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Background 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. Methods 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. Results 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. Conclusion Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.

Aim. To study of the effect of the diameter of the calibration tube and the distance from the pyloric sphincter on the outcomes of the laparoscopic sleeve gastrectomy. Methods. The study included 945 (915 women) patients with a body mass index 51.59 kg/m2. The average age of the patients was 53.58.5 years. The patients were divided into 2 groups by the type of laparoscopic surgery: in the first group (n=463), a 36 Fr calibration tube was used, the distance from the pyloric sphincter was 46 cm; in the second group (n=482), a 32 Fr calibration tube was used, the distance from the pyloric sphincter was 23 cm. The main comparison criteria was the percentage of body weight loss in the first 6 and 12 months, and an additional comparison criteria was the of concomitant diseases progress in postoperative and the existence of complications. Results. A comparative analysis showed that the first group in the first 6 months lost 593% of its initial body weight, while in 12 months 714%; in the second group, 733 and 873% of the initial weight, respectively. Concomitant diseases in the first group decreased by 7080% by the 6th month after surgery and by 8596% by the 12th month. In the 2nd group, similar remission with improvement was between 84 and 94% at the 6th month, and remained the same at the 12th month. Conclusion. The results of the study show that in laparoscopic sleeve gastrectomy with a calibration tube diameter 32 Fr and a distance of 23 cm from the pyloric sphincter, compared to a calibration tube diameter 36 Fr or more and a distance of 46 cm from the pyloric sphincter, a body weight loss faster and more effective with earlier remission of concomitant diseases, while the number of complications is comparable.

Laparoscopic sleeve gastrectomy (LSG) restricts gastric volume to achieve weight loss. We aimed to compare the efficacy of LSG with and without antrectomy for achieving weight loss. The prospective randomized study comprised 127 obese patients that underwent either LSG with antrectomy (2 cm to pylorus) (group 1) or LSG without antrectomy (6 cm to pylorus) (group 2), using 36 Fr and 32 Fr bougies, respectively. Patients were examined at 3-, 6-, 12-, and 24-month intervals for body mass index (BMI) measurements. Overall, 66 (51%) and 57 (49%) of patients were assigned to groups 1 and 2, respectively. The mean BMI of group 1 patients were 49.5 ± 8.01, 35.8 ± 5.40, 31.3 ± 4.9, 26.7 ± 4.02, and 22.9 ± 4.01 at the baseline, 3rd, 6th, 12th, and 24th month, respectively. The decreases in BMI were statistically significant. The mean BMI of group 2 patients were 46.7 ± 7.06, 39.3 ± 6.04, 32.4 ± 5.01, 26.6 ± 3.76, and 21.6 ± 3.70 at baseline, 3rd, 6th, 12th, and 24th month, respectively. The differences were also statistically significant. When compared with group 2, group 1 patients showed significantly lower BMI values on the 3rd month. Other differences were not statistically significant. LSG with or without antrectomy is safe and effective for weight loss. Larger studies are required to identify patients likely to benefit from LSG with antrectomy.

Weight regain following laparoscopic sleeve gastrectomy (LSG) may be due to dilation of the gastric reservoir. Laparoscopic re-sleeve gastrectomy (LrSG) is among the revisional surgery options. We aimed to investigate the effectiveness of LrSG for weight loss after a 12- and 24-month follow-up period. Bariatric surgery center in Baku/Azerbaijan. From June 2016 to June 2019, a total of 34 LSG patients with weight regain, underwent LrSG. We prospectively followed outcomes data were BMI changes, excessive weight loss, changes in laboratory values, and the presence of complications. The mean age at revision surgery was 36 ± 7.09 (range, 22–51) years, and the mean body mass index (BMI) before LrSG was 40 ± 5.2 kg/m2. The mean time between the primary and revision surgery was 50 ± 7.8 months. The main reasons for the revisions were weight regain and inadequate weight loss. The mean BMI value decrease at the 12th and 24th months were 27.7 ± 2 and 24.3 ± 1.02, which were statistically significant (p

Objective. To compare the results of the bariatric surgical operations for the 5 year period in patients, suffering obesity among population of Azerbaijan. Маterials and methods. Bariatric surgical operations were performed in 104 patients, suffering obesity among population of Azerbaijan. Average age of the patients was 33.1 years old, and average body mass index (BMI) - 57.5 kg/m2. Comparative analysis of various technical modifications and postoperative complications was conducted. The patients were examined preoperatively and in 1, 3, 6 and 12 mo after the operation. BMI, the signs of diabetes, hypertension, the apnoe syndrome while sleeping and hepatic adipose dystrophy were investigated in dynamics. Results. In 88 (84,6%) patients, in whom a standard laparoscopic sleeve gastrectomy (LSG) was performed, in 6 mo afterwards the body mass have reduced by (39.5 ± 11.5) kg at average. Of 12 (11.5%) patients after gastric shunting in 2 (1.9%) patients a gastric shunting in accordance to Roux method was performed, in 8 (7.6%) - gastric minishunting, 2 (1.9%) - LSG and Roux shunting. As a result, the body mass have reduced by (46 ± 14) kg, аnd during 6-12 mo observation its effective increase was observed by (33.5 ± 8.5) kg at average. In 1 (1%) patient in other clinic the gastric duplication operation was performed. The body mass during the following year have reduced by 20 kg and stopped, so the patient have been applied into our clinic and to him gastrorestrictive operation was performed. His body mass have reduced by 36 kg. In 3 (2.9%) patients, who have gained the body mass in 2 years after the operation, reoperation procedure was LSG. Subsequently in these patients a satisfactory reduction of the body mass was noted. Conclusion. After LSG performance the body mass reduction in patients with severe obesity is mostly satisfactory, the vitamin balance disorders are absent, and dynamics of concurrent pathology is positive, making this procedure mostly secure. Meanwhile after shunting bariatric surgery the abovementioned indices are higher and in presence of diabetes mellitus this procedure is mostly effective. LSG is anatomically and physiologically ideal operation, because in case of ineffective body mass lowering the reoperation is possible, and this operation is feasible in patients without diabetes Type II.

Цель. Изучить корреляцию между контролем уровня гликемии и степенью снижения индекса массы тела у пациентов после бариатрической операции. Материалы и методы. Проведен контроль уровня обмена глюкозы у 84 пациентов с предиабетом и сахарным диабетом 2-го типа, страдающих патологическим ожирением, после операции уменьшения желудка. Результаты. Из 84 пациентов у 30 (35,7%) продолжительность заболевания сахарным диабетом 2-го типа составляла 1 год, у 27 (32,1%) – 10 лет, у 12 (14,3%) - более 10 лет. У 15 (17,9%) пациентов диагностирован предиабет. При изучении антропометрических показателей отмечено снижение массы тела на 38% после операции по сравнению с исходными показателями. Индекс массы тела (ИМТ) снизился с 46,8 (41,3 – 54,3) до 27,6 (25,4 – 30,9) кг/м2 (р = 0,001). Через 2 года после операции общее снижение массы тела по сравнению с исходными показателями составило 42%, а ИМТ снизился до 26,8 (23,1 – 28,4) кг/м2. Ремиссия сахарного диабета 2-го типа в сроки наблюдения 1 - 3 года отмечена у 82 (98,6%) пациентов (уровень гликированного гемоглобина менее 6,0%, глюкозы натощак менее 5,6 ммоль/л). Выводы. Результаты проведенного исследования показали, что продольная резекция желудка у больных с сахарным диабетом 2-го типа эффективна не только для уменьшения ИМТ, но и для коррекции метаболического синдрома. В послеоперационном периоде у них наблюдали стабильность показателей гликемии и углеводного обмена.