OSSI GUIDELINES FOR BARIATRIC AND METABOLIC SURGERY:

As a national body of bariatric surgeons in India, OSSI through its Executive Committee published its guidelines on Obesity and Metabolic Surgery and keep updating it on a regular basis. Since the publishing of its first guidelines in 2017, there has been 2 more additions, latest being released in 2023. These guidelines include:

• Obesity is a disease and not just a life style disorder.
• Bariatric and metabolic surgeries are gastrointestinal surgeries to improve, prevent and/or treat obesity and its co morbidities which may be life threatening. This is a lifesaving surgery and not cosmetic surgery.
• Asians and in particular the Indian population needs a more aggressive approach in treating obesity and its co-morbidities as it is associated with higher morbidity and mortality at a relatively lower BMI.
• Presently accepted bariatric and metabolic surgeries are based on principles of restrictive, malabsorptive and combined procedures.
• Surgery for treatment of type 2 diabetes and metabolic syndrome in patients with or without obesity is considered as metabolic surgery since these gastrointestinal surgical procedures have anti-diabetic & metabolic effects independent of weight loss.
• All surgeons who are 'full members' of OSSI are members of IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) and are eligible to perform bariatric & metabolic surgery.

The presently accepted bariatric procedures include restrictive, malabsorptive and combination surgeries of both.

Indications for bariatric surgery include BMI above 32.5 kg/m2 with co-morbidities, and BMI above 37.5 kg/m2 without co-morbidities.

The standard procedures recognized were laparoscopic adjustable gastric banding(LAGB), Laparoscopic sleeve gastrectomy(LSG), Laparoscopic Roux en Y gastric bypass(LRYGB) and Biliopancreatic diversion(BPD). All other procedures were considered experimental procedures.

Misra A, et al, published the consensus statement for the diagnosis of obesity and metabolic syndrome in Asian Indians in the year 2008 and also provided recommendations for medical and surgical management.

OSSI executive committee, during the EC meeting held in New Delhi on 2 Dec 2016, recommends following as an adjunct to the existing guidelines.

STANDARD BARIATRIC PROCEDURES:

1. The procedures considered standard include laparoscopic adjustable gastric banding(LAGB), Laparoscopic Sleeve Gastrectomy(LSG), Laparoscopic Roux-En-Y Gastric bypass(LRYGB), Biliopancreatic Diversion with Duodenal Switch(BPD-DS) and Laparoscopic Mini-Gastric Bypass(MGB).
2. All other procedures would be defined experimental / novel bariatric procedures
3. Any novel procedure or surgery on patients outside the guidelines can only be done in the context of a clinical trial after an ICMR approved ethics committee clearance and registration in either www.clinicaltrials.gov or www.ctri.nic.in or by surgeons who have completed appropriate clinical trails.

INDICATIONS FOR BARIATRIC SURGERY:

1. BMI >37.5 without presence of any obesity related co-morbidities or
2. BMI > 32.5 with the presence of type 2 Diabetes / any obesity related co-morbidities
3. Patients motivated to lose weight and commitment to long term follow up
4. Patient should have attempted conservative methods of weight loss and failed
5. Bariatric Surgery to be considered only between ages of 18 - 65 years
6. Bariatric surgery may be considered in patients more than 65 years in the presence of severe obesity related co-morbidities / disability
7. Bariatric Surgery may be considered in patients < 18 years in special situations after pediatrician / endocrinology certification , but after attainment of puberty or completion of skeletal maturity

CONTRA-INDICATIONS:

The absolute contra-indications for bariatric surgery include Drug or Alcohol abuse , Uncontrolled Psychological Disease and Pregnancy

PREGNANCY AFTER BARIATRIC SURGERY:

Pregnancy has to be planned at least 15-18 months after the bariatric surgery. Artificial reproductive therapy(ART) can be initiated 12 months after the bariatric surgery.