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Abdelrahman A. Nimeri (President of IFSO Middle East - North Africa Chapter, President of the PanArab Society for Metabolic and Bariatric Surgery, Abu Dhabi) explains, in this lecture from IFSO 2018, the main concerns about weight regain and the treatment of superobese patients.
He remarks that there is no clear consensus on how much weight loss is significant or how to measure success after primary bariatric surgery. Although most authors agree that success should be measured as > 50% of Excess Weight Loss, this is not a good indicator, as it will be different depending on the initial BMI, with patients regaining weight afterwards. In medical literature, a 10% weight loss is considered significant as it reduces comorbidities, and Dr. Nimeri suggests this 10% as a marker of success.
He also explains the difficulties of treating superobese patients and, making comparisons with oncologic surgery, he suggests that the treatment of this group of patients may start with medical treatment - or even a balloon - and when the patient has lost some weight, then surgery is indicated.
He also discusses the importance of choosing the right procedure for each patient, especially now that sleeve gastrectomy is being increasingly performed. A thorough evaluation of the patient is mandatory. The presence of reflux is also important to decide which procedure is indicated.