|Year : 2013 | Volume
| Issue : 1 | Page : 33-36
The first Saudi Arabian Society of Metabolic and Bariatric Surgery (SASBMS) conference, 20-21 March, 2013, Dubia, UAE
|Date of Web Publication||8-Oct-2013|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. The first Saudi Arabian Society of Metabolic and Bariatric Surgery (SASBMS) conference, 20-21 March, 2013, Dubia, UAE. Saudi J Obesity 2013;1:33-6
Reversal of scopinaro standard biliopancreatic diversion (bpd) for morbid obesity
Mohd Khalid Mirza Gari
National Guard Health Affairs - Dammam, Kingdom of Saudi Arabia
Between 2003 and 2011, 735 bariatric procedures were performed at Imam AbdulRahman Al-Faisal Hospital (IAFH) and 452 standard biliopancreatic diversion (BPD) (400 ml gastric volume, 50 cm common limb and 200 cm alimentary limb). Two hundred and fifty-seven females and 195 males, with mean age of 34.4 years and mean body mass index (BMI) 47.5 kg/m 2 were recruited in the study. Fourteen patients underwent reversal surgery 12-23 months after the primary operation, 13 for recurrent protein malnutrition and one for intolerance of routine supplementations, after which they were followed-up for 3-30 months. The reversal consisted of dividing the ileum immediately proximal to the enteroenterostomy in all cases, with the ileal stump being then joined to the side of the biliopancreatic limb, 150 cm proximal to the enteroenterostomy (elongation of the common limb, 11 cases) or immediately distal to the ligament of Treitz (restoration of the intestinal continuity, two cases) or to the side of the duodenal stump (full restoration, one case). Mean excess weight loss in the restored patients (81.5%) was not significantly different from that of the nonrestored ones (79%), and the mean postreoperative weight regain, in the 14 patients with a minimum 6-month follow-up, led to a restabilization weight with a BMI increase from 15% to 20%. At the same postoperative time, serum total protein and albumin gradually increased to normal values in all cases (mean serum total protein 65.9 mg/dl, mean serum albumin 37.4 mg/dl). Therefore, it can be concluded that restoration of intestinal continuity after BPD is safe and effective, with resolution of the nutritional deficiency without excessive weight regain in all cases.
Laparoscopic sleeve gastrectomy: State of the art technique re-do in bariatric surgery, experience from Saudi Arabia
King Fahad Medical Military Complex, Kingdom of Saudi Arabia
Introduction: Bariatric surgery is the most effective treatment for severe obesity, producing durable weight loss, improvement of co-morbid conditions and longer life. In revision (RE-Do) bariatric surgery, the results can vary widely depending on the original procedure and the reason for the revision. Bariatric surgery revisions are usually successful in resolving the associated problems and promoting further weight loss, which is usually not as dramatic as the initial bariatric procedure, but it can be substantial over time. As revision surgery can be more complex, it is important to be performed in the Center of Excellence for Bariatric Surgery. We perform Re-Do bariatric surgery because of the failure to lose weight, recidivism and complications. Materials and Methods: This is a retrospective study for cases undergoing Re-Do bariatric surgery from April 2005 to January 2013 in three hospitals (King Fahad Medical Military Complex, Saad Specialist Hospital and Procare Hospital - Alkhobar) .This study includes the type of revision bariatric surgery, highlighting the reasons to perform revision bariatric surgery, while also describing the expected difficulties and the unexpected challenges and describe the techniques used in revision surgery and the outcome. Results: Cases underwent bariatric surgery in this period by a single surgeon (the author). Of 1650 cases in the study, 290 cases had a Re-Do (revision) bariatric surgery, equivalent to 17.5% of the total cases, and 268 cases had conversion from laparoscopic gastric banding (LGB) to laparoscopic R-Y gastric bypass (LRYGBP; 92.4%). Three cases had conversion from LGB to laparoscopic biliopancreatic diversion, seven cases had conversion from LGB to laparoscopic sleeve gastrectomy (LSG), eight cases had conversion from vertical banded gastroplasty to LRYGBP and four cases had conversion from sleeve gastrectomy to LRYGBP. The most common Re-Do bariatric surgery in our experience is conversion from gastric banding to LRYGBP. The study included 34.6% male patients and 65.4% female patients. There was removal of gastric band and LRYGBP in the same procedure (one step) in 265/290 patients (91.3%). Two steps or delayed LRYGBP was performed in 25/290 patients (8.7%). The average weight reduction in the patients post conversion of LGB to LRYGBP was 45-80% of their access body weight, with a mean of 60% over 1- 4 years, while the average weight reduction post conversion of VBG to LRYGBP was about 45% of their access body weight. Conclusion: Re-Do in bariatric surgery is challenging, needing an expert and the Excellence Center for Bariatric Surgery. To obtain good results, all efforts should be made to decrease the number of failed weight loss cases, which will decrease the revision bariatric surgery by good selection of the best procedure for the patient, education for the patients and good follow-up.
Long-term follow-up in laparoscopic adjustable gastric banding: Maladaptative eating behaviors, life style changes and outcomes
Venâncio C, Conceição E, Machado PP
Antσnio Sιrgio Clinic, Porto, University of Minho, Braga, Portugal
Background: Bariatric surgery requires a substantial life style change along the postoperative stage. The presence of maladaptative eating behaviors and other psychological symptoms have been related to poor outcomes. After surgery, many patients regain weight and fall in the adoption of healthy and permanent changes in nutrition and physical activity. Despite eating patterns tending to change with surgery and through time, little is known about eating problems, compliance with treatment and weight maintenance at the long-term follow-up of these patients. The purpose of this study is to describe a sample of patients with long-term follow-up (>7 years) in terms of weight loss, eating behavior, life style changes, difficulties and attitudes related to treatment. Materials and Methods: Sixteen participants (M = 3 [18.8%]; W = 13 [81.3%]) aged between 31 and 66 years (M = 45.07; SD = 10.71) who underwent laparoscopic adjustable gastric banding (LAGB) by the same surgeon were assessed by a trained psychologist in a late postsurgical period (>7 years and <11 years follow-up), with a postsurgical clinical semi-structured interview (Eating Disorders Examination [EDE]) and a set of self-report measures: Eating disordered symptoms and behaviors (EDE-Q; ODE-Q), Psychological distress (OQ-45), Depressive symptoms (BDI) and Impulsivity (BIS-11). Participants' informed consent was obtained at intake in the study. Results: Data show that 12 (75%) participants gained weight at the long-term and reported maladaptive eating behaviors, such as grazing (n = 8; 50%), loss of control over eating (n = 3; 18; 8%) and excessive food intake (n = 3; 18.8%). Participants also reported plugging (n = 8; 50%) and vomiting (n = 8; 50%) in the previous month. When asked about life style changes, all the participants reported nutrition changes, but only two of them reported physical activity (n = 2; 12.5%). Fourteen participants identified difficulties in the postsurgical process, like regain weight (n = 5; 29.4%), vomiting (n = 3; 17.7%), intake in stress conditions (n = 3; 17.7%) and swallow learning (n = 3; 17.7%), among others. Fourteen (87.5%) of the patients reported being motivated toward treatment, but only 11 (68.8%) felt satisfied with the treatment. Regarding self-report measures, values ranged within normal values for all measures except ODE, for assessing presence of maladaptive eating behaviors, which had scores higher than that in the normal population. Conclusions: The high percentage of weight regain, maladaptative eating behaviors, reported difficulties with treatment process and low rate of physical activity highlight the need for long-term follow-up. The screening of maladaptative eating behaviors and difficulties in treatment process and assessment of the ability to enroll in an active life style with physical activity is crucial to design multidisciplinary interventions that can enhance compliance with treatment and life style changes.
Laparoscopic sleeve gastrectomy (lsg) in morbidly obese patients in the uae: A sharjah experience
Tarek Mahdi Abdulwahid Alwahdi
Al Qassimi Hospital, Sharja United Arab Emirates
Background: Obesity remains a major health issue for individuals residing in the UAE. Laparoscopic sleeve gastrectomy (LSG) has been used as an isolated bariatric operation since a few years by both restrictive and probably hormonal actions. The aim of our study was to present our experience and results with LSG in morbidly obese UAE subjects at the Al Qassimi Hospital in Sharjah, UAE. Materials and Methods: From January 2008 to November 2012, 584 patients underwent LSG at the Al Qassimi Hospital. A standardized operating technique was used. Our patients were not "sweet-eaters" and had no symptoms of gastroesophageal reflux disease. During the procedure, a 34 Fr tube was inserted into the stomach to ensure adequate diameter and volume reduction with 60-mm-long green linear mechanical staplers. The change in total body weight and morbidity and clinical improvement in co-morbidities were studied. Results: LSG was performed in 584 patients (418 female and 166 male). The mean age and body mass index were 39.6 ± 9.3 years and 49.2 ± 9.8 kg/m 2 , respectively. The mean operative time for the LSG procedure was 68.7 ± 11.8 min. The median length of hospital stay was 3 days; the minimum follow-up duration was 6 months and the maximum follow-up duration was 40 months. The mean postoperative percent of excess body weight lose achieved was 84.6 ± 13.0 at 1 year, 91.2 ± 6.9 at 2 years and 81.1 ± 13.8 at 3 years. There was 64.7% resolution in diabetes, 80.4% resolution in hypertension and 87.4% resolution in dyslipidemia. The major complication rate was 1.9% (11 of 584), with one recorded death, five cases of leak (0.9%) that required reoperation, one case of portomesentric thrombosis (0.2%) and four cases of sleeve stricture (0.7%) that required endoscopic dilation. Late complication and gall stones disease developed in 8.6% of the patients and gastroesophageal reflux disease symptoms developed in 5.1% of the patients within the first postoperative year, but lessened over time to 2.7% at the end of 3 years. Conclusion: LSG is safe and effective in the reduction of both weight and co-morbidity in UAE patients. However, a long-term prospective comparative study with other bariatric procedures is required to draw effective conclusions.
Efficacy of laparoscopic sleeve gastrectomy (lsg) in morbidly obese with type 2 diabetes mellitus in uae: A sharjah experience
Tarek Mahdi, Abdulwahid Alwahdi
Al Qassimi Hospital, Sharja United Arab Emirates
Background: Many reports have showed that patients who have undergone laparoscopic sleeve gastrectomy (LSG) have experienced resolution of type 2 diabetes. The UAE ranks as the fifth fattest nation in the world, with a diabetes rate of roughly 20% for residents and 25% for Emirati nationals. The aim of our study was to evaluate the efficacy and safety of LSG in morbidly obese UAE subjects with type 2 diabetes mellitus. Materials and Methods: From March 2008 to January 2012, morbidly obese patients with Type 2 diabetes mellitus (T2DM) who underwent LSG were enrolled in this study. The change in fasting blood sugar, postprandial blood sugar and glycosylated hemoglobin, C-peptide and total body weight and use of oral hypoglycemic agents and insulin at the end of 1 year were studied. Results: A total of 167 patients with T2DM (101 women and 66 men aged 39.5 ± 8.7 years, body mass index 47.7 ± 6.6 kg/m 2 and hemoglobin A1c 8.7% ± 1.9%) had undergone LSG. Before LSG, 120 patients (71.9%) required oral hypoglycemic agents and 47 patients (28.1%) required oral hypoglycemic agents and insulin. Resolution of T2DM was achieved in 108 (64.7%), remission in 50 (29.9%) and stable in nine (5.4%) patients at 1 year after LSG. The diabetes resolution rates for those with preoperative C-peptide <3, 3-6 and >6 ng/mL were 5/43 (11.6%), 83/104 (79.8%) and 20/20 (100%), respectively. Conclusion: LSG is an effective treatment of T2DM in morbidly obese UAE patients. C-peptide as the predictor of successful T2DM resolution should be evaluated and used as patient selection criteria. The possible mechanisms explaining improvement in glycemic control need further investigation.
Laparoscopic roux-en-y gastric bypass for morbid obesity: A modified retrocolic supracolic tecknique
Javed Ahmed Division of Surgery, Royal Derby Hospital, UK
Introduction: Ante colic ante gastric and retro colic retro gastric techniques for anastomosis of the Roux limb and gastric pouch are the most commonly used approached in Laparoscopic Roux-en-Y gastric bypass surgery (RYGB). In this study, the postoperative outcome of using a modified retro colic supra colic technique is described. Aim: This was a retrospective analysis of a prospectively maintained database of 220 consecutive patients who underwent RYGB using a modified retro colic supra colic approach between December 2009 and May 2012. This new approach included drawing the jejunum into the lesser sac and returning into the infra colic compartment after completing the anastomosis. Procedure: A 5-port approach was used in all cases. A defect in the gastro-colic omentum was created and retro gastric adhesions were taken down. Then, a window was created through the pliable section of the superior aspect of the transverse mesocolon. The small bowel was identified from the DJ flexure and delivered through the window into the supra-colic compartment. Following the creation of the jejuno-jejunal anastomosis, an Ethibond suture was used to close the mesenteric defects and the Petersen's space. Results: This approach was attempted in 226 cases. This approach was not technically possible in only five patients (0.2%) due to a thickened and folded transverse mesocolon. There was no mortality or significant postoperative morbidity. Only one patient (0.5%) required developed symptomatic internal hernia that required surgery. Conclusion: This modified approach is both safe and feasible as it provides easy and direct access to the DJ flexure. It is also useful in patients who have abdominal wall hernia or omental adhesions to the anterior abdominal wall as adhesionolysis can be avoided.