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Objective: Bariatric surgery is considered the most effective treatment for morbid obesity, and is increasingly performed in Thailand and globally. We aimed to establish the outcomes of bariatric surgery performed at Siriraj Hospital, Bangkok. Materials and Methods: This was a retrospective study of patients who underwent bariatric surgery between January 2012 and June 2016. Results: The records of the first 100 patients who underwent bariatric surgery were reviewed, comprising 58 patients who underwent laparoscopic sleeve gastrectomy (LSG) and 42 patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). The median patient age, preoperative body weight, and BMI were 36 years old, 129 kg, and 46.3 kg/m2. All the procedures were performed by a laparoscopic approach. The median operative times for LSG and LRYGB were 156 [85-435] and 265 [180-435] minutes. The median hospital stay was 3 days [3-14]. The major complication rate was 4%. There was no mortality in the 30-day postoperative period. The mean %excess weight loss (%EWL) of LSG was 56.8 ± 19.8%, 59.9 ± 21.7%, and 55.1 ± 21.3%, at 1, 2, and 3 years after surgery. The mean %EWL of LRYGB was 67 ± 18.3%, 66.2 ± 21.4%, and 63.6 ± 19.9%, at 1, 2, and 3 years after surgery. In the patients with type-II diabetes mellitus, 67% had complete diabetic remission at 1 year. The median FBS dropped from 127 to 99 mg/dL (p < 0.001) and HbA1c from 6.6% to 5.5% (p < 0.001). The remission rates of hypertension and dyslipidemia were 58% and 73%. Conclusion: The bariatric procedures are safe with a low complication rate. The procedures also provide good outcomes in postoperative weight loss and comorbidity resolution.

Obesity is becoming a universal healthcare problem. The role of endoscopic bariatric and metabolic therapies is emerging in the management of obesity and its related conditions. The endoscopic treatment can be used as a primary weight loss procedure and a revision procedure after bariatric surgery. While the prevalence of obesity has been rising over the past two decades in Thailand, the treatment options have been limited to diet and exercise, pharmacological treatment, and bariatric surgery until recently. In 2020, an endoscopic full-thickness suturing device was introduced to Thailand, leading to successful endoscopic bariatric therapy using a suturing device in Thai patients. This article intends to report the first successful endoscopic sleeve gastroplasty and transoral outlet reduction in Thailand with a mini-review focusing on these two procedures' outcomes.

Morbid obesity is associated with multiple life-threatening comorbidities. Bariatric surgery is the most effective intervention to achieve the long-term weight loss required to reverse many of these comorbid conditions. Laparoscopic bariatric surgery is the current gold standard approach; however the robotic approach has potential intraoperative and postoperative advantages that may be realized if limitations to instrument torque effect are overcome. We review the literature about the robotic bariatric surgery and describe our first robotic sleeve gastrectomy (RSG) and a single docking operative approach to robotic Roux-en-Y gastric bypass (RRYGB) in Siriraj Hospital, and also the first in Thailand. We demonstrate the operative room setup, the port sites, the technical details, and the key step illustrations, that both operative procedures were performed using the da Vinci® Si platform. According to the literature review, a robotic approach to bariatric surgery is an alternative option with comparable outcomes to laparoscopic approach and the potential for intraoperative and postoperative advantages. It is safe, feasible, and provides good clinical outcomes that are comparable to a conventional laparoscopic method.