key: cord-1003012-6w4lad1u authors: nan title: Abstracts of the 12th BOMSS Annual Scientific Meeting date: 2021-10-23 journal: Obes Surg DOI: 10.1007/s11695-021-05591-8 sha: 2c8fb4a4d6de0f72c29aa6121e895f1d78bc264a doc_id: 1003012 cord_uid: 6w4lad1u nan outcomes (p>0.05) (Figure 1 ). Inter-domain analysis showed a decrease in sexual function for RYGB (p>0.05) at 6-and 12-month follow-up. Bariatric surgery in women of reproductive age is associated with an increase in HRQoL. Our comparison between the most performed bariatric procedures identified minimal difference in HRQoL and weight loss outcomes. These findings are vital for informing patient decision-making when considering bariatric procedure type. SG HRQoL RYGB HRQoL SG weight RYGB weight Figure 1 : A graph comparing the average HRQoL outcomes and weight (kg) for participants who underwent RYGB vs SG over the 12-month follow-up period. The graph shows there was no statistically significant difference between HRQoL scores for SG and RYGB (p>0.05) as well as no statistically significant difference in weight loss between the two procedures (p>0.05). Introduction: Afferent loop syndrome or obstruction is an infrequent mechanical complication after gastric surgery and gastrojejunostomy. It can be either acute or chronic. In the acute type favourable outcome is correlated with an expedient diagnosis and early surgical intervention. We present a case of (ALS) post single anastomosis gastric bypass (SAGB). Case presentation: A 49-year-old male patient presented to our Bariatric Unit through the ED with severe progressive upper abdominal pain for the last 12 hours, associated with significant sickness and decrease in oral intake. He had a SAGB for obesity 2 years ago performed elsewhere, with endoscopic dilatation of the anastomosis performed twice before. CT scan abdomen and pelvis showed small bowel obstruction with a transition point at the gastrojejunostomy causing severe dilatation of the small bowel and stomach remnant. A laparoscopic to open revision of the SAGB to a Roux en Y gastric bypass was performed. The patient made an eventful recovery and was discharged home 10 days post operatively. Conclusion: Afferent loop obstruction is rare complication of SAGB for obesity and it should considered as be part of the working diagnosis in patients presenting with obstructive symptoms. Prompt diagnosis and surgical intervention is crucial. P5 -Safety of bariatric surgery during COVID-19 pandemic, is there a need to screen low-risk patients? Dr Emad Aljohani 1 1 Prince Sattam Bin Abdullaziz University, Riyadh, Saudi Arabia Background: There seems to be a consensus in the current published literature on postponing elective, non-urgent surgery on COVID-19positive patients. However, so far, no recommendations have been published on when and how to start carrying out elective, non-urgent surgery on COVID-19-negative patients after the epidemic peak. Methodology: A retrospective chart review of patients who underwent bariatric surgery between March to June 2020, during the pandemic of COVID 19. The study participants were male and females with a BMI > 30 with a respiratory score of ≤ 3. Results: The mean age of the patients was 32.73 ± 7.81 years, and a higher proportion (n=48; 56.5%) of them were males. Only (n=1; 1.1%) of the patient was tested for Covid19 by RT-PCR before surgery and tested negative. Post-surgery, none of the patients developed any complications, and none of them were admitted to the ICU. Conclusion: During the COVID-19 pandemic, before considering patients for elective surgery, they should be screened. For patients who are obese or have underlying comorbidities, if on screening their respiratory score is ≤ 3 indicating a low risk of respiratory illness, elective procedures should continue. Strict precautionary measures should be followed, and a limited number of surgeries should be performed. Keywords: COVID-19, Bariatric surgery, respiratory score, low risk, elective surgery Introduction: Published randomised controlled trials (RCTs) have failed to show a statistically significant advantage of laparoscopic Roux-en-Y gastric bypass (LRYGB) over laparoscopic sleeve gastrectomy (LSG) in the improvement of dyslipidaemia due to small subgroup sizes.By performing an analysis on a larger sample size, our aim was to determine which procedure is likely to produce the greatest benefit for dyslipidaemia. Method: A comprehensive database search was undertaken for observational (OS) and RCTs published until 31st December 2020 comparing LRYGB with LSG. The primary outcome was rate of resolution and/or partial improvement of dyslipidemia at least 12 months after surgery.Data from our institute of 106 patients were also included. The magnitude of the experimental effect was calculated in terms of odds ratio (OR) while accounting for co-morbidities,gender, age and BMI. Results: Inclusion of 1148 LRYGB and 911 LSG patients from 7 RCTs and 18 OS demonstrated the primary outcome was achieved in 73% LRYGB vs 50.7% LSG(p<0.0001) with OR 2.29(95%CI 1.69-3.10 p<0.00001) for LRYGB compared with LSG. Separate analysis of only Introduction: In eligible people with obesity, Roux-en-Y gastric bypass (RYGB) has been shown to be highly successful in controlling both GORD symptoms and achieving significant weight loss maintenance, but such an option is underutilised in nonbariatric centres. The aim of our study was to determine the proportion of patients with obesity who may have been eligible for referral for bariatric surgery but instead underwent fundoplication at a non-bariatric centre. Methods: Using routinely collected hospital data, all patients who underwent fundoplication for GORD at a single academic teaching hospital over a 9-year period were identified and preoperative variables including Body Mass Index (BMI) and co-morbidities were collected. Results: A total of 321 patients underwent fundoplication between January 2011 and December 2020 of which 133 (41.4%) had available BMI data and were included in the analyses. BMI > 30kg/m² was seen in 40 patients (30%) and BMI >35kg/m² in 7 patients (5.3%). Of the 7 patients with BMI >35kg/m², five (4%) were eligible, due to obesity associated disease, for bariatric surgery referral. Conclusions: Given the well-established efficacy of RYGB not only for weight loss maintenance but also as an anti-reflux procedure, we recommend that this highly effective option be more available as a referral option. (1, 2) . Developed by the bariatric team at a designated BMS centre, the 'discharge six' is a discharge package designed to standardise postoperative protocol, thereby reducing complications and readmissions. This consists of enoxaparin, thrombo-embolus deterrent stockings (TEDs), analgesia, antiemetics, laxatives and a proton-pump inhibitor (PPI). Methods: Medical records from 100 consecutive patients undergoing BMS in 2019 were analysed, comparing discharge prescribing against the standard of the 'discharge six', and capturing any readmissions up until March 2021. Results: 84% of patients were prescribed five of the 'discharge six' and 99% were prescribed four of the six. The most commonly omitted item was TEDs. There was a 9% readmission rate for conditions relating to surgery and anaesthesia. The most common cause was constipation (3%) followed by nausea and vomiting (2%). Postoperative mortality was 0% with a 1% incidence of serious complications. In patients undergoing primary surgery the incidence of serious complications was 0%. When all six items were prescribed only one patient required readmission. Conclusion: The authors believe these preliminary findings may support the use of the 'discharge six' to standardise postoperative prescribing following BMS. C o l l S u r g E n g l . 2 0 0 9 M a y ; 9 1 ( 4 ) : 2 8 0 -6 . d o i : 1 0 . Background: There is a paucity of data regarding postoperative morbidity and mortality in patients on immunosuppression undergoing bariatric surgery. Aim: The primary aim was to evaluate 30-day morbidity and mortality in immunosuppressed patients undergoing bariatric surgery. Secondary aims included adherence to an enhanced recovery after bariatric surgery (ERABS) protocol and weight loss outcomes. Methods: A prospectively maintained database of patients undergoing bariatric surgery between August 2017-February 2020 was used to identify patients who were taking immunosuppressant medications preoperatively. Their clinical data were compared to patients not taking immunosuppressants. Results: Over a 30-month period, 183 patients underwent primary bariatric surgery. Ten patients (5.5%) were taking immunosuppressant medication. Mean age and preoperative weight was similar between groups (Table 1 ). There was no 30-day mortality and overall morbidity was 10.9%. There was no significant difference in 30-day morbidity between groups (p=0.91, Image 1). Both groups adhered to an ERABS protocol with median length of stay of 2 days in each group. Short-term postoperative weight loss was comparable in both groups ( Figure 1 ). Conclusion: This small series suggests that patients on immunosuppression are not at increased risk of morbidity or mortality after bariatric surgery, and have comparable weight loss outcomes. P19 -Remote tier 3 group programmes are an acceptable way to deliver preparatory dietetic and psychological intervention pre weight loss surgery and increase service capacity. Background: Tier 3 group dietetic and psychological interventions are a key element of pre-bariatric surgery preparation. The COVID-19 pandemic has necessitated a shift to remote delivery. We evaluated the acceptability of a remote Tier 3 group intervention, and impact on service capacity. Methods: Anonymous surveys were sent to 119 participants who completed an 8-week online tier 3 group programme (including pre-recorded and live sessions) between 17.08.20 and 15.04.21. The survey included 10 questions and focused on elements of the online group participants found helpful or unhelpful. Service capacity was assessed by maximum group session places offered. Results: Thirty responses were received. 90% rated the group as helpful or very helpful and 93% would recommend to others. 83% had no technical difficulties; connectivity issues were the main complaint. 76% rated session duration satisfactory. Ongoing access to content and convenience were found helpful although informal interaction was missed. Maximum service capacity increased 40% by using pre-recorded content. Conclusions: Remote Tier 3 group work was acceptable to most participants. Evaluation of patient outcomes is now needed. Remote group programmes will likely remain due to increased service capacity; reevaluation of acceptability post-pandemic and flexible modes of delivery may be beneficial. P20 -Roux-en-y bypass patient information: An analysis of webbased information using the EQIP tool Background: Roux-en-y gastric bypass is a commonly performed procedure for weight loss with over 70,000 annually worldwide. Patient information quality is important for informed consent, expectations and compliance with post-operative plans. Awareness of the standard of online resources can guide development of information media. Objective: To assess the quality of top-ranking patient information results on Google for Roux-En-Y gastric bypass. Methods: The review was conducted using the search terms "Roux-en-y" into Google. The first 50 results were analysed using the Ensuring Quality Information for Patients (EQIP) tool. Results: We calculated an EQIP score out of 100. Of 50 websites 40% had a score greater than 50, 52% had a score between 25 and 49, 8% had a score less than 25 which would represent a poor-quality resource. Median EQIP score was 45.5 (IQR 22.1). Mean was 46.9 (±11.9). Only 20% of websites discussed alternative treatments. Only 16% discussed how complications can be managed and 10% of sites quantified risks. Conclusions: This study shows the top-ranking resources to be of a poor standard, particularly regarding the risk of complications and their management. Many failed to mention alternate treatment options. There is a need to provide higher quality resources for patient education. P22 -Duodenal switch online patient information: an analysis using the EQIP tool Background: Duodenal Switch is a drastic procedure for weight loss. When patients choose between this procedure and other interventions, reliable information is paramount for informed consent. It is therefore important to review the quality of this information available online due to the unregulated sphere that is the World Wide Web. Objective: To assess the quality of publicly available online information on the duodenal switch operation. Methods: We reviewed online material regarding duodenal switch using the search term "duodenal switch" in google. The top 100 results that met the inclusion/exclusion criteria were scored using the validated EQIP tool. Results: 76 of the first 100 hits met the eligibility criteria. The overall median EQIP was 13.5; mean was 13.3. The scores ranged from 9 to 19. 72.4% of websites were from the USA. Most websites were those of private bariatric clinics that provided patient information as well as marketing. Conclusions: Based on the original EQIP tool used, the quality of the websites is extremely varied, with most being substandard. However, with a more focused version of the EQIP tool it would become clear that there is insufficient objective information pitched at the right level for patients. P23 -Prevalence of stigmatising language in bariatric-metabolic surgery journals Background: People with obesity are subject to prejudice and stigma, perpetuated by use of potentially harmful terms. We aimed to summarise negative terminology reported in bariatric journals. Methods: A systematic literature search of studies published in 2019 including terminology referring to words 'fail', 'morbid', and 'bariatric surgery'. Text from included articles was analysed. Papers were categorised into primary and revision articles and the use of 'fail' compared between groups. Descriptive statistics and odds ratio were performed to analyse association between type of papers and negative language. The use of the term 'morbid' was examined and prevalence was recorded. Results: Out of a total of 3,020 screened papers, 71 (2.4%) included the term 'fail'. Forty (56%) referred to revision surgery. The odds ratio of 'fail' appearing in a study of revision surgery was 38.9 (95% CI 22.1-70.2, p<0.0001). Nineteen separate definitions of 'fail' were identified (table) , with most (15/19, 79%) including an aspect of weight loss. The term 'morbid' used in conjunction with obesity was found in 508 papers (16.8%). Conclusions: This is the first study to examine the use of the terms 'fail' and 'morbid' in relation to bariatric surgery. There was a strong association between 'fail' and revision surgery. Obesity and weight loss are independent risk factors for cholelithiasis following bariatric surgery. Choledocholithiasis that require common bile duct clearance (CBD) can be complicated due to altered anatomy following Roux-en-Y gastric bypass preventing routine endoscopic retrograde cholangiopancreatography (ERCP). Alternate management options include laparoscopic-assisted ERCP, on table trans-cystic duct clearance and endoscopic ultrasound directed trans-gastric ERCP (EDGE). EDGE allows for safe CBD clearance through ERCP via an AXIOS stent placed with endoscopic ultrasound between the gastric pouch and the remnant stomach. This technique has a high clinical and technical success whilst being cost effective. We present a case of a 58 year old lady who underwent Roux-en-Y gastric bypass for morbid obesity with associated type 2 diabetes mellitus and non-alcoholic fatty liver disease in 2012. She presented with abdominal pain in February 2021 and diagnosed with cholangitis secondary to choledocholithiasis. She underwent an EDGE procedure and following a successful gastric stent placement she returned 21 days later for an ERCP where the CBD was cleared of stones. After stent removal, the gastro-gastric fistula was closed using the Apollo OverStitch device to prevent her regaining weight. She was discharged with urgent surgical follow up for a cholecystectomy. Introduction: The BARI-LIFESTYLE trial is a randomised controlled trial evaluating the efficacy of a post-surgery nutritional-behavioural telecounselling and supervised exercise to maximise the health benefits of bariatric surgery. Due to the coronavirus disease 2019 (COVID-19) pandemic, the in-person exercise had to be converted to remote tele-exercise. However, patients' acceptability of this method of exercise provision is unknown. Methods: Between 3-6 months following bariatric surgery, 13 adults participated in a weekly structured, 60-minute supervised exercise classes delivered via a video conferencing platform by a trained exercise therapist. 12 participants (n=8 female; mean age 46 ± 10 years) who had undergone either sleeve gastrectomy (n=8) or Roux-en-Y gastric bypass (n=4) surgery participated in one-to-one semi-structured interviews following the programme. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results: Five key themes emerged: i) tele-exercise helped participants to cope with the impact of COVID-19 lockdown, ii) the acceptability of teleexercise, iii) the importance of professional support and advice, iv) selfregulation of exercise, and v) physical, emotional and social benefits of tele-exercise. Conclusions: The tele-exercise was perceived as effective and useful as in-person exercise. These findings will inform future programmes that aim to integrate tele-exercise as part of the bariatric care pathway Background: The aim of this study was to assess perioperative and weight loss outcomes of revisional bariatric surgery (RBS) in an Irish bariatric patient cohort. Methods: Data on consecutive revisional bariatric procedures was prospectively recorded and reviewed retrospectively. Data collected included demographic details, perioperative and weight loss outcomes. Results: A total of 25 revisional bariatric procedures occurred in a 42-month period. Twenty-three patients underwent a second bariatric procedure, with two patients subsequently undergoing a third bariatric procedure. The primary bariatric procedures were gastric banding (n=13,56.5%), sleeve gastrectomy (N=9,39.1%), gastric bypass (N=1,4.35%). The most common indications for RBS included weight regain (68%,N=17), gastric band complications (32%,N=8) and severe reflux symptoms (20%,N=5). The majority of RBS patients were female (N=19,82.6%). Patient demographics are included in Table 1 . The revisional bariatric procedures were sleeve gastrectomy (N=5,20%), roux-en-Y gastric bypass (N=7,28%) and one-anastomosis gastric bypass (N=52%). There was no mortality recorded in this series. Overall postoperative morbidity rate was 16% (N=4). The 30-day readmission and reoperation rates were 8%(N=2) and 4%(N=1), respectively. Total body weight lost (TBWL) at 12-months postoperatively was 17.25%. Conclusions: RBS is a safe and beneficial intervention for patients who regain weight or develop complications after primary bariatric surgery. Background: In bariatric/metabolic surgery, Roux-en-Y gastric bypass (RYGB) remains one of the gold standard procedures. Post RYGB internal hernias affect around 4% of patients. It was hypothesized that having a shorter Biliopancreatic (BP) limb would decrease the risk of internal hernia. The aim of this analysis was to see how BP limb length affected the occurrence of internal hernia, regardless of mesenteric defects closure. Objective: To review the effect of short compared to standard BP limb on incidence of post RYGB internal hernia. Methods: A retrospective analysis of patients who underwent primary laparoscopic RYGB in a teaching university hospital was performed for the period between January 2010 and December 2020. Patients were divided into two groups: those with short BP limb (40-50 cm) without closure of mesenteric defects and those with standard BP limb (80-100 cm) with mesenteric defects closure. The primary outcome was the development of an internal hernia. Results: 691 cases of primary RYGB have been performed between 2010 and 2020. Of those, 429 patients had standard BP limb and 262 patients had short BP limb group. The overall incidence of internal hernia was 1.3% (n=9). There was no significant difference in the incidence between the two groups (6 patients in standard-limb group [1.39%] vs 3 patients in short-limb group [1.14%], P value= 0.53). Only one patient on each group required bowel resection due to ischemia (odds ratio=0.611). There was no internal hernia-related mortality in both groups. Conclusion: In our experience, having a short BP limb did not seem to decrease the incidence of post RYGB internal hernia. Introduction: Laparoscopic Sleeve Gastrectomy(LSG) is a well-established bariatric procedure for morbid obesity.There has been ongoing debate regarding the value of routine histopathologic examination of LSG specimen. Objectives: To examine our practice and discuss if a routine histology examination of the LSG specimen is necessary. Methods: Retrospective analysis of all patients who underwent LSG at the Bariatric Unit at Royal Derby Hospital (09/2009-02/2020) was undertaken. Results: Some 358 patients underwent LSG in a consecutive period of 10.5years.Mean age was 46years.One hundred and nine(30.5%)patients were male and 249(69.5%)female. For 84 patients(23.5%) the specimen had not been sent for analysis. Amongst the remaining 274patients,majority had no abnormality detected(N=181, 66.1%).The most common histopathological changes were chronic gastritis in 61(22.3%)patients and benign gastric polyps in 22(8%),which did not require any further attention. Eight(2.9%)patients were found to have Helicobacter pylori associated gastritis. More sinister findings were reported in 6(2.2%)patients, such as intestinal metaplasia(N=2) and gastrointestinal stromal tumor (GIST)(N=4).All of these patients were older than 50years and have been put on the surveillance list. Conclusion: Our study shows that histopathologic examination of LSG specimen, especially in older patients, might harbor significant findings requiring further medical attention. This is relevant to inform patients and offer surveillance. We recommend histopathological examination of all LSG specimens and especially in patients over 50years of age. Obesity is a disease that has severe consequences on physical and psychological health and quality of life (QOL). Polycystic Ovarian Syndrome (PCOS), closely associated with obesity, presents with a syndrome of subfertility, hyperandrogenism, and abnormal metabolism. This study looks at QOL before and after bariatric surgery in women with and without PCOS, to determine the impact of PCOS on QOL, and how weight loss can improve QOL. Participants completed questionnaires exploring health-related quality of life (HR-QoL) prior to surgery and at three, six and twelve months after surgery. Weight loss and improvement of clinical symptoms was assessed and compared to QOL improvements to identify factors impacting QOL. For both groups, bariatric surgery resulted in significant QOL improvements. Symptoms of irregular/absent periods and hirsutism, showed significant improvements in both groups, and were related to QOL improvements. The beneficial effects of bariatric surgery on QOL indicate that early consideration of surgery in these patients will likely provide significant and sustained clinical benefit. Resolution of clinical symptoms of PCOS with weight loss indicate how weight loss may ameliorate the syndrome of PCOS. The study results improve understanding of the impacts of PCOS on QOL and can be used to improve their clinical management. Background: Changes in various components of energy expenditure (EE), such as resting energy expenditure (REE) and diet-induced thermogenesis (DIT) may influence the long-term maintenance of weight loss after bariatric surgery. Roux-en-Y gastric bypass (RYGB) and Sleeve Gastrectomy (SG) are two widely used procedures with similar efficacy in inducing sustainable weight loss. Aim: To compare the REE, DIT and REE: FFM (Fat Free Mass) ratio between patients undergoing RYGB or SG at more than one-year post surgery. Methods: Sixteen patients (8 RYGB and 8 SG) were invited for a mixed meal test (MMT) at more than one-year post-surgery. EE was measured before and after 1 hour of the MMT ingestion using calorimetry. Body composition was measured using Tanita BC-418MA body composition analyser. Unpaired t test was used to compare the two groups. Results: There was no significant difference between the two groups in terms of weight, HbA1c, REE, DIT and REE: FFM ratio (p=0.222, p=0.525, p=0.678 p=0.759 and p=0.098 respectively). On the other hand, there was a significant increase in DIT in each of the RYGB and SG group (p=0.0002 and p=0.0018 respectively). Conclusion: Our preliminary findings demonstrated that there is no difference in neither REE nor DIT between RYGB and SG at more than oneyear post-surgery suggesting similar effect of both procedures on EE. Further studies with a larger sample size and longer term follow up are required to investigate whether a difference in the various components of EE between the two surgeries could play a role in weight loss maintenance and prevention of weight regain. P34 -An audit of the psychological factors related to feeding complications post bariatric surgery. An audit investigating whether individuals who experience PPS (persistent physical symptoms) post bariatric surgery, and such require a feeding tube, received the standard of psychological care outlined by the BPS (2019). PPS literature indicates that trauma, childhood abuse and illness specific stressors may be important factors in the development of PPS symptoms. Participants identified from bariatric database, n=5 met inclusion criteria with a control group (n=5) of participants randomly selected from the same database. Participant's notes on NHS clinical management systems were analysed using descriptive statistics outlining the psychological input received. Notes further reviewed to ascertain history of trauma, childhood abuse and illness specific stressors. Across all groups, 0% of participants met the standard of psychological care outlined by the BPS. Further exploration showed that 80% of the PPS group experienced trauma, 20% child abuse and 100% illness specific stressor. Control group results showed 20% trauma, 20% child abuse, 20% illness specific stressor. None of the patients audited met the predetermined standard of psychological care (BPS, 2019) . This exploratory study indicates that having an illness specific stressor is correlated with post-surgical feeding complications. This audit highlights the need to enhance the psychological support pre bariatric surgery so to potentially mitigate post-surgery complications. P36 -Does bariatric surgery result in improvement of liver function tests in people affected by obesity? Dr James Sandell 1 , Mr Zaher Toumi 1 Background: NAFLD is a common condition among people with obesity. The only effective treatment is weight loss. This study aims to find out if bariatric surgery can improve some of the biochemical parameters of NAFLD. Methods: A retrospective analysis of prospective database of patients who had bariatric surgery over 4-year period. The most recent liver function tests were compared to the last set of tests done preoperatively. Results: 108 consecutive patients underwent bariatric surgery by a single surgeon over a 4-year period. 102 were included in the study (51 sleeve gastrectomy and 51 Roux-en-Y gastric bypass). 78 were female and 24 were male, with a median age of 46. There was a significant decrease in median ALT post surgery (26u/l to 23u/l, p=0.02). When analysing patients who had LSG and RYGB separately, there was no significant difference in ALT levels in the RYGB cohort while there was a significant decrease in ALT in the LSG cohort. There was not a significant change in ALP and Bilirubin levels in the whole cohort and in the subgroups. Conclusions: Bariatric surgery results in improvement of some of the biochemical markers of NAFLD. The effect is more pronounced in patients who undergo sleeve gastrectomy. P38 -Long-term follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass versus mini gastric bypass: a prospective randomized comparative study of weight loss and remission of comorbidities: Ms Deeba Siddiqui 1 , Dr. Arun Prasad 1 Long-term follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass versus mini gastric bypass: a prospective non-randomized comparative study of weight loss and remission of comorbidities Background: Bariatric Surgery has exponentially increased in the last decade, as it is associated with very low complications, mortality, readmissions and reoperations rates, and shows excellent short-and long-term benefits of weight loss and resolution of comorbidities. The aim of this study was to compare the effect of SG, RYGB, and OAGB, on short-and long-term weight loss and comorbidities resolution. Methods: A prospective non randomized clinical study of all morbidly obese patients undergoing SG, RYGB, and MGB, as primary bariatric procedures, was performed. Patients were randomly assigned into 3 groups as per their choice after explaning all procedures. BMI, excess BMI loss (EBMIL) and remission of type 2 diabetes (T2DM), hypertension (HT), and dyslipidemia (DL) were assessed. Results: 150 patients were included in the study, 50 in each group. First 50 of each procedure were taken after the start date.Follow-up rate at 3 years postoperatively was 91% in SG group, 92% in RYGB, and 90% in MGB. MGB achieves significantly greater EBMIL than RYGB and SG at 1, 2, and 3 years (p < 0.001, respectively). At years, MGB achieves significantly greater remission of T2DM (p = 0.027), HT (p = 0.006), and DL (p < 0.001) than RYGB and SG. RYGB did not show significant superiority than SG in short-and long-term remission of T2DM and HT, but achieves greater remission of DL (p < 0.001). Conclusion: MGB achieves superior mid-and long-term weight loss than RYGB and SG. There are no significant differences in weight loss between SG and RYGB at 1, 2, and 3 years. MGB achieves better short-and long-term resolution rates of DM, HT, and DL than SG and RYGB. RYGB reaches significantly greater rates of T2DM & DL remission than SG. P39 -Gastric bypass is an effective treatment for individuals with Dercum's disease and obesity: A case report Introduction: Dercum's disease is a rare condition characterised by the extensive presence of multiple painful lipomas, with which there is a strong association with morbid obesity. Weight loss in affected patients is refractory to lifestyle modifications, and evidence for the efficacy of weight loss surgery is limited. We report successful weight loss after Roux-en-Y gastric bypass (RYGB) in a patient with Dercum's disease. Case Report: A 48 year old lady presented for consideration for weight loss surgery. Her co-morbidites included irritable bowel syndrome, eczema, gastrooesophageal reflux disease, and Dercum's disease for which she has had several lipoma excisions. Her body mass index (BMI) at presentation was 48kg/m². Prior to her surgery, she underwent full multidisciplinary evaluation. She underwent laparoscopic RYGB in November 2019, using a standard five-port approach, a 20cm³ gastric pouch, 80cm biliopancreatic limb, and 120cm alimentary limb. There were no complications, and she was discharged on the following day. At her sixteenmonth follow-up, her BMI reduced dramatically to 34kg/m². DiscussionThe role of surgery in patients with Dercum's disease is controversial, with one published case report reporting obesity resistant to RYGB with no weight loss effect postoperatively. This report suggests that people with Dercum's can respond to RYGB. P42 -A quantitative investigation into the impact of bariatric surgery on HbA1c levels, diabetes-related medication and weight in obese patients with type 2 diabetes and preoperative BMI of >35 kg/m2. Background: A lady in her fifth decade presented with ongoing weight regain after a vertical banded gastroplasty (VBG) operation 10 years ago. Due to the unsatisfactory results, the patient underwent Single Anastomosis Sleeve Ileal Bypass (SASI). Methods: Careful dissection of the stapled part of the stomach and excision of the previous sialistic ring was done followed by the construction of a laparoscopic Roux-en-Y Gastric Bypass with a 50 cm BP limb and a 150 Roux limb in ante-colic ante-gastric fashion. Results: The revision using laparoscopic RYGB was successful. There were no postoperative surgical complications and the patient progressed well postoperatively. Conclusion: VBG used to be one of the popular options for weight loss surgery, but now it poses a challenge to be revised to a different operation due to adhesions and the risk of a leak. Laparoscopic RYGB can be used as the gold standard for the management of such cases to improve and maintain weight loss. Procedure was performed laparoscopically. The bleeding ulcer was found eroding to the remnant stomach, the lesser omentum and to tributaries of left gastric artery. The ulcer was over-sewn, hemostasis was secured and the gastrojejunostomy was resected. A neo-gastrojejunostomy was created. Patient recovered well from the procedure with no complications or rebleed. Given revisional surgery is basically more challenging, the use of intraoperative endoscopy should always be taken into account in order to prevent complications and/or improve outcomes. Methods: -A 52 yo female with multiple Bariatric procedures since 2001 complained about severe reflux and weight regain. In fact, the last procedure was a duodenal switch in 2013. -Barium meal showed images compatible with stenosis in her duodenoileal anastomosis whereas endoscopy demonstrated that the anastomosis was patent -A diagnostic laparoscopy was performed to delineate the anatomy and try to fix both issues reflux and weight regain. Results -Distalization of the ileo-ileal anastomosis was performed in order to reduce common channel from 150 cm to 100 cm. -Intraoperative endoscopy : An angulation of the sleeve correlated with the laparoscopic view allowed us to focused on the problematic area and proceed to extensive adhesiolysis. -Once the sleeve was totally free and mobile a new gastroscopy was performed and stomach looked straighter. Conclusion: Intraoperative endoscopy allowed us to correlate anatomy in order to repair a mechanical problem. Introduction: The increasing incidence of obesity across the globe has led to a significant rise in the number of bariatric procedures per-formed for weight loss. Given laparoscopic Roux-en-Y gastric bypass is one of the commonest procedures performed worldwide, there is an increasing awareness of the complications associated with it including leak, hemorrhage, bowel obstruction, anastomotic stricture, gastro-gastric (GG) fistula formation, internal hernia and marginal ulcer. A 40 year old female with a surgical history of RYGB 3 years ago presented as an emergency due to excruciating 5-day epigastric abdominal pain. As a consequence of the severity of her symptoms, she was directly taken to theatre to perform a diagnostic laparoscopy. Results: After ruling out internal hernia, an intraoperative endoscopy was performed. Findings showed a big marginal ulcer so decision was made to excise it and re-do a primary reconstruction of the GJ anastomosis Patient was discharged the day after: able to eat and drink and not complaining of any pain. Conclusion: Although some post RYGB complications can be treated conservatively, it is necessary to tailor each patient´s presenting complaint in order to make a good decision at the right moment. Miss Hiba Shanti 1 , Miss Amber Shivarajan 1 , Professor Ameet G. Patel 1 1 King's College Hospital, London, United Kingdom Laparoscopic Gastric Plication (LGP) has been proposed as a less invasive and less costly alternative to sleeve gastrectomy. We present a 30-year-old lady with an initial weight of 160 Kg (BMI 55 Kg/m2) who underwent LGP five years previously in Prague. She lost 50 Kg in the first year, her lowest weight was 110 Kg. Unfortunately, her weight has gradually increased and is currently 148 Kg (BMI 51 Kg/m2). She is seeking further weight loss surgery. We believe to achieve her target weight of 70 Kg; she will require a malabsorptive procedure. Our approach was for a sleeve gastrectomy followed by a second stage SADI or DS if required. Intra-operatively, the gastric wall plication was noted to be disrupted in the middle with herniation of the stomach between plication sutures. The sutures were incorporated by scarring and fibrosis, these were divided. The gastric plication was completely dismantled in preparation for safe stapling. The patient recovered well with no complications. She lost 15 Kg in 6 weeks. O1 -Feasibility of a multi-parametric continuous monitoring wearable device in patients undergoing bariatric surgery Introduction: Continuous, remote vital sign monitoring in the perioperative period may lead to earlier detection of patient deterioration. This study aimed to explore acceptability and accuracy of a wearable sensor for patients undergoing bariatric surgery. Methods: A pilot prospective cohort study was undertaken at our bariatric unit in London. The sensor continuously measured heart rate (HR), temperature, respiratory rate (RR) and oxygen saturation. Accuracy was measured by comparing sensor readings with nurse readings while participants were inpatients, and acceptability was measured by daily usage and a patient satisfaction questionnaire. Results: 12706 sensor and 221 nurse readings were obtained from eight patients. Mean length of use was 7.0±1.5 days at an average of 104.7 hours per patient. High satisfaction scores were recorded from participants. The agreement was high in HR (mean bias -0.3bpm, 95% limits of agreement (LOA) -7.5bpm -6.9bpm), moderate in RR (median bias 0.0breaths/min, 95% LOA -5.5 -13.2breaths/min), poor in temperature (mean bias -1.9°C, 95% LOA -5.5°C -3.3°C) and poor in oxygen saturation (median bias -2.0%, 95% LOA -19.8% -3.5%). The device was well-received by all patients and reliably measured HR, but not any other observation. Despite the potential of remote monitoring devices, acceptability and accuracy must be further assessed in bariatric populations before widespread implementation. Background: DiaREM and ABCD are validated scores for predicting T2D remission following bariatric surgery. However, these scores were generated in ethnically homogeneous populations and are poorly predictive in an ethnically diverse population. Aim: To identify additional parameters that improve the performance of pre-existing remission scores in an ethnically diverse population from the UK. Method: Prospective analysis of 83 patients with T2D who underwent Roux-en-Y gastric bypass (RYGB). Remission (complete and partial) was judged using ADA criteria at 1-year after surgery. The performance of DiaREM was compared against ABCD using Area-under-curve for receiver-operator-characteristic (AUCROC). This was followed by modelling with the inclusion of other demographic parameters and biomarkers derived from a baseline mixed meal test (MMT). Prediction improvement was assessed via calculation of the Integrated Discrimination Improvement (IDI) statistic. Results: DiaREM was better at predicting T2D remission compared with ABCD (AUCROC 0.75 and 0.67, respectively). We found that adding AUC of insulin in response to MMT to DiaREM significantly improved the model's predictive performance (AUCROC 0.83, IDI p-value =0.0076). Conclusion: The addition of a clinically assessable biomarker (insulin secretion in response to MMT) to DiaREM could improve prediction of diabetes remission at 1-year following surgery. The lack of affordable bariatric procedures in the private sector and long waiting lists in the public sector are some of the most frequently voiced reasons by patients choosing to engage in Bariatric Medical Tourism (BMT). We analysed the impact of BMT on our bariatric service. All patients within our service who had undergone primary bariatric procedures outside the United Kingdom were identified through Multidisciplinary Team meeting records. From April 2015 to April 2021, 65 patients were referred to our service by their GPs due to bariatric surgery-related complications. Initial procedures were performed in 17 countries outside of the UK, Turkey being the most prevalent. Twenty-two patients underwent gastric-band placement, 11 Roux-en-Y gastric bypass, 20 sleeve gastrectomy, 1 mini gastric bypass, 3 revision/conversion surgery and 8 gastric-balloon placement. Twentytwo of the referrals to our service required revisional procedures at our hospital; 12 gastric-band removals, 8 gastric-balloon removals and 2 conversions to another surgery for symptom resolution. The cost of these revisions in the NHS were between £4,000-7,000 per surgery. Responsibility for follow-up and monitoring of BMT patients often falls onto NHS services, resulting in significant additional costs and impacting both primary and secondary care resources required for life-long aftercare. O7 -Anxiety and depression amongst participants of the By-Band-Sleeve Study and short term impact of surgery Mental health conditions are common amongst patients selected for bariatric surgery but prospective data about the impact of surgery on mental health are limited. We present Hospital Anxiety and Depression Scale (HADS) data from the NIHR By-Band-Sleeve (BBS) Study. BBS is a 12-centre RCT that has recruited 1351 patients. The validated HADS questionnaire is completed at randomisation and in follow-up. Scores of < 8 for anxiety and depression are normal, 8-10 suggestive of illness, and >11 indicative. Included were patients who underwent surgery within 6 months of randomisation. We examined, i) the prevalence of anxiety and depression (i.e. scores >8) in all patients with complete baseline questionnaires, and, ii) changes in anxiety and depression from baseline to 12 months in patients with complete data (χ2 test). Baseline prevalence of anxiety and depression was 46.2% (n 330/716) and 48.2% (n 343/712) respectively. Paired data for 503 individuals with complete HADS-A and 498 individuals with complete HADS-D showed statistically significant reductions in anxiety (-9.5%) and depression (-22 .3%) disorders (p< 0.001). Patients eligible for bariatric surgery commonly have serious problems with mental health. Improvements are seen in the short-term following surgery. Long-term follow up is needed to understand if benefits are maintained. O8 -The first COVID-19 'lockdown' period and weight-loss surgery: how did patients cope? Introduction: There is a strong relationship between obesity and psychological comorbidity including serious mental illness (National Obesity Observatory, 2011). Psychological support is a key part of a multidisciplinary approach and can be offered digitally allowing scalability and accessibility. Patients benefit from different types of psychological support according to clinical need. Methods: Using clinical expertise, user feedback and functions of a digital smartphone application, five levels of triage were designed to offer a stepped-care approach depending on need and preference, to be in line with current clinical psychology practices. Results: Upon referral into a 12-month tier 3 weight management programme, patients are triaged according to their questions and scores relating to psychological morbidity, emotional eating, trauma history, risk of harm to self and binge eating. Based on their score and preference, patients are triaged into one of five levels of care: (1) no intervention; (ii) guided self-help; (iii) app coaching; (iv) telephone/video call with psychological wellbeing practitioner; or (v) clinical psychologist. Conclusion: Evaluation of impact will be through standardised measures (e.g. PHQ9, BEDS-7 and EQ5D) body metrics (BMI, weight) and programme attendance rates. Expected outcomes are improved programme retention, greater quality of life and improved mood and binge eating scores. O11 -The impact of COVID-19 on total body weight loss in the first 12-months post bariatric surgery Background: The COVID-19 pandemic led to staff re-deployment, cancellation of face-to-face post-surgical clinics and switching to virtual clinics. These changes impacted how bariatric services supported their post-operative patients with potential advise effects on weight loss outcomes. This study aimed to investigate whether COVID-19 impacted on total body weight loss (TBWL) in the first 12-months post-surgery. Introduction: We have recently amended our bariatric protocol from 2-3 nights hospital stay before the pandemic to a planned one-night hospital stay since July 2020. The purpose of this study was to evaluate the safety and efficacy of the new protocol. Methods: We conducted a retrospective comparative study of all patients who underwent bariatric surgery at our bariatric unit from July to September 2019 (Cohort A) and compared it to the cohort during the Pandemic from July to September 2020 (Cohort B). Results: Sleeve Gastrectomy, OAGB, and RYGB constituted 16%, 47.5% ,35% of all procedures in Cohort A and 17%, 43.3%, 36% in Cohort B respectively. The mean and median peri-operative stay for Cohort B during the pandemic were 1.35 and 1.0 day, as compared to 2.5 and 2.0 days for Cohort A. The 30day mortality, reoperation, morbidity, and readmission in Cohort A were 0, 1.3%, 1.3%, 2.6% respectively and for Cohort B were 0, 0, 5.7%, 7.5% respectively. Conclusion: Our new one night stay bariatric protocol implemented during the COVID-19 pandemic has reduced the peri operative hospital stay. However, it may have increased 30-day minor morbidity and readmissions. Introduction: The prevalence of laryngotracheal stenosis (LTS) is greater in obese patients. Management includes serial endoscopic airway interventions and definitive airway reconstruction which is often not feasible in this population due to significant anaesthetic and surgical risks. No studies have investigated whether bariatric surgery (BS) is an effective treatment modality for LTS. Methods: Data was prospectively collected across two tertiary centres of LTS patients with co-existing BMI of >35 kg/m2 between 2014-2020. LTS patients were managed conservatively or underwent BS (Roux-en-Y gastric bypass or sleeve gastrectomy) and followed for 60 months. Results: Eleven LTS patients with mean BMI of 43 kg/m2 (37-45) were included; 6 underwent BS and 5 were controls. Total weight loss after BS was 19.4% (14-24%) at 12 months compared to 2.3% (1-3%) in controls. Significantly fewer endoscopic interventions (p=0.002) and dilatations (p=0.004) occurred in the BS group. No patients were suitable for airway surgery before BS however 50% underwent reconstruction after. LTS patients who had BS and reconstruction required less subsequent interventions in comparison to LTS controls ( Figure 1 ). Introduction: Non-alcoholic fatty liver disease (NAFLD) is characterised by dysregulated lipid metabolism and is a leading cause of liver failure. It is uncertain how bariatric surgery (BS) improves NAFLD, or whether sleeve gastrectomy (SG) and Rouxen-Y gastric bypass (RYGB) have differential effects. Our aims were to develop mechanistic insight into BS's effects on NAFLD and to compare SG and RYGB outcomes. Methods: 40 non-diabetic females were recruited (24 with obesity who were randomised to SG or RYGB and 16 non-obese controls (NOCs)). Research visits occurred before and after preoperative diet, at 20% weight loss and 1 year postoperatively. NAFLD was assessed using MRI, and comprehensive phenotyping including isotopically-labelled mixed meal tests was performed. Results: Imaging and biochemical biomarkers of liver steatosis (p<0.01), inflammation (p=0.01) and fibrosis (p<0.01) improved longitudinally. Hepatic de novo lipogenesis products including myristic acid (p=0.01) decreased, whilst lipid oxidation marker 3-hydroxybutyrate increased (p<0.01). Although postprandial response differed after SG or RYGB, both normalised liver steatosis relative to NOCs (p=0.14-0.29). Conclusions: BS was an effective intervention for NAFLD, normalising liver steatosis through suppression of hepatic de novo lipogenesis and increased lipid oxidation. Postprandial response and serum metabolome were distinct after SG or RYGB, but both induced NAFLD regression. O19 -Increased colonic permeability to oral chromium (51Cr)-EDTA in type two diabetics undergoing Roux-en-Y gastric bypass, compared to a non-operated control group Introduction: The mechanism of action of bariatric surgery is poorly understood but thought to involve altered gastrointestinal permeability (gut barrier function). We examined the relationship between Roux-en-Y bypass (RYGB), permeability and diabetes, and hypothesised that permeability in an operated diabetic group would improve compared to non-operated controls. Methods: Permeability was analysed using urinary Cr51-EDTA, in 15 type two diabetics, at baseline and twelve weeks after RYGB. This was compared to 15 non-operated diabetics of average BMI, matched for age, gender and time with diabetes. Results: No difference in baseline small intestinal and colonic permeability. Following surgery small intestinal and overall permeability did not change in either group, but in the RYGB group colonic permeability significantly increased (p<0.001) becoming different to controls (p=0.001). There was significant reduction in mean BMI (11.6kg/m2) with no change in controls, and a significant reduction in mean HbA1c (24.6mmol/mol) compared to controls (p<0.001). Conclusion: Despite BMI and diabetes improving, small intestinal permeability post-RYGB did not change. In keeping with findings following sleeve gastrectomy, colonic permeability deteriorated after RYGB. (1) This suggests that altered permeability may not be directly dependent on changes to weight or diabetes, and indicates surgery may have a detrimental effect on colonic permeability. 260 patients undergoing primary bariatric surgery, under the care of a single Consultant Surgeon, underwent routine pre-operative and post-operative endoscopy. Results78%(204) were female. The mean (SD) age was 46(11) years. The mean preoperative BMI was 49(7)kg/m2. 73%(191) underwent laparoscopic gastric bypass (LRYGB) and 26%(69) underwent sleeve gastrectomy (LSG). The median (range) time to post-operative endoscopy was 26(12-91) months. The median BMI on follow-up was 33(11) kg/m2. Endoscopic findings of oesophagitis resulted in 11(14%) patients changing preference from LSG to LRYGB pre-operatively By the time of post-operative endoscopy there was a greater reduction in the number of patients taking medication for GORD in the LRYGB group LSG was associated with a higher incidence of DE NOVO post-operative GORD requiring medication (10(14%) v 13(7%), p<0.001) and DE NOVO oesophagitis Post-LRYGB 1(10%) had resolved, 3(30%) had improved, 2(20%) had progressed. The four patients in the LSG group remained stable. Conclusion: Gastric bypass is associated with resolution of GORD symptomatology and endoscopically diagnosed oesophagitis in the majority of patients. This is not the case for LSG. De Novo GORD requiring medical intervention and oesophagitis occurs in both groups -but is more common following LSG. The behaviour of Barrett's oesophagus is unpredictable O17 -Semaglutide 2.4 mg once weekly reduces appetite, reduces energy intake, and improves control of eating in subjects with obesity Rachel Batterham 1 Methods: Adults aged 18-65yrs, BMI 30-45kg/m2 and HbA1c <6.5% were randomised to once-weekly semaglutide 2.4mg or placebo. Gastric emptying (paracetamol absorption), postprandial appetite (visual analogue scales), ad libitum energy intake and CoE (Control of Eating Questionnaire [CoEQ]) were assessed at baseline and week 20. Results: 72 subjects were randomised (44 males, mean age 42.8yrs, BMI 34.4kg/m2). Paracetamol AUC0-5h,para was modestly increased (8% [p<0.01]) with semaglutide 2.4mg. No effect was seen on AUC0-1h 001; Figure) were observed with semaglutide 2.4mg vs placebo. Overall, CoEQ indicated fewer and weaker food cravings and improved CoE with semaglutide 2 Impact of Laparoscopic Sleeve Gastrectomy on Gut Permeability in Morbidly Obese Subjects O20 -The impact of ursodeoxycholic acid on gallstone disease after bariatric surgery: a meta-analysis of randomised control trials Logistic regression determined the OR of progression to tier 4. Results:92, 93 and 42 patients spent <6m, 6-12m and >12m respectively in Tier 3 (overall mean BMI 51.0 kg/m2, mean age 44.3). 107 progressed to tier 4. 34.4%, 34.4% and 11 Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Purpose: The benefits of ursodeoxycholic acid (UDCA) after bariatric surgery have been described, however it is not currently the standard of care. This study aimed to evaluate the impact of UDCA on gallstone disease after bariatric surgery. Methods: A meta-analysis of randomised control trials (RCT) was performed. The primary outcome was formation of gallstones. Secondary outcomes included type of operation, time interval to gallstone formation and symptomatology. Results: Ten randomised control trials including 2583 patients were included, 1772 patients (68.6%) receiving UDCA and 811 (31.4%) receiving placebo. There was a significant reduction in gallstone formation in patients who received UDCA post-operatively (RR 0.36, 95% CI 0.22, 0.41, p = <0.00001) shown in Figure 1 . Subgroup outcomes are presented in Table 1 . A dose of ≤600mg day had a significantly reduced risk of gallstone formation compared to controls (RR 0.35; 95% CI 0.24, 0.53; P<0.001), this was not significant in >600mg/day (RR 0.30; 95% CI, 0.09, 1.01, p=0.05). Conclusion: UDCA reduces the risk of asymptomatic and symptomatic gallstones after bariatric surgery. A lower dose is associated with improved compliance and better outcomes. UDCA should be considered part of a standard postoperative care bundle.