|Year : 2016 | Volume
| Issue : 2 | Page : 94-103
Abstracts from the Second SASMBS Conference, 7–9th October, 2016, Abha, KSA
|Date of Web Publication||13-Jan-2017|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Abstracts from the Second SASMBS Conference, 7–9th October, 2016, Abha, KSA. Saudi J Obesity 2016;4:94-103
| Childhood and adolescence obesity in Gulf States|| |
Prof. Tawfiq Khoja
Background: Obesity has become one of the most important public health problems in the world. Obesity during childhood is a matter of growing concern. Several reports show increasing rates of obesity in developed countries, whereas the extent of the problem in developing countries remains unknown. As the prevalence of obesity increases, so does the prevalence of the co-morbidities associated with obesity. For this reason it is imperative that health care providers identify overweight and obese children so that counseling and treatment can be provided. Co-morbidities of obesity in children and adolescents and the clinical evaluation of the obese child or adolescent are discussed separately.
Objective: The aim of this study was to fill this gap by quantifying the prevalence and trends of overweight among preschool children in developing countries and to highlight the situation in GCC Countries.
Results: The highest rates of obesity and overweight were reported from Bahrain. Studies from Saudi Arabia, and Kuwait showed an upwards trend in childhood obesity compared with a decade ago.
Conclusion: The data presented confirm that obesity and over-weight remains a major public health problem worldwide and mainly in GCC Countries.
Recommendations: Primary prevention, based on comprehensive population-based programs, is the most cost-effective approach to contain this emerging epidemic. Therefore, action to reduce the risk of overweight and obesity should focus on preventing and controlling the risk factors in an integrated manner. Intervention at all levels of society, from communities to governments, private organizations and non-governmental groups, is essential for prevention since the risk groups are entrenched in the framework of society influenced by many areas of national policy.
- These estimates show that attention should be paid to monitoring levels and trends of overweight in children and adolescents in GCC Countries
- The high prevalence of childhood obesity in the GCC Countries should stimulate policy-makers in the GCC to set up effective national and regional surveillance systems
- Interventions to encourage healthier lifestyles for children are needed at the national level and GCC level
- Primary prevention programs are needed to counteract this condition and its cardiovascular and metabolic complications
- Intensify all the efforts of technical and scientific, media and diplomacy to work towards a unified presence and supportive of NCD (obesity) control and prevention as a framework for development and investment community
- Investment in health system research and implementing community health research models which have to be realistic and comparable.
| Prevalence of obesity among Saudi Board resident in Aseer Region|| |
Dr. Abdullah Alzahrani
Objectives: To determine the prevalence of obesity and overweight among resident physicians in the postgraduate training programs of Saudi Board in Aseer Region, KSA.
Materials and Methods: Cross-sectional study was conducted during October to November 2013. Data were collected through a questionnaire developed by the researchers, which included the demographic data, weight and height measurements, and dietary habit using food frequency questionnaire. The researcher met all the respondents and measured their weight and height, then every subject was asked to fill the self-administered questionnaire.
Results: Out of 255 invited residents, 82.7% participated in this study. The mean age of the respondents was 27.9 ± 2.6 years. Almost two-thirds of them (66.8%) were males. Majority of them (96.2%) were Saudi. Overweight and obesity were reported among 36% and 23.2% of the residents, respectively. Obesity was significantly higher among male than female resident physicians (31.9% vs. 7.1%), P < 0.001. Taking of potatoes chips, sweets, pizza, never drinking skimmed milk, and never drinking semi-skimmed milk were significantly associated with obesity among resident physicians.
Conclusions and Recommendations: Frequency of overweight and obesity was high among Saudi Board residents in Aseer Region and significantly higher in male than female physicians. Taking of potatoes chips, sweets, pizza, never drinking skimmed milk, and never drinking semi-skimmed milk were significantly associated with obesity in this study.
| Metabolic abnormality associated with obesity among college students|| |
Prof. Mostafa Abolfotouh
Objectives: To estimate the prevalence of the metabolic abnormalities among Saudi college students in Riyadh, Saudi Arabia, to investigate the association between different indicators of body composition and these abnormalities.
Materials and Methods: A total of 501 college students participated in a cross-sectional study. Anthropometric assessments, BP measurements, and biochemical assessment were done. Metabolic abnormalities were identified.
Results: Applying BMI, 21.9% and 20.6% of students were classified as overweight and obese, respectively. Central obesity was prevalent in 26.9% and 42.2% of students based on WC and WHtR, respectively. Other metabolic abnormalities were hypertension (23.6%) and abnormal FPG level (22.6%). Three or more abnormalities were prevalent in 7.8% of students and increased significantly to 26.4%, 20%, and 17.6 in obese subjects based on BMI, WC, and WHtR, respectively. With the exception of abnormal FPG, the prevalence of individual metabolic abnormalities as well as the number of these abnormalities significantly increased with increasing BMI, WC, and WHtR (P < 0.001 each).
Conclusions and Recommendations: Our findings provide evidence for the presence of MS in Saudi college students. Central adiposity contributes to the high incidence of individual MS components. College health programs that promote healthful lifestyle and avoidance of adult weight gain are recommended.
| Obesity among diabetic and hypertensive patients in Aseer Region|| |
Dr. Abdullah Al Shahrani
Objectives: To assess the prevalence of overweight/obesity among diabetics and hypertensive patients and to determine the association between the degree of weight and diabetes/HTN control among patients attending primary health care centers (PHCCs) in Aseer region, southwest of Saudi Arabia.
Materials and Methods: The study was conducted by the end of the year 2010. All medical records were assessed by trained doctors and nurses working in the Chronic Disease Clinic at each primary health care center (PHCC) using a check list derived from the quality assurance manual of PHC. The Chronic Disease Services were based on the recommendation of the relevant guidelines. Data entry and analysis was carried out using Statistical Package for Social Sciences. P values less than 0.05 were selected for statistical significance.
Results: The prevalence of obesity among diabetics and hypertensive patients was 46% and 54%, respectively. The diabetic patients with good control comprised 21% of the study population, while less than one third of the patients had fair diabetic control and about half of the diabetics had poor diabetic control. About more than one-third of patients had good control of HTN and less than one-third suffered from overweight and more than half had obesity.
Conclusions and Recommendations: Most of the DM and HTN patients in the PHCCs in Aseer region, Saudi Arabia, suffer from overweight and obesity that could contribute significantly to the poor control of DM and HTN. Obesity and overweight should be given more attention during management of DM and HTN patients. Intensive health education regarding life styles and behavioral therapy are mandatory to reduce weight and to improve metabolic control. DM and HTN patients with obesity should be counseled about the benefits of bariatric surgery, which could be a good option of management if life styles/behavioral and medical therapies fail to achieve good metabolic control.
| Type 2 diabetes remission post bariatric surgery in Saudi population|| |
Dr. Hamid AlQumaidi
Objectives: To study the long-term impact of bariatric surgery types in patients with diabetes.
Materials and Methods: Single-center, non-blinded, interventional prospective trial. Thirty-Three obese T2DM patients, aged (49.3 ± 9.4) years, with BMI (42.9 ± 7.2) kg/m2 and 70.3% were women. The primary endpoint of this trial during 10 years follow up will be full remission of T2DM vs partial remission without anti-diabetic therapy post bariatric surgery.
Results: Study result showed a significant and insignificant decrease in HbA1c, BMI, Fasting and 2 hour Plasma Glucose as well as lipids profile depending on the type of bariatric surgery.
Conclusions and Recommendations: This study proved that bariatric surgery leads to many desirable metabolic changes in patients with diabetes.
| Experience with sleeve gastrectomy over 10 years|| |
Prof. Adnan Mofti
Objectives: To discuss our experience in performing LSG as a primary procedure to manage obesity with highlighting on long term outcomes.
Materials and Methods: Over a period of 11 years (May 2005–May 2016) a total of 3904 LSG procedures were performed. Out of these procedures, 86.3% (3369) were Primary procedures. Females formed the majority (69.4%). The technique of sleeve gastrectomy was standardized and all patients were under standard protocol of preparation and assessment before surgery and standardized post-operative management and follow up protocol. The files of the patients of the period 2005-2009 were reviewed and data extracted, while the remaining patients from APR 2009 till May 2016 all had electronic files which facilitated much the extraction of data and enabled quick and easy analysis.
Results: In this series there was two deaths, One patient died from aspiration in the 6th postoperative day, while the second patient died on day 72 from the date of surgery after developing leak on day 16th post surgery. The overall leak rate was 0.76%, while the average sustained EWL% was calculated as over 62.6% after 3 years from the date of the procedure.
Conclusions and Recommendations: LSG appears to be a suitable and safe primary procedure to manage obesity over a relatively long period of time. The most obvious benefits of the procedure are the alleviations of most of the comorbidities of obesity and its metabolic disorders.
| The future of bariatric surgery sleeve and sleeve plus|| |
Dr. C K Huang
Obesity and diabetes has become “Health Bomb,” which attacks every city in the world, and Asia is not put as exception. Bariatric surgery has been proved to be clinically effective and economically viable for obese people compared to non-surgical interventions. Bariatric surgery not only proves its efficacy in marked long-term weight loss, also aids in achieving substantial improvement or remission of co-morbidities, attributed to metabolic derangement, including type 2 diabetes mellitus (T2DM), hypertension, hyperlipidemia, and obstructive sleep apnea. It also reduces mortality and cancer occurrence. Nowadays it is progressing towards the so-called “metabolic surgery,” which performing similar surgery in lower body weight to benefit patients with metabolic derangement particularly T2DM. At present, most popular techniques of bariatric surgeries include Roux-en-Y gastric bypass, sleeve gastrectomy, gastric band, and bilopancreatic diversion. The global trend is moving towards sleeve gastrectomy based procedure in recent 5 years due to it’s simplicity of technique and less nutritional deficiency concern. Otherwise, it is questioned about the comparable result when compared with Roux-en-Y gastric bypass in weight loss and diabetic remission. Some novel procedures are invented, which mostly adding malabsorption to sleeve gastrectomy (Sleeve +). Duodenojejunal bypass, proximal jejunal bypass, gastric bipartition are all belonging to this. In this speech we will review and update the condition of sleeve gastrectomy and sleeve plus procedures.
| Prevention and control of obesity in adults: An inter-professional system approach|| |
Prof. Mohammed Y Alnaami
Aim and Objectives: To involve concerned health care and non-health professions, policy makers, and other stakeholders to work together and achieve the following objectives: (1) To meet and discuss available evidence and experiences for the prevention and control of obesity. (2) To generate a comprehensive strategic plan to prevent and control obesity. (3) To formulate guidelines and policies to prevent and control obesity in adults. (4) To implement the strategic plan, policies, and guidelines at different sectorial levels. (5) To communicate results of these interventions to public, academia, and government sectors to support inter-professional projects/programs related to obesity prevention and control.
Materials and Methods: Original idea was generated at the first residential meeting of the Foundation for Advancement of International Medical Education and Research (FAIMER), Manipal University-FAIMER International Institute for Leadership in Interprofessional Education Fellowship (MUFIILIPE) Program in May 2015, when the author fellow choose this project as being already engaged in national work on obesity prevention and control. Further work was initiated on ground by holding an important conference in Riyadh, Saudi Arabia, entitled «The International Conference on Countering Diabesity in the Gulf Countries» in October 2015. As a result of this conference, strategic recommendations were generated to be executed by the National Preventive and Curative Policies Committee (NPCPC). A second important achievement coinciding with this was the generation of a National Clinical Guidelines for the Prevention and Management of Obesity in Adults initiated by the MOH, KSU, and expert panel from McMaster University in Canada building on a prior Guidelines for Bariatric Surgery made by The Saudi Arabian Society of Metabolic and Bariatric Surgery (SASMBS) and other works.
Results: The International Conference on Countering Diabesity in the Gulf countries resulted in several recommendations and tasks. These recommendations and tasks were immediately communicated by participants to the National Preventive and Curative Policies Committee (NPCPC) responsible for formulating a regional strategic plan, for dissemination and implementation by various concerned sectors and stakeholders. The other achievement was the generation of evidence-based clinical guidelines for prevention and management of obesity in adults. Outcomes of these activities were disseminated to all concerned health sectors and institutions with related responsibilities. Limitations of above works include: Lack of a governance system; lack of coordination among health, academia, and other government sectors; dissemination failures; lack of policies and a plan for their implementation.
Conclusions and Recommendations: Obesity is becoming an epidemic worldwide due to individuals› imbalance between caloric intake and physical activity expenditure, abnormal behaviors, obesogenic cultures and environment, and other etiologic factors. This project with the help of national and international expert groups tries to document a road map for a multisectorial interprofessional system approach to prevent and control obesity in the region to influence its impact on individuals and community.
| Safety and efficacy of laparoscopic sleeve gastrectomy as revisional surgery for failed gastric band|| |
Dr. Ali AlMuntashery
Introduction: With the ever-increasing number of gastric band failures and the need to explant and revise them, coupled with the known higher incidence of complications associated with revisional procedures. A proper approach aiming to decrease the perioperative morbidity and producing a good long-term result is needed. The Laparoscopic Sleeve Gastrectomy (LSG) has shown to be a good revisional procedure after gastric band failure, in this study were assessing the safety and efficacy of preforming LSG as a staged procedure after gastric band failure.
Methods: 20 Morbidly obese patients received a staged LSG at our center between 2012 and 2016. Completion of the LSG was done once a minimum period of time has elapsed after explanting the gastric band. Using our patient data base a retrospective analysis of the data was done, Demographics, operative time, perioperative complications, length of stay, time between the two stages, and the % EWL at 3, 6, 12 months was analyzed.
Results: The mean BMI was 55 (38-76), operative time was 95 min (85-145), and the time between the two stages was 133 days (96-185). No leaks, bleeding, DVT/PE were observed, the EWL % at 1 year 76%.
Conclusion: In our small cohort of patients preforming a staged LSG after gastric band failure have produced similar overall weight loss to the single stage approach, however when a two stage approach is used a decrease in the perioperative outcome is noticed compared to the usually done one stage approach. Given the small number of our group more cases and longer follow-up is warranted for firm conclusion.
| Metabolic variables post sleeve|| |
Dr. Mohammed A Bawahab
Objectives: The objectives of this study were to investigate inflammatory biomarkers, metabolic health variables, status of oxidative stress and protective antioxidants in the blood and to compare the results between normal controls and obese patients subjects following 1 year of Bariatric Surgery-induced weight loss.
Methods: This prospective study was carried out in Aseer Central Hospital and Abha Private Hospital in Kingdom of Saudi Arabia, between January 2012 and April 2014. A total of 50 normal (BMI = 22–25 kg/m2) subjects and 50 obese (BMI = 45–50 kg/m2) patients were included. There were 20 men and 80 women patients, aged between 20 and 45 years. In the study subjects systemic blood cell counts were determined by Beckman coulter Unicel analyzer. Metabolic health variables, serum hepatic enzymes, cardiovascular risk factors, oxidative stress, antioxidant enzymes, serum sodium, potassium, copper and zinc levels were determined by spectrophotometric procedures, TSH and T4 were analyzed by Siemens Immunoassay System.
Results: Group 1: (Obese: pre-operative): This group compared with normal controls exhibited significant (P < 0.05) increase in inflammatory biomarkers. Significant (P < 0.05) rise in hepatic enzymes. Significant (P < 0.05) decrease in serum total bilirubin. Concentration of serum total cholesterol (TC), triacylglycerides (TG), low density lipoprotein cholesterol (LDL-C) and fasting blood glucose (FBG) were significantly (P < 0.05) increased, but HDL-cholesterol (HDL-C) was significantly depleted (P < 0.05). Serum urea and creatinine contents were significantly (P < 0.05) decreased. Serum copper and zinc levels were significantly (P < 0.05) increased. Serum malondialdehyde, stress an index, was significantly (P < 0.001) elevated and significantly (P < 0.001) lower levels of total antioxidant status, superoxide dismutase (Cu-Zn SOD), glutathione peroxidase (GPx), glutathione –S-transferase (GST), glucose-6-phosphate dehydrogenase (G6PDH), and vitamin C. Group 2: Sleeve Gastrectomy Surgery (Obese: post-operative): This group compared with obese group, preoperatively, demonstrated profound reduction in body weight (-32%) and BMI (-29%). Remarkable improvements in deranged metabolic variables approaching toward normality. Inflammatory biomarkers in blood and hepatic enzymes in serum were significantly (P < 0.001) decreased. Serum albumin and total bilirubin concentration were significantly increased (P < 0.001). Serum TC, TG, LDL-C, FBG and HDL-C exhibited significant (P < 0.05) reductions, reversal toward normality. Serum sodium, potassium, copper, zinc, and TSH levels were significantly (P < 0.001) decreased. Serum MDA levels were significantly (P < 0.001) decreased with remarkable (P < 0.001) increase in total antioxidant status, Cu-Zn SOD, GPx, GST, G6PDH, enzymes and vitamin C.
Conclusion: This study unraveled that obesity has harmful effects on whole metabolism in the tissues. It is speculative these perturbations were associated with a decrease in protective antioxidants in the body and enhancement of oxidative stress. Bariatric surgery, by contrast, is associated with remarkable efficacy in sustaining weight loss and bringing back normal metabolism of variables in tissues. These beneficial changes are probably linked to inhibition of oxidative stress and an enhancement in total antioxidant status following one year of Bariatric surgery-induced weight loss.
| Impact of male obesity on semen quality and serum sex hormones|| |
Prof. Mamdoh Eskandar
Objectives: This study aimed to investigate the association of high Body Mass Index (BMI) with semen parameters and reproductive hormones in men of reproductive age.
Materials and Methods: This study was conducted during the period from February 2009 to February 2011. Subjects were exposed through medical history evaluation as well as physical examination. BMI was calculated. Two semen samples about 1 week apart were taken from each participant by masturbation after 2-5 days of abstinence. The samples were assessed according to the WHO Criteria. Blood samples (5 mL) were withdrawn; centrifuged and the resulting sera were preserved at -4 degrees Centigrade. Serum FSH, LH, PRL and Testosterone levels were estimated by the ELISA method.
Results: When subjects were classified into 2 groups based on a BMI of 30, there was no significant difference between the 2 groups in any of the semen or hormonal parameters. There was no significant correlation between BMI and any of semen and hormonal parameters. There was significant negative correlation between age and total motility. Only the advanced paternal age has shown significant association with low motility (P = 0.007).
Conclusions and Recommendations: Our study showed a significant effect of aging on sperm motility and concentration and there was no relation between the age and the sperm quality.
| Mini gastric bypass how I do it?|| |
Dr. R Rutledge
Background: The articles on the Mini-Gastric Bypass (MGB) have confirmed that the original MGB technique leads to excellent results, but there have been reports of complications following procedures claimed/labeled as MGB, “Omega Loop”, SAGB and others. Reviewing these cases demonstrated that the operative procedures violated both the techniques described for the original MGB and in many cases violated some of the principles of general surgery as well.
Objective: The purpose of this paper was to define the technique of the MGB procedure specifically as compared to other bariatric procedures with special attention to anatomical and physiological issues of the MGB that affect patient outcomes.
Materials and Methods: Worldwide bariatric surgeons, including Rutledge, the originator of the MGB, were recruited for participation in the “Global MGB Surgical Technique Writing Group”. This international collaborative group of 70 surgeons with a combined reported experience with 27,436 MGBs was organized to work online on the standards of the technique for MGB. Surgeons participated in reviewing and contributed to the editing of the manuscript online.
Results: Understanding the technique of the MGB is built upon an understanding the anatomy and physiology of the operation which include; non-obstructive restriction based on post-gastrectomy syndrome and “limited” fatty food intolerance/fat malabsorption. Critical Factors Identified include; (1) start pouch at/below the crow’s foot (long pouch), (2) avoid “bird’s beak” deformity, (3) loose pouch (non obstructive), (4) avoid the esophagogastric junction, (5) avoid a twisted pouch, (6) never dissect the hiatus neither for hiatal hernia or GERD, (7) conservative biliopancreatic limb length, Recognition that the length of the gut is constantly changing, (8) understanding the % bypass/common channel offers no advantage than a standard 150-200 cm biliopancreatic limb, (9) attention to detail in performance of anastomosis, (10) wide gastrojejunostomy 3-5 cm, (11) avoid lateral gastric pouch staple line.
Conclusions and Recommendations: The MGB is now growing rapidly around the world. Careful training and understanding of the anatomy and physiology and important technical aspects of this operation can lead to excellent results and helps to avoid problems and complications. The steps of the procedure defined in the present study should be followed for better short and long term results.
| Key note SADIS procedure updated outcome|| |
Dr. Antonio Torres
Objectives: Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (ATI) is a novel one loop duodenal switch with a 250 cm common limb. A sleeve gastrectomy over a large bore bougie (54 French) is initially performed and the duodenum is transected 2 to 4 cm from the pylorus. An ileal loop, 200-250 cm from the cecum, is ascended antecolically and anastomosed to the duodenum in an end-to-side fashion.
Materials and Methods and Results: One-hundred and eighty patients have been consecutively operated upon. Mean initial body mass index (BMI) was 45 and 60% of the patients were diabetic. Mean excess weight loss was 90-95%, with only 3% of the patients failing to reach a 50% excess weight loss. Glycemia and HbA1c values normalized in the early postoperative periods, with 85% of the diabetic patients showing levels of HbA1c below 6%. The overall conversion rate for malnutrition is 3.8%, but this fell to 2.3% for patients with a 250 cm common limb.
Conclusions and Recommendations: (1) It has demonstrated that Roux-en-Y is NOT NECESSARY to complete a Duodenal Switch. (2) It has demonstrated that BPD can be performed with similar postoperative morbidity/mortality rates than Gastric Bypass or Sleeve. (3) It offers the same weight and metabolic results as the Duodenal Switch, probably with a better QoL, (4) SADI-s is an effective therapeutic option for obese patients with dabetes mellitus.
| Revision bariatric surgery experience from Kuwait|| |
Dr. Salman Al-Sabah
Objectives: Laparoscopic sleeve gastrectomy (LSG) is increasing worldwide; however, long-term follow-up results included insufficient weight loss and weight regain. This study aims at assessing the outcomes of converting LSG to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic re-sleeve gastrectomy (LRSG).
Materials and Methods: A total of 1300 patients underwent LSG from 2009 to 2012, of which 12 patients underwent LRYGB and 24 patients underwent LRSG in Al-Amiri Hospital alone. Data included length of stay, percentage excessive weight loss (EWL%), and body mass index (BMI).
Results: Twenty-four patients underwent conversion from LSG to LRSG, and 12 patients underwent conversion from LSG to LRYGB due to insufficient weight loss and weight regain. Eighty-five percent were females. The mean weight and BMI prior to LSG for the LRYGB and LRSG patients were 136.5 kg and 52, and 134 kg and 50, respectively. The EWL% after the initial LSG was 37.9 and 43%, for LRYGB and LRSG, respectively. There were no complications recorded. Results of conversion of LSG to LRYGB involved a mean EWL% 61.3% after 1 year (P value 0.009). Results of LRSG involved a mean EWL% of 57% over interval of 1 year (P value 0.05). Comparison of the EWL% of LRYGB and LRSG for failed primary LSG was not significant (P value 0.097).
Conclusions and Recommendations: Following our algorithm, revising an LSG with an LRSG or LRYGB for poor weight loss is feasible with good outcomes. Larger and longer follow-up studies are needed to verify our results.
| Laparoscopic Roux Y gastric bypass correlation between radiographic and clinical findings and revision of literature|| |
Dr. Abdelrahman Nimeri
Background and Objectives: One anastomosis Gastric bypass/Mini Gastric bypass (OAGB/MGB) was described in 2001 by Dr Robert Rutlege. Initially, concerns regarding bile reflux gastritis were raised. However, large series from experts showed low rates of bile reflux gastritis. It is possible that bile reflux gastritis is common during the learning curve of OAGB/MGB. Here in we present 3 cases of laparoscopic management of patients with severe bile reflux gastritis after OAGB/MGB.
Materials and Methods: We have reviewed our prospective database for all patients presenting with complications of OAGB/MGB from 2012-2016.
Results: We have seen 3 patients with severe bile reflux gastritis, malnutrition after OAGB/MGB. All 3 patients were re operated by the primary surgeon before referral to our institution. Two had Braun jejuno-jejunostomy with or without hiatal hernia repair and one had laparoscopic cholecystectomy without improvement. Upper endoscopy confirmed severe bile reflux gastritis/esophagitis in all 3 patients. All 3 patients were malnourished and required enteral/parenteral nutrition for several weeks prior to conversion to Roux en Y gastric bypass. The most common intra operative finding in all 3 patients was a short gastric pouch 4-5 cm long. No conversions, leak, stenosis or mortality. Bile reflux gastritis, malnutrition resolved in all 3 patients. One patient developed a non-healing marginal ulcer requiring revision of the gastrojejunostomy.
Conclusions and Recommendations: Bile reflux gastritis is common after OAGB/MGB when the gastric pouch is short. Laparoscopic conversion to RYGB is safe and effective.
| Weight regain post gastric bypass adding restriction|| |
Dr. Khaled Gawdat
Background: The gastric bypass procedure is one of the most commonly performed bariatric procedures with variable success and Failure rates. Revisional bariatric surgery is an important part of the bariatric surgery practice and revision after failed gastric bypass is occasionally needed. Trimming and banding of the gastric pouch, malabsorptive intestinal configuration and jejunal sleeve are different surgical tools used to treat gastric bypass failures.
Objective: A prospective study evaluating the various surgical techniques used for revising failed gastric bypass procedures.
Methods: From April 2005 till March 2016, 76 failed gastric bypass patients had a revisional bariatric procedure. 62 patients (81.5%) had an intact Proximal Roux-en-Y gastric bypass, 11 patients had a mini gastric bypass (14.4%), 3 patients (3.9%) had a Roux-en-Y-gastric bypass with gastro-gastric fistula. All patients had a laparoscopic Banded micro-pouch gastric bypass procedure 6 patients had concomitant jejunal sleeve.
Results: 91% were females mean age 31 years, Mean preoperative BMI was 49.8 kg/m2 (39-62 kg/m2) Operative time mean 120 minutes. Hospital stay mean 3.4 days, 2 patients had postoperative leaks (2.6%), 1 patient had pulmonary embolism (1.3%), 1 patient had pneumonia (1.3%). No mortality was encountered. Late complications were band erosion in 3 patients (3.9%) anastomotic stricture in 2 patients (2.6%), excessive weight loss in 2 patients (2.6%). Postoperative weight loss was 76% EBWL at 18 months. 72% EBWL at 36 months, 69% EBWL at 5 years and 66% at 10 years.
Conclusion: LBMRYGB + jejunal sleeve gives excellent and durable weight loss as a revisional bariatric procedure. Complication rates are higher than the primary group but less than reviosional surgery after other bariatric procedures. Appropriate primary and secondary procedure choice remains very essential to reduce treatment failures.
| Portal vein thrombosis post sleeve gastrectomy 3 case series and literature review|| |
Dr. Essam Batayyah
Aim: To highlight this unique complication, post bariatric surgery after the most common performed procedure worldwide laparoscopic sleeve gastrectomy.
Methods and Results: Case series of 3 patient’s young males developed portal vein thrombosis from June 2015 to June 2016 at single institute Aseer central hospital, all patients treated with anticoagulation subcutaneous LMWH followed by warfarin with no further complications.
Conclusion: High index of suspension with proper diagnostic tools as the presentation is untypical in the 3 patients and early management is crucial for successful low morbidity and mortality.
| Portal vein thrombosis after laparoscopic sleeve gastrectomy|| |
Dr. Hussam Adi
Aim: Portal vein thrombosis (PVT) is an unusual complication after laparoscopic sleeve gastrectomy (LSG). Our study aims to review the incidence, etiology, clinical presentation and treatment of PVT after LSG.
Methods and Results: We are presenting a 43 year-old female patient who had uneventful LSG for morbid obesity with body mass index of 44.3 kg/m². She presented after 11 days with abdominal pain and vomiting. Computed tomography enhanced with oral and intravenous contrast (CT) revealed portal thrombosis extending to superior mesenteric and splenic veins without bowel ischemia. Prompt anticoagulation was started in form of Enoxaparin followed by wafarin. Hospitalization duration was 13 days. Thromobophillia tests were negative. The patient was asymptomatic on follow up after 3 months. We reviewed the literature about the incidence, causes, clinical features, treatment and the long-term outcomes of PVT after laparoscopic sleeve gastrectomy. The incidence of PVT after an uncomplicated surgery is 0.3-1%. Symptoms presented at a median of 15 days after operation with abdominal pain in most cases. The etiology of PVT is multifactorial including undiagnosed thrombophillia, smoking, local injury near the portal flow, oral contraceptive use prolonged time in the reverse Trendelenburg position and dehydration. CT has been reported to diagnose and monitor the patient with sensitivity of 90%. Early detection and management by full anticoagulation are necessary to improve the clinical outcomes. Late treatment of PVT can lead into portal cavernomatosis with its complications.
Conclusions: PVT is a rare complication post sleeve gastrectomy. High suspicion is the key for early diagnosis. Appropriate anticoagulation treatment is important to prevent fatal complications.
| Safety and efficacy of oral anticoagulation|| |
Dr. Raad Fayez
Introduction: Laparoscopic sleeve gastrectomy is being performed with an increasing frequency; portal and mesenteric vein thrombosis could occur following general laparoscopic and bariatric procedures, the challenge in diagnosis coupled with the devastating effect leading to bowel infraction makes it a serious complication.
Methods: We are presenting 3 cases of an uneventful LSG preformed for morbid obesity, Patients presented during the second week post operatively. CT scan of the abdomen confirmed the presence of Portomesenteric vein thrombosis; full anticoagulation therapy was initiated using therapeutic doses of low molecular weight heparin followed by Oral Factor Xa Inhibitors (rivaroxaban) as outpatient.
Results and Discussion: All patients were discharged within a week from the hospital, none of the patients required surgery and there was no death. Follow CT was done at 2 weeks and six months interval. At 6 month, CT scan showed initial recanalization of the portomesentric system. Portal and mesenteric vein thrombosis can lead to bowel infarction, lucky it occurs infrequently. It’s difficult to diagnose and a high index of suspicion is needed. Furthermore, identifying high-risk patient groups and keeping them on an extended low molecular weight heparin prophylaxis might be warranted to help prevent such a complication. In our small cohort Dehydration and early travelling might have played a role in the incidence of such complication.
Conclusion: The use of Oral Factor Xa Inhibitors showed good efficacy as a long term anti coagulation treatment with a good safety profile and ease of use without frequent monitoring.
| Feasibility and safety and intergalactic balloon in high risk patient|| |
Dr. Mohamed Khan
Introduction: Intragastric balloon is a temporary treatment for weight loss with proven safety and efficacy when associated with lifestyle intervention. It is indicated in the super--obese who are candidates for bariatric surgery to lose weight and to reduce their high surgical risk.
Methods and Results: 40 Super-super morbid obese/high-risk bariatric surgery candidates prospectively reviewed after endoscopic insertion of adjustable gastric balloon. Median body mass index (BMI) 69 ± 9,45 kg/m (2). The median weight loss of 12 ± 9,46 kg with mean excessive weight loss of 22.6 ± 16,99%. There was 1 patient required removal of the ballon due to significant upper GI bleeding. 4 patients went on to bariatric surgery. The median time between balloon removal and surgery was 220 days. Operated 4 patient had very smooth perioperative course with mean operative time 54 minutes and postoperative LOS 1.2 days. There were no complications nor mortality.
Conclusions: Intragastric balloon as bridging procedure for very high-risk bariatric surgery patients is save and feasible.
| Management of late complication of BPD by revision|| |
Dr. Mohammed K Mirza
Objectives: BPD is highly effective mal absorptive bariatric surgery buy it has some severe late metabolic and clinical complication which can be corrected by revision (total\restoration\elongation) but can associated with weight regain. In our technique we do revision with no weight regain.
Materials and Methods: Laparoscopic elongation\restoration of common limb with resizing of the stomach pouch using calibration tube.
Results: 2 hrs. operative time duration Uneventful surgery Immediate improve of diarrhea and bad smell of stool on the next day, no weight regains three months Post-OP with normalization of all biochemical parameters.
Conclusions: The procedure is safe, effective, and recommended as a revision surgery.
| Weight loss among obese patients in Aseer Region, KSA|| |
Dr. Yahia AL-Khaldi
Background and Objectives: In Saudi Arabia, overweight and obesity affect more than 75% of adult population. National studies concluded that the most two contributing factors leading to obesity epidemic in Saudi Arabia are intake of imbalanced diet and lack of regular physical activities. The purpose of this paper is to study the trial of weight loss and the factors determine it among adult overweight/obesity in Abha city, southwest Saudi Arabia.
Methodology: This cross sectional study was conducted in Abha city during August 2014G. In order to achieve the objectives of this study the investigators constructed a questionnaire in Arabic language with the following parts; demographic data, history of any medical condition, awareness about current weight, awareness about harm of obesity, past trials to lose weight, types of interventions to lose weight, results of trial. The questionnaire was validated by two family physicians and then administered by well trained nurses to all adult people visiting to “Obesity Exhibition” which was executed by SASMBS in August 2014 for one week.
Results: A total of 422 clients visited the obesity exhibition site during one week of the study. Out of them, 263 individuals (62%) were either overweight or obese. The mean age was 36 year, majority of participants was females (71%) and married (67%), housewives and officers constituted 27% and 29%% of participants respectively. About 83% knows their current weight, and 90% reported that obesity has harmful effect on their health. More than 2/3 of participants mentioned that they tried to lose their weight in the past but less than 20% of them reported its success. About 25% used both diet and exercise, 4% used drugs while 17% used traditional therapies as an intervention to lose weight. Most of participant (81%) fail to lose weight as they were poor compliant with diet and exercise. Average weight loss was 7.5 kilograms (SD = 6 kilogram), with maximum loss of 33 kilograms and a minimum of one kilogram. It was found that females (27%) use herbals to reduce their weight compared to males (6%) (P = 0.000). Practicing physical activity to lose weight was higher among males (31%) compared to female (19%), but no association with other demographic variables.
Conclusion: Majority of patients failed to achieve the target weight loss. The underlying reasons for failure were poor compliance to diet and physical activities.
| Changes in overweight and obesity during the early years of schooling among children in a central region of Saudi Arabia|| |
Background and Objectives: Childhood overweight and obesity have become a public health problem globally. This study aims to determine the prevalence of these health conditions in government school children in the two cities of Buraidah and Unaizah of the Qassim Region, Saudi Arabia. A key question we examined is whether the children enter the school as overweight or develop overweight after entering the school.
Methods: Using a cross-sectional, observational study design, a random sample of 874 school children between 6 – 10 years was enrolled in 2010/2011. A structured questionnaire was used for collecting data on the locations of the schools and socio-demographic characteristics of the study participants. Weight and height were measured, and the body mass index (BMI) was categorized.
Results: Based on the World Health Organization (WHO) definition, the overall prevalence of overweight and obesity was 12.8% and 10.1% respectively. Girls had a higher prevalence of overweight (18.4%) and obesity (15.6%) than boys. Overweight increased dramatically from 7.6% in Grade 1 to 19% in Grade 4. Similarly, obesity also increased progressively after entering the school.
Conclusion: Our study suggests that overweight and obesity are mostly acquired after entering the school. Intervention public health program should promote a healthy lifestyle from the early years of schooling.
| Weight status among pregnant women in Aseer Region, Saudi Arabia|| |
Bandar Abdullah Al-Asmari
Background and Objectives: Obesity is one of the most common chronic diseases in Saudi community that affecting all ages and both genders. The aim of this study is to estimate the weight status of pregnant women and its associated factors in Aseer Region, Saudi Arabia.
Methodology: This cross-sectional study was conducted on pregnant women who were follow at antenatal clinics in primary health care center (PHCC) in Aseer Region during the period (3rd to 7th of November 2013). Data collection sheet was designed by the investigators to achieve the aim of this study. Working nurses in the antenatal care clinics were given written instructions regarding the objective, the importance of this study and how to measure the weight and how to fill data collection sheet properly. Data were coded and then entered into a personal computer provided with SPSS.
Results: A total of 800 pregnant women attended PHCCs during the period of study. The mean age was 29.4 ± 6.3 years and about 50% of them were between 26 and 35 years old. Saudi represents the vast majority, and 85% of them were housewives. Mean of gravidity and parity were 4 and 2.5 respectively. Mean gestational age was 20 weeks, and rate of obesity and overweight were 32% and 38%, respectively.
Conclusions: This study revealed that most of pregnant women attending PHCC in Aseer Region were overweight or obese which indicated the importance of primary prevention (health education program) and secondary prevention (screening) regarding obesity and its associated health problems as early as possible particularly during premarital and preconception stages.
| Knowledge, attitude and practice of primary health care physicians in Aseer Region regarding obesity|| |
Yahia M Al-Khaldi, Waleed S Abu Melha, Abdullah M Al-S hahrani, Safar A Al-S aleem, Mohammed A Hamam
Background and Objectives: Obesity is one of the most common chronic diseases that could be managed at PHCC settings. The objective of this study was to explore knowledge, attitudes, and practice of PHCC physicians in Aseer Region, regarding obesity.
Materials and Methods: This cross-sectional study was conducted among physicians working at PHCC in 2012. In order to achieve the objectives of this study, the investigators designed a questionnaire which composed of three parts namely; sociodemographic data, knowledge related questions, attitude related questions, practice related questions in addition to some questions related to infrastructures, and barriers facing management of obesity at PHCC. Questionnaire was distributed to all PHCC doctors using post. Data entry and statistical analysis was carried out using SPSS version 21.
Results: The total number of doctors responded was 294 out of 339, giving a response rate of (87%). Mean age of participants was 38 year, male represented 63%, 61% had no post MBBS qualification and one third are working in big cities. More than 50% of centers were having registers, guidelines and screening program for obesity. The most common encountered barriers to care for obesity at PHCC were lack of (time, health education materials, guideline and referral system). Most of physicians showed good attitude regarding management of obesity compared to knowledge which was inadequate as reflected by total knowledge score which was less than 7 points among 64% of participants. More than half of participants reported that they gave advices about the roles of diet, exercise in management of obesity to their clients.
Conclusion: This study revealed that PHCCs in Aseer region need adequate infrastructures to care for obese patients while PHCC doctors are in need of training to improve their knowledge and develop their skills in order to introduce good care for their obese patients.
| Knowledge and training needs of primary healthcare physicians regarding obesity management in Saudi Arabia|| |
Shaker A Alomary, Mohammad Y Saeedi, Tahani M Alotaibi, Fahad S Al Shehri, Amal O Bashir, Anna Z Ali, Ashraf A El-Metwally
Background and Objectives: Obesity in Saudi Arabia is reaching an alarming level and hence the role of primary healthcare physicians becomes a necessity. This study aims to evaluate primary health care knowledge and the training needs with respect to managing obesity in Saudi Arabia.
Methods: A questionnaire based cross-sectional survey was conducted among PHCC physicians in Saudi Arabia between May and October 2014. Questionnaire consisted of three parts; demographic data, questions about basic knowledge on obesity and training needs of PHCC physician regarding obesity. Questionnaire was distributed to selected physicians and response by ordinary mail through technical supervisors in general directorates all over KSA. Data entry and analysis were s carried out using SPSS.
Results: Seven hundred and seven physicians completed the questionnaire and returned it to the investigator. General knowledge about obesity was acceptable, as most of questions were answered correctly, 83.6% of the physicians had not received any specialized course or training on obesity. Priority of training requested by physicians was psychotherapy, medications (88%), counseling on nutrition/exercise (84%), and surgical therapy (75%). The difference regarding needs for training was not significantly different in relation to gender and nationality.
Conclusion: This nationwide survey found that physicians had acceptable knowledge towards the management of obesity and overweight, however, they need to have more training regarding prevention and management of obesity.
| Association between obesity and mental disorders among male students of King Khalid University, Abha, Saudi Arabia|| |
Ali Abdullah AlMousa AlQahtani, Shamssun Nahar, Saeed Mohammed AlAhmari, Khaled Saad AlMousa AlQahtani
Background and Objectives: Previous research suggested that obesity is associated with an increased risk of mental illness. Depression, stress, and anxiety are among the psychological problems that are commonly associated with obesity among students. However, evidence linking obesity to mental illness is inconsistent. The objective of this study was to investigate the associations between mental disorders (in particular the depression, anxiety, and stress) and obesity in the male students of King Khalid University (KKU).
Subjects and Methods: A cross-sectional study was conducted including male Saudi students enrolled in KKU at Abha City during the academic year 2013–2014. A multi-stage random sampling technique was adopted. Data were collected using the Arabic version of the depression anxiety stress scale.
Results: The study included 389 university students. Their age ranged between 18 and 26 years with a mean age of 21.2 ± 1.5 years. They were almost equally distributed between four colleges (Medicine, Pharmacy, Sciences, and Languages and translation). Overweight was reported among 22.1% of the students whereas obesity was reported among 18.3% of them. The overall prevalence of depression, anxiety, and stress were 48.1, 58.9, and 40.4%, respectively. The association of obesity with depression, anxiety, and stress was found statistically significant (P < 0.001, <0.001 and <0.003, respectively).
Conclusion and Recommendations: The prevalence of overweight and obesity are considerably high among male University Students in Abha. These findings suggest that obesity is associated with depression, anxiety, and stress. Prospective studies will ultimately be required in order to clarify the temporal relation between obesity and common mental disorders.
| Dietary habits among female medical students in King Khalid University, Abha City, 2014|| |
Safar Abadi Al Saleem, Reem Saeed Alahmari, Mastorah Saeed Alahmari
Background and Objectives: Diet and physical activity play important roles in maintaining health. A better understanding of the relationships and healthy behaviors among people are considered as effective prevention and management techniques of lifestyle-related risk factors. This study aims to assess and determine the dietary habits among the female medical students in King Khalid University (KKU).
Materials and Methods: A cross-sectional study was conducted among female medical college students of KKU, Abha. A previously validated questionnaire was used. It consisted of information about the students (age, grade, and marital status), their measurements [weight, height, and body mass index (BMI)], their dietary assessment using Food Frequency Questionnaire, and physical exercise assessment using General Practice Physical Activity Questionnaire.
Results: Out of the 382 students, 314 female medical students were included for the study with a response rate of 82.2%. Their age ranged between 17 and 29 years. Half of them were normal whereas 20.7% and 9.2% were overweight and obese, respectively. Regarding physical activities, 60.8% female students were physically inactive whereas 29% and 8.6% of them were moderately inactive and active, respectively. Only 1.6% students were active. The infrequent intake of fresh vegetables was associated with higher significant rate of overweight and obesity among female students (12.2% vs. 8.3%, P = 0.009). Less intake of fresh fruits was associated with higher significant rate of obesity among female students (30.5% and 17% vs. 18.4% and 7.5%, respectively, P = 0.008), whereas the frequent intake of chocolate was associated with higher significant rate of overweight among female students (24.7% vs. 1.8%, P < 0.001).
Conclusion: A considerable proportion of female students of KKU, KSA were either overweight or obese. Some dietary habits were significantly associated with overweight and/or obesity among them.