OSSI GUIDELINES FOR BARIATRIC AND METABOLIC SURGERY: 2023

OSSI GUIDELINES FOR BARIATRIC AND METABOLIC SURGERY: 2023 

As a national body of bariatric and metabolic surgeons in India, OSSI through its Executive Committee published 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 postulate:

• 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 life altering or life saving 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 restriction, malabsorption and satiation.
• 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.

INDICATIONS FOR SURGERY:

• BMI above 32.5 kg/m2 with obesity related co-morbidities
• BMI above 37.5 kg/m2 without co-morbidities.
• BMI > 30 kg/m2 with life threatening obesity related disorders like uncontrolled diabetes, cardiovascular disease / cardiomyopathy and severe obstructive sleep apnoea.
• Patients motivated to lose weight and commitment to long term follow up
• Patient should have attempted conservative methods of weight loss and failed in the past
• Bariatric Surgery to be considered only between ages of 18 – 65 years
• Bariatric surgery may be considered in patients more than 65 years in the presence of severe obesity related co-morbidities / disability
• Bariatric Surgery may be considered in patients < 18 years in special situations after pediatrician / endocrinology certification , or after attainment of puberty or completion of skeletal maturity

CONTRA-INDICATIONS FOR SURGERY:

The absolute contra-indications for bariatric surgery include:

• Drug and/or Alcohol abuse
• Uncontrolled Psychological Disease
• Pregnancy

STANDARD PROCEDURES:

The presently accepted bariatric procedures include:

• Adjustable Gastric Band (AGB)
• Vertical Sleeve Gastrectomy(VSG)
• Roux en Y Gastric Bypass(RYGB)
• One Anastomosis Gastric Bypass (OAGB)
• Biliopancreatic Diversion with Duodenal Switch (BPD-DS).
• Procedure series that are published by an Indian author in peer reviewed journal are eligible as non-standard, but under OSSI guidelines.
• All other un-published procedures would be defined experimental / novel procedures. 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.

PREGNANCY AFTER SURGERY:

Pregnancy has to be planned:

• At least 12 to 18 months after surgery or until stabilization of weight occurs
• Artificial reproductive therapy(ART) can be initiated 12 months after surgery