Medicine

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First series of laparoscopic sleeve gastrectomy in Sri Lanka-technical feasibility and outcome in a resource poor setting in asia.
(New York; Springer, 2014) Wijeratne, T.K.; Bulugahapitiya, U.; Kumarage, S.; Rajaratnam, H.
INTRODUCTION: Morbid obesity and metabolic syndrome are emerging as a major health issues in developing South Asian countries. Laparoscopic Sleeve Gastrectomy (LSG) has been introduced to this region with excellent out comes in controlling morbid obesity and metabolic syndrome. OBJECTIVE(S): Assess the technical feasibility and outcome of LSG as a surgical procedure in a resource poor country in south Asia where Bariatric surgery is still a novel concept. METHOD(S): Prospective Analytical study of the first 15 patients who underwent LSG in a tertiary care hospital in Sri Lanka over 2 years. All data on pre operative, surgical and post operative follow up were recorded in a pre-designed research Performa and all patients were followed up for a minimum period of 6 months by Surgical and Endocrine team. All Surgeries were performed by the same surgeon and the surgical team using total Laparoscopic technique using a 40 F Gastric bougie to standardize the Sleeved stomach. There were 14 females and one male in the study group. Weight range was from 83 to 167 kg with a mean weight of 106.2 kg. Average BMI 45 kg/m2 Results: There were no major complications. The percentage excess weight loss during first 3 months was 28.8 % and at 6 months 42.3 %. Resolution of comorbidities especially Diabetes and Metabolic Syndrome was excellent and one out of two patients who had surgery for subfertility conceived during study period. CONCLUSION(S): LSG can be performed safely in a resource poor setting in south Asia and is effective as a Bariatric surgical procedure for Sri Lankan population.
Incidence, prevalence and demographic and life style risk factors for obesity among urban, adult Sri Lankans: a community cohort follow-up study
(Sri Lanka Medical Association, 2017) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Kottachchi, D.; Ranasinghe, R.M.A.G.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
INTRODUCTION & OBJECTIVES: Obesity is a global problem. Data from the South Asian region is limited. METHODS: In a cohort follow-up study we investigated obesity among urban, adult, Sri Lankans (35-64y; selected by age-stratified random sampling from Ragama-MOH area; initial screening 2007; re-evaluation 2014). On both occasions structured interview, anthropometry, liver ultrasound, biochemical and serological tests were performed. Total body fat (TBF) and visceral fat percentage (VFP) were assessed by impedance in 2014. General-obesity (GO) was BMI>25kg/m2. Central-obesity (CO) was waist circumference (WC)>90cm males and WC>80cm females. Multinomial logistic regression was fitted to assess associations. RESULTS: In 2007 (n=2967), 614 (20.7%) were overweight [51.9%-women], 1161(39.1%) had GO [65.9%-women] and 1584(53.4%) had CO [71%-women]. Females (p<0.001), raised-TG (p<0.001), low-HDL (p<0.001), diabetes (p<0.001), hypertension (p<0.001), NAFLD (p<0.001), and low household income (p<0.001) were significantly associated with prevalent GO and CO respectively. Additionally, increased-age (p=0.05), low-educational level (p<0.001) and unhealthy eating (p<0.001) were associated with prevalent CO. Inadequate physical activity was not associated with either. 2137 (72%) attended follow-up in 2014. Of those who were initially non-obese who attended follow-up, 189/1270 (14.9%) [64% women] had developed GO (annual-incidence 2.13%) and 206/947 (21.9%) [56.3% women] had developed CO (annual incidence 3.12%) after 7 years. TBF and VFP significantly correlated with incident GO and CO (p<0.001). Female gender (OR-1.78, p<0.001; 2.81, p<0.001) and NAFLD (OR-2.93, p<0.001; OR-2.27, p<0.001) independently predicted incident GO and CO respectively. CONCLUSION: The prevalence and incidence of GO and CO were high in this cohort. Both incident GO and CO were strongly associated with female gender and NAFLD.
How should we manage patients with non-alcoholic fatty liver disease in 2007?
(Wiley-Blackwell, 2007) Chan, H.L.; de Silva, H.J.; Leung, N.W.; Lim, S.G.; Farrell, G.C.
Evidence-based management guidelines for non-alcoholic fatty liver disease (NAFLD) are lacking in the Asia-Pacific region or elsewhere. This review reports the results of a systematic literature search and expert opinions. The Asia-Pacific Working Party on NAFLD (APWP-NAFLD) has generated practical recommendations on management of NAFLD in this region. NAFLD should be suspected when there are metabolic risk factors and/or characteristic changes on hepatic ultrasonography. Diagnosis by ultrasonography, assessment of liver function and complications, exclusion of otherliver diseases and screening for metabolic syndrome comprise initial assessment. Liver biopsy should be considered when there is diagnostic uncertainty, for patients at risk of advanced fibrosis, for those enrolled in clinical trials and at laparoscopy for another purpose. Lifestyle measures such as dietary restrictions and increased physical activity (aerobic exercise) should be encouraged, although the best management strategy to achieve this has yet to be defined. Complications of metabolic syndrome should be screened for regularly. Use of statins to treat hypercholesterolemia is safe and recommended; frequent alanine aminotransferase (ALT) monitoring is not required. Obese patients who do not respond to lifestyle measures should be referred to centers specializing in obesity management; consideration should be given to bariatric surgery or gastric ballooning. The role of pharmacotherapy remains investigational and is not recommended for routine clinical practice. Non-alcoholic fatty liverdisease should be recognized as part of the metabolic syndrome and managed in a multidisciplinary approach that addresses liver disease in the context of risk factors for diabetes and premature cardiovascular disease. Lifestyle changes are the first line and mainstay of management

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