Tarek Mahdy | Mansoura University (original) (raw)

Papers by Tarek Mahdy

Research paper thumbnail of Peer review report 1 on “Laparoscopic sleeve gastrectomy versus laparoscopic mini gastric bypass: One year outcomes of a retrospective study”

International Journal of Surgery, 2016

This is an interesting text about a personal experience in the application of a bariatric surgica... more This is an interesting text about a personal experience in the application of a bariatric surgical technique and the comparison of its results with those of international literature. (Referring to 'IJS-D-16-00071 0 , page 1). The abstract accurately reflects and summarizes the information described in the full text. (Referring to 'IJS-D-16-00071 0 , page 5). The objective of the study was to assess the safety and efficacy of the technique. (Referring to 'IJS-D-16-00071 0 , page 6). We're told that the patients were subjected to 3, 6, 12, 18 and 24month follow-up, followed by yearly measurements, but no values are present in the results section concerning 24-month follow-up. (Referring to 'IJS-D-16-00071 0 , page 7). The use of a lower cutoff value for the KeS test as a means to compensate for its often-too-high sensitivity was interesting. (Referring to 'IJS-D-16-00071 0 , page 9). The variability in GERD diagnostic methods may lead to differences in the end results, including the number of GERD patients, since some may even be asymptomatic. (Referring to 'IJS-D-16-00071 0 , page 7). The hypertension resolution rate is good, although slightly inferior to other series'. It would be interesting to compare the remission rates in patients with both hypertension and diabetes to those in patients with only hypertension. (Referring to 'IJS-D-16-00071 0 , page 11). These are my comments to this paper. I believe they don't necessarily invoke a correction, since they were likely not present in the authors' objectives in the first place, although they may be weak points. Nevertheless, I believe this paper is an interesting choice for publication, since it portrays an interesting experience and contains useful information for the surgical community. (Referring to 'IJS-D-16-00071 0 , page 15). Anonymous reviewer.

Research paper thumbnail of Perioperative Interventions to Prevent Gastroesophageal Reflux Disease and Marginal Ulcers After Bariatric Surgery — an International Experts’ Survey

Research paper thumbnail of Patient Selection in One Anastomosis/Mini Gastric Bypass—an Expert Modified Delphi Consensus

Obesity Surgery

Purpose One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obe... more Purpose One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by ASMBS. The main criticisms are the risk of bile reflux, esophageal cancer, and malnutrition. Although IFSO has recognized this procedure, guidance is needed regarding selection criteria. To give clinicians a daily support in performing the right patient selection in OAGB/MGB, the aim of this paper is to generate clinical guidelines based on an expert modified Delphi consensus. Methods A committee of 57 recognized bariatric surgeons from 24 countries created 69 statements. Modified Delphi consensus voting was performed in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus. Results Consensus was achieved for 56 statements. Remarkably, ≥ 90.0% of the experts felt that OAGB/MGB is an acceptable and suitable option "in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m 2 as a one-stage procedure," "as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m 2 (instead of BPD/DS)," and "in patients with weight regain after restrictive procedures. No consensus was reached on the statement that OAGB/ MGB is a suitable option in case of resistant Helicobacter pylori. This is likely as there is a concern that this procedure is associated with reflux and its related long-term complications including risk of cancer in the esophagus or stomach. Also no consensus reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved "in case of intestinal metaplasia of the stomach" (74.55%), "in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)" (75.44%), "in patients with Barrett's metaplasia" (89.29%), and "in documented insulinoma" (89.47%). Key Points • OAGB/MGB is a suitable option in elderly patients. • OAGB/MGB is a suitable option for patients with low BMI (30-35 kg/m 2) with associated metabolic problems. • OAGB/MGB is a suitable option in patients with BMIs more than 50 kg/m 2 as one-stage procedure. OAGB/MGB can be a suitable procedure in patients with large/giant hiatal hernia with concurrent hiatal hernia repair. Extended author information available on the last page of the article Obesity Surgery 1 3 Conclusion Patient selection in OAGB/MGB is still a point of discussion among experts. There was consensus that OAGB/ MGB is a suitable option in elderly patients, patients with low BMI (30-35 kg/m 2) with associated metabolic problems, and patients with BMIs more than 50 kg/m 2 as one-stage procedure. OAGB/MGB can also be a safe procedure in vegetarian and vegan patients. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, it should not be offered to patients with grade C or D esophagitis or Barrett's metaplasia.

Research paper thumbnail of Detection of Insulin Resistance in Obese young men and its association with metabolic abnormalities in Najran, Saudi Arabia

The association between obesity and type 2 diabetes mellitus (T2DM) has been recognized for decad... more The association between obesity and type 2 diabetes mellitus (T2DM) has been recognized for decades. The major basis for this link is the ability of obesity to engender insulin resistance (IR). Homeostasis Model Assessment - Insulin Resistance (HOMA - IR) is an indirect marker of IR. The present study evaluated the usefulness of HOMA - IR in the prediction of the risk of the development of T2DM among overweight and obese indivi duals in Najran, Saudi Arabia. This study was carried out on 116 male individuals divided into 3 groups. Of these, 20 healthy control (GI), 44 prediabetic overweight and obese individuals with high normal serum glucose levels (GII) and 52 diabetic overweig ht and obese individuals with high serum glucose levels (GIII). Body mass index (BMI) was calculated for all individuals. In addition, fasting serum glucose and insulin levels, lipid profile and liver and kidney function tests were estimated for all indiv iduals. The mean BMI was 21.84±1.28 kg/m 2 in GI, 28...

Research paper thumbnail of Effects of MGB on Type 2 Diabetes in Lower BMI Patients

The Mini-gastric bypass (MGB) has resulted in significant weight loss and resolution of type 2 di... more The Mini-gastric bypass (MGB) has resulted in significant weight loss and resolution of type 2 diabetes (T2D). The current indication for bariatric surgery is mainly for patients with BMI >35 with co-morbidities. However, success is being reported with MGB for T2D with BMI <35. Evidence suggests that bypass of the duodenum may provide superiority of MGB over sleeve gastrectomy (SG) and even over Roux-en-Y gastric bypass (RYGB) for T2D remission. MGB and RYGB have similar mechanisms of T2D remission, but being easier to perform, MGB may be the superior option.

Research paper thumbnail of Peer review report 2 on “To assess the effects of parathyroidectomy (TPTX versus TPTX+AT) for secondary hyperparathyroidism in chronic renal failure: A meta-analysis”

International Journal of Surgery, 2017

Research paper thumbnail of Peer review report 1 on “Laparoscopic sleeve gastrectomy versus laparoscopic mini gastric bypass: One year outcomes of a retrospective study”

International Journal of Surgery, 2016

This is an interesting text about a personal experience in the application of a bariatric surgica... more This is an interesting text about a personal experience in the application of a bariatric surgical technique and the comparison of its results with those of international literature. (Referring to 'IJS-D-16-00071 0 , page 1). The abstract accurately reflects and summarizes the information described in the full text. (Referring to 'IJS-D-16-00071 0 , page 5). The objective of the study was to assess the safety and efficacy of the technique. (Referring to 'IJS-D-16-00071 0 , page 6). We're told that the patients were subjected to 3, 6, 12, 18 and 24month follow-up, followed by yearly measurements, but no values are present in the results section concerning 24-month follow-up. (Referring to 'IJS-D-16-00071 0 , page 7). The use of a lower cutoff value for the KeS test as a means to compensate for its often-too-high sensitivity was interesting. (Referring to 'IJS-D-16-00071 0 , page 9). The variability in GERD diagnostic methods may lead to differences in the end results, including the number of GERD patients, since some may even be asymptomatic. (Referring to 'IJS-D-16-00071 0 , page 7). The hypertension resolution rate is good, although slightly inferior to other series'. It would be interesting to compare the remission rates in patients with both hypertension and diabetes to those in patients with only hypertension. (Referring to 'IJS-D-16-00071 0 , page 11). These are my comments to this paper. I believe they don't necessarily invoke a correction, since they were likely not present in the authors' objectives in the first place, although they may be weak points. Nevertheless, I believe this paper is an interesting choice for publication, since it portrays an interesting experience and contains useful information for the surgical community. (Referring to 'IJS-D-16-00071 0 , page 15). Anonymous reviewer.

Research paper thumbnail of Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: Gastric bipartition, a novel metabolic surgery procedure: A retrospective cohort study

International Journal of Surgery, 2016

INTRODUCTION The single anastomosis sleeve ileal (SASI) bypass is a Novel Metabolic/Bariatric Sur... more INTRODUCTION The single anastomosis sleeve ileal (SASI) bypass is a Novel Metabolic/Bariatric Surgery operation based on mini gastric bypass operation and Santoro's operation in which a sleeve gastrectomy is followed by a side to side gastro-ileal anastomosis. The purpose of this Study is to report the clinical results of the outcomes of SASI bypass as a therapeutic option for obese T2DM patients. METHODS We conducted a retrospective cohort study of type 2 diabetic obese patients who underwent SASI bypass at one hospital from March 1, 2013 to December 31, 2014. Patients with previous bariatric surgery, history of upper laparotomy, and with less than one year follow up, were excluded. Sleeve gastrectomy was performed over a 36-Fr bougie, 6 cm from the pylorus, and 250 cm from the ileocecal valve the ileum brought to be anastomosis side to side with the antrum. Data collected included comorbidity resolution, percent excess weight loss (% EWL), and one-year morbidity and mortality. RESULTS During the study period, 61 underwent laparoscopic SASI bypass. Ultimately, 50 patients with a mean BMI of 48.7 ± 7.6 kg/m2 met inclusion criteria and were evaluated. %EWL reached 90% at one year and all patients have normal glucose level in the first 3 months after surgery. Hypertension remitted in 86%, hypercholesterolemia in 100% and hypertriglyceridemia in 97% of patients. There were 6 postoperative complications. One pulmonary embolism, one postoperative bleeding, one leak from biliary limb and one complete obstruction at the gastro-ileal anastomosis. Six months postoperative, one patient was diagnosed with marginal ulcer, 12 months after surgery, another patient was re-operated for fear of more excessive weight loss. CONCLUSION SASI bypass is a promising operation that offers excellent weight loss and diabetic resolution.

Research paper thumbnail of The Association between Peptide Hormones with Obesity and Insulin Resistance Markers in Lean and Obese Individuals in the United Arab Emirates

Nutrients, 2022

Peptide hormones play a crucial role in body weight and glucose homeostasis. In this study, we ai... more Peptide hormones play a crucial role in body weight and glucose homeostasis. In this study, we aimed to explore this association and recruited 43 obese and 31 age- and sex-matched lean participants. We assessed their body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), percentage body fat (PBF), fasting blood levels of peptide hormones (GLP-1, GLP-2, insulin, leptin, ghrelin, CCK, and PYY), fasting blood sugar (FBS), and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). We tested the associations between peptide hormones and markers of obesity and insulin resistance (IR) by using the Independent-Samples t-test and Mann-Whitney U test, partial correlation, and logistic regression. FBS, insulin, HOMA-IR, GLP-1, GLP-2, and leptin were significantly higher in the obese group; ghrelin and CCK were significantly higher in lean participants, and no difference was seen for PYY. Controlling for BMI, GLP-1 was positively correlated with WtHR, while ghreli...

Research paper thumbnail of Effect of Parathyroidectomy on Patients with Tertiary Hyperpara-Thyroidism (Retrospective Study)

Mansoura Medical Journal, Dec 1, 2006

Research paper thumbnail of Revisional Surgery: Sleeve to Single Anastomosis Sleeve Ileal (SASI) Bypass

Research paper thumbnail of Efficacy of single anastomosis sleeve ileum (SASI) Bypass for type-2 diabetic obese patients, 2 years follow up

Surgery for Obesity and Related Diseases, 2017

Research paper thumbnail of Impact of Baseline BMI and Adherence to Follow-Up on the Outcome of Sleeve Gastrectomy in Treatment of Adolescent Obesity

Obesity Surgery, 2021

Adolescent obesity is considered a public health challenge. Sleeve gastrectomy (SG) may be consid... more Adolescent obesity is considered a public health challenge. Sleeve gastrectomy (SG) may be considered a safe option for treatment of adolescent obesity. This study aimed to assess the outcomes of SG in treatment of severe obesity in adolescents, with emphasis on the impact of baseline body mass index (BMI) and adherence to follow-up. This was a single-center retrospective cohort study on adolescents with severe obesity who underwent SG at a tertiary referral bariatric center. The main outcome measures were weight loss, improvement in comorbidities at 12 months postoperatively, and complications. A total of 72 adolescent patients (47 female) of a mean BMI of 47.9 ± 7.1 kg/푚2 were enrolled in the study. The mean %TWL was 34.94 ± 9.35 and the mean %EWL was 73.47 ± 22.12. Complete remission was recorded in all patients with type 2 diabetes mellitus (DM), pre-DM, and sleep apnea, in 80% of patients with hypertension, and 57% of patients with hypothyroidism. The long-term complication rat...

Research paper thumbnail of Systematic review of the outcome of single-anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity with proportion meta-analysis of improvement in diabetes

International journal of surgery, 2021

BACKGROUND Single-anastomosis sleeve ileal (SASI) bypass has emerged as a promising bariatric and... more BACKGROUND Single-anastomosis sleeve ileal (SASI) bypass has emerged as a promising bariatric and metabolic procedure. We aimed to review the current literature on the outcome of SASI procedure in terms of weight loss, improvement in comorbidities, and complications. METHODS We conducted a systematic literature search, querying electronic databases and Google Scholar, for studies that reported the outcome of the SASI bypass. The main outcome measures of the review were change in body mass index (BMI), % of excess weight loss (%EWL), improvement in comorbidities, and complications after SASI bypass. RESULTS This systematic review comprised ten studies including 941 patients with a median BMI of 45.6 kg/m2. The median %EWL at 6 months was 59.4% and significantly (p = 0.04) increased to 90.1% at 12 months. The weighted mean rate of improvement in diabetes mellitus was 99.1 (95%CI: 98.2-99.9, I2 = 0). The crude percentages of patients with improvement in hypertension, hyperlipidemia, an...

Research paper thumbnail of Single Anastomosis Sleeve Ileal (SASI) Bipartition

Obesity, Bariatric and Metabolic Surgery

Research paper thumbnail of Analysis of Emergency Department Visits and Unplanned Readmission After Bariatric Surgery

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

BACKGROUND Bariatric surgery is the most effective treatment of morbid obesity. As the number of ... more BACKGROUND Bariatric surgery is the most effective treatment of morbid obesity. As the number of bariatric procedures performed has increased, visits to the emergency department (ED) and readmissions have subsequently increased. The present study aimed to assess the rates and indications for of ED visits and readmission after bariatric surgery and to identify the predictors of hospital readmission. PATIENTS AND METHODS This was a retrospective cohort study on patients who underwent bariatric surgery from January 2018 to April 2020. The percentage of ED visits and unplanned readmission was estimated and the indications and management of each were analyzed. The association of age, sex, body mass index, and type of procedure with readmission was assessed. RESULTS Of 582 patients who underwent bariatric surgery in the study period, 204 (35%) required ED visits, and 42 (7.2%) required readmission. The mean age of patients was 33 years, and the mean body mass index was 43 kg/m2. The most common indication for ED visits was abdominal pain (41.2%). In all, 64.8% of ED visits and 43% of readmissions were unrelated to bariatric surgery complications. A total of 94.1% of patients who required ED visits and 71.4% of readmitted patients were managed conservatively. The most common procedure followed by readmission was laparoscopic sleeve gastrectomy (50%) then one-anastomosis gastric bypass (21.4%). Age, sex, body mass index, and procedure type were not significantly associated with higher readmission. CONCLUSIONS The rates of ED visits and readmission in our cohort were 35% and 7.2%, respectively. Most cases of ED visits were not related to adverse effects of bariatric surgery and the majority of which were managed conservatively.

Research paper thumbnail of Religious Fasting of Muslim Patients After Metabolic and Bariatric Surgery: a Modified Delphi Consensus

Obesity Surgery

Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effec... more Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS. A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus. The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient’s situation and surgeon’s experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively. Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.

Research paper thumbnail of Roux-en-Y Gastric Bypass with Long Biliopancreatic Limb Compared to Single Anastomosis Sleeve Ileal (SASI) Bypass in Treatment of Morbid Obesity

Obesity Surgery

Bariatric surgery is the most effective treatment of morbid obesity. Bariatric procedures employ ... more Bariatric surgery is the most effective treatment of morbid obesity. Bariatric procedures employ different mechanisms of action to induce weight loss. The present study aimed to compare single-anastomosis sleeve ileal (SASI) bypass and roux-en-Y gastric bypass RYGB with long biliopancreatic limb (BPL) in terms of weight loss, remission of comorbidities, complications, and nutritional status. This was a single-center cohort study on patients with morbid obesity who underwent RYGB with long BPL of 150 cm or SASI bypass. The main outcome measures were weight loss and improvement in comorbidities at 12 months, nutritional status, and complications. The present study included 92 patients (59.8% females) of a mean age of 38.4 years and mean BMI of 42 kg/m2. RYGB and SASI bypass were followed by a significant decrease in body mass index at 12 months and were comparable in terms of excess and total weight loss. Improvement in comorbidities after the two procedures was similar. The serum albumin levels showed a significant decline after RYGB, but not after SASI bypass. The postoperative serum iron levels were higher after SASI bypass than after RYGB. There was no significant difference in regard to complication rates (13% vs 4.3%, p = 0.27). RYGB with long BPL and SASI bypass achieved satisfactory weight loss and improvement in comorbidities that were comparable among the two groups. Long BPL RYGB was followed by a significant decrease in serum albumin and iron levels at one year, which was not observed after SASI bypass.

Research paper thumbnail of Intraoperative Electrophysiological Mon-Itoring of the Recurrent Laryngeal Nerve in Thyroid Surgery - is It Worthwhile?

Research paper thumbnail of Sleeve Gastrectomy, One-Anastomosis Gastric Bypass (OAGB), and Single Anastomosis Sleeve Ileal (SASI) Bypass in Treatment of Morbid Obesity: a Retrospective Cohort Study

Obesity Surgery

Purpose Bariatric surgery is the most effective treatment for morbid obesity. The present study a... more Purpose Bariatric surgery is the most effective treatment for morbid obesity. The present study aimed to assess three bariatric procedures with different mechanisms of actions; sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and single anastomosis sleeve ileal (SASI) bypass, in terms of efficacy and safety. Methods This was a retrospective cohort study on patients with morbid obesity who underwent SG, OAGB, or SASI bypass. The main outcome measures were weight loss and improvement in comorbidities at 6 and 12 months postoperatively, and complications. Results A total of 264 patients (186 female) with mean preoperative body mass index (BMI) of 43.6 ± 9.9 kg/m 2 were included to the study. Significant weight loss was recorded at 6 and 12 months after the three procedures. At 6 and 12 months postoperatively, body weight and BMI were significantly lower after SASI bypass than after SG and OAGB. The %total weight loss (%TWL) and %excess weight loss (%EWL) were significantly higher after SASI bypass than after SG and OAGB. SASI bypass was associated with a significantly higher rate of improvement in DM than SG and OAGB (97.7% vs 71.4% vs 86.7%; p = 0.04) whereas improvement in other comorbidities was similar. The short-term complication rate was similar between the three procedures, yet SASI bypass was followed by higher long-term complication rate. Conclusion Based on retrospective review of data, SASI bypass was associated with more reduction in body weight and BMI, higher %TWL and %EWL, better improvement in T2DM, and more long-term nutritional complications than SG and OAGB.

Research paper thumbnail of Peer review report 1 on “Laparoscopic sleeve gastrectomy versus laparoscopic mini gastric bypass: One year outcomes of a retrospective study”

International Journal of Surgery, 2016

This is an interesting text about a personal experience in the application of a bariatric surgica... more This is an interesting text about a personal experience in the application of a bariatric surgical technique and the comparison of its results with those of international literature. (Referring to 'IJS-D-16-00071 0 , page 1). The abstract accurately reflects and summarizes the information described in the full text. (Referring to 'IJS-D-16-00071 0 , page 5). The objective of the study was to assess the safety and efficacy of the technique. (Referring to 'IJS-D-16-00071 0 , page 6). We're told that the patients were subjected to 3, 6, 12, 18 and 24month follow-up, followed by yearly measurements, but no values are present in the results section concerning 24-month follow-up. (Referring to 'IJS-D-16-00071 0 , page 7). The use of a lower cutoff value for the KeS test as a means to compensate for its often-too-high sensitivity was interesting. (Referring to 'IJS-D-16-00071 0 , page 9). The variability in GERD diagnostic methods may lead to differences in the end results, including the number of GERD patients, since some may even be asymptomatic. (Referring to 'IJS-D-16-00071 0 , page 7). The hypertension resolution rate is good, although slightly inferior to other series'. It would be interesting to compare the remission rates in patients with both hypertension and diabetes to those in patients with only hypertension. (Referring to 'IJS-D-16-00071 0 , page 11). These are my comments to this paper. I believe they don't necessarily invoke a correction, since they were likely not present in the authors' objectives in the first place, although they may be weak points. Nevertheless, I believe this paper is an interesting choice for publication, since it portrays an interesting experience and contains useful information for the surgical community. (Referring to 'IJS-D-16-00071 0 , page 15). Anonymous reviewer.

Research paper thumbnail of Perioperative Interventions to Prevent Gastroesophageal Reflux Disease and Marginal Ulcers After Bariatric Surgery — an International Experts’ Survey

Research paper thumbnail of Patient Selection in One Anastomosis/Mini Gastric Bypass—an Expert Modified Delphi Consensus

Obesity Surgery

Purpose One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obe... more Purpose One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by ASMBS. The main criticisms are the risk of bile reflux, esophageal cancer, and malnutrition. Although IFSO has recognized this procedure, guidance is needed regarding selection criteria. To give clinicians a daily support in performing the right patient selection in OAGB/MGB, the aim of this paper is to generate clinical guidelines based on an expert modified Delphi consensus. Methods A committee of 57 recognized bariatric surgeons from 24 countries created 69 statements. Modified Delphi consensus voting was performed in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus. Results Consensus was achieved for 56 statements. Remarkably, ≥ 90.0% of the experts felt that OAGB/MGB is an acceptable and suitable option "in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m 2 as a one-stage procedure," "as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m 2 (instead of BPD/DS)," and "in patients with weight regain after restrictive procedures. No consensus was reached on the statement that OAGB/ MGB is a suitable option in case of resistant Helicobacter pylori. This is likely as there is a concern that this procedure is associated with reflux and its related long-term complications including risk of cancer in the esophagus or stomach. Also no consensus reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved "in case of intestinal metaplasia of the stomach" (74.55%), "in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)" (75.44%), "in patients with Barrett's metaplasia" (89.29%), and "in documented insulinoma" (89.47%). Key Points • OAGB/MGB is a suitable option in elderly patients. • OAGB/MGB is a suitable option for patients with low BMI (30-35 kg/m 2) with associated metabolic problems. • OAGB/MGB is a suitable option in patients with BMIs more than 50 kg/m 2 as one-stage procedure. OAGB/MGB can be a suitable procedure in patients with large/giant hiatal hernia with concurrent hiatal hernia repair. Extended author information available on the last page of the article Obesity Surgery 1 3 Conclusion Patient selection in OAGB/MGB is still a point of discussion among experts. There was consensus that OAGB/ MGB is a suitable option in elderly patients, patients with low BMI (30-35 kg/m 2) with associated metabolic problems, and patients with BMIs more than 50 kg/m 2 as one-stage procedure. OAGB/MGB can also be a safe procedure in vegetarian and vegan patients. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, it should not be offered to patients with grade C or D esophagitis or Barrett's metaplasia.

Research paper thumbnail of Detection of Insulin Resistance in Obese young men and its association with metabolic abnormalities in Najran, Saudi Arabia

The association between obesity and type 2 diabetes mellitus (T2DM) has been recognized for decad... more The association between obesity and type 2 diabetes mellitus (T2DM) has been recognized for decades. The major basis for this link is the ability of obesity to engender insulin resistance (IR). Homeostasis Model Assessment - Insulin Resistance (HOMA - IR) is an indirect marker of IR. The present study evaluated the usefulness of HOMA - IR in the prediction of the risk of the development of T2DM among overweight and obese indivi duals in Najran, Saudi Arabia. This study was carried out on 116 male individuals divided into 3 groups. Of these, 20 healthy control (GI), 44 prediabetic overweight and obese individuals with high normal serum glucose levels (GII) and 52 diabetic overweig ht and obese individuals with high serum glucose levels (GIII). Body mass index (BMI) was calculated for all individuals. In addition, fasting serum glucose and insulin levels, lipid profile and liver and kidney function tests were estimated for all indiv iduals. The mean BMI was 21.84±1.28 kg/m 2 in GI, 28...

Research paper thumbnail of Effects of MGB on Type 2 Diabetes in Lower BMI Patients

The Mini-gastric bypass (MGB) has resulted in significant weight loss and resolution of type 2 di... more The Mini-gastric bypass (MGB) has resulted in significant weight loss and resolution of type 2 diabetes (T2D). The current indication for bariatric surgery is mainly for patients with BMI >35 with co-morbidities. However, success is being reported with MGB for T2D with BMI <35. Evidence suggests that bypass of the duodenum may provide superiority of MGB over sleeve gastrectomy (SG) and even over Roux-en-Y gastric bypass (RYGB) for T2D remission. MGB and RYGB have similar mechanisms of T2D remission, but being easier to perform, MGB may be the superior option.

Research paper thumbnail of Peer review report 2 on “To assess the effects of parathyroidectomy (TPTX versus TPTX+AT) for secondary hyperparathyroidism in chronic renal failure: A meta-analysis”

International Journal of Surgery, 2017

Research paper thumbnail of Peer review report 1 on “Laparoscopic sleeve gastrectomy versus laparoscopic mini gastric bypass: One year outcomes of a retrospective study”

International Journal of Surgery, 2016

This is an interesting text about a personal experience in the application of a bariatric surgica... more This is an interesting text about a personal experience in the application of a bariatric surgical technique and the comparison of its results with those of international literature. (Referring to 'IJS-D-16-00071 0 , page 1). The abstract accurately reflects and summarizes the information described in the full text. (Referring to 'IJS-D-16-00071 0 , page 5). The objective of the study was to assess the safety and efficacy of the technique. (Referring to 'IJS-D-16-00071 0 , page 6). We're told that the patients were subjected to 3, 6, 12, 18 and 24month follow-up, followed by yearly measurements, but no values are present in the results section concerning 24-month follow-up. (Referring to 'IJS-D-16-00071 0 , page 7). The use of a lower cutoff value for the KeS test as a means to compensate for its often-too-high sensitivity was interesting. (Referring to 'IJS-D-16-00071 0 , page 9). The variability in GERD diagnostic methods may lead to differences in the end results, including the number of GERD patients, since some may even be asymptomatic. (Referring to 'IJS-D-16-00071 0 , page 7). The hypertension resolution rate is good, although slightly inferior to other series'. It would be interesting to compare the remission rates in patients with both hypertension and diabetes to those in patients with only hypertension. (Referring to 'IJS-D-16-00071 0 , page 11). These are my comments to this paper. I believe they don't necessarily invoke a correction, since they were likely not present in the authors' objectives in the first place, although they may be weak points. Nevertheless, I believe this paper is an interesting choice for publication, since it portrays an interesting experience and contains useful information for the surgical community. (Referring to 'IJS-D-16-00071 0 , page 15). Anonymous reviewer.

Research paper thumbnail of Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: Gastric bipartition, a novel metabolic surgery procedure: A retrospective cohort study

International Journal of Surgery, 2016

INTRODUCTION The single anastomosis sleeve ileal (SASI) bypass is a Novel Metabolic/Bariatric Sur... more INTRODUCTION The single anastomosis sleeve ileal (SASI) bypass is a Novel Metabolic/Bariatric Surgery operation based on mini gastric bypass operation and Santoro's operation in which a sleeve gastrectomy is followed by a side to side gastro-ileal anastomosis. The purpose of this Study is to report the clinical results of the outcomes of SASI bypass as a therapeutic option for obese T2DM patients. METHODS We conducted a retrospective cohort study of type 2 diabetic obese patients who underwent SASI bypass at one hospital from March 1, 2013 to December 31, 2014. Patients with previous bariatric surgery, history of upper laparotomy, and with less than one year follow up, were excluded. Sleeve gastrectomy was performed over a 36-Fr bougie, 6 cm from the pylorus, and 250 cm from the ileocecal valve the ileum brought to be anastomosis side to side with the antrum. Data collected included comorbidity resolution, percent excess weight loss (% EWL), and one-year morbidity and mortality. RESULTS During the study period, 61 underwent laparoscopic SASI bypass. Ultimately, 50 patients with a mean BMI of 48.7 ± 7.6 kg/m2 met inclusion criteria and were evaluated. %EWL reached 90% at one year and all patients have normal glucose level in the first 3 months after surgery. Hypertension remitted in 86%, hypercholesterolemia in 100% and hypertriglyceridemia in 97% of patients. There were 6 postoperative complications. One pulmonary embolism, one postoperative bleeding, one leak from biliary limb and one complete obstruction at the gastro-ileal anastomosis. Six months postoperative, one patient was diagnosed with marginal ulcer, 12 months after surgery, another patient was re-operated for fear of more excessive weight loss. CONCLUSION SASI bypass is a promising operation that offers excellent weight loss and diabetic resolution.

Research paper thumbnail of The Association between Peptide Hormones with Obesity and Insulin Resistance Markers in Lean and Obese Individuals in the United Arab Emirates

Nutrients, 2022

Peptide hormones play a crucial role in body weight and glucose homeostasis. In this study, we ai... more Peptide hormones play a crucial role in body weight and glucose homeostasis. In this study, we aimed to explore this association and recruited 43 obese and 31 age- and sex-matched lean participants. We assessed their body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), percentage body fat (PBF), fasting blood levels of peptide hormones (GLP-1, GLP-2, insulin, leptin, ghrelin, CCK, and PYY), fasting blood sugar (FBS), and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). We tested the associations between peptide hormones and markers of obesity and insulin resistance (IR) by using the Independent-Samples t-test and Mann-Whitney U test, partial correlation, and logistic regression. FBS, insulin, HOMA-IR, GLP-1, GLP-2, and leptin were significantly higher in the obese group; ghrelin and CCK were significantly higher in lean participants, and no difference was seen for PYY. Controlling for BMI, GLP-1 was positively correlated with WtHR, while ghreli...

Research paper thumbnail of Effect of Parathyroidectomy on Patients with Tertiary Hyperpara-Thyroidism (Retrospective Study)

Mansoura Medical Journal, Dec 1, 2006

Research paper thumbnail of Revisional Surgery: Sleeve to Single Anastomosis Sleeve Ileal (SASI) Bypass

Research paper thumbnail of Efficacy of single anastomosis sleeve ileum (SASI) Bypass for type-2 diabetic obese patients, 2 years follow up

Surgery for Obesity and Related Diseases, 2017

Research paper thumbnail of Impact of Baseline BMI and Adherence to Follow-Up on the Outcome of Sleeve Gastrectomy in Treatment of Adolescent Obesity

Obesity Surgery, 2021

Adolescent obesity is considered a public health challenge. Sleeve gastrectomy (SG) may be consid... more Adolescent obesity is considered a public health challenge. Sleeve gastrectomy (SG) may be considered a safe option for treatment of adolescent obesity. This study aimed to assess the outcomes of SG in treatment of severe obesity in adolescents, with emphasis on the impact of baseline body mass index (BMI) and adherence to follow-up. This was a single-center retrospective cohort study on adolescents with severe obesity who underwent SG at a tertiary referral bariatric center. The main outcome measures were weight loss, improvement in comorbidities at 12 months postoperatively, and complications. A total of 72 adolescent patients (47 female) of a mean BMI of 47.9 ± 7.1 kg/푚2 were enrolled in the study. The mean %TWL was 34.94 ± 9.35 and the mean %EWL was 73.47 ± 22.12. Complete remission was recorded in all patients with type 2 diabetes mellitus (DM), pre-DM, and sleep apnea, in 80% of patients with hypertension, and 57% of patients with hypothyroidism. The long-term complication rat...

Research paper thumbnail of Systematic review of the outcome of single-anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity with proportion meta-analysis of improvement in diabetes

International journal of surgery, 2021

BACKGROUND Single-anastomosis sleeve ileal (SASI) bypass has emerged as a promising bariatric and... more BACKGROUND Single-anastomosis sleeve ileal (SASI) bypass has emerged as a promising bariatric and metabolic procedure. We aimed to review the current literature on the outcome of SASI procedure in terms of weight loss, improvement in comorbidities, and complications. METHODS We conducted a systematic literature search, querying electronic databases and Google Scholar, for studies that reported the outcome of the SASI bypass. The main outcome measures of the review were change in body mass index (BMI), % of excess weight loss (%EWL), improvement in comorbidities, and complications after SASI bypass. RESULTS This systematic review comprised ten studies including 941 patients with a median BMI of 45.6 kg/m2. The median %EWL at 6 months was 59.4% and significantly (p = 0.04) increased to 90.1% at 12 months. The weighted mean rate of improvement in diabetes mellitus was 99.1 (95%CI: 98.2-99.9, I2 = 0). The crude percentages of patients with improvement in hypertension, hyperlipidemia, an...

Research paper thumbnail of Single Anastomosis Sleeve Ileal (SASI) Bipartition

Obesity, Bariatric and Metabolic Surgery

Research paper thumbnail of Analysis of Emergency Department Visits and Unplanned Readmission After Bariatric Surgery

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

BACKGROUND Bariatric surgery is the most effective treatment of morbid obesity. As the number of ... more BACKGROUND Bariatric surgery is the most effective treatment of morbid obesity. As the number of bariatric procedures performed has increased, visits to the emergency department (ED) and readmissions have subsequently increased. The present study aimed to assess the rates and indications for of ED visits and readmission after bariatric surgery and to identify the predictors of hospital readmission. PATIENTS AND METHODS This was a retrospective cohort study on patients who underwent bariatric surgery from January 2018 to April 2020. The percentage of ED visits and unplanned readmission was estimated and the indications and management of each were analyzed. The association of age, sex, body mass index, and type of procedure with readmission was assessed. RESULTS Of 582 patients who underwent bariatric surgery in the study period, 204 (35%) required ED visits, and 42 (7.2%) required readmission. The mean age of patients was 33 years, and the mean body mass index was 43 kg/m2. The most common indication for ED visits was abdominal pain (41.2%). In all, 64.8% of ED visits and 43% of readmissions were unrelated to bariatric surgery complications. A total of 94.1% of patients who required ED visits and 71.4% of readmitted patients were managed conservatively. The most common procedure followed by readmission was laparoscopic sleeve gastrectomy (50%) then one-anastomosis gastric bypass (21.4%). Age, sex, body mass index, and procedure type were not significantly associated with higher readmission. CONCLUSIONS The rates of ED visits and readmission in our cohort were 35% and 7.2%, respectively. Most cases of ED visits were not related to adverse effects of bariatric surgery and the majority of which were managed conservatively.

Research paper thumbnail of Religious Fasting of Muslim Patients After Metabolic and Bariatric Surgery: a Modified Delphi Consensus

Obesity Surgery

Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effec... more Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS. A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus. The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient’s situation and surgeon’s experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively. Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.

Research paper thumbnail of Roux-en-Y Gastric Bypass with Long Biliopancreatic Limb Compared to Single Anastomosis Sleeve Ileal (SASI) Bypass in Treatment of Morbid Obesity

Obesity Surgery

Bariatric surgery is the most effective treatment of morbid obesity. Bariatric procedures employ ... more Bariatric surgery is the most effective treatment of morbid obesity. Bariatric procedures employ different mechanisms of action to induce weight loss. The present study aimed to compare single-anastomosis sleeve ileal (SASI) bypass and roux-en-Y gastric bypass RYGB with long biliopancreatic limb (BPL) in terms of weight loss, remission of comorbidities, complications, and nutritional status. This was a single-center cohort study on patients with morbid obesity who underwent RYGB with long BPL of 150 cm or SASI bypass. The main outcome measures were weight loss and improvement in comorbidities at 12 months, nutritional status, and complications. The present study included 92 patients (59.8% females) of a mean age of 38.4 years and mean BMI of 42 kg/m2. RYGB and SASI bypass were followed by a significant decrease in body mass index at 12 months and were comparable in terms of excess and total weight loss. Improvement in comorbidities after the two procedures was similar. The serum albumin levels showed a significant decline after RYGB, but not after SASI bypass. The postoperative serum iron levels were higher after SASI bypass than after RYGB. There was no significant difference in regard to complication rates (13% vs 4.3%, p = 0.27). RYGB with long BPL and SASI bypass achieved satisfactory weight loss and improvement in comorbidities that were comparable among the two groups. Long BPL RYGB was followed by a significant decrease in serum albumin and iron levels at one year, which was not observed after SASI bypass.

Research paper thumbnail of Intraoperative Electrophysiological Mon-Itoring of the Recurrent Laryngeal Nerve in Thyroid Surgery - is It Worthwhile?

Research paper thumbnail of Sleeve Gastrectomy, One-Anastomosis Gastric Bypass (OAGB), and Single Anastomosis Sleeve Ileal (SASI) Bypass in Treatment of Morbid Obesity: a Retrospective Cohort Study

Obesity Surgery

Purpose Bariatric surgery is the most effective treatment for morbid obesity. The present study a... more Purpose Bariatric surgery is the most effective treatment for morbid obesity. The present study aimed to assess three bariatric procedures with different mechanisms of actions; sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and single anastomosis sleeve ileal (SASI) bypass, in terms of efficacy and safety. Methods This was a retrospective cohort study on patients with morbid obesity who underwent SG, OAGB, or SASI bypass. The main outcome measures were weight loss and improvement in comorbidities at 6 and 12 months postoperatively, and complications. Results A total of 264 patients (186 female) with mean preoperative body mass index (BMI) of 43.6 ± 9.9 kg/m 2 were included to the study. Significant weight loss was recorded at 6 and 12 months after the three procedures. At 6 and 12 months postoperatively, body weight and BMI were significantly lower after SASI bypass than after SG and OAGB. The %total weight loss (%TWL) and %excess weight loss (%EWL) were significantly higher after SASI bypass than after SG and OAGB. SASI bypass was associated with a significantly higher rate of improvement in DM than SG and OAGB (97.7% vs 71.4% vs 86.7%; p = 0.04) whereas improvement in other comorbidities was similar. The short-term complication rate was similar between the three procedures, yet SASI bypass was followed by higher long-term complication rate. Conclusion Based on retrospective review of data, SASI bypass was associated with more reduction in body weight and BMI, higher %TWL and %EWL, better improvement in T2DM, and more long-term nutritional complications than SG and OAGB.