Religious Fasting of Muslim Patients After Metabolic and Bariatric Surgery: a Modified Delphi Consensus.

BACKGROUND: Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS. 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.

Analysis of the five-year outcomes of sleeve gastrectomy and mini gastric bypass: a report from the Indian sub-continent.

BACKGROUND: Few reports have compared laparoscopic sleeve gastrectomy (LSG) to laparoscopic Roux-en-Y procedure (LRNY). This study aims at comparing the 5-year follow-up results of mini gastric bypass (MGB or omega gastric bypass (OGB)) and LSG in terms of weight loss, weight regain, complications, and resolution of co-morbidities. METHODS: A retrospective analysis of the prospectively collected database was done from the start of our bariatric practice from February 2007 to August 2008 (minimum 5-year follow-up). During this period, 118 patients underwent LSG. These patients were matched in age, gender, preoperative weight, and BMI to 104 patients who underwent MGB in the same time period. The results were compared. RESULTS: Follow-up was achieved in 72 MGB vs 76 LSG patients up to 5 years. The mean BMI for the MGB and LSG group was 44 ± 3.1 and 42 ± 5.2 kg/m(2), respectively (P < 0.001). The average percentage of excess weight loss (%EWL) for MGB vs LSG was 63 vs 69 % at 1 year and 68 vs 51.2 % at 5 years (P = 0.166), respectively. Post-op gastro-esophageal reflux disease (GERD) was seen in 2.8 % MGB patients and marginal ulcer was diagnosed in 1 MGB patient (1.4 %). GERD was seen in 21 % post-LSG patients. CONCLUSIONS: Both MGB and LSG are safe, short, and simple operations. Weight loss is similar in MGB and LSG in the first years, but lesser %EWL with LSG at 5 years (68 % in MGB vs 51 % in LSG). Post-op GERD is more common after LSG.

A 6-year experience with 1,054 mini-gastric bypasses-first study from Indian subcontinent.

BACKGROUND: We started laparoscopic mini-gastric bypass (MGB) for the first time in India in February 2007 for its reported safety, efficacy, and easy reversibility. METHODS: A retrospective review of prospectively maintained data of all 1,054 consecutive patients (342 men and 712 women) who underwent MGB at our institute from February 2007 to January 2013 was done. RESULTS: Mean age was 38.4 years, preoperative mean weight was 128.5 kg, mean BMI was 43.2 kg/m(2), mean operating time was 52 ± 18.5 min, and mean hospital stay was 2.5 ± 1.3 days. There were 49 (4.6%) early minor complications, 14 (1.3%) major complications, and 2 leaks (0.2%). In late complications, one patient had low albumin and one had excess weight loss; MGB was easily reversed in both (0.2%). Marginal ulcers were noted in five patients (0.6%) during follow-up for symptomatic dyspepsia, and anemia was the most frequent late complication occurring in 68 patients (7.6%). Patient satisfaction was high, and mean excess weight loss was 84, 91, 88, 86, 87, and 85% at years 1 to 6, respectively. CONCLUSION: This study confirms previous publications showing that MGB is quite safe, with a short hospital stay and low risk of complications. It results in effective and sustained weight loss with high resolution of comorbidities and complications that are easily managed.