Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus

Bariatric surgery; Consensus; Metabolic surgeryCirugía bariátrica; Consenso; Cirugía metabólicaCirurgia bariàtrica; Consens; Cirurgia metabòlicaMetabolic 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for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines.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

Severity of post-Roux-en-Y gastric bypass dumping syndrome and weight loss outcomes: is there any correlation?

Bariatric surgery; Gastric bypass; Weight lossCirugía bariátrica; Bypass gástrico; Pérdida de pesoCirurgia bariàtrica; Bypass gàstric; Pèrdua de pesPurpose The present research was conducted to evaluate the effect of the severity of dumping syndrome (DS) on weight loss outcomes after Roux-en-Y gastric bypass (RYGB) in patients with class III obesity. Methods The present retrospective cohort study used the dumping symptom rating scale (DSRS) to evaluate the severity of DS and its correlation with weight loss outcomes in 207 patients 1 year after their RYGB. The patients were assigned to group A with mild-to-moderate DS or group B with severe DS. Results The mean age of the patients was 42.18 ± 10.46 years and their mean preoperative BMI 42.74 ± 5.59 kg/m2. The total weight loss percentage (%TWL) in group B was insignificantly higher than that in group A, but besides that was not significantly different in the two groups. Conclusion The present findings suggested insignificant relationships between the presence and severity of DS after RYGB and adequate postoperative weight loss.Open Access Funding provided by Universitat Autonoma de Barcelona

Areas of Non-Consensus Around One Anastomosis/Mini Gastric Bypass (OAGB/MGB): A Narrative Review

One anastomosis/mini gastric bypass (OAGB/MGB) is now an established bariatric and metabolic surgical procedure with good outcomes. Despite two recent consensus statements around OAGB/MGB, there are some issues which are not accepted as consensus and need more long-term data and research

Severity of post-Roux-en-Y gastric bypass dumping syndrome and weight loss outcomes : is there any correlation?

Altres ajuts: acords transformatius de la UABPurpose: The present research was conducted to evaluate the effect of the severity of dumping syndrome (DS) on weight loss outcomes after Roux-en-Y gastric bypass (RYGB) in patients with class III obesity. Methods: The present retrospective cohort study used the dumping symptom rating scale (DSRS) to evaluate the severity of DS and its correlation with weight loss outcomes in 207 patients 1 year after their RYGB. The patients were assigned to group A with mild-to-moderate DS or group B with severe DS. Results: The mean age of the patients was 42.18 ± 10.46 years and their mean preoperative BMI 42.74 ± 5.59 kg/m2. The total weight loss percentage (%TWL) in group B was insignificantly higher than that in group A, but besides that was not significantly different in the two groups. Conclusion: The present findings suggested insignificant relationships between the presence and severity of DS after RYGB and adequate postoperative weight loss

Type 2 diabetes remission after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one anastomosis gastric bypass (OAGB) : results of the longitudinal assessment of bariatric surgery study

Acknowledgements The authors would like to thank the staff at the Minimally Invasive Surgery Research Center (MISRC) in Rasoul-e-Akram Hospital. Funding Information: This study was supported by the Deputy of Research of Iran University of Medical Sciences, Tehran, Iran.Peer reviewedPublisher PD

COVID-19. Pandemic surgery guidance

Abstract – Based on high quality surgery and scientific data, scientists and surgeons are committed to protecting patients as well as healthcare staff and hereby provide this Guidance to address the special issues circumstances related to the exponential spread of the Coronavirus disease 2019 (COVID-19) during this pandemic. As a basis, the authors used the British Intercollegiate General Surgery Guidance as well as recommendations from the USA, Asia, and Italy. The aim is to take responsibility and to provide guidance for surgery during the COVID-19 crisis in a simplified way addressing the practice of surgery, healthcare staff and patient safety and care. It is the responsibility of scientists and the surgical team to specify what is needed for the protection of patients and the affiliated healthcare team. During crises, such as the COVID-19 pandemic, the responsibility and duty to provide the necessary resources such as filters, Personal Protective Equipment (PPE) consisting of gloves, fluid resistant (Type IIR) surgical face masks (FRSM), filtering face pieces, class 3 (FFP3 masks), face shields and gowns (plastic ponchos), is typically left up to the hospital administration and government. Various scientists and clinicians from disparate specialties provided a Pandemic Surgery Guidance for surgical procedures by distinct surgical disciplines such as numerous cancer surgery disciplines, cardiothoracic surgery, ENT, eye, dermatology, emergency, endocrine surgery, general surgery, gynecology, neurosurgery, orthopedics, pediatric surgery, reconstructive and plastic surgery, surgical critical care, transplantation surgery, trauma surgery and urology, performing different surgeries, as well as laparoscopy, thoracoscopy and endoscopy. Any suggestions and corrections from colleagues will be very welcome as we are all involved and locked in a rapidly evolving process on increasing COVID-19 knowledg

Petersen’s Space Internal Hernia after Laparoscopic One Anastomosis (Mini) Gastric Bypass

Background. One anastomosis gastric bypass (OAGB) is now considered as an appropriate alternative for Roux-en-Y gastric bypass (RYGB) with some advantages such as absence of risk for internal hernia (IH). But, is really the risk of IH equal zero after OAGB? Case Summary. A 37-year-old male was admitted due to severe abdominal crampy pain, nausea, vomiting, and obstipation. He had chronic and intermittent abdominal pain from 2 years after OAGB. With high suspicion of complete obstruction, the exploratory laparoscopy was performed. Intraoperative findings showed incarcerated bowel hernia from Petersen’s defect. The incarcerated bowel was reduced, and the defect was repaired. The patient was discharged 2 days after operation. Conclusion. The incidence of IH after OAGB is rare but not zero. In any suspicious signs and symptoms for IH, the early exploratory laparoscopy is mandatory to diagnose and treat

Petersen’s Space Internal Hernia after Laparoscopic One Anastomosis (Mini) Gastric Bypass

Background. One anastomosis gastric bypass (OAGB) is now considered as an appropriate alternative for Roux-en-Y gastric bypass (RYGB) with some advantages such as absence of risk for internal hernia (IH). But, is really the risk of IH equal zero after OAGB? Case Summary. A 37-year-old male was admitted due to severe abdominal crampy pain, nausea, vomiting, and obstipation. He had chronic and intermittent abdominal pain from 2 years after OAGB. With high suspicion of complete obstruction, the exploratory laparoscopy was performed. Intraoperative findings showed incarcerated bowel hernia from Petersen’s defect. The incarcerated bowel was reduced, and the defect was repaired. The patient was discharged 2 days after operation. Conclusion. The incidence of IH after OAGB is rare but not zero. In any suspicious signs and symptoms for IH, the early exploratory laparoscopy is mandatory to diagnose and treat

The Essential Role of Esophagogastroduodenoscopy Prior to bariatric surgery

We read with interest the case report entitled “Dieulafoy’s Lesion related massive Intraoperative Gastrointestinal Bleeding during Single Anastomosis Gastric Bypass necessitating total Gastrectomy: A Case Report” published in Archives of Surgery and Clinical Research b Ashraf Imam et al. [1]. We appreciate the authors for managing such a complicated case and for sharing their experience but, we have some conflict about the management, and we wanted to add some comments regarding the importance of EGD before bariatric surgery. In the published case, no preoperative EGD was done and the authors mentioned that Dieulafoy’s Lesion is very unlikely to be diagnosed in the routine endoscopy. We agree with that statement but, it is not a good reason to eliminate this diagnostic modality before surgery. Though controversial, there is growing evidence which supports the importance of routine EGD prior to obesity surgery [2]. This may alter the surgical or medical plan for the obese patient, Furthermore, we have a different opinion about this patient’s management and, we wanted to share this with the authors. In the reported patient, after control of the bleeding during gastrojejunal anastomosis, the OAGB(One Anastomosis Gastric Bypass) concluded successfully but, the patient was re-intubated because of severe bloody emesis at the recovery room and then an arterial bleeding point in the posterior wall of the lesser curvature close to the esophagogastric junction was found. This does not illustrate the reason for the huge gastric remnant seen at the laparoscopy because it was at least 200 cm far from the pouch and backwards flow of blood is very unlikely. Our opinion is, due to 90% diagnostic rate and about 75-100% success in hemostasis, on-table EGD should have a more highlighted role in treatment of the reported case [3]. Even if the pouch was dilated, it was not rational to perform a total gastrectomy in such an unstable patient and a laparoscopic pouch resection followed by Roux- en-y esophagojejunostomy could be a better choice in our point of view. Moreover, Feeding gastrostomy could be a better option rather than feeding jejunostomy, if needed. In summary the essential role of endoscoy for screening the patients before bariatric surgery and, for the management of complications (though controversial), should always be kept in mind by bariatric surgeons

Interconnection of severe obesity, gastric intestinal metaplasia, gastric cancer, bariatric surgery and the necessity of preoperative endoscopy

Obesity is a growing challenge around the globe accounting for approximately 1.7 billion adults with reduced life expectancy of 5–20 years and these patients are at greater risk for various cancers. Bariatric surgery is one efficient an approved treatment of severe obesity for losing weight and to decrease associated health complications. Besides correct indications and contraindications as well as the various risks of individual bariatric surgical procedures, many more variables influence decision-makings, such as patient’s family history of diseases, as well as individual patient-specific factors, patient and family socioeconomic and nutrition status, and professionalism of a bariatric surgical unit and the presence of intestinal metaplasia that is the replacement of columnar epithelial cells by intestinal architecture and morphology. Patients with severe obesity undergoing esophagogastroduodenoscopy (EGD) and biopsy prior to bariatric surgery may present with gastric IM because regular follow-up to early diagnosis of any subsequent pathological changes is necessary and reveals the importance of addressing interconnections between pre-existing conditions and outcomes. However, there is currently no unified recommendation about preoperative EGD before bariatric surgery. With this short review, we point out the necessary knowledge that undermines why the responsibility for a patient with severe obesity cannot be divided across various disciplines, and why we recommend that EGD always be performed preoperatively