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Dixon J.B.,Baker IDI Heart and Diabetes Institute | Bhasker A.G.,Center for Obesity and Digestive Surgery | Bhasker A.G.,The Surgical Center | Lambert G.W.,Baker IDI Heart and Diabetes Institute | And 2 more authors.
Surgery for Obesity and Related Diseases | Year: 2016

Background: Bioelectrical impedance analysis (BIA) is well tolerated, inexpensive, and readily available, but can it be used to detect with clinical precision aberrant changes in the proportion of fat mass to fat-free mass during weight loss? Objectives: To assess the variance in percentage body fat mass explained by the readily available inputs and assess residual variance provided by leg-to-leg BIA scales. Methods: Using cross-sectional data from a cohort of 665 patients of Indian ethnicity presenting for bariatric surgery, we examine the determinants of percentage body fat as provided by leg-to-leg output from Tanita SC-330 BIA scales. Results: Four input factors-sex, weight, height, and age-contributed to provide 92% and 95% explanation in output variance for percentage fat mass (%FM) and actual fat mass, respectively, in 665 patients. Body mass index alone explained 89% and 81% of variance in %FM output for women and men, respectively. Neither weight distribution, as indicated by waist and hip circumference or waist to hip ratio, nor plasma lipids or markers of glucose metabolism contributed additional variance in %FM when controlled for the 4 key inputs. Conclusions: Simple, known input variables dominate the leg-to-leg BIA output of %FM, and this may compromise the detection of aberrant changes in %FM and fat-free mass with substantial weight loss. For clinical research, validated methods not largely dependent on known inputs should be used for evaluating changes in body composition after substantial weight loss. © 2016 American Society for Bariatric Surgery. Source


Remedios C.,Center for Obesity and Digestive Surgery | Bhasker A.G.,Center for Obesity and Digestive Surgery | Dhulla N.,Saifee Hospital | Dhar S.,Center for Obesity and Digestive Surgery | Lakdawala M.,Center for Obesity and Digestive Surgery
Obesity Surgery | Year: 2015

Background: Bariatric surgery numbers have seen a sharp rise in India in the last decade. A country known for its undernourished population has seen economic growth and with it, greater influence of western culture and foods. The obesity epidemic is on the rise here and India is one of the 10 most obese nations of the world being second only to China in the number of type 2 diabetes. Nutritionists in India often rely on recommendations and guidelines meant for the Caucasian population. Religious and cultural practices influence the dietary habits and patterns of the Indian population to a great extent; because of which the nutritional requirements are very different. This document was put together with an aim to provide nutritionists with recommendations on how to manage the Indian bariatric patient. Methods: A bariatric nutrition round table meeting was initiated by the Centre for Obesity and Digestive Surgery (CODS) to bring together experts in the field of bariatric nutrition to review current data on nutritional deficiencies in the morbid obese and existing post-operative deficiencies and to formulate nutritional recommendations for bariatric/metabolic surgery specific to patients from India. Results: Percentage of nutritional deficiencies and reasons for the same were identified among the Indian population and recommendations were made to suit this particular population. Conclusion: It is recommended that all patients undergo compulsory pre-operative nutritional counseling and nutritional investigations and that nutritional follow-up be continued lifelong. In addition, long-term implications like hypoglycemia, dumping syndrome, sugar cravings, and weight regain, need to be picked up and managed efficiently. Most importantly, post-operative supplementation is a must irrespective of type of surgery. © 2015 Springer Science+Business Media New York Source


Bhasker A.G.,Center for Obesity and Digestive Surgery | Bhasker A.G.,The Surgical Center | Remedios C.,Center for Obesity and Digestive Surgery | Batra P.,Center for Obesity and Digestive Surgery | And 6 more authors.
Obesity Surgery | Year: 2015

Background: Bariatric surgery has proven results for diabetes remission in obese diabetics. Despite this, a lot of ambiguity exists around patient selection. The objectives of this study are the following: (1) evaluation of results of laparoscopic Roux-en-y gastric bypass (LRYGB) in obese type 2 diabetic (T2DM) Indian patients at 5 years and (2) to define predictors of success after surgery. Methods: This is a prospective observational study. One hundred six Indian patients underwent LRYGB from January 2004 to July 2009. Patients were evaluated for percent excess weight loss (%EWL) and remission of T2DM. Mean age 50.34 ± 9.08 years, mean waist circumference 129.8 ± 20.8 cm, mean weight 119.2 ± 23.6 kg, mean BMI 45.01 ± 7.9 kg/m2, and mean duration of diabetes 8.2 ± 6.2 years. Results: At 5 years, mean EWL% was 61.4 ± 20.3, mean weight regain of 8.6 ± 6.2 kg was seen in 63.6 %, mean glycosylated hemoglobin dropped from 8.7 ± 2.1 to 6.2 ± 01.3 %, mean triglycerides declined by 31 %, and serum high density lipoprotein rose by 18.4 %. Mean low-density lipoprotein levels declined by 6.8 %. Age, BMI, fasting C-peptide levels, duration of T2DM, and pre-op use of insulin emerged as significant predictors of success after surgery. One hundred percent remission was seen in patients with T2DM <5 years. Conclusions: LRYGB is safe and efficacious for long-term remission of T2DM (BMI ≥ 35 kg/m2). In a country with the second largest population of type 2 diabetics in the world, predictors of success after surgery can help in prioritizing patients who have a greater chance to benefit from metabolic surgery. © 2014, Springer Science+Business Media New York. Source


Lakdawala M.,Center for Obesity and Digestive Surgery | Lakdawala M.,The Surgical Center | Agarwal A.,Center for Obesity and Digestive Surgery | Dhar S.,Center for Obesity and Digestive Surgery | And 4 more authors.
Obesity Surgery | Year: 2015

Background: This is a 2-year study to evaluate the feasibility; outcomes in terms of postoperative pain, weight loss, and complication rates; and cosmesis of the single-incision sleeve gastrectomy versus the conventional multiport sleeve gastrectomy. Methods: A prospective comparative analysis was done in 300 patients in each arm who underwent laparoscopic sleeve gastrectomy and single-incision sleeve gastrectomy from September 2009 till January 2012. Both groups were matched for age and BMI. Postoperative pain scoring was done using visual analogue scale. Outcomes in terms of pain score, scar satisfaction score, excess weight loss, resolution of co-morbidities, and complications were compared in both groups at the end of 6 months, 1 year, and 2 years. Results: Female patients preferred to undergo single-incision sleeve gastrectomy. Operating time and intraoperative blood loss were comparable in both groups. Visual analogue scale (VAS) scoring revealed lesser postoperative pain in the single-incision group. Excess weight loss and resolution of co-morbidities were also comparable in both groups at 6 months, 1 year, and 2 years. Incisional hernia was seen in 3 patients (1 %) in the single-incision group. Leak rate was comparable. Cosmetic satisfaction was superior in patients who underwent single-incision surgery. Conclusions: Surgical outcomes are comparable in both groups at the end of 2 years. The myth of high long-term incisional hernia rate after single-incision surgery has been dispelled. Single-incision surgery is less painful with better cosmesis. It has come of age and should no longer be considered as an experimental procedure. © 2014, Springer Science+Business Media New York. Source


Bhasker A.G.,Center for Obesity and Digestive Surgery | Khalifa H.,Center for Obesity and Digestive Surgery | Sood A.,Center for Obesity and Digestive Surgery | Lakdawala M.,Center for Obesity and Digestive Surgery
Asian journal of endoscopic surgery | Year: 2014

Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure performed in Asia. Staple-line leaks post LSG are notoriously difficult to treat. Here we report a case of a gastro-colic fistula after a post-LSG leak. While reperforming laparoscopy and/or stenting remain the mainstay of early leak management, chronic complications such as a gastro-colic fistula are rare and require a tailor-made approach. Stenting alone has a limited role in managing chronic fistulas after LSG. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd. Source

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