Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 6/2017

01-06-2017 | Original Contributions

The Peri-operative Bariatric Surgery Care in the Middle East Region

Authors: Abdelrahman Nimeri, Mohammed Al Hadad, Mousa Khoursheed, Ahmed Maasher, Aayed Al Qahtani, Talat Al Shaban, Hayssam Fawal, Bassem Safadi, Amer Alderazi, Emad Abdalla, Ahmad Bashir

Published in: Obesity Surgery | Issue 6/2017

Login to get access

Abstract

Background

Bariatric surgery is common in the Middle East region. However, regional accreditation bodies and guidelines are lacking. We present the current peri-operative practice of bariatric surgery in the Middle East region.

Setting

Public and private practice in the Middle East region.

Methods

A questionnaire was designed to study trends of peri-operative care in bariatric surgery. It was sent to members of the Pan Arab Society for Metabolic and Bariatric Surgery (PASMBS).

Results

Ninety-three surgeons (88.6%) responded, 63.4% were in private practice, 68.5% have been in practice for more than 5 years, and 61.1% performed more than 125 cases per year. Laparoscopic sleeve gastrectomy (LSG) was the commonest procedure performed, then laparoscopic Roux-en-Y gastric bypass (LRYGB), one anastomosis gastric bypass/mini gastric bypass (OAGB/MGB), and laparoscopic adjustable gastric banding (LAGB). Pre-operatively as a routine, 65% referred patients for dietitian and (78.3%) for smoking cessation. In contrast as a routine, 22.6% referred patients to a psychologist, 30% screened for obstructive sleep apnea (OSA), and when they did, they did not use a questionnaire. For patients 50 years of age, 22% performed a screening colonoscopy and 33.7% referred patients to a cardiologist. Intra-operatively as a routine, 25.3% placed a drain and 42.2% placed urinary catheters. In contrast, 77.1% performed a leak test (82.7% as a methylene blue leak test). Post-operatively, 79.5% used chemoprophylaxis for venous thromboembolism and 89% required patients to take vitamins. In contrast, 25% prescribed ursodeoxycholic acid.

Conclusion

The wide variation in the peri-operative care of bariatric surgery in the Middle East region highlights the need for regional guidelines based on international guidelines.
Literature
1.
Klautzer L, Becker J, Mattke S. The curse of wealth—Middle Eastern countries need to address the rapidly rising burden of diabetes. Int J Health Policy Manag. 2014;2(3):109–14.CrossRefPubMedPubMedCentral
2.
3.
Meyer SB, Booth S, Gray J, et al. Ward PR quantitative analysis of bariatric procedure trends 2001-13 in South Australia: implications for equity in access and public healthcare expenditure. Aust Health Rev. 2015;39(1):63–9.
4.
Allan R. Martin, BASc, MD, Jason Klemensberg, Laz V. Klein, MD, MSc, David Urbach, MD, MSc, Chaim M. Bell, MD, PhD Comparison of public and private bariatric surgery services in Canada Can J Surg 2011; 54(3): 154–160.
5.
Varban OA, Reames BN, Finks JF, et al. Hospital volume and outcomes for laparoscopic gastric bypass and adjustable gastric banding in the modern era. Surg Obes Relat Dis. 2015;11(2):343–9. doi:10.​1016/​j.​soard.​2014.​09.​030.
6.
Ninh T. Nguyen, Mahbod Paya C. Melinda Stevens, Shahrzad Mavandadi, Kambiz Zainabadi, and Samuel E. Wilson, The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg 2004 ; 240(4): 586–594.
7.
Caroline M. Apovian,1 Sue Cummings et al. Best practice updates for multidisciplinary care in weight loss surgery obesity (Silver Spring). 2009 May; 17(5): 871–879. Published online 2009 Feb 19. doi: 10.​1038/​oby.​2008.​58010
8.
Jeffrey I. Mechanick, Adrienne Youdim, M.D., Daniel B. Jones, et al. AACE/TOS/ASMBS guidelines clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis 9 (2013) 159–191.
9.
De Luca M et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2016;26(8):1659–96.CrossRefPubMed
10.
11.
Khan A, King WC, Patterson EJ, et al. Assessment of obstructive sleep apnea in adults undergoing bariatric surgery in the longitudinal assessment of bariatric surgery-2 (LABS-2) study. J Clin Sleep Med. 2013;9(1):21–9.
12.
de Raaff CA, Pierik AS, Coblijn UK, de Vries N, Bonjer HJ, van Wagensveld BA. Value of routine polysomnography in bariatric surgery.Surg Endosc. 2016.
13.
Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.
14.
15.
Bauchowitz AU, Gonder-Frederick LA, Olbrisch ME, et al. Psychosocial evaluation of bariatric surgery candidates: a survey of present practices. Psychosom Med. 2005;67(5):825–32.
16.
Morgan DJ, Ho KM. Incidence and risk factors for deliberate self-harm, mental illness, and suicide following bariatric surgery: a state-wide population-based linked-data cohort study.Ann Surg. 2016 18.
17.
18.
Hadad M, Dehni N, Alakhras A, et al. Screening colonoscopy in the initial workup of bariatric surgery patients: guidelines are needed. Surg Endosc. 2014;28(5):1607–12.
19.
Ponce J, DeMaria EJ, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis. 2016 26
20.
Milone L, Strong V, Gagner M. Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI > or =50). Obes Surg. 2005;15(5):612–7.CrossRefPubMed
21.
Peterli R, Borbely Y, Kern B, et al. Early results of the Swiss Multicenter Bypass or Sleeve Study (SMBOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg. 2013;258(5):690–4. discussion
22.
Almazeedi S, Al-Sabah S, Alshmmai D. Routine trans-abdominal ultrasonography before laparoscopic sleeve gastrectomy: the findings. Obes Surg. 2014;24(3):397–9.CrossRefPubMed
23.
Abd Ellatif ME, Alfalah H, Asker WA, et al. Place of upper endoscopy before and after bariatric surgery: a multicenter experience with 3219 patients. World J Gastrointest Endosc. 2016;8(10):409–17.CrossRefPubMedPubMedCentral
24.
Sharaf RN, Weinshel EH, Bini EJ, et al. Radiologic assessment of the upper gastrointestinal tract: does it play an important preoperative role in bariatric surgery? Obes Surg. 2004;14(3):313–7.
25.
Medina FJ, Miranda-Merchak A, Martinez A, et al. Uselfulness of upper gastrointestinal series to detect leaks in the early postoperative period of bariatric surgery. (Spanish) Rev Med Chil. 2016;144(4):451–5.
26.
Miller K, Hell E, Lang B, et al. Gallstone formation prophylaxis after gastric restrictive procedures for weight loss: a randomized double-blind placebo-controlled trial. Ann Surg. 2003;238(5):697–702.
27.
Sugarman HJ, Brewer WH, Shiffman ML, et al. Multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss. Am J Surg. 1995;169(1):91–6. discussion 96-7
28.
Kavaturu S, Rogers AM, Haluck RS. Routine drain placement in Roux-en-Y gastric bypass: an expanded retrospective comparative study of 755 patients and review of the literature. Obes Sur. 2012;22(1):177–81.CrossRef
29.
Finks JF, English WJ, Carlin AM, et al. Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Ann Surg. 2012;255(6):1100–4.
30.
Aminian A, Andalib A, Khorgami Z, Cetin D, Burguera B, Bartholomew J, Brethauer SA, Schauer PR. Who should get extended thromboprophylaxis after bariatric surgery?: a risk assessment tool to guide indications for 305 post-discharge pharmacoprophylaxis. Ann Surg. 2016 8.
31.
Nimeri AA, Gamaleldin MM, McKenna KL, Turrin NP, Mustafa BO. Reduction of venous thromboembolism in surgical patients using a mandatory risk-scoring system: 5-year follow-up of an American College of Surgeons National Surgical Quality Improvement Program. Clin Appl Thromb Hemost. 2015 Nov 25.
32.
Frühbeck G. Bariatric and metabolic surgery: a shift in eligibility and success criteria. Nat Rev Endocrinol. 2015;11:465–77.CrossRefPubMed
Metadata
Title
The Peri-operative Bariatric Surgery Care in the Middle East Region
Authors
Abdelrahman Nimeri
Mohammed Al Hadad
Mousa Khoursheed
Ahmed Maasher
Aayed Al Qahtani
Talat Al Shaban
Hayssam Fawal
Bassem Safadi
Amer Alderazi
Emad Abdalla
Ahmad Bashir
Publication date
01-06-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 6/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-016-2503-7

Other articles of this Issue 6/2017

Obesity Surgery 6/2017 Go to the issue

Original Contributions

Postoperative Outcomes of Laparoscopic Bariatric Surgery in Older Obese Patients: a Matched Case-Control Study

Original Contributions

Predictors of Inadequate Weight Loss After Laparoscopic Gastric Bypass for Morbid Obesity

Erratum

Erratum to: Effects of Neighborhood Walkability on Physical Activity and Sedentary Behavior Long-Term Post-Bariatric Surgery

Original Contributions

Clinical and Metabolic Effects of Biliopancreatic Diversion Persist After Reduction of the Gastric Pouch and Elongation of the Common Alimentary Tract. Preliminary Report in a Series of Patients with a 10-Year Follow-Up

Original Contributions

Anthropometric Assessment for Bariatric Procedures in the Private Practice of a Registered Dietitian in Colombia

Letter to the Editor

Long-Term Results of Laparoscopic Sleeve Gastrectomy for Morbid Obesity: 5 to 8-Year Results