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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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Abstract
Background: Bariatric metabolic surgery is evolving as an option for the treatment of type 2 diabetes mellitus (T2DM) in patients with obesity and T2DM, warranting more studies on the efficacy of bariatric metabolic surgery on T2DM. Objective: To determine T2DM remission in patients with obesity and T2DM with up to two years follow-up after bariatric metabolic surgery. Materials and Methods: A retrospective review of prospectively maintained data was undertaken to identify patients who had T2DM and underwent bariatric surgery at a single centre in 2016. Data collected included age, gender, body mass index (BMI), fasting plasma glucose, haemoglobin A1c, hypertension, (HTN), Obstructive sleep apnea (OSA), initial weight and the weight at intervals of 6, 12, and 24 months. Data on the treatment of T2DM before the surgery was also collected. The criteria of the American Diabetes Association were used for the definition of T2DM remission. Only the data on patients in this study who had more than 12 months’ follow-up information was analysed. Results: Two hundred and eighty patients with T2DM were identified. 191 patients had more than 12 months’ follow-up information. Mean age and BMI were 49.58 ± 10.64 years and 44.03 ± 7.86 kg/m2 respectively. There were 29 patients on insulin, 21 (10.9%) on insulin only and 8 (4.2%) on insulin and oral hypoglycaemic agents (OHA). One hundred and forty-six patients (76.4%) were on OHA, 134 on a single OHA and 12 on more than one OHA. Twenty-six patients (13.6%) were newly diagnosed with T2DM when they came in for bariatric metabolic surgery. One hundred and fifty-six patients (81.7%) achieved complete remission. 14 (7.3%) of these patients used to be on insulin with or without OHA and 142 (74.3%) were patients either on OHA or no OHA. There were 12 (6.4%) patients in partial remission. There was improvement in 23 (12.04%). Eight patients were on insulin but at lower doses and 15 were on a single OHA. The average percentage of total weight loss at 6, 12 and 24 months was 29.7%, 33.9% and 35.6% respectively. Patients with shorter duration of T2DM had higher remission rates as compared to patients with longer duration (r = −0.874, P = 0.001). There was also a significant resolution of HTN (81.8%) and OSA (82.3%) after bariatric metabolic surgery. Conclusion: This study collaborates reports that there is significant remission of T2DM after bariatric metabolic surgery in patients with obesity and T2DM. There is a need for prospective, multi-centre, and long-term studies on bariatric metabolic surgery to treat patients with obesity and T2DM.
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Affiliation(s)
- Vinod Bhandari
- Department of Surgery, Sri Aurobindo Medical College and P.G. Institute, Indore, Madhya Pradesh, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Mahak Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, Madhya Pradesh, India
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Bhandari M, Kosta S, Khurana M, Mathur W, Reddy MK, Fobi M. Emerging Procedures in Bariatric Metabolic Surgery. Surg Clin North Am 2021; 101:335-353. [PMID: 33743973 DOI: 10.1016/j.suc.2020.12.001] [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] [Indexed: 10/21/2022]
Abstract
Bariatric/metabolic surgery has emerged as an option for significant and durable weight loss in the treatment of clinically severe obesity; there is increasing demand for bariatric/metabolic surgery worldwide. New procedures have been developed and changed the face of modern bariatric surgery. Gastrointestinal metabolic surgery is a new treatment modality for obesity-related type 2 diabetes mellitus for patients with body mass index greater than 35 kg/m2. Providing safe bariatric/metabolic surgery, training qualified bariatric surgeons, and developing better techniques are important issues. This article discusses emerging procedures; a multitude of bariatric metabolic procedures enables surgeons to tailor treatment to patients' needs.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India.
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Khurana
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Kumar Reddy
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
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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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Goel R, Nasta AM, Goel M, Prasad A, Jammu G, Fobi M, Ismail M, Raj P, Palaniappan R, Aggarwal S, Bindal V, Katakwar A, Vennapusa A, Bhasker AG, Peters A, Goel D, Bedi D, Palep J, Kona L, Mehrotra M, Baijal M, Bhandari M, Dukkipati N, Wadhawan R, Baig S, Pattanshetti S, Ugale S. Complications after bariatric surgery: A multicentric study of 11,568 patients from Indian bariatric surgery outcomes reporting group. J Minim Access Surg 2021; 17:213-220. [PMID: 32964881 PMCID: PMC8083745 DOI: 10.4103/jmas.jmas_12_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Complications after bariatric surgery are not uncommon occurrences that influence the choice of operations both by patients and by surgeons. Complications may be classified as intra-operative, early (<30 days post-operatively) or late (beyond 30 days). The prevalence of complications is influenced by the sample size, surgeon's experience and length and percentage of follow-up. There are no multicentric reports of post-bariatric complications from India. Objectives To examine the various complications after different bariatric operations that currently performed in India. Materials and Methods A scientific committee designed a questionnaire to examine the post-bariatric surgery complications during a fixed time period in India. Data requested included demographic data, co-morbidities, type of procedure, complications, investigations and management of complications. This questionnaire was sent to all centres where bariatric surgery is performed in India. Data collected were reviewed, were analysed and are presented. Results Twenty-four centres responded with a report on 11,568 bariatric procedures. These included 4776 (41.3%) sleeve gastrectomy (SG), 3187 (27.5%) one anastomosis gastric bypass (OAGB), 2993 (25.9%) Roux-en-Y gastric bypass (RYGB) and 612 (5.3%) other procedures. Total reported complications were 363 (3.13%). Post-operative bleeding (0.75%) and nutritional deficiency (0.75%) were the two most common complications. Leaks (P = 0.009) and gastro-oesophageal reflux disease (P = 0.019) were significantly higher in SG, marginal ulcers in OAGB (P = 0.000), intestinal obstruction in RYGB (P = 0.001) and nutritional complications in other procedures (P = 0.000). Overall, the percentage of complications was higher in 'other' procedures (6.05%, P = 0.000). There were 18 (0.16%) reported mortalities. Conclusions The post-bariatric composite complication rate from the 24 participating centres in this study from India is at par with the published data. Aggressive post-bariatric follow-up is required to improve nutritional outcomes.
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Affiliation(s)
- Ramen Goel
- Centre For Metabolic Surgery, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | - Amrit Manik Nasta
- Centre For Metabolic Surgery, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | - Madhu Goel
- Centre For Metabolic Surgery, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | - Arun Prasad
- Department of Surgery, Manipal Hospital, New Delhi, India
| | - Gurvinder Jammu
- Director and Chief Surgeon, Bariatric Surgery, Jammu Hospital, Jalandhar, Punjab, India
| | - Mathias Fobi
- Director of Clinical Affairs and Research, Mohak Bariatrics and Robotics; Clinical Professor of Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | - Mohamed Ismail
- Bariatric Surgeon, Moulana Hospital, Perintalmanna; Bariatric Surgeon, RIMS Hospital, Kottayam, Kerala, India
| | - Praveen Raj
- Bariatric Surgeon, Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India
| | - Raj Palaniappan
- Lead Consultant, Bariatric, Metabolic and Robotic Surgery, Institute of Bariatrics, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Vivek Bindal
- Vice-Chairman, Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Abhishek Katakwar
- Associate Director, Laparoscopic/Robotic Bariatric and Metabolic Surgery, AIG Hospitals, Hyderabad, Telangana, India
| | - Amar Vennapusa
- Chief Consultant Metabolic and Bariatric Surgeon, Dr. Amar Bariatric and Metabolic Center, Hyderabad, Telangana, India
| | - Aparna Govil Bhasker
- Bariatric and Laparoscopic GI Surgeon, Gleneagles Global Hospital, Parel, Mumbai; Bariatric and Laparoscopic GI Surgeon, Apollo Hospital, Navi Mumbai, Maharashtra, India
| | - Atul Peters
- HOD and Senior Consultant, Apollo Institute of Bariatric and Metabolic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Deep Goel
- Department of Surgical Gastroenterology, Bariatric and Metabolic Surgery, BLK Super Specialty Hospital, New Delhi, India
| | | | - Jaydeep Palep
- Department of Bariatric and Minimal Access Surgery, Nanavati Super Speciality Hospital, Mumbai, Maharashtra, India
| | - Lakshmi Kona
- Senior Consultant, Gleneagles Global Hospital, Hyderabad, Telangana, India
| | - Magan Mehrotra
- Director, Bariatric Surgery, Apex Hospital, Moradabad, Uttar Pradesh, India
| | - Manish Baijal
- Director, Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Hospital, New Delhi, India
| | - Mohit Bhandari
- Director of Clinical Affairs and Research, Mohak Bariatrics and Robotics; Clinical Professor of Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | | | - Randeep Wadhawan
- Department of Minimal Access, Bariatric and Gastrointestinal Surgery, Fortis Hospital, New Delhi, India
| | - Sarfaraz Baig
- Department of Minimal Access Surgery, Belle Vue Clinic, Kolkata, West Bengal, India
| | | | - Surendra Ugale
- Director, Bariatric and Metabolic Surgery, Kirloskar and Virinchi Hospitals, Hyderabad, Telangana, India
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Bhandari M, Jain S, Mathur W, Kosta S, Neto MG, Brunaldi VO, Fobi M. Endoscopic sleeve gastroplasty is an effective and safe minimally invasive approach for treatment of obesity: First Indian experience. Dig Endosc 2020; 32:541-546. [PMID: 31394006 DOI: 10.1111/den.13508] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 05/09/2019] [Accepted: 08/05/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Endoscopic sleeve gastroplasty (ESG) is gaining acceptance as a non-surgical option for the treatment of obesity. However, its role is still not consolidated for all populations and the ideal indications are yet to be determined. We aimed to study the efficacy and safety of ESG in Indian patients. METHODS We conducted a single-center retrospective study of obese patients who underwent consecutive ESG at our tertiary care center. Data on weight loss and adverse events at 1, 3, 6, and 12 months were collected and analyzed. RESULTS Fifty-three patients underwent ESG from March 2017 to October 2018. Eighty one percent of patients were female (43/53). Mean baseline age and body mass index were 40.54 ± 13.79 years and 34.78 ± 5.20 kg/m2 , respectively. Mean duration of procedure was 68.96 ± 11.19 min. Immediate postoperative complications included mainly epigastric pain (45.2%) and nausea (22.6%) but there was no serious adverse event. Average percentage of total weight loss (%TWL) was 8.26%, 11.96%, 14.25%, and 19.94% at 1, 3, 6, and 12 months, respectively. Eighty-eight percent of patients achieved >15% TWL at 12 months. Younger patients (<30 years old) and female patients had greater %TWL at 12 months (P = 0.01 and P = 0.021, respectively). Last 18 procedures were significantly faster than the first 35 cases (P = 0.01). CONCLUSIONS Endoscopic sleeve gastroplasty is effective and safe at promoting weight loss in the Indian population. Young age and female gender are related to better outcomes.
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Affiliation(s)
- Mohit Bhandari
- Department of Bariatric and Metabolic Surgery, Mohak Bariatrics and Robotics Center, Indore, India
| | - Saransh Jain
- Department of Bariatric and Metabolic Surgery, Mohak Bariatrics and Robotics Center, Indore, India
| | - Winni Mathur
- Department of Bariatric and Metabolic Surgery, Mohak Bariatrics and Robotics Center, Indore, India
| | - Susmit Kosta
- Department of Bariatric and Metabolic Surgery, Mohak Bariatrics and Robotics Center, Indore, India
| | - Manoel Galvao Neto
- Department of Surgery and Anatomy, Center for Gastrointestinal Endoscopy, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | | | - Mathias Fobi
- Department of Bariatric and Metabolic Surgery, Mohak Bariatrics and Robotics Center, Indore, India
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Haddad A, Fobi M, Bashir A, Al Hadad M, ElFawal MH, Safadi B, Taha O, Abouzeid M, Alqahtani A, Nimeri A. Outcomes of One Anastomosis Gastric Bypass in the IFSO Middle East North Africa (MENA) Region. Obes Surg 2020; 29:2409-2414. [PMID: 30969389 DOI: 10.1007/s11695-019-03881-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Since it was first described in 2001, the one anastomosis gastric bypass (OAGB) has been gaining popularity in the Middle East region and worldwide. We designed a survey to evaluate the trends, techniques, and outcomes of OAGB in our region. METHODS A questionnaire to study OAGB was sent to the members of the IFSO MENA chapter. RESULTS One-hundred and forty-eight surgeons (74%) responded. Forty-six percent of all respondents (64 surgeons) performed OAGB routinely. The most commonly performed procedures were the laparoscopic sleeve gastrostomy (LSG), followed by OAGB, and then Roux-en-Y (RYGB). Of the surgeons who responded, 65% did not perform routine pre-operative endoscopy. Seventy-two percent believed that OAGB produces better weight loss than the LSG while 58% did not believe it produced better results to RYGB. The most common length of biliopancreatic limb utilized was 200 cm, and 72% of surgeons did not measure the total length of the small bowel. Fifty percent of the surgeons offered OAGB as a treatment for acid reflux and 33% offered it to active smokers. Early complications included leak (< 1%), venous thromboembolism (< 1%), and mortality (< 0.5%) in most centers. Leaks were managed conservatively (23%), by conversion to RYGB (20%), reinforcing the anastomosis (19%), reversal to normal anatomy (6%), and others (32%). Of the total surgeons, 41% reported revising at least one patient for malnutrition and steatorrhea, and 32% reported revising at least one patient for sever bile reflux. CONCLUSION OAGB is a commonly performed and safe procedure in the MENA region. Malnutrition and bile reflux requiring surgical intervention are serious long-term concerns.
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Affiliation(s)
- Ashraf Haddad
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Queen Noor Street, Amman, 11152, Jordan.
| | - Mathias Fobi
- Mohak Bariatric and Robotics, SAIMS Campus, Indore - Ujjain State Highway, Indore, India
| | - Ahmad Bashir
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Queen Noor Street, Amman, 11152, Jordan
| | - Mohamed Al Hadad
- Bariatric Surgery, Healthpoint Hospital, Abu Dhabi, United Arab Emirates
| | - Mohamad Hayssam ElFawal
- Bariatric Surgery Clinic "BSC," Bariatric and Metabolic Unit, Makassed General Hospital Beirut, Beirut, Lebanon
| | - Basem Safadi
- Department of Surgery, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Osama Taha
- Bariatric and General Surgery, Assiut University, Assiut, Egypt
| | | | | | - Abdelrahman Nimeri
- Carolinas Bariatic/MIS Fellowship Program, Carolinas Weight Management, Carolinas Medical Center, Charlotte, NC, USA
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Benamro F, Bhandari M, Gusani R, Khurana M, Rajvaidya A, Fobi M. Lengthening of the common channel improves hypoalbuminemia and intractable diarrhea after OAGB/MGB. Surg Obes Relat Dis 2020; 16:817. [PMID: 32192864 DOI: 10.1016/j.soard.2020.01.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Faraj Benamro
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India.
| | - Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Rajat Gusani
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Manoj Khurana
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Ashish Rajvaidya
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
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Bhandari M, Fobi M, Mathur W, Kosta S. Response to "Time to Seek a More Personalized Approach to Bariatric Surgery". Obesity (Silver Spring) 2020; 28:222. [PMID: 31970911 DOI: 10.1002/oby.22692] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, Indore, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, Indore, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, Indore, India
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Salvi P, Kosta S, Fobi M, Bhandari M, Reddy M, Gusani R, Khurana M, Benamro F, Mathur W, Bhandari M. Banded Sleeve Gastrectomy and One Anastomosis Gastric Bypass/Mini-gastric Bypass for Treatment of Obesity: a Retrospective Cohort Comparative Study with 6 years follow-up. Obes Surg 2020; 30:1303-1309. [PMID: 31898044 DOI: 10.1007/s11695-019-04369-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/28/2022]
Abstract
BACKGROUND Banded sleeve gastrectomy (BSG), a modification of the laparoscopic sleeve gastrectomy (SG), and one anastomotic gastric bypass/mini-gastric bypass (OAGB/MGB), a modification to the Roux-en-Y gastric bypass (RYGB), have been reported to enhance weight loss and minimize significant weight regain when compared with the SG and RYGB respectively. However, there has not been any report or study comparing these two operations. OBJECTIVE We did a retrospective cohort study comparing these two operations and present a review and analysis with follow-up for 6 years. METHOD A review of all the operations performed at MBRSC in 2011 from a prospectively maintained database was done. Patients who had either a BSG or OAGB/MGB were identified. Data on the patients' profile, co-morbid conditions, perioperative complications, late complications, weight loss, resolution of comorbidities, and changes in quality of life (QLF) were collected reviewed and analyzed. RESULT Sixty-eight patients were identified who had a primary BSG and 55 who had an OAGB/MGB in 2011. The follow-up rate, the age, BMI, and gender composition were similar in both groups. There were more patients with type 2 diabetes (T2D) in the BSG group than in the OAGB/MGB group (44.1% vs. 27.2%). The incidences of hypertension (HTN) and obstructive sleep apnea (OSA) were higher in the OAGB/MGB group (62% vs. 36% and 96.3% vs. 2.9% respectively). The weight loss was faster in the OAGB/MGB group in the first year, but by the sixth year, the weight loss was slightly higher in the BSG group (84% vs. 79%). Resolution rate of T2D and HTN was higher after the OAGB/MGB group, 86.6% vs. 75.7% and 85.3% vs. 64.0% respectively. There was a 20% incidence of nutrient deficiencies in OAGB/MGB group and none in the BSG group. CONCLUSION Both operations produced excellent weight loss and maintenance in the short to intermediate term. There was better resolution of T2D and HTN after OAGB/MGB at the expense of a higher incidence of nutrient deficiency and some protein caloric malnutrition. There is need for prospective and larger series studies to confirm these findings.
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Affiliation(s)
- Prashant Salvi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Mahak Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Reddy
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Rajat Gusani
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Khurana
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Faraj Benamro
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India.
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Bhandari M, Humes T, Kosta S, Bhandari M, Mathur W, Salvi P, Fobi M. Revision operation to one-anastomosis gastric bypass for failed sleeve gastrectomy. Surg Obes Relat Dis 2019; 15:2033-2037. [PMID: 31711949 DOI: 10.1016/j.soard.2019.09.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 06/27/2019] [Revised: 08/09/2019] [Accepted: 09/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are few publications on revising sleeve gastrectomy (SG) to one-anastomosis gastric bypass (OAGB). OBJECTIVE This study was undertaken to determine outcomes in terms of weight loss and resolution of co-morbidities in patients who had SG revised to OAGB. SETTINGS A high-volume university-affiliated bariatric surgery center in India. METHOD Information was collected from patients identified in a prospectively maintained database of patients who had a revision from SG to OAGB. An analysis of outcomes in terms of weight loss and maintenance with up to 3-years follow-up is reported. RESULTS Thirty-two patients were revised from SG to OAGB. Of the 32 revised patients, 9 (28%) had type 2 diabetes, 15 (47%) had hypertension, and 2 (6%) had sleep apnea at the time of the initial SG. At the time of revision only 2 of 32 (6.25%) had type 2 diabetes, 3 (9.4%) had hypertension, and none had sleep apnea. The average initial weight in this study before SG was 118 kg and body mass index was 44.04 kg/m2. The average weight at the nadir and at revision was 92.1 and 103.5 kg, respectively. Average weight was 93.5, 94.3, and 100.6 kg (P < .002) at 1-, 2-, and 3-year follow-up, respectively. There was reoccurrence of type 2 diabetes in 1 patient at 3 years after revision due to weight regain. There were no complications in this study. CONCLUSION In this study, revision of SG to OAGB because of inadequate weight loss or significant weight regain was safe and effective at 2-year follow-up; however, there was a tendency toward weight regain at 3 years. Multicenter studies with larger series of patients and longer-term follow-up after SG revision to OAGB are needed.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India.
| | - Terrel Humes
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Mahak Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Prashant Salvi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
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Fobi M. A596 WEIGHT REGAIN AFTER LAPAROSCOPIC SLEEVE GASTROSTOMY IS PART OF THE NATURAL HISTORY OF THE OPERATION. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.532] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bhandari M, Fobi M, Mathur W, KOSTA SUSMIT. A543 A retrospective study of revision operations for inadequate weight loss or weight regain after sleeve gastrectomy in 74 patients at a single institution by a single surgeon. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.481] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bhandari M, Ponce de Leon-Ballesteros G, Kosta S, Bhandari M, Humes T, Mathur W, Fobi M. Surgery in Patients with Super Obesity: Medium-Term Follow-Up Outcomes at a High-Volume Center. Obesity (Silver Spring) 2019; 27:1591-1597. [PMID: 31479206 DOI: 10.1002/oby.22593] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Received: 02/01/2019] [Accepted: 06/15/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE There is a need to determine which bariatric operations are the most effective for patients with super obesity and super-super obesity. METHODS A retrospective cohort study was performed on patients with super obesity and super-super obesity at Mohak Bariatrics and Robotics Surgery Center in Indore, India. RESULTS Five hundred fourteen patients with super obesity and super-super obesity had surgery at our center from January 2010 through December 2013. The baseline characteristics were different in different operations. The initial average age, weight, and BMI were 44.4 (SD 11.9) years, 145.4 (SD 24.2) kg, and 55.48 (SD 5.32) kg/m2 , respectively. Sleeve gastrectomy (SG) (227 [44.2%]) was the most common procedure, followed by one-anastomosis gastric bypass (OAGB) (124 [24.1%]), Roux-en-Y gastric bypass (RYGB) (102 [19.8%]), banded sleeve gastrectomy (BSG) (33 [6.4%]), and banded Roux-en-Y gastric bypass (BRYGB) (28 [5.4%]). After 3 years, the percentages of excess body weight loss (%EBWL) for SG, OAGB, RYGB, BSG, and BRYGB were 62.38%, 78.59%, 69.55%, 85.11%, and 75.77% (P < 0.0001), respectively. Failure to achieve BMI < 35 kg/m2 was more frequent in the group who underwent SG (67.9%), followed by RYGB (29.16%), BRYGB (22.2%), OAGB (9.87%), and none in the BSG group. CONCLUSIONS BSG, OAGB, and BRYGB have very good to excellent midterm outcomes for patients with super obesity and super-super obesity, whereas RYGB and SG have average outcomes at 3 years. There is a need for multicenter, long-term, and prospective studies to be performed to confirm these findings.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | | | - Susmit Kosta
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Mahak Bhandari
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Terrel Humes
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
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Mathur W, Bhandari M, Fobi M, KOSTA SUSMIT. A607 Can Incretin-Based Therapies augment results of Endoscopic Bariatric Procedures. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.543] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bhandari M, Mathur W, Kosta S, Salvi P, Fobi M. Assessment of functional ability of nonambulatory patients with obesity: after and before bariatric surgery. Surg Obes Relat Dis 2019; 15:2087-2093. [PMID: 31711943 DOI: 10.1016/j.soard.2019.09.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/27/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Functional ability is often impaired as a direct consequence of severe obesity. Bariatric surgery is the most effective treatment for severe obesity. OBJECTIVE To examine the effect of weight loss after bariatric surgery on patients with impaired functional ambulatory abilities due to obesity. SETTINGS A high-volume university-affiliated bariatric surgery center in India. METHOD We conducted a prospective study in a cohort of nonambulatory patients with functional disabilities (bedridden, wheelchair-bound, or walker-dependent) who underwent bariatric surgery. Data on sex, body mass index, co-morbid conditions, the severity of pain, and types of limitations in functional abilities were collected at baseline and at 1 year after bariatric surgery and analyzed. RESULTS Forty-five patients were enrolled in this study with 100% follow-up at 1 year. The mean age and body mass index of the patients were 54.7 ± 8.5 years and 54.2 ± 8.6 kg/m2, respectively. Thirty-four (75.5%) were female, 27 (60%) were walker-dependent, 14 (31.1%) were wheelchair-bound, and 4 (8.9%) were bedridden. At baseline 88.8% and 75.5% patients had severe knee and back pain, respectively. The percentage of total weight loss was 22% and 31% at 6 and 12 months, respectively. At 1 year, 37 (82.2%) patients were ambulating independently, only 1 (2.2%) patient was still bedridden, and 7 (15.5%) patients were walker-dependent. Mild, moderate, and severe classification on all functional ability scales were significantly improved. CONCLUSION Weight loss after bariatric surgery results in significant amelioration of knee and/or back pain with an improvement in functional abilities and quality of life.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India.
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
| | - Prashant Salvi
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
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Bhandari M, Kosta S, Mathur W, Nautiyal HK, Fobi M. Reply to letter to the editor: Comparison of one-anastomosis gastric bypass and Roux-en-Y-gastric bypass for treatment of obesity: a 5-year study. Surg Obes Relat Dis 2019; 15:1646. [PMID: 31427223 DOI: 10.1016/j.soard.2019.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Centre, Indore, Madhya Pradesh, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Centre, Indore, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Centre, Indore, Madhya Pradesh, India
| | | | - Mathias Fobi
- Mohak Bariatrics and Robotics Centre, Indore, Madhya Pradesh, India
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Bhandari M, Reddy M, Kosta S, Mathur W, Fobi M. Laparoscopic sleeve gastrectomy versus laparoscopic gastric bypass: A retrospective cohort study. Int J Surg 2019; 67:47-53. [PMID: 31121327 DOI: 10.1016/j.ijsu.2019.05.004] [Citation(s) in RCA: 19] [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] [Received: 02/18/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND There are many reports on short-term outcomes following sleeve gastrectomy, which demonstrate that it has comparable efficacy to gastric bypass. However, there are very few long-term comparative reports. This study compared the outcomes from laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB) in a cohort of patients who had surgery in 2011 with a six-year follow up. MATERIALS AND METHODS Data on patients who had either LSG or LGB at a single centre in Mohak Bariatric and Robotic Surgery Centre, Indore, M.P. India in 2011 were identified from a database of routinely collected data. This retrospective cohort was analysed for weight loss, resolution of comorbidities and nutritional status over six years. Patients who had revision operations or for whom six-year follow-up data were not available were excluded from the analysis. RESULTS 154 patients had LGB and 152 had LSG. The six-year follow up rate was 61.7% (n = 95) and 64.5% (n = 98) respectively for LGB and LSG. Percentage of excess bodyweight loss (%EWL) peaked at approximately 70% after two years in the LSG group and after three years in the LGB group. However, after six years %EWL was 61% for LGB and 50% for LSG (p = 0.001). Resolution of type-2 diabetes was more common in the LGB group compared to the LSG group (79% vs 62%, p = 0.126). Resolution of hypertension and dyslipidaemia was similar in both groups at approximately half of patients in each group for each condition. Nutrient deficiencies were found in both groups but were generally more pronounced in the LGB group. CONCLUSION LGB is a better operation for weight loss, weight loss maintenance, and resolution of type-2 diabetes than LSG. This is at the expense of an increased incidence of nutrient deficiencies. LSG appears to have greater treatment failure by six years follow up and this should be further investigated.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Manoj Reddy
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Susmit Kosta
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Winni Mathur
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Mathias Fobi
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
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Kosta S, Bhandari M, Mathur W, Fobi M. The obscure role of genetics on weight loss after bariatric surgery. Surg Obes Relat Dis 2018; 15:515-518. [PMID: 30713120 DOI: 10.1016/j.soard.2018.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Susmit Kosta
- Central Research Lab, Sri Aurbindo Medical College and PG Institute, Indore, India
| | - Mohit Bhandari
- Mohak Bariatrics and Robotics, Mohak Hi-Tech Specialty Hospital, SAIMS Campus, Indore, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics, Mohak Hi-Tech Specialty Hospital, SAIMS Campus, Indore, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics, Mohak Hi-Tech Specialty Hospital, SAIMS Campus, Indore, India
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MATHUR WINNI, Bhandari M, Fobi M. Banded Gastric Bypass VS Standard Gastric Bypass: Weight loss and maintenance after four years. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.180] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bhandari M, Mathur W, Fobi M. Outcome of Sleeve revisions for inadequate weight loss or weight regain to BGBP VS. MGB VS. Re-sleeve. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.354] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bhandari M, MATHUR WINNI, Fobi M. Weight regain after LSG starts after the second year and increases yearly with 30% of the weight lost regained after six years. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.260] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bhandari M, Fobi M, Mathur W, Mishra AK. A Retrospective, Comparative Study of Banded Sleeve Gastrectomy (BSG) vs. Mini-Gastric Bypass (MGB), a cohort comparative study of patients operated in 2011 with five years follow up. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.115] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fobi M, Stanchyk M. [Gastric shunting operation for the morbid obesity treatment]. Klin Khir 2012:11-17. [PMID: 22950268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Affiliation(s)
- Mathias Fobi
- Center for Surgical Treatment of Obesity, Tri-City Regional Hospital, Hawaiian Gardens, California, USA.
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Fobi M, Lee H, Igwe D, Felahy B, James E, Stanczyk M, Fobi N. Band erosion: incidence, etiology, management and outcome after banded vertical gastric bypass. Obes Surg 2001; 11:699-707. [PMID: 11775567 DOI: 10.1381/09608920160558632] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [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: 11/08/2022]
Abstract
BACKGROUND Prosthetic devices have been used in bariatric operations to control the outlet of the gastric pouch and thus maintain weight loss. A complication of these prostheses is erosion or migration into the gastric lumen. The transected banded vertical gastric bypass (TBVGBP) is one of the modifications of gastric bypass. This modification has a silastic ring placed around the pouch to form the stoma. METHOD The records of patients with band erosion (BE) after this operation were reviewed, to determine the incidence, etiology, management and outcome during a 9-year period. RESULTS From May 1992 through May 2001, 2,949 primary and secondary TBVGBP were performed through the Center for Surgical Treatment of Obesity, utilizing 3 hospitals. 48 patients (1.63%) were documented to have BE: 40 documented by us and 8 by subsequent treating surgeons or at other facilities. Presenting symptoms were weight regain (18), stenosis or obstruction (17), pain (9), bleeding (7), and 5 were incidental findings. Some patients presented with more than one symptom. 8 were treated expectantly with spontaneous extrusion of the band. 16 bands have been removed endoscopically in 14 patients. 26 patients had open surgical revision, with 12 having band removal only and 14 band removal and revision of either the gastroenterostomy with or without band replacement or conversion to a distal Roux-en-Y gastric bypass (DRYGBP). Two patients who had revision to DRYGBP were re-revised to a longer common limb because of protein malnutrition. Three patients who had revision of the gastroenterostomy with band removal and replacement developed leaks that were managed non-surgically. Two of these re-eroded and the band was removed endoscopically with a subsequent revision to a DRYGBP. There was no death due to BE. CONCLUSION BE is an uncommon complication of TBVGBP. Infection, previous bariatric operations and surgical technique play a role in BE. BE is best managed by endoscopic removal but can be treated expectantly or by open surgical intervention. Band removal without replacement or revision to DRYGBP may result in weight regain.
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Affiliation(s)
- M Fobi
- Center for Surgical Treatment of Obesity, 21520 S. Pioneer Blvd., Suite 204, Hawaiian Gardens, CA 90716, USA.
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Abstract
Silastic ring vertical gastric bypass is a composite operation which maximizes the advantages of the vertical banded gastroplasty and the gastric bypass operations. It is our operation of choice because it appears to date to be the only operation that addresses the medical and psychosocioeconomic problem of severe obesity. Acute complications include wound infection, wound seroma and anastomotic leaks. Late complications include marginal ulcers (6%), staple-line breakdown (4%), iron deficiency, vitamin B&inf1;&inf2; deficiency and anemia. The operation is relatively simple, safe, effective and acceptable to the patients and doctors.
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Affiliation(s)
- M Fobi
- Departments of Surgery: King/Drew Medical Center, Cedars-Sinai Medical Center, and the Center for Surgical Treatment of Obesity, Los Angeles, CA 90310 USA
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Fobi M, Johnson AP, Bristo LD, Alexander JL. The "limiting proximal gastric pouch": the evolving solution of morbid obesity. J Natl Med Assoc 1982; 74:1005-9. [PMID: 7143463 PMCID: PMC2561379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Seventy-five patients received the "limiting proximal gastric pouch." The technique used is the complete transverse gastric stapling with Roux-en-Y reconstruction of gastrointestinal continuity. There was one death, 13 patients required rehospitalization, and five patients required reoperation because of complications. Both the weight loss and percentage of excess weight loss were satisfactory. The patients' acceptance was very high. The limiting proximal gastric pouch is evolving as the procedure of choice for morbid obesity.
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Abstract
Five cases of multilocular cyst of the kidney are presented with a follow-up of 8 mo to 13 yr. Two children were treated with partial nephrectomy and three with nephrectomy. Radiation therapy and chemotherapy were not given pre- or postoperatively. Ultrasonography is helpful in preoperative diagnosis of this lesion. A brief review of the literature, differential diagnosis, possible etiology, preoperative evaluation and treatment are discussed.
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