METHODS: A retrospective analysis of medical records from a Malaysian tertiary care hospital documented bariatric surgeries conducted from January 2020 to January 2022. Rigorous criteria selected 200 patients from 327, evenly split between standard care and intensive dietary support groups. The latter underwent six mandatory visits with a surgeon and a dietitian in the initial 3 months post-surgery. A dual-review mechanism was implemented for data interpretation, increasing robustness, and reducing biases in our findings.
RESULTS: At 6 and 12 months, the intensive dietary support group exhibited significantly greater weight loss and BMI reduction (p < 0.01). Postoperative complications did not significantly differ between groups.
CONCLUSION: In an Asian population, intensive dietary support enhances weight loss and BMI reduction compared to standard care after bariatric surgery.
MATERIALS AND METHODS: This double-blinded RCT enrolled 110 patients who underwent laparoscopic sleeve gastrectomy at Hospital Canselor Tuanku Muhriz UKM from November 2020 to May 2021. Any patients with previous abdominal surgery, chronic kidney disease, or liver disease were excluded. The patients were randomised into two groups: (i) the IPLA group which received ropivacaine intraperitoneal instillation at the dissected left crus and (ii) the placebo group (sterile water instillation). Perioperative analgesia was standardised. The first 24-h postoperative pain was assessed using a VAS. The respiratory effort was assessed using incentive spirometry simultaneously.
RESULTS: Total of 110 patients were recruited. The VAS score was lower with an enhanced recovery of respiratory effort in the local anaesthetic group compared to the placebo group (P < 0.05) within the first 24 h postoperatively. In addition, the placebo group required additional postoperative analgesia (P < 0.05). No side effects were reported with the use of intraperitoneal instillation of ropivacaine.
CONCLUSION: The use of intraperitoneal instillation of ropivacaine in laparoscopic sleeve gastrectomy is recommended as it is safe, effectively reduces acute postoperative pain, and enhances the recovery of respiratory effort postoperatively.
MATERIALS AND METHODS: We conducted a non-randomized quasi-experimental study (prospective) between 2 groups, those who underwent surgery with the control group. In this study, the resolution of erectile dysfunction following bariatric surgery comparing with the control group was evaluated in terms of International Index of Erectile Function (IIEF) score. IIEF score is taken by delivering validated questionnaire to participants that enrolled in this study, both the control and intervention group.
RESULTS: A total of 25 patients were included in this study, 13 from the intervention group and 12 from the control group. From our study, we evaluated the resolution of IIEF score in both groups. We found that the resolution of erectile function is statistically significant in the intervention group compared to control group. Spearman rank correlation (rs) test was performed to identify the correlation between age and IIEF score.
CONCLUSION: Statistically significant improvements in erectile function were found following bariatric surgery. This is evidenced by the improvements in the IIEF score post-surgery compared to control group.
METHODS: A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus.
RESULTS: The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient's situation and surgeon's experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively.
CONCLUSION: Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.
METHODS: We searched PubMed, Embase, and CENTRAL from inception until August 2020 for randomized controlled trials comparing both techniques. The primary outcome was cumulative morphine consumption at 24 h. Secondary pain-related outcomes included pain score at rest and on movement at 2, 6, 12, and 24 h; postoperative nausea and vomiting; and length of hospital stay.
RESULTS: We included 23 studies with a total of 2,178 patients. TAP block is superior to control in reducing opioid consumption at 24 h, improving pain scores at all the time points and postoperative nausea and vomiting. The cumulative opioid consumption at 24 h for IPLA is less than control, while the indirect comparison between IPLA with PSI and control showed a significant reduction in pain scores at rest, at 2 h, and on movement at 12 h, and 24 h postoperatively.
CONCLUSIONS: Transversus abdominis plane block is effective for reducing pain intensity and has superior opioid-sparing effect compared to control. Current evidence is insufficient to show an equivalent analgesic benefit of IPLA to TAP block.
MATERIALS AND METHODS: Thirty-four patients listed for bariatric surgery in a single tertiary referral center were recruited, where 31 (77.4% female, mean age 46.3 ± 8.9 years) fulfilled the eligibility criteria. Of the eligible patients, 54.8% and 45.2% underwent sleeve gastrectomy (SG) and gastric bypass (GB), respectively. LPR symptoms were assessed using the self-reported reflux symptom index (RSI). Video-recorded endolaryngeal signs were scored using the reflux finding score (RFS) by two blinded otolaryngologists. Patients' presurgical and 3-month postsurgical body mass index (BMI), RSI, and RFS were determined. Patients were deemed as having LPR when RSI > 13 or RFS > 7.
RESULTS: There was a significant correlation between the postsurgical RSI and RFS changes (Pearson's r = 0.474, p = 0.007). Of the 31 patients, 12.9% (RSI) and 6.4% (RFS) recovered from preexisting LPR, whereas 22.6% (RSI) and 3.2% (RFS) developed new de novo LPR postsurgery. The postsurgical mean RFS change improved significantly in the GB group compared with that of the SG group (p < 0.05).
CONCLUSION: LPR is best assessed clinically using a multimodal approach (RSI and RFS). Bariatric surgery may worsen or lead to de novo LPR. Recognizing the LPR outcomes in these patients is paramount for optimal voice, speech, and swallowing functions.
METHODS: Fifty-two internationally recognized bariatric experts from 28 countries convened for voting on 90 consensus statements over two rounds to identify those on which consensus could be reached. Inter-voter agreement of ≥ 70% was considered consensus, with voting participation ≥ 80% considered a robust vote.
RESULTS: At least 70% consensus was achieved for 65 of the 90 questions (72.2% of the items), 61 during the first round of voting and an additional four in the second round. Where consensus was reached on a binary agree/disagree or yes/no item, there was agreement with the statement presented in 53 of 56 instances (94.6%). Where consensus was reached on a statement where options favorable versus unfavorable to OAGB-MGB were provided, including statements in which OAGB-MGB was compared to another procedure, the response option favorable to OAGB-MGB was selected in 13 of 23 instances (56.5%).
CONCLUSION: Although there is general agreement that the OAGB-MGB is an effective and usually safe option for the management of patients with obesity or severe obesity, numerous areas of non-consensus remain in its use. Further empirical data are needed.
METHODS: A 37-item questionnaire-based survey was conducted to capture the perioperative practices of the global community of bariatric surgeons. Data were analyzed using descriptive statistics.
RESULTS: Response of 863 bariatric surgeons from 67 countries with a cumulative experience of 520,230 SGs were recorded. A total of 689 (80%) and 764 (89%) surgeons listed 13 absolute and relative contraindications, respectively. 65% (n = 559) surgeons perform routine preoperative endoscopy and 97% (n = 835) routinely use intraoperative orogastric tube for sizing the resection. A wide variation is observed in the diameter of the tube used. 73% (n = 627) surgeons start dividing the stomach at a distance of 3-5 cm from the pylorus, and 54% (n = 467) routinely use staple line reinforcement. Majority (65%, n = 565) of surgeons perform routine intraoperative leak test at the end of the procedure, while 25% (n = 218) surgeons perform a routine contrast study in the early postoperative period. Lifelong multivitamin/mineral, iron, vitamin D, calcium, and vitamin B12 supplementation is advocated by 66%, 29%, 40%, 38% and 44% surgeons, respectively.
CONCLUSION: There is a considerable variation in the perioperative practices concerning SG. Data can help in identifying areas for future consensus building and more focussed studies.
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
MATERIAL AND METHODS: This is a prospective study of women undergoing bariatric surgery, between May 2017 and April 2018. FSD was diagnosed using the Malay version of Female Sexual Function Index (MVFSFI) questionnaire. Patients filled up the questionnaire before and 6 months after surgery. Association between BMI reduction and FSFI score improvement was measured using Fisher's exact test. Outcomes between types of surgery (sleeve gastrectomy and gastric bypass) was compared.
RESULTS: Fifty-two women completed the study. The mean age was 38.77 ± 6.7. There were 44 (84.6%) Malay patients, 7 (13.5%) Indian patients, and 1 (1.9%) Chinese patient. There was a significant reduction in mean BMI, 39.89 ± 6.9 pre-surgery to 30.32 ± 5.4 post-surgery (p value
METHODS: All the patients with end-stage heart failure (ESHF) and implanted LVAD who underwent LSG from2013 to January 2017 were studied.
RESULTS: Seven patients with end stage heart failure (ESHF) and implanted LVAD were included. The median age and median preoperative BMI were 39 years (range: 26-62) and 43.6 kg/m2 (range 36.7-56.7), respectively. The median interval between LVAD implantation and LSG was 38 months (range 15-48). The median length of hospital stay was 9 days (rang: 6-23) out of which 4 patients had planned postoperative ICU admission. Thirty-day complications were noted in 5 patients (3 major and 2 minor) without any perioperative mortality. The median duration of follow-up was 24 months (range 2-30). At the last available follow-up, the median BMI, %EWL, and %TWL were 37 kg/m2, 47%, and 16%, respectively. The median LVEF before LSG and at the last follow-up point (before heart transplant) was 19% (range 15-20) and 22% (range, 16-35), respectively. In addition, the median NYHA class improved from 3 to 2 after LSG. Three patients underwent successful heart transplantations.
CONCLUSION: Patients with morbid obesity, ESHF, and implanted LVAD constitute a high-risk cohort. Our results with 7 patients and result from other studies (19 patients) suggested that bariatric surgery may be a reasonable option for LVAD patients with severe obesity. Bariatric surgery appears to provide significant weight loss in these patients and may improve candidacy for heart transplantation.
METHODS: A questionnaire including data of 2016 and 2017 and consisting of eight general questions was prepared and sent to representatives in 18 Asia-Pacific countries by e-mail before the congress. After the congress, the data were analyzed and summarized.
RESULTS: Seventeen of 18 countries responded to the survey. The frequency of obesity (BMI ≥ 30) in the 4 Gulf countries was > 30%, much higher than that in the other countries. In total, 1640 surgeons and 869 institutions were engaging in bariatric/metabolic surgery. In many East and Southeast Asian countries, the indication for bariatric surgery was BMI ≥ 35 or ≥ 37, whereas in many Gulf countries and Australia, it was BMI ≥ 40 or ≥ 35 with obesity-related disease. Ten of the 17 countries (58.8%) but only one of the 5 Southeast Asian countries (20.0%) had public health insurance coverage for bariatric surgery. In 2017, 95,125 patients underwent bariatric/metabolic surgery, with sleeve gastrectomy accounting for 68.0%, bypass surgery for 19.5%, and others for 12.5%. Current problems included public insurance coverage, training system, national registry, and lack of awareness and comprehension.
CONCLUSION: This summary showed that bariatric/metabolic surgery is rapidly developing along with various problems in Asia-Pacific countries.
METHODS: Patient undergoing bariatric surgery from 2008 to 2015 who developed AKI within 60 days after surgery were studied. Patients on dialysis before surgery were excluded.
RESULTS: Out of 4722 patients, 42 patients (0.9%) developed early postoperative AKI after bariatric surgery of whom five had chronic kidney disease (CKD) preoperatively including CKD stage 3 (n = 2), stage 4 (n = 2), and stage 5 (n = 1). Etiologies of AKI included prerenal in 37 and renal in 5 patients. Nine patients (21%) underwent hemodialysis in early postoperative period for AKI. The median duration of follow-up was 28 months (interquartile range, 4-59). Of the 40 patients eligible for follow-up, 36 patients (90%) returned to their baseline renal function. However, four patients (10%) had worsening of renal function at follow-up.
CONCLUSIONS: The incidence of early postoperative AKI after bariatric surgery is about 1%. The most common causes of AKI after bariatric surgery are dehydration and infectious complications. In our series, 10% of patients who developed AKI in early postoperative period had worsening of renal function in long-term follow-up. In the absence of severe sepsis and severe underlying kidney dysfunction (CKD stages 4 and 5), full recovery is expected after postoperative AKI.
METHOD: All cirrhotic patients with portal hypertension who underwent laparoscopic bariatric surgery, from 2007 to 2017, were retrospectively reviewed.
RESULTS: Thirteen patients were included; eight (62%) were female. The median age was 54 years (interquartile range, IQR 49-60) and median BMI was 48 kg/m2 (IQR 43-55). Portal hypertension was diagnosed based on endoscopy (n = 5), imaging studies (n = 3), intraoperative increased collateral circulation (n = 2), and endoscopy and imaging studies (n = 3). The bariatric procedures included sleeve gastrectomy (n = 10, 77%) and Roux-en-Y gastric bypass (n = 3, 23%). The median length of hospital stay was 3 days (IQR 2-4). Three 30-day complications occurred including wound infection (n = 1), intra-abdominal hematoma (n = 1), and subcutaneous hematoma (n = 1). No intraoperative or 30-day mortalities. There were 11 patients (85%) at 1-year follow-up and 9 patients (69%) at 2-year follow-up. At 2 years, the median percentage of excess weight loss (EWL) and total weight loss (TWL) were 49 and 25%, respectively. There was significant improvement in diabetes (100%), dyslipidemia (100%), and hypertension (50%) at 2 years after surgery.
CONCLUSION: Bariatric surgery in selected cirrhotic patients with portal hypertension is relatively safe and effective.