestive and Bariatric Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Haist
- Department of General and Visceral Surgery, Asklepios Paulinen Klinik, Wiesbaden, Germany
| | - Oliver Scheffel
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - Maud Robert
- Department of Digestive and Bariatric Surgery, Hôpital Edouard Herriot, Lyon, France
| | | | - Santiago Azagra
- General and Minimally Invasive (Laparoscopic and Robotic) Surgery Department, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Lilian Kow
- Adelaide Bariatric Centre, Department of Surgery, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Arun Prasad
- Department of Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Carlos Vaz
- Robotic Surgery Unit, Cuf Tejo Hospital, Lisbon, Portugal
| | - Michel Vix
- Department of Endocrine and Digestive Surgery, Strasbourg University Hospital – IRCAD, Strasbourg, France
| | - Vivek Bindal
- Institute of Minimal Access, Bariatric and Robotic Surgery, Max Super Speciality Hospital, Delhi NCR, India
| | - Jan H Beckmann
- Department of General, Abdominal, Thoracic, Transplantation and Paediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
- Kurt Semm Centre for Laparoscopic and Robot Assisted Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David Soussi
- Department of Endocrine and Digestive Surgery, University Hospital of Poitiers, Poitiers, France
| | - Ramon Vilallonga
- Endocrine-Metabolic and Bariatric Unit, Robotic Surgery, Vall Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maher El Chaar
- Department of Surgery, Division of Bariatric Surgery, St. Luke’s University Health Network, Bethlehem, Pennsylvania, USA
| | - Erik B Wilson
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Arif Ahmad
- Bariatric and Robotic Center of Excellence, Mather Northwell Hospital Health, Port Jefferson, New York, USA
| | - Andre Teixeira
- Department of Surgery, Orlando Health, University of Central Florida, Orlando, Florida, USA
| | - Monika E Hagen
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Minoa K Jung
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
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9
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Salminen P, Kow L, Aminian A, Kaplan LM, Nimeri A, Prager G, Behrens E, White KP, Shikora S. IFSO Consensus on Definitions and Clinical Practice Guidelines for Obesity Management-an International Delphi Study. Obes Surg 2024; 34:30-42. [PMID: 37999891 PMCID: PMC10781804 DOI: 10.1007/s11695-023-06913-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION This survey of international experts in obesity management was conducted to achieve consensus on standardized definitions and to identify areas of consensus and non-consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice guidelines for the management of obesity. METHODS A three-round Delphi survey with 136 statements was conducted by 43 experts in obesity management comprising 26 bariatric surgeons, 4 endoscopists, 8 endocrinologists, 2 nutritionists, 2 counsellors, an internist, and a pediatrician spanning six continents over a 2-day meeting in Hamburg, Germany. To reduce bias, voting was unanimous, and the statements were neither favorable nor unfavorable to the issue voted or evenly balanced between favorable and unfavorable. Consensus was defined as ≥ 70% inter-voter agreement. RESULTS Consensus was reached on all 15 essential definitional and reporting statements, including initial suboptimal clinical response, baseline weight, recurrent weight gain, conversion, and revision surgery. Consensus was reached on 95/121 statements on the type of surgical procedures favoring Roux-en-Y gastric bypass, sleeve gastrectomy, and endoscopic sleeve gastroplasty. Moderate consensus was reached for sleeve gastrectomy single-anastomosis duodenoileostomy and none on the role of intra-gastric balloons. Consensus was reached for MBS in patients > 65 and < 18 years old, with a BMI > 50 kg/m2, and with various obesity-related complications such as type 2 diabetes, liver, and kidney disease. CONCLUSIONS In this survey of 43 multi-disciplinary experts, consensus was reached on standardized definitions and reporting standards applicable to the whole medical community. An algorithm for treating patients with obesity was explored utilizing a thoughtful multimodal approach.
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Affiliation(s)
- Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland.
- Division of Digestive Surgery and Urology, Turku University Hospital, P.O. Box 52, 20521, Turku, Finland.
| | - Lilian Kow
- Department of Surgery, Flinders University, Adelaide, SA, Australia
| | - Ali Aminian
- Department of General Surgery, Cleveland Clinic, Bariatric and Metabolic Institute, Cleveland, OH, USA
| | - Lee M Kaplan
- Section On Obesity Medicine, Geisel School of Medicine at Darthmouth, Hanover, NH, USA
| | - Abdelrahman Nimeri
- Division of General & GI Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerhard Prager
- Division of Visceral Surgery, Vienna Medical University, Vienna, Austria
| | | | - Kevin P White
- ScienceRight International Health Research, London, ON, Canada
| | - Scott Shikora
- Division of General & GI Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
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10
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Kow L. Achieving equity in bariatric and metabolic surgery: why do we need new guidelines? ANZ J Surg 2023; 93:2803-2805. [PMID: 37953529 DOI: 10.1111/ans.18767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Lilian Kow
- Department of GastroIntestinal Surgery, Southern Adelaide Local Health Network I, Flinders Medical Centre, Flinders University South Australia, Adelaide, South Australia, Australia
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11
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Jazi AHD, Mahjoubi M, Shahabi S, Alqahtani AR, Haddad A, Pazouki A, Prasad A, Safadi BY, Chiappetta S, Taskin HE, Billy HT, Kasama K, Mahawar K, Gawdat K, Rheinwalt KP, Miller KA, Kow L, Neto MG, Yang W, Palermo M, Ghanem OM, Lainas P, Peterli R, Kassir R, Puy RV, Da Silva Ribeiro RJ, Verboonen S, Pintar T, Shabbir A, Musella M, Kermansaravi M. Bariatric Evaluation Through AI: a Survey of Expert Opinions Versus ChatGPT-4 (BETA-SEOV). Obes Surg 2023; 33:3971-3980. [PMID: 37889368 DOI: 10.1007/s11695-023-06903-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Recent advancements in artificial intelligence, such as OpenAI's ChatGPT-4, are revolutionizing various sectors, including healthcare. This study investigates the use of ChatGPT-4 in identifying suitable candidates for bariatric surgery and providing surgical recommendations to improve decision-making in obesity treatment amid the global obesity epidemic. METHODS We devised ten patient scenarios, thoughtfully encompassing a spectrum that spans from uncomplicated cases to more complex ones. Our objective was to delve into the decision-making process regarding the recommendation of bariatric surgery. From July 29th to August 10th, 2023, we conducted a voluntary online survey involving thirty prominent bariatric surgeons, ensuring that there was no predetermined bias in the selection of a specific type of bariatric surgery. This survey was designed to collect their insights on these scenarios and gain a deeper understanding of their professional experience and background in the field of bariatric surgery. Additionally, we consulted ChatGPT-4 in two separate conversations to evaluate its alignment with expert opinions on bariatric surgery options. RESULTS In 40% of the scenarios, disparities were identified between the two conversations with ChatGPT-4. It matched expert opinions in 30% of cases. Differences were noted in cases like gastrointestinal metaplasia and gastric adenocarcinoma, but there was alignment with conditions like endometriosis and GERD. CONCLUSION The evaluation of ChatGPT-4's role in determining bariatric surgery suitability uncovered both potential and shortcomings. Its alignment with experts was inconsistent, and it often overlooked key factors, emphasizing human expertise's value. Its current use requires caution, and further refinement is needed for clinical application.
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Affiliation(s)
- Amir Hossein Davarpanah Jazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran
| | - Mohammad Mahjoubi
- Clinical Research Development Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Shahab Shahabi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran.
| | | | - Ashraf Haddad
- Gastrointestinal Metabolic and Bariatric Center, GBMC M, Jordan Hospital, Amman, Jordan
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran
| | - Arun Prasad
- GI, Bariatric and Robotic Surgery Apollo Hospital, New Delhi, India
| | | | - Sonja Chiappetta
- Bariatric and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Halit Eren Taskin
- Department of General Surgery, Cerrahpaşa Medical Faculty, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | | | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | | | - Khaled Gawdat
- Ain Shams University Faculty of Medicine Department of General Surgery, Cairo, Egypt
| | - Karl Peter Rheinwalt
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus Hospital, Cologne, Germany
| | | | - Lilian Kow
- Department GI Surgery Flinders, University South Australia, Adelaide, Australia
| | | | - Wah Yang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Mariano Palermo
- Gastrointestinal and Bariatric Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Panagiotis Lainas
- Department of Digestive and Bariatric Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece
| | - Ralph Peterli
- Deputy Head of Visceral Surgery and Head of Bariatric-Metabolic Surgery Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Radwan Kassir
- Digestive Surgery Unit, University Hospital of La Réunion -Félix Guyon Hospital, Saint-Denis, La Réunion, France
| | - Ramon Vilallonga Puy
- Head Endocrine-Metabolic and Bariatric Surgery Unit, Vall Hebron Barcelona Hospital Campus, Pg. De La Vall d'hebron, 119-129, 08035, Barcelona, Spain
| | - Rui José Da Silva Ribeiro
- General Surgery Department, Multidisciplinary Center for Obesity Treatment - Hospital Lusíadas Amadora, Amadora, Portugal
| | | | - Tadeja Pintar
- UMC Ljubljana, Department of Abdominal Surgery and Medical Faculty, Ljubljana, Slovenia
| | - Asim Shabbir
- National University of Singapore, Singapore, Singapore
| | - Mario Musella
- Advanced Biomedical Sciences Department, "Federico II" University, Naples, Italy
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran
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12
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Kow L, Sharaiha RZ, O'Kane M, White KP, Macedo G, Toouli J, Shikora S. Methodology and Results of a Joint IFSO-WGO Delphi Survey of 94 Intercontinental, Interdisciplinary Experts in Obesity Management. Obes Surg 2023; 33:3337-3352. [PMID: 37831326 PMCID: PMC10602939 DOI: 10.1007/s11695-023-06757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Obesity affects 1.5 billion people worldwide, yet few are treated effectively and considerable variability exists in its management. In 2020, a joint International Federation of Surgery for Obesity and Metabolic Diseases (IFSO) and World Gastroenterology Organization (WGO) advisory committee initiated the drafting of consensus guidelines on obesity management, to be based on detailed literature reviews and the results of an extensive multi-disciplinary survey of intercontinental experts. This paper reports on the latter. The objective of this study is to identify areas of consensus and non-consensus among intercontinental, inter-disciplinary experts in obesity management. METHODS Guided by an international consensus-survey expert, a three-round online Delphi survey was conducted in the summer of 2021 of international obesity-management experts spanning the fields of medicine, bariatric endoscopy and surgery, psychology, and nutrition. Issues like epidemiology and risk factors, patient selection for metabolic and bariatric surgery (ASMBS-Clinical-Issues-Committee, Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 8:e27-32, 1), psychological issues, patient preparation for MBS, bariatric endoscopy, and outcomes and follow-up were addressed. RESULTS Ninety-four experts from six continents voted on 180 statements, with consensus reached on 158, including consensus agreement with 96 and disagreement with 24 statements (38 had other response options besides agree/disagree). Among unanimous opinions were the need for all medical societies to work together to address obesity, for regular regional and national obesity surveillance, for multi-disciplinary management, to recognize the increasing impact of childhood and adolescent obesity, to accept some weight regain as normal after MBS, and for life-long follow-up of MBS patients. CONCLUSIONS Obesity is a major health issue that requires aggressive surveillance and thoughtful multidisciplinary management.
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Affiliation(s)
- Lilian Kow
- Dept. of Surgery, Flinders University, Adelaide, SA, Australia.
| | - Reem Z Sharaiha
- Dept. of Gastroenterology, Weill Cornell Medical College, New York, NY, USA
| | - Mary O'Kane
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin P White
- ScienceRight International Health Research Consulting (SRIHRC), London, ON, Canada
| | - Guilherme Macedo
- Dept. of Gastroenterology & Hepatology, Centro Hospitalar de São João, Porto, Portugal
| | - Jim Toouli
- Dept. of Surgery, Flinders University, Adelaide, SA, Australia
| | - Scott Shikora
- Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA
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13
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Shahmiri SS, Parmar C, Yang W, Lainas P, Pouwels S, DavarpanahJazi AH, Chiappetta S, Seki Y, Omar I, Vilallonga R, Kassir R, Abbas SI, Bashir A, Singhal R, Kow L, Kermansaravi M. Bariatric and metabolic surgery in patients with low body mass index: an online survey of 543 bariatric and metabolic surgeons. BMC Surg 2023; 23:272. [PMID: 37689633 PMCID: PMC10492360 DOI: 10.1186/s12893-023-02175-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/29/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) in patients with low body mass index patients is a topic of debate. This study aimed to address all aspects of controversies in these patients by using a worldwide survey. METHODS An online 35-item questionnaire survey based on existing controversies surrounding MBS in class 1 obesity was created by 17 bariatric surgeons from 10 different countries. Responses were collected and analysed by authors. RESULTS A total of 543 bariatric surgeons from 65 countries participated in this survey. 52.29% of participants agreed with the statement that MBS should be offered to class-1 obese patients without any obesity related comorbidities. Most of the respondents (68.43%) believed that MBS surgery should not be offered to patients under the age of 18 with class I obesity. 81.01% of respondents agreed with the statement that surgical interventions should be considered after failure of non-surgical treatments. CONCLUSION This survey demonstrated worldwide variations in metabolic/bariatric surgery in patients with class 1 obesity. Precise analysis of these results is useful for identifying different aspects for future research and consensus building.
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Affiliation(s)
- Shahab Shahabi Shahmiri
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Centre of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
- Iran National Centre of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
| | - Chetan Parmar
- Consultant Surgeon and Head of Department, Whittington Hospital, London, UK
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Panagiotis Lainas
- Department of Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Amir Hossein DavarpanahJazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Centre of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
- Iran National Centre of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Islam Omar
- Wirral University Teaching Hospital, Birkenhead, UK
| | - Ramon Vilallonga
- Obesity and Metabolic Surgery Unit, Vall Hebron Campus Hospital, Barcelona, Spain
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Syed Imran Abbas
- Director Obesity & Metabolic Surgery Clinic, Iranian Hospital Dubai, UAE. CEO & Founder of GLR International, Dubai, UAE
| | | | - Rishi Singhal
- Consultant Bariatric & Upper GI Surgeon, Birmingham Heartlands Hospital, University Hospital Birmingham, UK. Honorary Senior Lecturer, University of Birmingham, Medical Director, Healthier Weight, Birmingham, UK
| | - Lilian Kow
- Flinders University South Australia, Adelaide, Australia
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Centre of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran.
- Iran National Centre of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran.
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Coulman KD, Chalmers K, Blazeby J, Dixon J, Kow L, Liem R, Pournaras DJ, Ottosson J, Welbourn R, Brown W, Avery K. Development of a Bariatric Surgery Core Data Set for an International Registry. Obes Surg 2023; 33:1463-1475. [PMID: 36959437 PMCID: PMC10156789 DOI: 10.1007/s11695-023-06545-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Bariatric and metabolic surgery is an effective treatment for severe and complex obesity; however, robust long-term data comparing operations is lacking. Clinical registries complement clinical trials in contributing to this evidence base. Agreement on standard data for bariatric registries is needed to facilitate comparisons. This study developed a Core Registry Set (CRS) - core data to include in bariatric surgery registries globally. MATERIALS AND METHODS Relevant items were identified from a bariatric surgery research core outcome set, a registry data dictionary project, systematic literature searches, and a patient advisory group. This comprehensive list informed a questionnaire for a two-round Delphi survey with international health professionals. Participants rated each item's importance and received anonymized feedback in round 2. Using pre-defined criteria, items were then categorized for voting at a consensus meeting to agree the CRS. RESULTS Items identified from all sources were grouped into 97 questionnaire items. Professionals (n = 272) from 56 countries participated in the round 1 survey of which 45% responded to round 2. Twenty-four professionals from 13 countries participated in the consensus meeting. Twelve items were voted into the CRS including demographic and bariatric procedure information, effectiveness, and safety outcomes. CONCLUSION This CRS is the first step towards unifying bariatric surgery registries internationally. We recommend the CRS is included as a minimum dataset in all bariatric registries worldwide. Adoption of the CRS will enable meaningful international comparisons of bariatric operations. Future work will agree definitions and measures for the CRS including incorporating quality-of-life measures defined in a parallel project.
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Affiliation(s)
- Karen D Coulman
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, BS8 2BN, UK.
- Bristol Centre for Surgical Research, University of Bristol, Bristol, BS8 2PS, UK.
- Obesity and Bariatric Surgery Service, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
| | - Katy Chalmers
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Centre for Surgical Research, University of Bristol, Bristol, BS8 2PS, UK
| | - Jane Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Centre for Surgical Research, University of Bristol, Bristol, BS8 2PS, UK
| | - John Dixon
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, 3122, Australia
| | - Lilian Kow
- College of Medicine and Public Health, Flinders University, Adelaide, 5042, Australia
| | - Ronald Liem
- Department of Surgery, Groene Hart Hospital, 2803 HH, Gouda, The Netherlands
| | - Dimitri J Pournaras
- Obesity and Bariatric Surgery Service, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Johan Ottosson
- School of Medical Sciences, Örebro University, 701 82, Örebro, Sweden
| | - Richard Welbourn
- Department of Upper GI and Bariatric Surgery, Somerset NHS Foundation Trust, Taunton, TA1 5DA, UK
| | - Wendy Brown
- Department of Surgery, Monash University, Melbourne, 3800, Australia
| | - Kerry Avery
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Centre for Surgical Research, University of Bristol, Bristol, BS8 2PS, UK
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15
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Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O’Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. Publisher Correction: 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:15-16. [PMID: 36445365 PMCID: PMC9834333 DOI: 10.1007/s11695-022-06369-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA 94304 USA
| | - Scott A. Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA USA
| | - Edo Aarts
- WeightWorks Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH USA
| | - Luigi Angrisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ricardo V. Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paolo, Brazil
| | | | - Silvia L. Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Center, Jordan Hospital, Amman, Jordan
| | | | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY USA
| | - Ken Loi
- St. George Hospital and Sutherland Hospital, Kogarah, NSW Australia
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, NC USA
| | - Mary O’Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pavlos K. Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT USA
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN USA
| | - Janey S. A. Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA 94304 USA ,Division of Pediatric Surgery, Lucille Packard Children’s Hospital, Palo Alto, CA USA
| | - Ann M. Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA USA
| | - Kimberley E. Steele
- NIDDK Metabolic and Obesity Research Unit, National Institutes of Health, Bethesda, MD USA
| | - Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland ,Department of Visceral Surgery, University Hospital, Lausanne, Switzerland
| | - Shanu N. Kothari
- Department of Surgery, Prisma Health, University of South Carolina School of Medicine, Greenville, SC USA
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16
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Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O'Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:3-14. [PMID: 36336720 PMCID: PMC9834364 DOI: 10.1007/s11695-022-06332-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
MAJOR UPDATES TO 1991 NATIONAL INSTITUTES OF HEALTH GUIDELINES FOR BARIATRIC SURGERY: Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) >35 kg/m2, regardless of presence, absence, or severity of co-morbidities.MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.BMI thresholds should be adjusted in the Asian population such that a BMI >25 kg/m2 suggests clinical obesity, and individuals with BMI >27.5 kg/m2 should be offered MBS.Long-term results of MBS consistently demonstrate safety and efficacy.Appropriately selected children and adolescents should be considered for MBS.(Surg Obes Relat Dis 2022; https://doi.org/10.1016/j.soard.2022.08.013 ) © 2022 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA.
| | - Scott A Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Edo Aarts
- WeightWorks Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luigi Angrisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paolo, Brazil
| | | | - Silvia L Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Center, Jordan Hospital, Amman, Jordan
| | | | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Ken Loi
- St. George Hospital and Sutherland Hospital, Kogarah, New South Wales, Australia
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, NC, USA
| | - Mary O'Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pavlos K Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, USA
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN, USA
| | - Janey S A Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA
- Division of Pediatric Surgery, Lucille Packard Children's Hospital, Palo Alto, CA, USA
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kimberley E Steele
- NIDDK Metabolic and Obesity Research Unit, National Institutes of Health, Bethesda, MD, USA
| | - Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
- Department of Visceral Surgery, University Hospital, Lausanne, Switzerland
| | - Shanu N Kothari
- Prisma Health, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
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17
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Haddad A, Kow L, Herrera MF, Cohen RV, Himpens J, Greve JW, Shikora S. Correction to: Innovative Bariatric Procedures and Ethics in Bariatric Surgery: The IFSO Position Statement. Obes Surg 2022; 32:3231. [PMID: 35996041 DOI: 10.1007/s11695-022-06249-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ashraf Haddad
- Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan.
| | - Lilian Kow
- Flinders University, Bedford Park, South Australia, Australia
| | - Miguel F Herrera
- Endocrine and Bariatric Surgery, UNAM at INCMNSZ, Mexico City, México
| | - Ricardo V Cohen
- The Centre for the Treatment of Obesity and Diabetes Hospital Oswaldo Cruz, Sao Paulo, Brazil
| | | | - Jan Willem Greve
- Research School NUTRIM and Department of Surgery Zuyderland Medical Center, Maastricht University Medical Center, Heerlen, the Netherlands
| | - Scott Shikora
- Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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18
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Kermansaravi M, Parmar C, Chiappetta S, Shahabi S, Abbass A, Abbas SI, Abouzeid M, Antozzi L, Asghar ST, Bashir A, Bhandari M, Billy H, Caina D, Campos FJ, Carbajo MA, Chevallier JM, Jazi AHD, de Gordejuela AGR, Haddad A, ElFawal MH, Himpens J, Inam A, Kassir R, Kasama K, Khan A, Kow L, Kular KS, Lakdawala M, Layani LA, Lee WJ, Luque-de-León E, Loi K, Mahawar K, Mahdy T, Musella M, Nimeri A, González JCO, Pazouki A, Poghosyan T, Prager G, Prasad A, Ramos AC, Rheinwalt K, Ribeiro R, Ruiz-Úcar E, Rutledge R, Shabbir A, Shikora S, Singhal R, Taha O, Talebpour M, Verboonen JS, Wang C, Weiner R, Yang W, Vilallonga R, De Luca M. Patient Selection in One Anastomosis/Mini Gastric Bypass-an Expert Modified Delphi Consensus. Obes Surg 2022; 32:2512-2524. [PMID: 35704259 DOI: 10.1007/s11695-022-06124-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by ASMBS. The main criticisms are the risk of bile reflux, esophageal cancer, and malnutrition. Although IFSO has recognized this procedure, guidance is needed regarding selection criteria. To give clinicians a daily support in performing the right patient selection in OAGB/MGB, the aim of this paper is to generate clinical guidelines based on an expert modified Delphi consensus. METHODS A committee of 57 recognized bariatric surgeons from 24 countries created 69 statements. Modified Delphi consensus voting was performed in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus. RESULTS Consensus was achieved for 56 statements. Remarkably, ≥ 90.0% of the experts felt that OAGB/MGB is an acceptable and suitable option "in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m2 as a one-stage procedure," "as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m2 (instead of BPD/DS)," and "in patients with weight regain after restrictive procedures. No consensus was reached on the statement that OAGB/MGB is a suitable option in case of resistant Helicobacter pylori. This is likely as there is a concern that this procedure is associated with reflux and its related long-term complications including risk of cancer in the esophagus or stomach. Also no consensus reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved "in case of intestinal metaplasia of the stomach" (74.55%), "in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)" (75.44%), "in patients with Barrett's metaplasia" (89.29%), and "in documented insulinoma" (89.47%). CONCLUSION Patient selection in OAGB/MGB is still a point of discussion among experts. There was consensus that OAGB/MGB is a suitable option in elderly patients, patients with low BMI (30-35 kg/m2) with associated metabolic problems, and patients with BMIs more than 50 kg/m2 as one-stage procedure. OAGB/MGB can also be a safe procedure in vegetarian and vegan patients. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, it should not be offered to patients with grade C or D esophagitis or Barrett's metaplasia.
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Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Shahab Shahabi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alaa Abbass
- Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
| | | | - Mohamed Abouzeid
- Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
| | | | | | - Ahmad Bashir
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Amman, Jordan
| | | | - Helmuth Billy
- Ventura Advanced Surgical Associates, Ventura, CA, USA
| | - Daniel Caina
- Dr. Federico Abete Hospital for Trauma and Emergency, Obesity and Metabolic Center, Malvinas, Argentina
| | | | - Miguel-A Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
| | | | - Amir Hossein Davarpanah Jazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ashraf Haddad
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Amman, Jordan
| | | | - Jacques Himpens
- Bariatric Surgery Unit, Delta Chirec Hospital, Brussels, Belgium
| | - Aatif Inam
- Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Amir Khan
- Walsall Healthcare NHS Trust, Walsall, UK
| | - Lilian Kow
- Flinders Medical Centre, Adelaide, Australia
| | | | | | | | - Wei-Jei Lee
- Min-Sheng General Hospital, Taoyuan City, Taiwan
| | | | - Ken Loi
- St George Surgery, Sydney, Australia
| | - Kamal Mahawar
- South Tyneside and Sunderland Foundation NHS Trust, Sunderland, UK
| | - Tarek Mahdy
- Mansoura Faculty of Medicine, Sharjah University Hospital, Sharjah, UAE
| | - Mario Musella
- Advanced Biomedical Sciences Department, "Federico II" University, Naples, Italy
| | | | | | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Tigran Poghosyan
- Hôpital Européen-Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | | | | | | | - Karl Rheinwalt
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus Hospital, Cologne, Germany
| | - Rui Ribeiro
- Centro de Excelencia Para a Cirurgia MetabolicaGrupo Lusiadas, Lisbon, Portugal
| | - Elena Ruiz-Úcar
- Bariatric and Metabolic Surgery Department, University Hospital of Fuenlabrada, Madrid, Spain
| | - Robert Rutledge
- International Center for Laparoscopic Obesity Surgery, Punjab, India
| | - Asim Shabbir
- National University of Singapore, Singapore, Singapore
| | - Scott Shikora
- Department of Surgery Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rishi Singhal
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Osama Taha
- Plastic and Obesity Surgery Department, Bariatric Unit, Assiut University Hospital, Assiut, Egypt
| | - Mohammad Talebpour
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Rudolf Weiner
- Bariatric Surgery Unit, Sana Clinic Offenbach, Offenbach, Germany
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ramon Vilallonga
- Endocrine, Bariatric and Metabolic Surgery Department, Universitary Hospital Vall Hebron, Barcelona, Spain
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19
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Welbourn R, Hollyman M, Kinsman R, Dixon J, Cohen R, Morton J, Ghaferi A, Higa K, Ottosson J, Pattou F, Al-Sabah S, Anvari M, Himpens J, Liem R, Våge V, Walton P, Brown W, Kow L. Bariatric-Metabolic Surgery Utilisation in Patients With and Without Diabetes: Data from the IFSO Global Registry 2015-2018. Obes Surg 2021; 31:2391-2400. [PMID: 33638756 PMCID: PMC8113173 DOI: 10.1007/s11695-021-05280-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Comparative international practice of patients undergoing bariatric-metabolic surgery for type 2 diabetes mellitus (T2DM) is unknown. We aimed to ascertain baseline age, sex, body mass index (BMI) and types of operations performed for patients with T2DM submitted to the IFSO Global Registry. MATERIALS AND METHODS Cross-sectional analysis of patients having primary surgery in 2015-2018 for countries with ≥90% T2DM data completion and ≥ 1000 submitted records. RESULTS Fifteen countries including 11 national registries met the inclusion criteria. The rate of T2DM was 24.2% (99,537 of 411,581 patients, country range 12.0-55.1%) and 77.1% of all patients were women. In every country, patients with T2DM were older than those without T2DM (overall mean age 49.2 [SD 11.4] years vs 41.8 [11.9] years, all p < 0.001). Men were more likely to have T2DM than women, odds ratio (OR) 1.68 (95% CI 1.65-1.71), p < 0.001. Men showed higher rates of T2DM for BMI <35 kg/m2 compared to BMI ≥35.0 kg/m2, OR 2.76 (2.52-3.03), p < 0.001. This was not seen in women, OR 0.78 (0.73-0.83), p < 0.001. Sleeve gastrectomy was the commonest operation overall, but less frequent for patients with T2DM, patients with T2DM 54.9% vs without T2DM 65.8%, OR 0.63 (0.63-0.64), p < 0.001. Twelve out of 15 countries had higher proportions of gastric bypass compared to non-bypass operations for T2DM, OR 1.70 (1.67-1.72), p < 0.001. CONCLUSION Patients with T2DM had different characteristics to those without T2DM. Older men were more likely to have T2DM, with higher rates of BMI <35 kg/m2 and increased likelihood of food rerouting operations.
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Affiliation(s)
- Richard Welbourn
- Department Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK.
| | - Marianne Hollyman
- Department Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Robin Kinsman
- Dendrite Clinical Systems Ltd., Henley-on-Thames, Oxfordshire, RG9 1AY, UK
| | - John Dixon
- Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Australia
| | - Ricardo Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - John Morton
- Division Chief, Bariatric and Minimally Invasive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Amir Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | | | - Salman Al-Sabah
- Al-Amiri Hospital Kuwait, Royale Hyatt Hospital, Kuwait City, Kuwait
| | - Merhan Anvari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Ronald Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Bergen, Norway
| | - Peter Walton
- Dendrite Clinical Systems Ltd., Henley-on-Thames, Oxfordshire, RG9 1AY, UK
| | - Wendy Brown
- Centre of Obesity Research and Education, Monash University, Melbourne, Australia
| | - Lilian Kow
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Angrisani L, Santonicola A, Iovino P, Ramos A, Shikora S, Kow L. Bariatric Surgery Survey 2018: Similarities and Disparities Among the 5 IFSO Chapters. Obes Surg 2021; 31:1937-1948. [PMID: 33432483 PMCID: PMC7800839 DOI: 10.1007/s11695-020-05207-7] [Citation(s) in RCA: 213] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The 2018 IFSO Survey focused on similarities and disparities in the number and types of surgical and endoluminal interventions among the IFSO chapters occurred in the last decade. METHODS All IFSO Societies were asked to fill in the IFSO survey form on how many and which surgical and endoluminal interventions have been performed in the 2018. A special section was added, asking about the existence of national guidelines for bariatric and metabolic surgery, national recommendations for preoperative gastroscopy, type of reimbursement for bariatric/metabolic surgery, including for patients with BMI < 35 kg/m2. The trend analyses from 2008 to 2018 were also performed. RESULTS Fifty-seven/65 (87.7%) IFSO Societies submitted completed forms. The American Society for Metabolic and Bariatric Surgery did not fill the IFSO survey form but provided an official report on the performed interventions. The total number of surgical and endoluminal procedures performed in 2018 in the world was 696,191. Sleeve gastrectomy (SG) remained the most commonly performed bariatric procedure (N = 386,096; 55.4%). Among the total reported bariatric/metabolic interventions, 604,223 (86.8%) were primary surgical and 29,167 (4.2%) primary endoluminal operations; 62,801 (9%) were revisional procedures. CONCLUSIONS There was only a slight increase (10.317 procedures) in the total number of the reported bariatric interventions compared to the last IFSO survey. SG continues to be the most commonly performed operation since 2014. The one anastomosis gastric bypass (OAGB), currently the third most performed procedure after SG and Roux-en-Y gastric bypass (RYGB), continues to rise in popularity worldwide.
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Affiliation(s)
- Luigi Angrisani
- Public Health Department "Federico II" University of Naples, Naples, Italy.
| | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Almino Ramos
- Gastro-Obeso-Center Institute, São Paulo, Brazil
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lilian Kow
- Flinders University, Adelaide, South Australia, Australia
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Haddad A, Bashir A, Fobi M, Higa K, Herrera MF, Torres AJ, Himpens J, Shikora S, Ramos AC, Kow L, Nimeri AA. The IFSO Worldwide One Anastomosis Gastric Bypass Survey: Techniques and Outcomes? Obes Surg 2021; 31:1411-1421. [PMID: 33517557 DOI: 10.1007/s11695-021-05249-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) has become one of the most commonly performed gastric bypass procedures in some countries. OBJECTIVES To assess how surgeons viewed the OAGB, perceptions, indications, techniques, and outcomes, as well as the incidence of short- and long-term complications and how they were managed worldwide. METHODS A questionnaire was sent to all IFSO members in all 5 chapters to study the pattern of practice and outcomes of OAGB. RESULTS Seven hundred and forty-two surgeons responded. The most commonly performed procedures were sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and OAGB. Preoperatively, 70% of the surgeons performed endoscopy routinely. In regards to weight loss, 83% (570 surgeons) responded that OAGB produces better weight loss than SG, and 49% (342 surgeons) responded that OAGB produces better weight loss than RYGB. The most common length of the biliopancreatic limb (BPL) utilized was 200 cm. Sixty-seven percent of surgeons did not measure the total length of the small bowel. In patients with reflux disease and history of smoking, 53% and 22% of surgeons respectively still offered OAGB as a treatment option. Postoperatively, leak was documented in 963 patients, and it was the leading cause for mortality. Leak management was conservative in 35%. Conversion to RYGB was performed in 31%. In 16% the anastomosis was reinforced, 6% of the patients were reversed, and other procedures were performed in 12%. Revision of OAGB for malnutrition/steatorrhea or severe bile reflux was reported at least once by 37% and 45% of surgeons, respectively (200 cm was the most commonly encountered biliopancreatic limb BPL in those revised for malnutrition). Most common strategy for revision was conversion to RYGB (43%), reversal to normal anatomy (32%), shortening of the BPL (20%), and conversion to SG (5%). Nevertheless, 5 out of 98 mortalities (5%) were due to liver failure/malnutrition. CONCLUSION There are infrequent but potentially severe specific complications including malnutrition, liver failure, and bile reflux that may require surgical correction after OAGB.
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Affiliation(s)
- Ashraf Haddad
- Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC) -Jordan Hospital, Queen Noor St., 4th Circle, P.O BOX 3073, Amman, 11181, Jordan.
| | - Ahmad Bashir
- Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC) -Jordan Hospital, Queen Noor St., 4th Circle, P.O BOX 3073, Amman, 11181, Jordan
| | - Mathias Fobi
- Clinical Affairs and Research, Mohak Bariatric and Robotics, Indore, India
| | - Kelvin Higa
- Advanced Laparoscopic Surgery Associates, University of California San Francisco-Fresno, Fresno Heart and Surgical Hospital, Fresno, CA, USA
| | - Miguel F Herrera
- Endocrine and Bariatric Surgery, UNAM at INCMNSZ, Mexico City, México
| | - Antonio J Torres
- General and Bariatric Surgery, Complutense University of Madrid, Hospital Clinico "San Carlos", Madrid, Spain
| | - Jacques Himpens
- Metabolic-Bariatric Surgery, CHIREC Delta Hospital, Brussels, Belgium
- St Pierre University Hospital, Brussels, Belgium
| | - Scott Shikora
- Harvard Medical School, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Almino Cardoso Ramos
- Gastro-Obeso-Center Institute of Metabolic Optimization, Bela Vista, São Paulo, SP, Brazil
| | - Lilian Kow
- Adelaide Bariatric Centre, 12 The Parade, Norwood, SA, 5067, Australia
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Fisher OM, Chan DL, Talbot ML, Ramos A, Bashir A, Herrera MF, Himpens J, Shikora S, Higa KD, Kow L, Brown WA. Barrett's Oesophagus and Bariatric/Metabolic Surgery-IFSO 2020 Position Statement. Obes Surg 2021; 31:915-934. [PMID: 33460005 DOI: 10.1007/s11695-020-05143-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/07/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022]
Abstract
The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has been playing an integral role in educating both the metabolic surgical and the medical community at large about the importance of surgical and/or endoscopic interventions in treating adiposity-based chronic diseases. The occurrence of chronic conditions following bariatric/metabolic surgery (BMS), such as gastro-oesophageal reflux disease (GERD) and columnar (intestinal) epithelial metaplasia of the distal oesophagus (also known as Barrett's oesophagus (BE)), has long been discussed in the metabolic surgical and medical community. Equally, the risk of neoplastic progression of Barrett's oesophagus to oesophageal adenocarcinoma (EAC) and the resulting requirement for surgery are the source of some concern for many involved in the care of these patients, as the surgical alteration of the gastrointestinal tract may lead to impaired reconstructive options. As such, there is a requirement for guidance of the community.The IFSO commissioned a task force to elucidate three aspects of the presenting problem: First, to determine what the estimated incidence of Barrett's oesophagus is in patients presenting for BMS; second, to determine the frequency at which Barrett's oesophagus may develop following BMS (with a particular focus on the laparoscopic sleeve gastrectomy (LSG)); and third, to determine if regression of Barrett's oesophagus may occur following BMS given the close relationship of obesity and the development of BE/EAC. Based on these findings, a position statement regarding the management of this pathology in the context of BMS was developed. The following position statement is issued by the IFSO Barrett's Oesophagus task force andapproved by the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion and published peer-reviewed scientific evidence. It will be reviewed regularly.
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Affiliation(s)
- Oliver M Fisher
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Daniel L Chan
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Michael L Talbot
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Almino Ramos
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Ahmad Bashir
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Miguel F Herrera
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Jacques Himpens
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Scott Shikora
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Kelvin D Higa
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Lilian Kow
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Wendy A Brown
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy. .,Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia.
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23
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Angrisani L, Santonicola A, Iovino P, Ramos A, Shikora S, Kow L. Bariatric Surgery Survey 2018: Similarities and Disparities Among the 5 IFSO Chapters. Obes Surg 2021. [PMID: 33432483 DOI: 10.1007/s11695-020-05207-7.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND The 2018 IFSO Survey focused on similarities and disparities in the number and types of surgical and endoluminal interventions among the IFSO chapters occurred in the last decade. METHODS All IFSO Societies were asked to fill in the IFSO survey form on how many and which surgical and endoluminal interventions have been performed in the 2018. A special section was added, asking about the existence of national guidelines for bariatric and metabolic surgery, national recommendations for preoperative gastroscopy, type of reimbursement for bariatric/metabolic surgery, including for patients with BMI < 35 kg/m2. The trend analyses from 2008 to 2018 were also performed. RESULTS Fifty-seven/65 (87.7%) IFSO Societies submitted completed forms. The American Society for Metabolic and Bariatric Surgery did not fill the IFSO survey form but provided an official report on the performed interventions. The total number of surgical and endoluminal procedures performed in 2018 in the world was 696,191. Sleeve gastrectomy (SG) remained the most commonly performed bariatric procedure (N = 386,096; 55.4%). Among the total reported bariatric/metabolic interventions, 604,223 (86.8%) were primary surgical and 29,167 (4.2%) primary endoluminal operations; 62,801 (9%) were revisional procedures. CONCLUSIONS There was only a slight increase (10.317 procedures) in the total number of the reported bariatric interventions compared to the last IFSO survey. SG continues to be the most commonly performed operation since 2014. The one anastomosis gastric bypass (OAGB), currently the third most performed procedure after SG and Roux-en-Y gastric bypass (RYGB), continues to rise in popularity worldwide.
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Affiliation(s)
- Luigi Angrisani
- Public Health Department "Federico II" University of Naples, Naples, Italy.
| | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Almino Ramos
- Gastro-Obeso-Center Institute, São Paulo, Brazil
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lilian Kow
- Flinders University, Adelaide, South Australia, Australia
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24
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Mahawar KK, Omar I, Singhal R, Aggarwal S, Allouch MI, Alsabah SK, Angrisani L, Badiuddin FM, Balibrea JM, Bashir A, Behrens E, Bhatia K, Biertho L, Biter LU, Dargent J, De Luca M, DeMaria E, Elfawal MH, Fried M, Gawdat KA, Graham Y, Herrera MF, Himpens JM, Hussain FA, Kasama K, Kerrigan D, Kow L, Kristinsson J, Kurian M, Liem R, Lutfi RE, Menon V, Miller K, Noel P, Ospanov O, Ozmen MM, Peterli R, Ponce J, Prager G, Prasad A, Raj PP, Rodriguez NR, Rosenthal R, Sakran N, Santos JN, Shabbir A, Shikora SA, Small PK, Taylor CJ, Wang C, Weiner RA, Wylezol M, Yang W, Aminian A. The first modified Delphi consensus statement on sleeve gastrectomy. Surg Endosc 2021; 35:7027-7033. [PMID: 33433676 DOI: 10.1007/s00464-020-08216-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG. METHODS We established a committee of 54 globally recognized opinion makers in this field. The committee agreed to vote on several statements concerning SG. An agreement or disagreement amongst ≥ 70.0% experts was construed as a consensus. RESULTS The committee achieved a consensus of agreement (n = 71) or disagreement (n = 7) for 78 out of 97 proposed statements after two rounds of voting. The committee agreed with 96.3% consensus that the characterization of SG as a purely restrictive procedure was inaccurate and there was 88.7% consensus that SG was not a suitable standalone, primary, surgical weight loss option for patients with Barrett's esophagus (BE) without dysplasia. There was an overwhelming consensus of 92.5% that the sleeve should be fashioned over an orogastric tube of 36-40 Fr and a 90.7% consensus that surgeons should stay at least 1 cm away from the angle of His. Remarkably, the committee agreed with 81.1% consensus that SG patients should undergo a screening endoscopy every 5 years after surgery to screen for BE. CONCLUSION A multinational team of experts achieved consensus on several aspects of SG. The findings of this exercise should help improve the outcomes of SG, the commonest bariatric procedure worldwide, and guide future research on this topic.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK.
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.
| | - Islam Omar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | - Rishi Singhal
- Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sandeep Aggarwal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | | | | | | | | | | | | | - Laurent Biertho
- Quebec Heart and Lung Institute-Laval University, Quebec, Canada
| | - L Ulas Biter
- Franciscus Gasthuis Rotterdam, Rotterdam, Netherlands
| | | | | | | | | | - Martin Fried
- OB Klinika-Center for Treatment of Obesity and Metabolic Disorders, Prague, Czech Republic
| | | | - Yitka Graham
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Miguel F Herrera
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico
| | | | | | | | | | - Lilian Kow
- Flinders University, Adelaide, South Australia, Australia
| | | | - Marina Kurian
- New York University School of Medicine, New York, USA
| | - Ronald Liem
- Dutch Obesity Clinic (NOK), The Hague, Netherlands
| | | | - Vinod Menon
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Karl Miller
- Diakonissen & Wehrle Private Hospital, Salzburg, Austria
| | - Patrick Noel
- Bouchard Private Hospital, Elsan, Marseille, France
- Mediclinic Parkview, Dubayy, United Arab Emirates
| | - Oral Ospanov
- KF "University Medical Center", Nur-Sultan, Kazakhstan
| | | | | | | | | | | | | | | | | | | | | | - Asim Shabbir
- National University Hospital, Singapore, Singapore
| | - Scott A Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Peter K Small
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Craig J Taylor
- Concord Repatriation General Hospital, Sydney, Australia
| | - Cunchuan Wang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | | | | | - Wah Yang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
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Brown WA, de Leon Ballesteros GP, Ooi G, Higa K, Himpens J, Torres A, Shikora S, Kow L, Herrera MF. Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy/One Anastomosis Duodenal Switch (SADI-S/OADS) IFSO Position Statement-Update 2020. Obes Surg 2021; 31:3-25. [PMID: 33409979 DOI: 10.1007/s11695-020-05134-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022]
Abstract
PreambleThe International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has played an integral role in educating both the metabolic surgical and the medical communities at large about the role of innovative and new surgical and or endoscopic interventions in treating adiposity-based chronic diseases. The single anastomosis duodenal-ileal bypass with sleeve gastrectomy/one anastomosis duodenal switch (SADI-S/OADS) is a relatively new procedure that has been proposed as an alternative to the conventional duodenal switch (DS) procedure. The IFSO published a position paper on SADI-S/OADS in 2018 with which concluded that this procedure was likely to be a safe and efficacious treatment for adiposity and its related diseases. However, it noted that there was insufficient long-term data and minimal high-level evidence available. The position statement called for patients to be enrolled in long-term multidisciplinary care encouraged the registration of patients in national registries, and called for more randomized controlled trials (RCT) (Obes Surg 28:1207-16, 2018) involving the procedure. The following position statement is an update of the previous position statement. It is issued by the IFSO SADI-S/OADS task force and has been reviewed and approved by both the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence. It will be reviewed again in 2 years.
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Affiliation(s)
- Wendy A Brown
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy.
| | | | - Geraldine Ooi
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Kelvin Higa
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Jacques Himpens
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Antonio Torres
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Scott Shikora
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Lilian Kow
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Miguel F Herrera
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
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26
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Parmar CD, McCluney SJ, Rodriguez N, Behrens E, Lakdawala M, Kow L, Shikora S, Ramos A. A Global Survey by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) on Perceptions of Bariatric Medical Tourism (BMT) by Health Professionals: Guidelines from IFSO for BMT. Obes Surg 2021; 31:1401-1410. [PMID: 33387264 DOI: 10.1007/s11695-020-05185-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bariatric medical tourism (BMT) is a rapidly expanding industry, with over 650 million people with obesity worldwide and total number rising by over 300% between 2003 and 2014. The overall health tourism industry is worth over $400 billion/year. METHODS International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) conducted a global survey to analyze the details of BMT and the perceptions of bariatric health care professionals (HCP) regarding BMT. RESULTS A total of 383 bariatric HCP's with experience of 272,548 procedures responded from 65 countries. Seventy-three percent of respondents had managed BMT patients, whilst low cost of surgery was felt to be the driving factor in 77% of cases. The USA contributed the most patients travelling for BMT with 11.6%. Twenty-four percent of respondents stated that they had no access to adequate notes regarding the patient's operation, whilst 12% felt BMT is associated with a higher mortality. Only 49% of respondents felt that IFSO guidelines were followed by the operating surgeon. Sleeve gastrectomy was the commonly offered surgery and an overall mean operation cost was $8716. Nearly 64% of respondents felt BMT needed better coordination between practitioners, whilst almost 85% of respondents supported the idea of a forum to facilitate safe BMT worldwide. CONCLUSION This IFSO survey has outlined the current BMT trends worldwide and highlighted areas of concern in the care of such patients. It has expanded our knowledge and should be used as a starting point to establish international forums to aid collaboration.
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Affiliation(s)
- Chetan D Parmar
- Whittington Hospital, London, N19 5NF, UK.
- University College London Medical School, London, UK.
| | | | | | | | | | - Lilian Kow
- Adelaide Bariatric Centre, Flinders Private Hospital, Bedford Park, Adelaide, South Australia, Australia
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Almino Ramos
- Gastro-Obeso-Center Institute of Metabolic Optimization, São Paulo, Brazil
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27
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Pouwels S, Omar I, Aggarwal S, Aminian A, Angrisani L, Balibrea JM, Bhandari M, Biter LU, Blackstone RP, Carbajo MA, Copaescu CA, Dargent J, Elfawal MH, Fobi MA, Greve JW, Hazebroek EJ, Herrera MF, Himpens JM, Hussain FA, Kassir R, Kerrigan D, Khaitan M, Kow L, Kristinsson J, Kurian M, Lutfi RE, Moore RL, Noel P, Ozmen MM, Ponce J, Prager G, Purkayastha S, Rafols JP, Ramos AC, Ribeiro RJS, Sakran N, Salminen P, Shabbir A, Shikora SA, Singhal R, Small PK, Taylor CJ, Torres AJ, Vaz C, Yashkov Y, Mahawar K. The First Modified Delphi Consensus Statement for Resuming Bariatric and Metabolic Surgery in the COVID-19 Times. Obes Surg 2020; 31:451-456. [PMID: 32740826 PMCID: PMC7395568 DOI: 10.1007/s11695-020-04883-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to achieve consensus amongst a global panel of expert bariatric surgeons on various aspects of resuming Bariatric and Metabolic Surgery (BMS) during the Coronavirus Disease-2019 (COVID-19) pandemic. A modified Delphi consensus-building protocol was used to build consensus amongst 44 globally recognised bariatric surgeons. The experts were asked to either agree or disagree with 111 statements they collectively proposed over two separate rounds. An agreement amongst ≥ 70.0% of experts was construed as consensus as per the predetermined methodology. We present here 38 of our key recommendations. This first global consensus statement on the resumption of BMS can provide a framework for multidisciplinary BMS teams planning to resume local services as well as guide future research in this area.
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Affiliation(s)
- Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Islam Omar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK
| | - Sandeep Aggarwal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Luigi Angrisani
- Public Health Department - Federico II School of Medicine, University of Naples, Naples, Italy
| | | | - Mohit Bhandari
- Mohak Bariatric and Robotic Surgery Center Indore, Indore, India
| | - L Ulas Biter
- Franciscus Gasthuis Rotterdam, Rotterdam, The Netherlands
| | | | - Miguel A Carbajo
- Center of Excellence for the Study and Treatment of the Obesity and Diabetes, Valladolid, Spain
| | | | | | | | - Mathias A Fobi
- Mohak Bariatric and Robotic Surgery Center Indore, Indore, India
| | - Jan-Willem Greve
- Zuyerland Medical Center, University of Maastricht, Maastricht, The Netherlands
| | | | - Miguel F Herrera
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | | | | | - Radwan Kassir
- Department of Bariatric Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | | | | | - Lilian Kow
- Flinders University, Adelaide, South Australia, Australia
| | | | - Marina Kurian
- New York University School of Medicine, New York, NY, USA
| | | | | | - Patrick Noel
- Bouchard Private Hospital, Elsan, Marseille, France.,Mediclinic Parkview, Dubai, United Arab Emirates
| | | | | | | | | | | | | | | | | | - Paulina Salminen
- Turku University Hospital, Turku, Finland.,Satasairaala Central Hospital, Pori, Finland
| | - Asim Shabbir
- National University Hospital, Singapore, Singapore
| | - Scott A Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rishi Singhal
- Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter K Small
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK.,Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Craig J Taylor
- Concord Repatriation General Hospital, Sydney, Australia
| | - Antonio J Torres
- Hospital Clinico San Carlos, Universidad Complutense Madrid, IdISSC, Madrid, Spain
| | | | | | - Kamal Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK. .,Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.
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Lazaridis II, Kraljević M, Schneider R, Klasen JM, Schizas D, Peterli R, Kow L, Delko T. The Impact of the COVID-19 Pandemic on Bariatric Surgery: Results from a Worldwide Survey. Obes Surg 2020; 30:4428-4436. [PMID: 32654018 PMCID: PMC7352090 DOI: 10.1007/s11695-020-04830-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The ongoing "coronavirus disease 19" (COVID-19) pandemic has had a strong effect on the delivery of surgical care worldwide. Elective surgeries have been canceled or delayed in order to reallocate resources to the treatment of COVID-19 patients. Currently, the impact of the COVID-19 pandemic on bariatric and metabolic surgical practice remains unclear. METHODS An internet-based online survey was performed among bariatric surgeons worldwide. The survey was sent to bariatric surgeons via the International Bariatric Club Facebook group and by electronic mail via the International Federation for the Surgery of Obesity and metabolic disorders (IFSO) secretariat to members of the associated national IFSO societies. RESULTS One hundred sixty-nine (n = 169) bariatric surgeons participated in the survey. The majority of the respondents postponed preoperative upper gastrointestinal tract endoscopies, appointments in the outpatient clinic and bariatric operations. Most surgeons performed video calls for follow-up appointments instead of meeting the patients in the outpatient clinics. Laparoscopy was still the preferred treatment for surgical emergencies, but a trend towards conservative treatment of acute appendicitis and acute cholecystitis was shown. Rapid preoperative COVID-19 testing availability was poor; therefore, routine screening of emergency bariatric cases was not widely provided. A wide variance occurred regarding precautions and personal protection equipment among the participants. CONCLUSION The COVID-19 pandemic showed a strong impact on bariatric surgical practice regarding surgical and outpatient planning as well as personnel management. Coordinated effort from the national bariatric societies should focus on strict implementation of the current recommendations regarding precaution measures and personal protection equipment. Further studies should evaluate how this impact will evolve in the near future.
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Affiliation(s)
- Ioannis I Lazaridis
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Marko Kraljević
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Romano Schneider
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Jennifer M Klasen
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ralph Peterli
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders Private Hospital, Bedford Park, Adelaide, South Australia, Australia
| | - Tarik Delko
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland.
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Affiliation(s)
- Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital, Jinan University, Guangzhou, China.
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders Private Hospital, Bedford Park, Adelaide, South Australia, Australia.
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30
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Koh ZJ, Tai BC, Kow L, Toouli J, Lakdawala M, Delko T, Kraljević M, Huang CK, Raj P, Cheng A, Rao J, Eng A, Kosai NR, Rajan R, Kim GW, Han SM, So JBY, Kasama K, Lee WJ, Kim YJ, Wong SKH, Ikramuddin S, Shabbir A. Influence of Asian Ethnicities on Short- and Mid-term Outcomes Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 29:1781-1788. [PMID: 30767187 DOI: 10.1007/s11695-019-03716-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE Prevalence of obesity in Asia has been on the increasing trend, with corresponding increase in utilisation of bariatric surgery. The objective of this study was to examine differences in weight loss outcomes following bariatric surgery between Asian ethnicities. MATERIALS AND METHODS A retrospective database review was conducted of patients undergoing primary laparoscopic sleeve gastrectomy between 2009 and 2013 in 14 centres from Singapore, Malaysia, Taiwan, Hong Kong, Japan, Korea, India, Australia, Switzerland, and the USA. All patients with available follow-up data at 12 months and 36 months post-surgery were included in this study. Outcome measures used were percentage excess weight loss (%EWL) and percentage total weight loss (%TWL). Differences in outcomes between ethnicities were analysed after adjusting for age, gender, baseline body mass index (BMI), and presence of diabetes. RESULTS The study population (n = 2150) consisted of 1122 Chinese, 187 Malays, 309 Indians, 67 Japanese, 259 Koreans, and 206 Caucasians. 67.1% were female and 32.9% were male. Mean age was 37.1 ± 11.2 years. Mean pre-operative BMI was 40.7 ± 8.1 kg/m2. With the Caucasian population as reference, Japanese had the best %TWL (3.90, 95% CI 1.16-6.63, p < 0.05) and %EWL (18.55, 95% CI 10.33-26.77, p < 0.05) while the Malays had the worst outcomes. Both Chinese and Koreans had better %EWL but worse %TWL as compared to Caucasians and there were no significant differences with the Indian study group. CONCLUSION There are differences in weight loss outcomes following bariatric surgery between Asian ethnicities.
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Affiliation(s)
- Zong Jie Koh
- Division of General Surgery, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore.
| | - Bee Choo Tai
- Epidemiology and Public Health, Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Lilian Kow
- Bariatric Surgery, Flinders Medical Centre, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - James Toouli
- Bariatric Surgery, Flinders Medical Centre, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Muffazal Lakdawala
- Bariatric Surgery, Digestive Health Institute, #L301, 3rd Floor, Trade View, Oasis City, Gate No. 4, Pandurang Budhkar Marg, Worli, Mumbai, 400013, India
| | - Tarik Delko
- General Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | - Marko Kraljević
- General Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | - Chih-Kun Huang
- General Surgery, China Medical University Hospital, No. 2, Yude Road, North District, 404, Taichung City, Taiwan
| | - Praveen Raj
- General Surgery, GEM Hospital and Research Center, 45, Pankaja Mill Rd, Coimbatore, 641045, India
| | - Anton Cheng
- General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Jaideepraj Rao
- General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Alvin Eng
- General Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Nik Ritza Kosai
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Batu 9 Cheras, Wilayah Persekutuan, 56000, Kuala Lumpur, Malaysia
| | - Reynu Rajan
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Batu 9 Cheras, Wilayah Persekutuan, 56000, Kuala Lumpur, Malaysia
| | - Guo Wei Kim
- Division of General Surgery, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Sang-Moon Han
- General Surgery, Gangnam CHA General Hospital, 569, Nonhyon-ro, Gangnam-gu, Seoul, 135-081, South Korea
| | - Jimmy Bok Yan So
- Division of General Surgery, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Kazunori Kasama
- General Surgery, Yotsuya Medical Cube, 7-7 Nibanchō, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Wei-Jei Lee
- General Surgery, Min-Sheng General Hospital, #168 Jin-Kuo Rd, 330, Taoyuan City, Taiwan, Republic of China
| | - Yong Jin Kim
- General Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Hannam-dong, Yongsan-gu, Seoul, South Korea
| | - Simon Kin Hung Wong
- General Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Room 94020, 7/F, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Sayeed Ikramuddin
- General Surgery, GI/Bariatric Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Asim Shabbir
- Division of General Surgery, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore
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Singendonk M, Kritas S, Omari T, Feinle-Bisset C, Page AJ, Frisby CL, Kentish SJ, Ferris L, McCall L, Kow L, Chisholm J, Khurana S. Upper Gastrointestinal Function in Morbidly Obese Adolescents Before and 6 Months After Gastric Banding. Obes Surg 2019; 28:1277-1288. [PMID: 29103072 DOI: 10.1007/s11695-017-3000-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The effects of laparoscopic adjustable gastric band (LAGB) placement on upper gastrointestinal tract function in obese adolescents are unknown. Therefore, our aim was to determine the short-term effects of LAGB on esophageal motility, gastroesophageal reflux, gastric emptying, appetite-regulatory hormones, and perceptions of post-prandial hunger and fullness. METHODS This study was part of a prospective cohort study (March 2009-December 2015) in one tertiary referral hospital. The study included obese adolescents (14-18 years) with a body mass index (BMI) > 40 (or ≥ 35 with comorbidities). Gastric emptying was assessed by 13C-octanoic acid breath test, pharyngeal, and esophageal motor function by high-resolution manometry with impedance (HRIM), and appetite and other perceptions using 100-mm visual analogue scales. Dysphagia symptoms were scored using a Dakkak questionnaire. Data were compared pre- and post-LAGB placement and at a 6-month follow-up. RESULTS Based upon analysis of 15 adolescents, at the 6-month follow-up, LAGB placement: (i) led to a significant reduction in weight and BMI; (ii) increased fullness and decreased hunger post-meal; (iii) increased symptoms of dysphagia after solid food; and, despite these effects, (iv) caused little or no changes to appetite hormones, while (v) effects on gastric emptying, esophageal motility, esophageal bolus transport, and esophageal emptying were not significant. CONCLUSION In adolescents, LAGB improved BMI and altered the sensitivity to nutrients without significant effects on upper gastrointestinal tract physiology at the 6-month follow-up.
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Affiliation(s)
- M Singendonk
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/AMC, Amsterdam, The Netherlands
| | - S Kritas
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - T Omari
- Human Physiology, Medical Science and Technology, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
| | - C Feinle-Bisset
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - A J Page
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - C L Frisby
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - S J Kentish
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - L Ferris
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia.,Human Physiology, Medical Science and Technology, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - L McCall
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - L Kow
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - J Chisholm
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - S Khurana
- Paediatric Surgery & Urology, Women's & Children's Hospital, Adelaide, Australia.,Department of Surgery, Flinders Medical Centre, Adelaide, Australia
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Mahawar KK, Himpens JM, Shikora SA, Ramos AC, Torres A, Somers S, Dillemans B, Angrisani L, Greve JWM, Chevallier JM, Chowbey P, De Luca M, Weiner R, Prager G, Vilallonga R, Adamo M, Sakran N, Kow L, Lakdawala M, Dargent J, Nimeri A, Small PK. The first consensus statement on revisional bariatric surgery using a modified Delphi approach. Surg Endosc 2019; 34:1648-1657. [PMID: 31218425 DOI: 10.1007/s00464-019-06937-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/12/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Revisional bariatric surgery (RBS) constitutes a possible solution for patients who experience an inadequate response following bariatric surgery or significant weight regain following an initial satisfactory response. This paper reports results from the first modified Delphi consensus-building exercise on RBS. METHODS We created a committee of 22 recognised opinion-makers with a special interest in RBS. The committee invited 70 RBS experts from 27 countries to vote on 39 statements concerning RBS. An agreement amongst ≥ 70.0% experts was regarded as a consensus. RESULTS Seventy experts from twenty-seven countries took part. There was a consensus that the decision for RBS should be individualised (100.0%) and multi-disciplinary (92.8%). Experts recommended a preoperative nutritional (95.7%) and psychological evaluation (85.7%), endoscopy (97.1%), and a contrast series (94.3%). Experts agreed that Roux-Y gastric bypass (RYGB) (94.3%), One anastomosis gastric bypass (OAGB) (82.8%), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (71.4%) were acceptable RBS options after gastric banding (84.3%). OAGB (84.3%), bilio-pancreatic diversion/duodenal switch (BPD/DS) (81.4%), and SADI-S (88.5%) were agreed as consensus RBS options after sleeve gastrectomy. lengthening of bilio-pancreatic limb was the only consensus RBS option after RYGB (94.3%) and OAGB (72.8%). CONCLUSION Experts achieved consensus on a number of aspects of RBS. Though expert opinion can only be regarded as low-quality evidence, the findings of this exercise should help improve the outcomes of RBS while we develop robust evidence to inform future practice.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
| | | | - Scott A Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Almino C Ramos
- Gastro-Obeso-Center Metabolic Optimisation Institute, Sao Paulo, Brazil
| | - Antonio Torres
- Hospital Clinico San Carlos, Complutense University, Madrid, Spain
| | - Shaw Somers
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Luigi Angrisani
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Jan Willem M Greve
- Zuyderland Medical Center, Heerlen, The Netherlands.,The Netherlands and Maastricht University (MUMC+), Maastricht, The Netherlands
| | | | - Pradeep Chowbey
- Max Institute of Minimal Access Metabolic and Bariatric Surgery, Max Hospital, Saket, New Delhi, India
| | | | - Rudolf Weiner
- Clinic Obesity Surgery, Sana-Klinikum Offenbach, Offenbach, Germany
| | | | | | - Marco Adamo
- University College London Hospital, London, UK
| | | | - Lilian Kow
- Flinders Private Hospital, Adelaide, Australia
| | | | | | | | - Peter K Small
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
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Mahawar KK, Himpens J, Shikora SA, Chevallier JM, Lakdawala M, De Luca M, Weiner R, Khammas A, Kular KS, Musella M, Prager G, Mirza MK, Carbajo M, Kow L, Lee WJ, Small PK. The First Consensus Statement on One Anastomosis/Mini Gastric Bypass (OAGB/MGB) Using a Modified Delphi Approach. Obes Surg 2018; 28:303-312. [PMID: 29243145 DOI: 10.1007/s11695-017-3070-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND An increasing number of surgeons worldwide are now performing one anastomosis/mini gastric bypass (OAGB/MGB). Lack of a published consensus amongst experts may be hindering progress and affecting outcomes. This paper reports results from the first modified Delphi consensus building exercise on this procedure. METHODS A committee of 16 recognised opinion-makers in bariatric surgery with special interest in OAGB/MGB was constituted. The committee invited 101 OAGB/MGB experts from 39 countries to vote on 55 statements in areas of controversy or variation associated with this procedure. An agreement amongst ≥ 70.0% of the experts was considered to indicate a consensus. RESULTS A consensus was achieved for 48 of the 55 proposed statements after two rounds of voting. There was no consensus for seven statements. Remarkably, 100.0% of the experts felt that OAGB/MGB was an "acceptable mainstream surgical option" and 96.0% felt that it could no longer be regarded as a new or experimental procedure. Approximately 96.0 and 91.0% of the experts felt that OAGB/MGB did not increase the risk of gastric and oesophageal cancers, respectively. Approximately 94.0% of the experts felt that the construction of the gastric pouch should start in the horizontal portion of the lesser curvature. There was a consensus of 82, 84, and 85% for routinely supplementing iron, vitamin B12, and vitamin D, respectively. CONCLUSION OAGB/MGB experts achieved consensus on a number of aspects concerning this procedure but several areas of disagreements persist emphasising the need for more studies in the future.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
| | | | - Scott A Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Rudolf Weiner
- Clinic Obesity Surgery, Sana-Klinikum Offenbach, Offenbach, Germany
| | - Ali Khammas
- Rashid Hospital, Dubai, United Arab Emirates
| | | | - Mario Musella
- Advanced Biomedical Sciences Department, Federico II University, Naples, Italy
| | | | | | - Miguel Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
| | - Lilian Kow
- Adelaide Bariatric Centre, Adelaide, Australia
| | - Wei-Jei Lee
- Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Peter K Small
- Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
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Walsh TP, Quinn SJ, Evans AM, Yaxley A, Chisholm JA, Kow L, Shanahan EM. Fat mass, but not fat-free mass, predicts increased foot pain with obesity, independent of bariatric surgery. Surg Obes Relat Dis 2018; 14:1389-1395. [PMID: 30057094 DOI: 10.1016/j.soard.2018.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/07/2018] [Accepted: 06/14/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Foot pain is a common manifestation of obesity. OBJECTIVE To determine if bariatric surgery is associated with a reduction in foot pain and if body mass index (BMI) or body composition predict a change in foot pain. SETTING University hospital. METHODS Participants with foot pain awaiting bariatric surgery were recruited for this prospective study. Multivariable linear regression was used to determine predictors of change in foot pain between baseline and 6-month follow-up using body composition (fat mass index and fat-free mass index) or BMI, adjusting for, depression, age, sex, and group (surgery versus control). RESULTS Forty-five participants (38 female), mean ± standard deviation age of 45.7 ± 9.4 years, were recruited for this study. Twenty-nine participants mean ± standard deviation BMI of 44.8 ± 7.0 kg underwent bariatric surgery, while 16 participants mean ± standard deviation BMI of 47.9 ± 5.2 kg were on the waiting list (control). One participant was lost to follow-up. The treatment group lost a mean of 24.3 kg (95% confidence interval [CI] 21.1-27.5), while the control group gained 1.2 kg (95% CI -2.5 to 4.9), respectively. In multivariable analysis, bariatric surgery was significantly associated with reduced foot pain at 6-month follow-up -32.6 points (95% CI -43.8 to -21.4, P < .001), while fat mass index was significantly associated with increased pain at follow-up 1.5 points (95% CI .2 to 2.8, P = .027), after controlling for fat-free mass index, age, sex, and depression. CONCLUSIONS Bariatric surgery was significantly associated with reduced foot pain. Higher baseline fat mass index, but not fat-free mass index or BMI, was predictive of increased foot pain at follow-up. Foot pain may be mediated by metabolic, rather than mechanical, factors in bariatric surgery candidates.
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Affiliation(s)
- Tom P Walsh
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia; Department of Orthopaedics and Trauma, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
| | - Stephen J Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia
| | - Angela M Evans
- Discipline of Podiatry, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Alison Yaxley
- Nutrition & Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Jacob A Chisholm
- Department of Gastrointestinal Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Lilian Kow
- Department of Gastrointestinal Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - E Michael Shanahan
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia; Department of Rheumatology, Southern Adelaide Local Health Network, South Australia, Australia
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Walsh TP, Gill TK, Evans AM, Yaxley A, Chisholm JA, Kow L, Arnold JB, Shanahan EM. Changes in foot pain, structure and function following bariatric surgery. J Foot Ankle Res 2018; 11:35. [PMID: 29988337 PMCID: PMC6022514 DOI: 10.1186/s13047-018-0277-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/14/2018] [Indexed: 12/25/2022] Open
Abstract
Background Bariatric surgery candidates have a high prevalence of foot pain, depression and elevated plantar pressures. There is, however, limited research into how these factors interact pre- and post-surgery. The aims of this study were therefore to investigate the mechanical and non-mechanical factors associated with foot pain severity before, and the change after, surgery. Methods Bariatric surgery candidates underwent baseline and six-month follow-up measures. Foot pain was measured with the Manchester-Oxford Foot Questionnaire. Mechanical measures included body mass index (BMI), dynamic plantar pressures, radiographic foot posture, and hindfoot range of motion. Depressive symptoms, the non-mechanical measure, were assessed by questionnaire. Multivariable linear regression was used to determine which variables were associated with foot pain at baseline and at follow-up. Multilevel repeated models assessed the associations between foot pain and plantar pressure, adjusting for the interaction between group and follow-up time. Results Forty-five participants (84% female), with mean (SD) age of 45.7 (9.4) years were recruited. Twenty-nine participants had bariatric surgery and 16 participants remained on the waiting list (controls). Following bariatric surgery, foot pain reduced significantly by - 35.7 points (95% CI -42.2 to - 28.8), while depressive symptoms and whole foot peak pressures had a significant mean change of - 5.9 points (95% CI -10.3 to - 1.5) and - 36 kPa (95% CI -50 to - 22), respectively. In multivariable analysis, depressive symptoms were associated with foot pain at baseline β = 0.7 (95% CI 0.2 to 1.2) after controlling for age, gender, BMI, foot posture and plantar pressure. Depressive symptoms were also associated with foot pain at follow-up in those undergoing bariatric surgery, β = 1.2 (95% CI 0.8 to 1.7). Foot posture and hindfoot range of motion did not change following surgery and a change in plantar pressures was not associated with a change in foot pain. Conclusions Foot pain severity in bariatric surgery candidates was associated with depressive symptoms at baseline. Reduced foot pain following bariatric surgery was associated with an improvement in depressive symptoms, without a significant change in foot posture or foot function. Foot pain severity in bariatric candidates may be mediated by non-mechanical or non-local factors before and following surgery.
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Affiliation(s)
- Tom P Walsh
- 1College of Medicine and Public Health, Flinders University, Bedford Park, South Australia 5042 Australia.,2Department of Orthopaedics and Trauma, The Queen Elizabeth Hospital, Woodville South, South Australia 5011 Australia
| | - Tiffany K Gill
- 3Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia 5005 Australia
| | - Angela M Evans
- 4Discipline of Podiatry, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086 Australia
| | - Alison Yaxley
- 5Nutrition & Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia 5042 Australia
| | - Jacob A Chisholm
- 6Department of Gastrointestinal Surgery, Flinders Medical Centre, Bedford Park, South Australia 5042 Australia
| | - Lilian Kow
- 6Department of Gastrointestinal Surgery, Flinders Medical Centre, Bedford Park, South Australia 5042 Australia
| | - John B Arnold
- 7Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia 5000 Australia
| | - E Michael Shanahan
- 1College of Medicine and Public Health, Flinders University, Bedford Park, South Australia 5042 Australia.,Department of Rheumatology, Southern Adelaide Local Health Network, Bedford Park, South Australia 5042 Australia
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36
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Kow L, Collins J, Barreto SG. How to do the 'peritoneal slit': extracting the sleeve gastrectomy made simple! ANZ J Surg 2018; 88:502-503. [PMID: 29573089 DOI: 10.1111/ans.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 11/26/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Lilian Kow
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park Adelaide, South Australia, Australia.,Adelaide Bariatric Centre, Flinders Private Hospital, Adelaide, South Australia, Australia
| | - Jane Collins
- Adelaide Bariatric Centre, Flinders Private Hospital, Adelaide, South Australia, Australia
| | - Savio G Barreto
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park Adelaide, South Australia, Australia
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Barreto SG, Chisholm J, Schloithe A, Collins J, Kow L. Outcomes of Two-Step Revisional Bariatric Surgery: Reasons for the Gastric Banding Explantation Matter. Obes Surg 2017; 28:520-525. [DOI: 10.1007/s11695-017-2889-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Barreto SG, Soenen S, Chisholm J, Chapman I, Kow L. Does the ileal brake mechanism contribute to sustained weight loss after bariatric surgery? ANZ J Surg 2017; 88:20-25. [DOI: 10.1111/ans.14062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Savio G. Barreto
- Hepatobiliary and Oesophagogastric Unit, Division of Surgery and Perioperative Medicine; Flinders Medical Centre; Adelaide South Australia Australia
- School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
| | - Stijn Soenen
- National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health, Discipline of Medicine, Faculty of Health Sciences; Royal Adelaide Hospital, The University of Adelaide; Adelaide South Australia Australia
| | - Jacob Chisholm
- Hepatobiliary and Oesophagogastric Unit, Division of Surgery and Perioperative Medicine; Flinders Medical Centre; Adelaide South Australia Australia
- Adelaide Bariatric Centre; Flinders Private Hospital; Adelaide South Australia Australia
| | - Ian Chapman
- National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health, Discipline of Medicine, Faculty of Health Sciences; Royal Adelaide Hospital, The University of Adelaide; Adelaide South Australia Australia
| | - Lilian Kow
- Hepatobiliary and Oesophagogastric Unit, Division of Surgery and Perioperative Medicine; Flinders Medical Centre; Adelaide South Australia Australia
- School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- Adelaide Bariatric Centre; Flinders Private Hospital; Adelaide South Australia Australia
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Meyer SB, Thompson C, Hakendorf P, Horwood C, McNaughton D, Gray J, Ward PR, Mwanri L, Booth S, Kow L, Chisholm J. Bariatric surgery revisions and private health insurance. Obes Res Clin Pract 2017; 11:616-621. [PMID: 28506856 DOI: 10.1016/j.orcp.2017.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To identify: 1. The percentage of bariatric procedures that are revisions; 2. What proportion of bariatric revision procedures in public hospitals are for patients whose primary weight loss procedure occurred in a private hospital; 3. The age, sex and level of socioeconomic disadvantage of patients needing revisions. METHODS An analysis of patient level admission data from the Integrated South Australian Activity Collection (ISAAC) was performed. Data were collected on all revisions for weight loss related procedures at all South Australian public and private hospitals, between 2000-2015 using the ISAAC codes for revision procedures. RESULTS 12,606 bariatric procedures occurred in hospitals; ∼27% of which represent a revision (n=3366). Of these revisions, ∼82% occurred in a private hospital (n=2771), and ∼18% occurred in a public hospital (n=595). Of the 595 revisions in a public hospital, 51% of patients had their original bariatric procedure performed in a private hospital. The majority of patients who had a revision procedure are female (≥82%) with a mean age of ∼45. Individuals from the lowest 2 IRSD quintiles were over-represented for public hospital revisions and primary bariatric procedures. CONCLUSION Further investigation is needed to identify: 1. Why 27% of bariatric procedures are revisions; 2. Why at least 51% of revisions in public hospitals are on patients whose original primary bariatric procedure was done in a private hospital; 3. The impact that revision procedures in public hospitals, particularly for originally private weight loss procedures, is having on public hospital wait times; 4. The impact of socioeconomic disadvantage on weight loss procedure outcomes.
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Affiliation(s)
- Samantha B Meyer
- University of Waterloo, 200 University Ave, Waterloo, Ontario N2L3G1, Canada.
| | | | - Paul Hakendorf
- Flinders Medical Centre, Sturt Road, Bedford Park, SA 5042, Australia.
| | - Chris Horwood
- Flinders Medical Centre, Sturt Road, Bedford Park, SA 5042, Australia.
| | | | - John Gray
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia.
| | - Paul R Ward
- Flinders University, Sturt Road, Bedford Park, SA5042, Australia.
| | - Lillian Mwanri
- Flinders University, Sturt Road, Bedford Park, SA5042, Australia.
| | - Sue Booth
- Flinders University, Sturt Road, Bedford Park, SA5042, Australia.
| | - Lilian Kow
- Flinders Medical Centre and Flinders University,Sturt Road, Bedford Park, SA 5042, Australia.
| | - Jacob Chisholm
- Flinders Medical Centre and Flinders University,Sturt Road, Bedford Park, SA 5042, Australia.
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Shikora SA, Toouli J, Herrera MF, Kulseng B, Brancatisano R, Kow L, Pantoja JP, Johnsen G, Brancatisano A, Tweden KS, Knudson MB, Billington CJ, Billingto CJ. Intermittent Vagal Nerve Block for Improvements in Obesity, Cardiovascular Risk Factors, and Glycemic Control in Patients with Type 2 Diabetes Mellitus: 2-Year Results of the VBLOC DM2 Study. Obes Surg 2016; 26:1021-8. [PMID: 26471783 DOI: 10.1007/s11695-015-1914-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND One-year results of the VBLOC DM2 study found that intermittent vagal blocking (VBLOC therapy) was safe among subjects with obesity and type 2 diabetes mellitus (T2DM) and led to significant weight loss and improvements in glycemic parameters and cardiovascular risk factors. Longer-term data are needed to determine whether the results are sustained. METHODS VBLOC DM2 is a prospective, observational study of 28 subjects with T2DM and body mass index (BMI) between 30 and 40 kg/m(2) to assess mid-term safety and weight loss and improvements in glycemic parameters, and other cardiovascular risk factors with VBLOC therapy. Continuous outcome variables are reported using mixed models. RESULTS At 24 months, the mean percentage of excess weight loss was 22% (95% CI, 15 to 28, p < 0.0001) or 7.0% total body weight loss (95% CI, 5.0 to 9.0, p < 0.0001). Hemoglobin A1c decreased by 0.6 percentage points (95% CI, 0.2 to 1.0, p = 0.0026) on average from 7.8% at baseline. Fasting plasma glucose declined by 15 mg/dL (95% CI, 0 to 29, p = 0.0564) on average from 151 mg/dL at baseline. Among subjects who were hypertensive at baseline, systolic blood pressure declined 10 mmHg (95% CI, 2 to 19, p = 0.02), diastolic blood pressure declined by 6 mmHg (95% CI, 0 to 12, p = 0.0423), and mean arterial pressure declined 7 mmHg (95% CI, 2 to 13, p = 0.014). Waist circumference was significantly reduced by 7 cm (95% CI, 4 to 10, p < 0.0001) from a baseline of 120 cm. The most common adverse events were mild or moderate heartburn, implant site pain, and constipation. CONCLUSIONS Improvements in obesity and glycemic control were largely sustained after 2 years of treatment with VBLOC therapy with a well-tolerated risk profile.
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Affiliation(s)
- Scott A Shikora
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,EnteroMedics Inc, 2800 Patton Road, St. Paul, MN, 55113, USA.
| | - James Toouli
- Adelaide Bariatric Center, Flinders Private Hospital, Suite 502/Level 5, Bedford Park, SA, 5041, Australia
| | - Miguel F Herrera
- Instituto Nacional de al Nutricion, Salvador Zubrian (INNSZ), Vasco de Quiroga 15, Tlalpan, 1400, Mexico City, DF, Mexico
| | - Bård Kulseng
- Center for Obesity, St. Olavs Hospital, Olav Kyrres Gate 6, 7006, Trondheim, Norway
| | - Roy Brancatisano
- Institute of Weight Control, 495 Windsor Road, Baulkham Hills, NSW, 2153, Australia
| | - Lilian Kow
- Adelaide Bariatric Center, Flinders Private Hospital, Suite 502/Level 5, Bedford Park, SA, 5041, Australia
| | - Juan P Pantoja
- Instituto Nacional de al Nutricion, Salvador Zubrian (INNSZ), Vasco de Quiroga 15, Tlalpan, 1400, Mexico City, DF, Mexico
| | - Gjermund Johnsen
- Center for Obesity, St. Olavs Hospital, Olav Kyrres Gate 6, 7006, Trondheim, Norway
| | - Anthony Brancatisano
- Institute of Weight Control, 495 Windsor Road, Baulkham Hills, NSW, 2153, Australia
| | | | - Mark B Knudson
- EnteroMedics Inc, 2800 Patton Road, St. Paul, MN, 55113, USA
| | - Charles J Billington
- University of Minnesota, Minneapolis, Minnesota Veterans' Administration Medical Center, One Veterans' Drive, Minneapolis, MN, 55417, USA
| | - Charles J Billingto
- University of Minnesota, Minneapolis, Minnesota Veterans' Administration Medical Center, One Veterans' Drive, Minneapolis, MN, 55417, USA
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Tweden K, F Herrera M, Toouli J, Kulseng B, Brancatisano R, Kow L, P Pantoja J, Johnsen G, Brancatisano A, J Waataja J, J Billington C, A Shikora S. Vagal Nerve Block for Improvements in Glycemic Control in Obese Patients with Type 2 Diabetes Mellitus: Three-Year Results of the VBLOC DM2 Study. ACTA ACUST UNITED AC 2016. [DOI: 10.15436/2376-0494.17.1250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rothwell L, Kow L, Toouli J. Effect of a post-operative structured exercise programme on short-term weight loss after obesity surgery using adjustable gastric bands. Obes Surg 2015; 25:126-8. [PMID: 24898721 DOI: 10.1007/s11695-014-1323-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Exercise has been recommended as an adjunct to diet control to achieve weight loss. No previous studies in the area had formal exercise guidelines or education [1, 2]. Unique to our practice is Bandfit, a personal trainer-led exercise programme for patients following bariatric surgery. METHODS We analysed the effect of Bandfit on short-term weight loss. A retrospective review of a prospectively collected database of consecutive patients between 2007 and 2008 was undertaken. Patients were educated about appropriate exercises for obese people with active participation. Percentage excess weight loss was calculated at 12 and 36 months. Weights were accepted ±3 months following the gastric banding. Patients were divided into subgroups based on zero, one or greater than one session attended. Patients without available records, 12-month data or a rural address were excluded. Data were statistically analysed utilising a two-sample t test and an analysis of variance (ANOVA) calculation. RESULTS One hundred sixty-three patients were eligible for inclusion with 26 excluded as described in the methods. In the remaining 137 patients, 49 (36 %) did not attend any sessions, 28 (20 %) attended one, and 60 (44 %) attended more than one session. CONCLUSIONS Analysis of the %EWL and sessions attended demonstrated a significant difference between those who attended more than one Bandfit session (p < 0.03), compared to those who did not attend any. However, this effect was not seen at 36 months. Attendance at a dedicated educational exercise programme significantly enhances short-term weight loss, but the effect is not seen at 36 months.
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Affiliation(s)
- Lincoln Rothwell
- Flinders Private Hospital, Adelaide Bariatric Centre, Suite 502, 1 Flinders Drive, Bedford Park, Adelaide, Australia,
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Ikramuddin S, Blackstone RP, Brancatisano A, Toouli J, Shah SN, Wolfe BM, Fujioka K, Maher JW, Swain J, Que FG, Morton JM, Leslie DB, Brancatisano R, Kow L, O'Rourke RW, Deveney C, Takata M, Miller CJ, Knudson MB, Tweden KS, Shikora SA, Sarr MG, Billington CJ. Effect of reversible intermittent intra-abdominal vagal nerve blockade on morbid obesity: the ReCharge randomized clinical trial. JAMA 2014; 312:915-22. [PMID: 25182100 DOI: 10.1001/jama.2014.10540] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Although conventional bariatric surgery results in weight loss, it does so with potential short-term and long-term morbidity. OBJECTIVE To evaluate the effectiveness and safety of intermittent, reversible vagal nerve blockade therapy for obesity treatment. DESIGN, SETTING, AND PARTICIPANTS A randomized, double-blind, sham-controlled clinical trial involving 239 participants who had a body mass index of 40 to 45 or 35 to 40 and 1 or more obesity-related condition was conducted at 10 sites in the United States and Australia between May and December 2011. The 12-month blinded portion of the 5-year study was completed in January 2013. INTERVENTIONS One hundred sixty-two patients received an active vagal nerve block device and 77 received a sham device. All participants received weight management education. MAIN OUTCOMES AND MEASURES The coprimary efficacy objectives were to determine whether the vagal nerve block was superior in mean percentage excess weight loss to sham by a 10-point margin with at least 55% of patients in the vagal block group achieving a 20% loss and 45% achieving a 25% loss. The primary safety objective was to determine whether the rate of serious adverse events related to device, procedure, or therapy in the vagal block group was less than 15%. RESULTS In the intent-to-treat analysis, the vagal nerve block group had a mean 24.4% excess weight loss (9.2% of their initial body weight loss) vs 15.9% excess weight loss (6.0% initial body weight loss) in the sham group. The mean difference in the percentage of the excess weight loss between groups was 8.5 percentage points (95% CI, 3.1-13.9), which did not meet the 10-point target (P = .71), although weight loss was statistically greater in the vagal nerve block group (P = .002 for treatment difference in a post hoc analysis). At 12 months, 52% of patients in the vagal nerve block group achieved 20% or more excess weight loss and 38% achieved 25% or more excess weight loss vs 32% in the sham group who achieved 20% or more loss and 23% who achieved 25% or more loss. The device, procedure, or therapy-related serious adverse event rate in the vagal nerve block group was 3.7% (95% CI, 1.4%-7.9%), significantly lower than the 15% goal. The adverse events more frequent in the vagal nerve block group were heartburn or dyspepsia and abdominal pain attributed to therapy; all were reported as mild or moderate in severity. CONCLUSION AND RELEVANCE Among patients with morbid obesity, the use of vagal nerve block therapy compared with a sham control device did not meet either of the prespecified coprimary efficacy objectives, although weight loss in the vagal block group was statistically greater than in the sham device group. The treatment was well tolerated, having met the primary safety objective. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01327976.
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Affiliation(s)
| | - Robin P Blackstone
- University of Minnesota, Minneapolis; Scottsdale Healthcare Bariatric Center, Scottsdale, Arizona
| | | | | | - Sajani N Shah
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health & Science University, Portland
| | | | - James W Maher
- Division of General Surgery, Virginia Commonwealth University, Richmond
| | - James Swain
- University of Minnesota, Minneapolis; Scottsdale Healthcare Bariatric Center, Scottsdale, Arizona
| | - Florencia G Que
- Department of Gastroenterologic and General Surgery, Mayo Clinic Rochester, Rochester, Minnesota
| | - John M Morton
- Division of General Surgery, Stanford University School of Medicine, Stanford, California
| | | | | | - Lilian Kow
- Adelaide Bariatric Centre, Adelaide, Australia
| | - Robert W O'Rourke
- Department of Surgery, University of Michigan and Ann Arbor VA Hospital
| | - Clifford Deveney
- Department of Surgery, Oregon Health & Science University, Portland
| | | | | | | | | | - Scott A Shikora
- EnteroMedics Inc, St Paul, Minnesota14Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael G Sarr
- Department of Gastroenterologic and General Surgery, Mayo Clinic Rochester, Rochester, Minnesota
| | - Charles J Billington
- Division of Endocrinology and Diabetes, Minneapolis VA Medical Center and University of Minnesota, Minneapolis
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Rothwell L, Kow L, Toouli J. Effect of Preoperative Very Low-Calorie Diets on Short-Term Postoperative Weight Loss Following Laparoscopic Adjustable Gastric Banding. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Lilian Kow
- Adelaide Bariatric Centre, Adelaide, South Australia, Australia
| | - James Toouli
- Adelaide Bariatric Centre, Adelaide, South Australia, Australia
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Opolski M, Winefield H, Howell C, Toouli J, Collins J, Kow L. Banding Together: An Investigation of Post-Surgery Support Groups for Laparoscopic Adjustable Gastric Banding Patients. Health Psychol Res 2014; 2:1464. [PMID: 26973932 PMCID: PMC4768544 DOI: 10.4081/hpr.2014.1464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 04/23/2013] [Accepted: 04/24/2013] [Indexed: 11/23/2022] Open
Abstract
Though advocated as useful for patients, there is little in the literature regarding the use and effectiveness of bariatric support groups. This study investigated characteristics and experiences of bariatric patients who did and did not attend offered groups. Seventy-eight postoperative laparoscopic adjustable gastric banding patients from a private bariatric clinic completed mailed self-report questionnaires. Almost 60% reported having attended the clinic groups, with most wanting to meet other patients and obtain information rather than access psychological assistance. Participants reported generally positive experiences of attending. Nonattendance was often attributed to practical barriers. Satisfaction with support from others was not related to past or predicted future attendance, but higher psychological distress was related to and predictive of greater intention to attend future groups. Likely future attenders also held more positive beliefs about the groups than those who were unlikely to attend. Further research is required into potential positive and negative consequences of attendance, and characteristics of those who are likely to benefit or be harmed by attending. Interventions addressing stereotypes about support groups may help patients make informed decisions about whether to attend a bariatric support group.
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Affiliation(s)
- Melissa Opolski
- School of Psychology, University of Adelaide, Australia; Discipline of Psychiatry, School of Medicine, University of Adelaide, Australia
| | - Helen Winefield
- School of Psychology, University of Adelaide, Australia; Discipline of Psychiatry, School of Medicine, University of Adelaide, Australia
| | - Cate Howell
- Adelaide Bariatric Centre, Flinders Private Hospital , Bedford Park, Australia
| | - Jim Toouli
- Adelaide Bariatric Centre, Flinders Private Hospital , Bedford Park, Australia
| | - Jane Collins
- Adelaide Bariatric Centre, Flinders Private Hospital , Bedford Park, Australia
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders Private Hospital , Bedford Park, Australia
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Kritas S, Khurana S, Chisholm J, Couper R, Kow L, Omari T. Oesophageal function in morbidly obese adolescents after gastric banding. Obes Res Clin Pract 2013. [DOI: 10.1016/j.orcp.2013.12.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shikora S, Toouli J, Herrera MF, Kulseng B, Zulewski H, Brancatisano R, Kow L, Pantoja JP, Johnsen G, Brancatisano A, Tweden KS, Knudson MB, Billington CJ. Vagal blocking improves glycemic control and elevated blood pressure in obese subjects with type 2 diabetes mellitus. J Obes 2013; 2013:245683. [PMID: 23984050 PMCID: PMC3745954 DOI: 10.1155/2013/245683] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 05/15/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND An active device that downregulates abdominal vagal signalling has resulted in significant weight loss in feasibility studies. OBJECTIVE To prospectively evaluate the effect of intermittent vagal blocking (VBLOC) on weight loss, glycemic control, and blood pressure (BP) in obese subjects with DM2. METHODS Twenty-eight subjects were implanted with a VBLOC device (Maestro Rechargeable System) at 5 centers in an open-label study. Effects on weight loss, HbA1c, fasting blood glucose, and BP were evaluated at 1 week to 12 months. RESULTS 26 subjects (17 females/9 males, 51 ± 2 years, BMI 37 ± 1 kg/m(2), mean ± SEM) completed 12 months followup. One serious adverse event (pain at implant site) was easily resolved. At 1 week and 12 months, mean excess weight loss percentages (% EWL) were 9 ± 1% and 25 ± 4% (P < 0.0001), and HbA1c declined by 0.3 ± 0.1% and 1.0 ± 0.2% (P = 0.02, baseline 7.8 ± 0.2%). In DM2 subjects with elevated BP (n = 15), mean arterial pressure reduced by 7 ± 3 mmHg and 8 ± 3 mmHg (P = 0.04, baseline 100 ± 2 mmHg) at 1 week and 12 months. All subjects MAP decreased by 3 ± 2 mmHg (baseline 95 ± 2 mmHg) at 12 months. CONCLUSIONS VBLOC was safe in obese DM2 subjects and associated with meaningful weight loss, early and sustained improvements in HbA1c, and reductions in BP in hypertensive DM2 subjects. This trial is registered with ClinicalTrials.gov NCT00555958.
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Affiliation(s)
- S. Shikora
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - J. Toouli
- Adelaide Bariatric Center, Flinders Private Hospital, Suite 502/Level 5, Bedford Park, SA, 5041, Australia
| | - M. F. Herrera
- Instituto Nacional de la Nutricion, Salvador Zubiran (INNSZ), Vasco de Quiroga 15, Tlalpan, 1400 Mexico City, DF, Mexico
| | - B. Kulseng
- Center for Obesity, St. Olavs Hospital, Olav Kyrres Gate 6, 7006 Trondheim, Norway
| | - H. Zulewski
- Division of Gastroenterology, University Hospital Basel, 4031 Basel, Switzerland
| | - R. Brancatisano
- Institute of Weight Control, 495 Windsor Road, Baulkham Hills, NSW 2153, Australia
| | - L. Kow
- Adelaide Bariatric Center, Flinders Private Hospital, Suite 502/Level 5, Bedford Park, SA, 5041, Australia
| | - J. P. Pantoja
- Instituto Nacional de la Nutricion, Salvador Zubiran (INNSZ), Vasco de Quiroga 15, Tlalpan, 1400 Mexico City, DF, Mexico
| | - G. Johnsen
- Center for Obesity, St. Olavs Hospital, Olav Kyrres Gate 6, 7006 Trondheim, Norway
| | - A. Brancatisano
- Institute of Weight Control, 495 Windsor Road, Baulkham Hills, NSW 2153, Australia
| | - K. S. Tweden
- EnteroMedics Inc., 2800 Patton Road, St. Paul, MN 55113, USA
- *K. S. Tweden:
| | - M. B. Knudson
- EnteroMedics Inc., 2800 Patton Road, St. Paul, MN 55113, USA
| | - C. J. Billington
- University of Minnesota, Minneapolis, Minnesota Veterans' Administration Medical Center, One Veterans' Drive, Minneapolis, MN 55417, USA
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Sarr MG, Billington CJ, Brancatisano R, Brancatisano A, Toouli J, Kow L, Nguyen NT, Blackstone R, Maher JW, Shikora S, Reeds DN, Eagon JC, Wolfe BM, O’Rourke RW, Fujioka K, Takata M, Swain JM, Morton JM, Ikramuddin S, Schweitzer M, Chand B, Rosenthal R. The EMPOWER Study: Randomized, Prospective, Double-Blind, Multicenter Trial of Vagal Blockade to Induce Weight Loss in Morbid Obesity. Obes Surg 2012; 22:1771-82. [DOI: 10.1007/s11695-012-0751-8] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kasama K, Mui W, Lee WJ, Lakdawala M, Naitoh T, Seki Y, Sasaki A, Wakabayashi G, Sasaki I, Kawamura I, Kow L, Frydenberg H, Chen A, Narwaria M, Chowbey P. IFSO-APC consensus statements 2011. Obes Surg 2012; 22:677-84. [PMID: 22367008 DOI: 10.1007/s11695-012-0610-7] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Associations of BMI with body composition and health outcomes may differ between Asian and European populations. Asian populations have also been shown to have an elevated risk of type 2 diabetes, hypertension, and hyperlipidemia at a relatively low level of BMI. New surgical indication for Asian patients should be discussed by the expert of this field. Forty-four bariatric experts in Asia-Pacific and other regions were chosen to have a voting privilege for IFSO-APC Consensus at the 2nd IFSO-APC Congress. A computerized audience-response voting system was used to analyze the agreement with the sentence of the consensus. Of all delegates, 95% agreed with the necessity of the establishment of IFSO-APC consensus statements, and 98% agreed with the necessity of a new indication for Asian patients. IFSO-APC Consensus statements 2011. Bariatric surgery should be considered for the treatment of obesity for acceptable Asian candidates with BMI ≥ 35 with or without co-morbidities. Bariatric/GI metabolic surgery should be considered for the treatment of T2DM or metabolic syndrome for patients who are inadequately controlled by lifestyle alternations and medical treatment for acceptable Asian candidates with BMI ≥ 30. The surgical approach may be considered as a non-primary alternative to treat inadequately controlled T2DM, or metabolic syndrome, for suitable Asian candidates with BMI ≥ 27.5. Other eight sentences are agreed with by majority of the voting delegates to form IFSO-APC consensus statements. This will help to make safe and wholesome the progress of bariatric and metabolic surgery in Asia.
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Affiliation(s)
- Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan.
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Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) remains the most popular bariatric procedure performed in Australia and Europe. Gastric band erosion is a significant complication that results in band removal. The aim of this study is to assess the prevalence of band erosion and its subsequent management with a particular focus on rebanding results. METHODS Patients who underwent LAGB in a prospective cohort study from August 1996 to October 2010 were evaluated. Patients that developed band erosion were identified and clinical presentations, band characteristics and subsequent management were evaluated. RESULTS One thousand eight hundred seventy-four morbidly obese patients underwent LAGB. Band erosion developed in 63 patients (3.4%). Median preoperative BMI was 41.5 kg/m(2) (range 30-61 kg/m(2)). Median time from operation to diagnosis was 39 months (range 6-132 months). Twenty nine patients (46%) were asymptomatic (sudden loss of restriction, weight gain, turbid fluid, or absence of fluid). Symptoms included abdominal pain in 24 (38%), obstruction in 7 (11%), recurrent port infection in 5 (8%), reflux symptoms in 2 (3%) and sepsis in 2 (3%). Fourteen patients (22%) had discolouration of the fluid in their band. Endoscopic removal was attempted in 50 patients with successful removal in 46 (92%). Median number of endoscopies prior to removal was 1.0 (range 1-5). The median duration of the procedure was 46 min (range 17-118 min). Rebanding was performed in 29 patients and 5 (17%) experienced a second erosion. Mean percentage excess weight loss was 54% in the remaining 22 patients with at least 3 months follow-up. CONCLUSIONS Band erosion prevalence was 3.4%. Endoscopic removal of eroded gastric bands was proven safe and effective. Band erosion is now preferably managed endoscopically in our institution. Rebanding following erosion results in acceptable weight loss but an unacceptable reerosion rate.
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Affiliation(s)
- Jacob Chisholm
- Department of General and Digestive Surgery, Flinders Medical Centre and Circle of Care, Bedford Park, Adelaide, SA, 5042, Australia.
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