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Meeting report

Special report: First GOSS annual meeting

Gulf Obesity and Metabolic Surgery Society

The First Gulf Obesity and Metabolic Surgery Society (GOSS) Meeting was held in Kuwait on December 12-14 December 2014. Bariatric News talked to Dr Abdelrahman Nimeri (Head of Division of General, Thoracic, & Vascular Surgery, Director of Bariatric & Metabolic Institute (BMI) Abu Dhabi), Program co-Chair of the meeting to discuss the successful first event

The meeting was attended by approximately 600 delegates, the majority were from the six countries of the Gulf region (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates), as well as from Jordan, Lebanon, Egypt and India. There were also a considerable number of international speakers from Taiwan, Brazil, Canada, US, Europe and Australia among others.

“The meeting incorporated some very interesting live cases transmissions including a reversal of a RYGB, a revisional BPD, and a sleeve for a 15 year-old with a BMI 70,” explained Nimeri. “The session created lively debate and some fantastic discussions.”

Abdelrahman Nimeri


In addition, to the live cases, the meeting also examined the current status of bariatric surgery the six countries of the Gulf region. It was reported that Kuwait, Qatar, Saudi Arabia and United Arab Emirates were performing the most procedures, with surgical numbers in Bahrain and Oman some way behind. Sleeve gastrectomy was the most performed procedure and RYGB the second most popular, with a small number of surgeons performing mini gastric bypass.

“I think there are several reasons why sleeve is so popular in the region, primarily because of the public ‘perception’ that the procedure is seen as easier with less complications” he explained. “It is also a technically simpler procedure for the surgeon compared with a bypass. Gastric bands are really on the down turn, I think more surgeons in the region are removing them compared with implanting them. For example, in my centre we have performed 100 revision surgeries for bands and performed six primary banding procedures in the past three years.”

The meeting also hosted several Keynote presentations including one from Gerald Fried, President of Society of American Gastrointestinal and Endoscopic Surgeons, who discussed training and the opportunities in the field of surgery.

“He really emphasised the importance of training before a surgeon enters the operating room and how much one can learn from a dry-lab, animal lab and simulated training so on,” he added. “His message was that by reducing their learning curve, a surgeon can reduce their complication rate.”


A second Keynote presenter was Professor John Dixon who examined the impact of bariatric surgery registries and it became clear that despite the large number of bariatric procedures carried out in the Gulf Region there is very little literature published.

John Dixon

“I think this is one of the things the Gulf Obesity and Metabolic Surgery Society is looking at and we must try and make it easier for our members to join registries so they can record, collect and report their data,” said Nimeri. “The aims of the Gulf Obesity and Metabolic Surgery Society include hosting an annual meeting, making it easier for our members to get training in different countries and be able to join bariatric surgery registries.”


Another interesting session examined the role of surgery for patients with T2DM and Dr Philip Schauer reviewed randomised controlled trials of surgery Vs. intensive medical therapy for T2DM. The session also debated the impact surgery has on patients with BMI more or less than 35, the long term outcomes of surgery for T2DM, hypertension and dyslipidaemia.

“Overall, the session concluded that diabetes improves but is not cured by surgery in the same way surgery does resolve hypertension and dyslipidaemia,” he added. “Patients with BMI<35 do not behave the same way as patients with BMI>35. You have to quantify the patient and look at diabetes duration, age and medication.”

Bypass gold standard?

One of the key debates during the meeting assessed whether RYGB is still the gold standard procedure with and Mufazzal Lakdawala arguing for the motion and Karl Miller and against the motion.

“Even though the literature supports the view that RYGB is the gold standard procedure, I think it is still a difficult procedure to learn and if a RYGB patient has weight recidivism there are very few options available, whereas with a sleeve patient there are more options available,” he said. “Although the proponents of RYGB won the debate I don’t think it will alter practice.”

Another interesting topic was debated by Khalid Gari and Wei-Jei Lee  - malabsorptive procedures and in particular the mini-gastric bypass.

Wei-Jei Lee

Mohammed Talebpour also discussed gastric plication and said that procedure was not for everyone who is morbidly obese, and is more likely to success in young motivated females with BMI<45, as well as emphasising the importance of placating two layers.

The meeting also examined complications after surgery and discussed the endoscopic and operative management of management leak after gastrectomy (early, late, chronic fistula), malnutrition and hernias, as well as the best options for treating staple line leaks.

“This was a very lively discussion in which the importance of a multidisciplinary programme was emphasised, as well as discussing all the surgical options available with the patient and of course their parents,” he said. “John Dixon also highlighted impact bariatric surgery can have on the bone metabolism in adolescent patients and he stressed that it was crucial these patients were followed in the long term.”

There was also a session on emerging technologies such as the Endobarrier, the POSE procedure and new intragastric balloon technology (Obalon System). “All these technologies are still experimental and still not ready, but they all show promise and although they do provide as much weight loss as surgery they could be used as a bridge to lose weight in the superobese population,” he explained. “Or, as in the case with POSE, in patients with a BMI 30-40.”

Revisional surgery

“A lot of surgeons in the region are converting banding to sleeve so there was much debate on whether conversion should be made to sleeve or bypass. Advocates of the sleeve said it was safe, however, bypass advocates argued that performing a sleeve is merely adding another restrictive procedure but by performing a bypass it could have an added affect.”

Concerns were also voiced over the complication rates of converting from band to sleeve with much discussion about leak rates.

“Very few surgeons convert their patients to a malabsorptive procedure in the region, primarily because of the lack of protein in diets, compared to Western diets.


“I would like to thanks all the faculty and attendees for making the First Gulf Obesity and Metabolic Surgery Society meeting such a great success and I look forward to seeing you all in Abu Dhabi December 11–13 for the S]second meeting,” he concluded.

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