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Background: Obesity is associated with increased mortality due to higher cardiovascular risk. A proportion of this risk is attributed to impaired lipid profile in the form of high levels of serum total cholesterol, triglycerides, and low levels of HDL cholesterol. Both sleeve gastrectomy (LSG) and gastric bypass (LGB) have been shown to have favourable effects on lipid profile with some variability in improvement. We aimed to study the difference in changes in lipid profile after LSG and LGB., Methods: We performed a retrospective case-matched study comparing effects of LSG and LGB on lipid profile of patients who underwent bariatric surgery from September 2014 to September 2015. The matching was done based on criteria of age and body mass index (BMI)., Results: Out of a total of 92 selected patients, 69 patients underwent LSG and 23 patients underwent LGB. There was a significant improvement in serum triglycerides and HDL cholesterol with no significant reduction in serum total cholesterol in both LSG and LGB group. There was a significant reduction in cardiovascular risk calculated as total cholesterol: HDL cholesterol ratio following bariatric surgery (p = 0.002)., Conclusion: Both LSG and LGB have similar effects on lipid profile cardiovascular risk attributed to it in Indian obese. Thus, sleeve gastrectomy may be considered as effective as a gastric bypass for dyslipidaemia improvement in Indian patients.

Background: Surgically induced weight loss improves nonalcoholic fatty liver disease (NAFLD) in morbidly obese Caucasian patients. Similar data are lacking from India., Objective: To compare the histologic features of NAFLD in morbidly obese Indian patients before and 6 months after bariatric surgery. Histologic changes were also separately assessed according to the type of bariatric intervention., Setting: Teaching institution, India; private practice., Methods: All patients undergoing bariatric surgery from July 2012 to July 2013 underwent a routine liver biopsy at the time of bariatric surgery. If the biopsy specimen indicated NAFLD, patients were asked to undergo a second biopsy after 6 months. Baseline anthropometry, clinical data, biochemistry, and pathology were recorded and repeated at follow-up., Results: Eighty-eight of 134 index biopsy specimens indicated NAFLD. Thirty patients had paired liver biopsies. Steatosis was present in all, 14 had lobular inflammation, 10 had ballooning degeneration, and 14 had fibrosis. Mean time between the biopsies was 7.1 months (range 6-8 months). At the second biopsy, steatosis had resolution in 19 and improvement in 11, lobular inflammation had resolution in 12 and improvement in 2, ballooning had resolution in 9 and improvement in 1 and fibrosis had resolution in 11 and improvement in 3 (P<0.05 for all). Improvement was greater among those who underwent a sleeve gastrectomy in comparison to a Roux-en-Y gastric bypass, although this difference was not statistically significant. None had worsening of liver histologic results., Conclusions: Surgically induced weight loss significantly and rapidly improves liver histology in morbidly obese Indians with NAFLD., (Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To analyze the safety in combing laparoscopic ventral hernia repair with a mesh and bariatric surgery., Background: Obesity is one of the important precipitating factors for primary and recurrent ventral hernias (incisional and umbilical) and it is not uncommon to find these hernias in patients opting for obesity surgery. But, with no consensus or recommendation and concern of mesh infection, surgeons fear in combining these procedures, especially Roux en Y gastric bypass and sleeve gastrectomy., Methods: In this study, we have retrospectively analyzed all patients who underwent concomitant bariatric procedure and mesh repair for ventral hernia at our institute., Results: A total of 36 out of 765 patients operated at our institute between 2003 and 2011 had concomitant procedures. Eleven patients had Roux en Y gastric bypass (group I) and remaining 25 had sleeve gastrectomy (group II) performed on them. The operating times were 149 min(120-210 min) in group I and 122 min (90-220min) in group II. No immediate complications or any incidence of mesh infection or recurrence in either of the groups., Conclusion: Concomitant mesh repair for ventral hernias can be safely combined with bariatric procedures like Roux en Y gastric bypass and sleeve gastrectomy. But, for beginners, these should be done only in selected cases after fully informed consent from the patients.

Background: The incidence of obesity and related metabolic disorders in India and that of stomach carcinoma is one of the highest in the world. Hence, one requires a procedure that allows postoperative surveillance of the stomach with the best outcomes in terms of weight control and resolution of co-morbidities. Here, we compare one such procedure, duodenojejunal bypass with sleeve against the standard Roux-en Y gastric bypass., Methods: Fifty-seven patients who were selected for a bypass procedure were randomized into two groups of laparoscopic duodenojejunal bypass with sleeve (DJB) and laparoscopic Roux en Y gastric bypass. The limb lengths were similar in both the groups, and the sleeve was done over a 36F bougie., Results: The mean body mass index and percent excess weight loss at the end of 3, 6, and 12 months between the groups were not statistically significant. The operating times were higher in the DJB group. The rate of resolution of diabetes, hypertension, and dyslipidemias were also similar with no statistical significance. There was 100% resolution of dyslipidemias in both groups. There was one patient in the DJB group who presented with internal herniation 1 month post-op and was managed surgically. There was no mortality in both the groups., Conclusion: Laparoscopic duodenojejunal with sleeve gastrectomy, a procedure which combines the principles and advantages of sleeve gastrectomy and foregut hypothesis, is a safe and effective alternative to gastric bypass in weight reduction and resolution of co-morbidities especially for Asian countries. But, long-term follow-up is required.

Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed metabolic surgery worldwide. There are few mid- to long-term studies for LSG, especially from the Indian subcontinent. Objective: The primary outcome of the study was percent total weight loss (%TWL), and secondary outcomes included type 2 diabetes mellitus remission (T2DM) rates, comorbidity resolution rates, revisional surgeries, and complications related to LSG, 3 and 5 years after surgery. Method: The study was a single-center, retrospective analysis from patients who underwent primary as well as revisional LSG between January 2012 and December 2013 from a tertiary care center in India. We included patients who completed a minimum follow-up of 5 years. Details of the patients were collected from outpatient and inpatient case sheet records, during their follow-up. Results: Out of a total of 284 patients, 57% were females. Mean baseline body mass index (BMI) was 44.9 ± 7.9 kg/m2. The diabetic population comprised 14.8% of the total patients. Mean %TWL at 5 years was 26.0 ± 9.9%. T2DM remission at 1, 3, and 5 years were 78.5%, 71.4%, and 66.6%, respectively. Preoperative BMI (p = 0.02), glycosylated hemoglobin (HbA1c) (p = 0.04), duration of diabetes in years (p = 0.04), and preoperative insulin usage (p = 0.04) were the preoperative predictors for T2DM remission. Early (< 30 days) and late (> 30 days) complications were seen in 4.5% and 0.7% of the population, respectively. Conclusion: Weight loss after LSG was maintained in the majority of the patients, while a small proportion has significant weight regain at 5 years. T2DM resolution and other comorbidity resolutions were well supported after LSG. [ABSTRACT FROM AUTHOR]

Bariatric surgery has proven benefits for morbid obesity and its associated comorbidities. Laparoscopic approach is well established for bariatric surgery. Single-incision laparoscopic surgery (SILS) offers even more minimally invasive approach for the same with the added advantage of better cosmesis. We have developed and standardised the SILS approach at our institute. We share our experience and technical 'tips' and modifications which we have learnt over the years. Technical details of performing sleeve gastrectomy and Roux-en-Y gastric bypass with special attention to liver retraction, techniques of dissection in difficult areas, creation of anastomoses and suturing have all been described. In our experience and in experience of others, single-incision bariatric surgery is feasible. Use of conventional laparoscopic instruments makes single-incision approach practical for day-to-day practice. Supervised training is essential to learn these techniques. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgeries are now redefined as metabolic surgeries given the excellent resolution of metabolic derangements accompanying obesity. Duodenojejunal bypass (DJB) is a novel metabolic surgery based on foregut hypothesis. Reports describe DJB as a stand-alone procedure for the treatment of diabetes in nonobese subjects. For obese subjects, DJB is combined with sleeve gastrectomy. This combination of DJB and sleeve gastrectomy is proposed as an ideal alternative to Roux-en-Y gastric bypass (RYGB) with these advantages: (1) easy postoperative endoscopic surveillance, (2) preservation of the pyloric mechanism, which prevents dumping syndrome, and (3) reduced alimentary limb tension. This study aimed to analyze the short-term outcomes of laparoscopic DJB with sleeve gastrectomy for morbidly obese patients. Methods: At our institution, 38 patients who underwent laparoscopic DJB with sleeve gastrectomy were followed up. The inclusion criteria for the study were according to the Asian Pacific Bariatric Surgery Society guidelines. Sleeve gastrectomy was performed over a 36-Fr bougie, with the first part of the duodenum mobilized and transected. The jejunum was divided 50 cm distal to duodenojejunal flexure. A 75- to 150-cm alimentary limb was fashioned and brought in a retrocolic manner. End-to-end hand-sewn duodenojejunostomy was performed. Intestinal continuity was restored with a stapled jejunojejunostomy, and mesenteric rents were closed. Results: The study population consisted of 38 patients (15 men and 23 women) ranging in age from 31 to 48 years. During a mean follow-up period of 17 months, the excess body weight loss was 72%, with a 92% resolution of diabetes. One patient presented with internal herniation through the retrocolic window 1 month after the operation and was managed surgically without any complication. No other minor or major complications occurred, and there was no mortality. Conclusion: Laparoscopic DJB with sleeve gastrectomy is safe and effective in achieving durable weight loss and excellent resolution of comorbidities. Long-term follow-up studies are needed. [ABSTRACT FROM AUTHOR]