Bariatric surgery

Should gastric band slippage be managed with laparoscopic unclipping and re-clipping? (2023)

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Type of publication:
Conference abstract

Author(s):
*Maharaj G.; *Jain R.; *Riera M.

Citation:
14th Annual Scientific Meeting of British Obesity and Metabolic Surgery Society, BOMSS 2023

Abstract:
INTRODUCTION: Laparoscopic Adjustable Gastric Band (LABG) is a popular bariatric procedure. Gastric band slippage is a recognised complication. Treatment options include band removal or unclip. Subsequent re-clip/reposition of a previously unclipped band may provide further weight loss. This study aims to examine patient outcomes following un-clipping of slipped gastric bands. METHOD(S): Electronic Records of patients who underwent gastric band unclipping during a ten year period were examined. RESULT(S): 11 female patients underwent gastric band unclipping, five as emergencies. Nine patients (82%) had confirmed band slippage/pouch dilatation. Mean age at unclip was 46.5yrs. Median duration band insertion to unclip was 7yrs (range 3-11yrs). 8 patients underwent subsequent band reclip/reposition. 1 patient had attempted re-clip converted to removal. Median duration unclip to re-clip was 9months (range 4-14months). 3/8 patients with re-clipped bands had no further procedures and maintained weight loss. Of the remaining five patients, two had early removal because of acute dysphagia on days-2 and 5 post re-clipping. The other three patients eventually suffered further slippage and band intolerance. Median duration re-clip to band removal 2yrs (range 0-4yrs). Two patients were never re-clipped (one had symptomatic removal, the other is awaiting a further procedure). In total, seven bands were removed (64%). Four of these patients suffered significant weight regain, with two requiring revisional surgery. CONCLUSION(S): This study is small. However 64% of patients who underwent gastric band unclipping had subsequent removal. Hence gastric band unclipping does not appear to provide added benefit to patient care, and exposes them to additional procedures.

A Case of the Cascade Stomach; Laparoscopic Sleeve of Fundoplication (2023)

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Type of publication:Conference abstract

Author(s):*Davies S.; *Maharaja G.; *Riera M.

Citation:14th Annual Scientific Meeting of British Obesity and Metabolic Surgery Society, BOMSS 2023

Abstract:A Case of the Cascade Stomach; Sleeve of Fundoplication Introduction The cascade stomach is a long standing known entity often referred to as 'cup and spill deformity' but very little is known on the management of these cases particularly surgically. Cases often present with acid reflux and vomiting due to the physiological and anatomical deformity of the stomach and are subsequently referred to the benign upper gastrointestinal/bariatric surgeon to manage. Surgical options reported in the literature are sparse but include gastropexy, laparoscopic sleeve gastrectomy and laparoscopic fundoplication. Methods We present this unusual condition as a case report, discuss the challenges in management and propose surgical management options. Conclusion Although rare this cases propose a challenge to the benign UGI surgeon as currently there is very little in the literature to support best management options. This unusual case was managed with a laparoscopic Nissen's fundoplication and we further propose that this should potentially be the standard recognised course of treatment in these cases due to the pathophysiological nature of this condition and the functional process which often leads to these patients to be high risk of acid reflux.

Improving the care of patients with obesity needing joint replacement - time for a combined ortho-bariatric approach? (2023)

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Type of publication:Conference abstract

Author(s):Sinha Y.; Ikram S.; Ballinger T.; Gouveia S.; Burak M.; Wiggins T.; *Bathgate S.;

Citation:Obesity Surgery. Conference: 14th Annual Scientific Meeting of British Obesity and Metabolic Surgery Society, BOMSS 2023. Birmingham United Kingdom. 33(Supplement 1) (pp S129), 2023. Date of Publication: July 2023.

Abstract:Introduction Patients with obesity awaiting joint replacement surgery of the lower limbs may benefit from referral to weight-management services. (1) NICE provides BMI criteria for referral to tertiary bariatric services, however this does not always translate into clinical practice. (2, 3) Our aim was to assess the number and management of patients with obesity attending orthopaedic clinics for consideration of lower limb joint replacement. Methods A retrospective analysis was undertaken of all patients attending orthopaedic clinics for joint replacement secondary to osteoarthritis, in the lower limbs, at a single centre, over a two year period. Details of demographics, BMI, comorbidities and management plans were recorded from electronic patient records. Results 335 patients (60% of 558 cases) had BMI recorded and were used for subsequent analysis. 36% (n=120) of patients were eligible for referral to weight-management services. 10% (n=32) were refused joint replacement surgery due to BMI, of which 81% (n=26) were eligible for referral to weight-management services. Instead of surgery, these 32 patients were offered: physiotherapy (n=10, 38%), analgesia (n=12, 46%), non-specific weight-loss advice (n=16, 62%), GP referral for weight-loss (n=6, 23%), and tertiary service referral for weight-loss (n=2, 8%). Conclusions BMI is an important risk factor for orthopaedic operations and increased efforts should be made to record it pre-operatively. An MDT approach would capture the notable proportion of patients who are not being appropriately referred to weight-management services which may impact on their quality of life and postoperative outcomes.

Bariatric surgeons' experiences of working in the first year of the pandemic (2023)

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Type of publication:
Journal article

Author(s):
Graham Y.N.H.; Mahawar K.; Singhal R.; Madhok B.; Yang W.; *Riera M.; Martinez-Duartez P.; Pouwels S.; Sharma M.; Hayes C.

Citation:
Obesity Science and Practice. 9(4) (pp 329-336), 2023. Date of Publication: August 2023.

Abstract:
Background: The first year of the Covid-19 pandemic saw drastic changes to bariatric surgical practice, including postponement of procedures, altered patient care and impacting on the role of bariatric surgeons. The consequences of this both personally and professionally amongst bariatric surgeons has not as yet been explored. Aim(s): The aim of this research was to understand bariatric surgeons' perspectives of working during the first year of the pandemic to explore the self-reported personal and professional impact. Method(s): Using a retrospective, two phased, study design with global participants recruited from closed, bariatric surgical units. The first phase used a qualitative thematic analytic framework to identify salient areas of importance to surgeons. Themes informed the construction of an on-line, confidential survey to test the potential generalizability of the interview findings with a larger representative population from the global bariatric surgical community. Finding(s): Findings of the study revealed that the first year of the pandemic had a detrimental effect on bariatric surgeons both personally and professionally globally. Conclusion(s): This study has identified the need to build resilience of bariatric surgeons so that the practice of self-care and the encouragement of help-seeking behaviors can potentially be normalized, which will in turn increase levels of mental health and wellbeing.

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Global Level of Harm experienced by Bariatric Surgeons for Bariatrics surgical interventions: An exploration of predictors (2022)

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Type of publication:
Conference abstract

Author(s):
Cheruvu C.; Bangash A.H.; Isik A.; Parmar C.; Galanis M.; Yang W.; Kok J.H.H.; *Bandyopadhyay S.K.; Di Maggio F.; Atici S.D.; Abouelazayem M.; Viswanath Y.K.S.

Citation:
British Journal of Surgery. Conference: AUGIS Annual Scientific Meeting. Aberdeen United Kingdom. 109(Supplement 9) (pp ix17-ix18), 2022. Date of Publication: December 2022.

Abstract:
Background: COVID-19 pandemic has taken the world by surprise with the depth and breadth of its effect on all walks of life, bariatric surgery being no exception. With the scientific literature hitherto unable to comment and ascertain the influence of the COVID-19 pandemic on bariatric surgery and the level of harm experienced by bariatric surgeons, we- TUGS 'Level of Harm' collaborative group- attempted to gauge the effect of the said pandemic on bariatrics surgery specifically vis a vis the level of harm experienced by bariatric surgeons due to the pandemic. Method(s): A virtual questionnaire- developed on both: Google forms and Survey Monkey- was circulated via TUGS social media platforms to reach bariatric consultant surgeons, fellows and residents practising throughout the world in a bid to explore the influence of the COVID-19 pandemic on their surgical practice including but not limited to the annual surgical volume including re-do surgeries volume and postoperative complications. Moreover, they were also requested to categorise their respective level of harm vis a vis bariatric surgical interventions they undertake. After de-identification of the data, SPSS (V.26) was adopted to undergo statistical analysis. After exploring the dataset by descriptive analyses, the Chi-square test was applied to pursue the association of categorical variables with the reported level of harm. A double-sided p-value of less than 0.05 was considered statistically significant. Result(s): 16.8% of the respondents (21/125) indicated no harm vis a vis bariatrics surgery work whereas a comparative 18.4% of the respondents (23/125) reported moderate harm with significant worsening of symptoms. None of those who indicated less than 10% increase in surgery waitlisted patients being subjected to endoscopic interventions (0/14) reported Moderate Harm for bariatrics surgery work with significant worsening of symptoms whereas 1 in every 3 of those who indicated between 10% to 25% increase in surgery waitlisted patients being subjected to endoscopic interventions (5/15) reported such level of harm for bariatrics surgery work. (p < 0.001) Upon exhaustive sub-group analysis, it was uncovered that 33.6% of bariatrics surgical professionals perceived no harm (no evidence of change in clinical condition) during gastric band or related surgery work with only 4% perceiving Moderate Harm (significant worsening of symptoms/ comorbidities control/ minor increase in medications) for such surgical interventions. All of those who reported No harm for gastric band or related surgical work reported that Single anastomosis duodeno-ileal bypass (SADI-S) accounts for 10% of their practice whereas none of those who indicated that SADI-S accounts for more than 10% of their practice reported No harm for such surgical work. (p = 0.019) Conclusion(s): The global snapshot illustrates a trend of low harm vis a vis bariatrics surgery work in surgical professionals practising in the private sector with a lesser number of patients developing COVID-19 postoperatively and no postoperative COVID-19 related mortality. The patient being subjected to endoscopic intervention portends a higher level of harm for bariatrics surgical work- strict adherence to criteria and safety protocols being a logical inference. For gastric band and related surgery work, preoperative COVID-19 testing appears to be influenced by confounders in its effect on the surgeon's level of harm for the said interventions warranting further exploration. SADI-S, at a cut-off of 10%, exhibits strong interaction with the surgeon's level of harm for gastric band insertion and relation surgery work. Women surgical professionals came out to exhibit equivalent mental resilience and technical prowess at par with their male colleagues when it came to bariatrics surgical intervention

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Patient experiences of weight loss and eating after bariatric surgery: A Systematic Review and Qualitative Synthesis (2023)

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Type of publication:Journal article

Author(s):*Ansari M; Serjeant S

Citation:Journal of Human Nutrition & Dietetics. 36(4):1438-1450, 2023 Aug.

Abstract:Background: An estimated 26% of men and 29% of women in the UK are living with obesity according to recent statistics. Bariatric Surgery (BS) can induce significant weight loss and improve co-morbidity status. However previous studies highlight challenges in maintaining dietary changes and weight loss. This systematic review aimed to investigate patient experiences of weight loss and eating in the first two years following surgery, to provide clinical recommendations to support this group.Methods: Ethical approval was granted by the University. A systematic search was conducted in four databases. Studies were selected according to the predefined eligibility criteria and methodological quality, assessed via the CASP tool. Data were extracted and analysed using a thematic synthesis method. Rigour was enhanced via use of a data extraction tool, a validated method for data synthesis, peer-review and transparent reporting.Results: In total, 507 records were screened; nine studies met the inclusion criteria. The thematic synthesis yielded four, interlinked analytical themes based on 154 patients' experiences: relationship with food, relationship with oneself, relationship with others and unfinished journey. Positive experiences were reported including development of healthy eating behaviours and significant weight loss, improving physical and psychosocial wellbeing. On the other hand, challenges in adjusting to life after surgery were also reported.Conclusions: This study highlighted the need for personalised dietary advice, addressing the psychological aspects of eating. Support should be extended to the family. Ongoing psychological support must be incorporated in the post-surgery care pathway to help patients deal with the negative outcomes of surgery such as excess skin.

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Emotional Resilience and Bariatric Surgical Teams: a Priority in the Pandemic (2021)

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Type of publication:Conference abstract

Author(s):Graham Y.; Mahawar K.; Omar I.; *Riera M.; Bhasker A.; Wilson M.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:The infection control measures implemented as a result of COVID-19 led to a postponement of bariatric surgical procedures across many countries worldwide. Many bariatric surgical teams were in essence left without a profession, with many redeployed to other areas of clinical care and were not able to provide the levels of patient support given before COVID-19. As the pandemic continues, some restrictions have been lifted, with staff adjusting to new ways of working, incorporating challenging working conditions and dealing with continuing levels of stress. This article explores the concept of emotional labour, defined as 'inducing or suppressing feelings in order to perform one's work', and its application to multidisciplinary teams working within bariatric surgery, to offer insight into the mental health issues that may be affecting healthcare professionals working in this discipline.

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30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data (2021)

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Type of publication:Journal article

Author(s):Singhal R.; Wiggins T.; Cardoso V.R.; Gkoutos G.V.; Super J.; Ludwig C.; Mahawar K.; Pedziwiatr M.; Major P.; Zarzycki P.; Pantelis A.; Lapatsanis D.P.; Stravodimos G.; Matthys C.; Focquet M.; Vleeschouwers W.; Spaventa A.G.; Zerrweck C.; Vitiello A.; Berardi G.; Musella M.; Sanchez-Meza A.; Cantu F.J.; Mora F.; Cantu M.A.; Katakwar A.; Reddy D.N.; Elmaleh H.; Hassan M.; Elghandour A.; Elbanna M.; Osman A.; Khan A.; layani L.; Kiran N.; Velikorechin A.; Solovyeva M.; Melali H.; Shahabi S.; Agrawal A.; Shrivastava A.; Sharma A.; Narwaria B.; Narwaria M.; Raziel A.; Sakran N.; Susmallian S.; Karagoz L.; Akbaba M.; Piskin S.Z.; Balta A.Z.; Senol Z.; Manno E.; Iovino M.G.; Qassem M.; Arana-Garza S.; Povoas H.P.; Vilas-Boas M.L.; Naumann D.; Li A.; Ammori B.J.; Balamoun H.; Salman M.; Nasta A.M.; Goel R.; Sanchez-Aguilar H.; Herrera M.F.; Abou-mrad A.; Cloix L.; Mazzini G.S.; Kristem L.; Lazaro A.; Campos J.; Bernardo J.; Gonzalez J.; Trindade C.; Viveiros O.; Ribeiro R.; Goitein D.; Hazzan D.; Segev L.; Beck T.; Reyes H.; Monterrubio J.; Garcia P.; Benois M.; Kassir R.; Contine A.; Elshafei M.; Aktas S.; Weiner S.; Heidsieck T.; Level L.; Pinango S.; Ortega P.M.; Moncada R.; Valenti V.; Vlahovic I.; Boras Z.; Liagre A.; Martini F.; Juglard G.; Motwani M.; Saggu S.S.; Momani H.A.; Lopez L.A.A.; Cortez M.A.C.; Zavala R.A.; D'Haese RN C.; Kempeneers I.; Himpens J.; Lazzati A.; Paolino L.; Bathaei S.; Bedirli A.; Yavuz A.; Buyukkasap C.; Ozaydin S.; Kwiatkowski A.; Bartosiak K.; Waledziak M.; Santonicola A.; Angrisani L.; Iovino P.; Palma R.; Iossa A.; Boru C.E.; De Angelis F.; Silecchia G.; Hussain A.; Balchandra S.; Coltell I.B.; Perez J.L.; Bohra A.; Awan A.K.; Madhok B.; Leeder P.C.; Awad S.; Al-Khyatt W.; Shoma A.; Elghadban H.; Ghareeb S.; Mathews B.; Kurian M.; Larentzakis A.; Vrakopoulou G.Z.; Albanopoulos K.; Bozdag A.; Lale A.; Kirkil C.; Dincer M.; Bashir A.; Haddad A.; Hijleh L.A.; Zilberstein B.; de Marchi D.D.; Souza W.P.; Broden C.M.; Gislason H.; Shah K.; Ambrosi A.; Pavone G.; Tartaglia N.; Kona S.L.K.; Kalyan K.; Perez C.E.G.; Botero M.A.F.; Covic A.; Timofte D.; Maxim M.; Faraj D.; Tseng L.; Liem R.; Oren G.; Dilektasli E.; Yalcin I.; AlMukhtar H.; Hadad M.A.; Mohan R.; Arora N.; Bedi D.; Rives-Lange C.; Chevallier J.-M.; Poghosyan T.; Sebbag H.; Zinai L.; Khaldi S.; Mauchien C.; Mazza D.; Dinescu G.; Rea B.; Perez-Galaz F.; Zavala L.; Besa A.; Curell A.; Balibrea J.M.; Vaz C.; Galindo L.; Silva N.; Caballero J.L.E.; Sebastian S.O.; Marchesini J.C.D.; da Fonseca Pereira R.A.; Sobottka W.H.; Fiolo F.E.; Turchi M.; Coelho A.C.J.; Zacaron A.L.; Barbosa A.; Quinino R.; Menaldi G.; Paleari N.; Martinez-Duartez P.; de Esparza G.M.A.R.; Esteban V.S.; Torres A.; Garcia-Galocha J.L.; Josa M.; Pacheco-Garcia J.M.; Mayo-Ossorio M.A.; Chowbey P.; Soni V.; de Vasconcelos Cunha H.A.; Castilho M.V.; Ferreira R.M.A.; Barreiro T.A.; Charalabopoulos A.; Sdralis E.; Davakis S.; Bomans B.; Dapri G.; Van Belle K.; Takieddine M.; Vaneukem P.; Karaca E.S.A.; Karaca F.C.; Sumer A.; Peksen C.; Savas O.A.; Chousleb E.; Elmokayed F.; Fakhereldin I.; Aboshanab H.M.; Swelium T.; Gudal A.; Gamloo L.; Ugale A.; Ugale S.; Boeker C.; Reetz C.; Hakami I.A.; Mall J.; Alexandrou A.; Baili E.; Bodnar Z.; Maleckas A.; Gudaityte R.; Guldogan C.E.; Gundogdu E.; Ozmen M.M.; Thakkar D.; Dukkipati N.; Shah P.S.; Shah S.S.; Adil M.T.; Jambulingam P.; Mamidanna R.; Whitelaw D.; Jain V.; Veetil D.K.; Wadhawan R.; Torres M.; Tinoco T.; Leclercq W.; Romeijn M.; van de Pas K.; Alkhazraji A.K.; Taha S.A.; Ustun M.; Yigit T.; Inam A.; Burhanulhaq M.; Pazouki A.; Eghbali F.; Kermansaravi M.; Jazi A.H.D.; Mahmoudieh M.; Mogharehabed N.; Tsiotos G.; Stamou K.; Rodriguez F.J.B.; Navarro M.A.R.; Torres O.M.; Martinez S.L.; Tamez E.R.M.; Cornejo G.A.M.; Flores J.E.G.; Mohammed D.A.; Elfawal M.H.; Shabbir A.; Guowei K.; So J.B.; Kaplan E.T.; Kaplan M.; Kaplan T.; Pham D.T.; Rana G.; Kappus M.; Gadani R.; Kahitan M.; Pokharel K.; Osborne A.; Pournaras D.; Hewes J.; Napolitano E.; Chiappetta S.; Bottino V.; Dorado E.; Schoettler A.; Gaertner D.; Fedtke K.; Aguilar-Espinosa F.; Aceves-Lozano S.; Balani A.; Nagliati C.; Pennisi D.; Rizzi A.; Frattini F.; Foschi D.; Benuzzi L.; Parikh C.; Shah H.; Pinotti E.; Montuori M.; Borrelli V.; Dargent J.; Copaescu C.A.; Hutopila I.; Smeu B.; Witteman B.; Hazebroek E.; Deden L.; Heusschen L.; Okkema S.; Aufenacker T.; den Hengst W.; Vening W.; van der Burgh Y.; Ghazal A.; Ibrahim H.; Niazi M.; Alkhaffaf B.; Altarawni M.; Cesana G.C.; Anselmino M.; Uccelli M.; Olmi S.; Stier C.; Akmanlar T.; Sonnenberg T.; Schieferbein U.; Marcolini A.; Awruch D.; Vicentin M.; de Souza Bastos E.L.; Gregorio S.A.; Ahuja A.; Mittal T.; Bolckmans R.; Baratte C.; Wisnewsky J.A.; Genser L.; Chong L.; Taylor L.; Ward S.; Hi M.W.; Heneghan H.; Fearon N.; Geoghegan J.; Ng K.C.; Plamper A.; Rheinwalt K.; Kaseja K.; Kotowski M.; Samarkandy T.A.; Leyva-Alvizo A.; Corzo-Culebro L.; Wang C.; Yang W.; Dong Z.; *Riera M.; *Jain R.; Hamed H.; Said M.; Zarzar K.; Garcia M.; Turkcapar A.G.; Sen O.; Baldini E.; Conti L.; Wietzycoski C.; Lopes E.; Pintar T.; Salobir J.; Aydin C.; Atici S.D.; Ergin A.; Ciyiltepe H.; Bozkurt M.A.; Kizilkaya M.C.; Onalan N.B.D.; Zuber M.N.B.A.; Wong W.J.; Garcia A.; Vidal L.; Beisani M.; Pasquier J.; Vilallonga R.; Sharma S.; Parmar C.; Lee L.; Sufi P.; Sinan H.; Saydam M.

Citation:International Journal of Obesity; 2021 [epub ahead of print]

Abstract:Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Material(s) and Method(s): This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien-Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Result(s): In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusion(s): This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.

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Emotional Resilience and Bariatric Surgical Teams: a Priority in the Pandemic (2021)

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Type of publication:
Journal article

Author(s):
Graham, Yitka; Mahawar, Kamal; *Riera, Manel; Islam, Omar; Bhasker, Aparna Ghovil; Wilson, Michael; Tahrani, Abd; Moize, Violeta; Leal, Angela; Hayes, Catherine

Citation:
Obesity Surgery; Apr 2021; vol. 31 (no. 4); p. 1887-1890

Abstract:
The infection control measures implemented as a result of COVID-19 led to a postponement of bariatric surgical procedures across many countries worldwide. Many bariatric surgical teams were in essence left without a profession, with many redeployed to other areas of clinical care and were not able to provide the levels of patient support given before COVID-19. As the pandemic continues, some restrictions have been lifted, with staff adjusting to new ways of working, incorporating challenging working conditions and dealing with continuing levels of stress. This article explores the concept of emotional labour, defined as 'inducing or suppressing feelings in order to perform one's work', and its application to multidisciplinary teams working within bariatric surgery, to offer insight into the mental health issues that may be affecting healthcare professionals working in this discipline.

Link to full-text [no password required]

Effectiveness of Intra-Gastric Balloon as a Bridge to Definitive Surgery in the Super Obese (2019)

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Type of publication:
Journal article

Author(s):
Ball, William; Raza, Syed Soulat; Loy, John; *Riera, Manel; *Pattar, Jayaprakash; *Adjepong, Samuel; *Rink, James

Citation:
Obesity surgery; Feb 2019

Abstract:
BACKGROUND British National guidelines (NICE) recommend bariatric surgery for patients with a body mass index (BMI) > 40 kg/m2, or BMI > 35 kg/m2 with any comorbidities of the metabolic syndrome. Intra-gastric balloons (IGB) can be used in super obese patients as a first step, before definitive surgery. AIMS Quantify weight loss 6 months after IGB placement, measure progression to definitive surgery and identify complications.METHODSData collected retrospectively on 50 patients. Forty-six proposed for definitive bariatric surgery, four patients excluded. Analysis performed using SPSS v23.0. RESULTS Median weight decreased from 165.5 to 155 kg (range 78 to 212, p < 0.01), BMI from 57.4 to 52.15 (range 32.9 to 70.5, p < 0.01), percentage excess weight loss (%EWL) was 12.9% (range – 3.3 to 64.66%, p < 0.01) and BMI reduction was 4.25 kg/m2 (range – 1.3 to 13.9, p < 0.01). Twenty-nine out of 46 patients (63%) progressed to definitive bariatric surgery. Ten out of 46 patients (21.7%) had complications requiring readmission. Seven of these patients required early balloon removal and six failed to progress to definitive surgery. Six patients had a second balloon placement, their actual weight loss was less successful, with some regaining weight. DISCUSSION IGB is useful to aid weight loss prior to definitive bariatric surgery. Results from first balloon placement are encouraging and comparable with other studies "as reported by Genco et al. (Int J of Obes 30:129-133, 2006)." Readmission due to nausea, vomiting, dehydration and poor compliance may be associated with poor weight loss and failure to progress to definitive surgery. Second balloon placements were less successful. CONCLUSION IGB as bridging therapy is a safe and useful adjunct. Sequential IGBs do not seem to provide additional benefit.