The first Asian Metabolic Surgery Task Force Meeting (ACMOMS 5) was held on 6th and 7th of July 2012 at Fortis Memorial Research Institute in Gurgaon. This was the first time in India that experts from endocrinology, diabetology, research and epidemiology gathered together to brainstorm on the pros and cons of bariatric surgery. The meeting had representation from WHO, IDF, DASG and RSSDI. It was endorsed by multiple societies like AETF (Asia Endosurgery Task Force), IFSO APC (International Federation for the Surgery of Obesity and Metabolic Disorders- Asia Pacific Chapters), APBSS (Asia Pacific Bariatric and Metabolic Surgery Society), IEF (International Excellence Federation), ESLES (Emirates Society of Laparoendoscopic Surgeons), IAGES (Indian Association of Gastrointestinal Endosurgeons), AMASI (Association of Minimal Access Surgeons of India, OMSSS (Obesity and Metabolic Surgery Society of Singapore), TSMBS (Thai Society for Metabolic and Bariatric Surgery, TSMBS (Taiwan Society for Metabolic and Bariatric Surgery.
The meeting was chaired by Dr. Muffazal Lakdawala and Dr. V. Mohan. The idea was to bring forth the current concepts in worldwide research in metabolic surgery and to dispel the myths associated with it.
After two days of deliberations, didactic lectures, debates and symposia the following guidelines were proposed:
Criteria for metabolic surgery
- Type two diabetic patients with a BMI between 35 to 40 are eligible for surgery and must be prioritized for surgery. (BMI points may be dropped by 2.5 for Asian patients)
- Type two diabetic patients with a BMI between 30 to 35 are eligible for surgery conditionally. (BMI points may be dropped by 2.5 for Asian patients)
- Type two diabetic patients less than a BMI of 30 must be offered surgery only under experimental protocol. (BMI points may be dropped by 2.5 for Asian patients)
The other recommendations were:
- Metabolic surgery team must be a multidisciplinary team that includes a bariatric surgeon, bariatric nutritionist, endocrinologist/diabetologist/ bariatric physician, bariatric anesthetist and a psychologist.
- Patients who undergo surgery need a lifelong follow up and surveillance by the diabetologist/endocrinologist/bariatric physician and a nutritionist
- High risk bariatric procedures must be performed only at high volume centres performing more than hundred procedures in a year.
- Any patient with a BMI < 30 (BMI points may be dropped by 2.5 for Asian patients) must be operated only as part of a research study approved by the IRB.
Proposal for a prospective trial:
Prospective trial comparing the results of surgery with medical management to see the effects on micro and macro vascular complications of diabetes in these patients