Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the world, accounting for more than 50% of all bariatric procedures [1]. There are several factors that have led to its rapid traction since its inception. Firstly, in comparison to the laparoscopic adjustable gastric banding a gastric-restriction based procedure, which was still popular at that time, the sleeve was a simple, yet a powerful metabolic operation, activating significant hormonal pathways that lead to changes in eating behavior, glycemic control, and gut functions; all without the need for an implant and adjustments. Secondly, in contrast to Roux-en-Y gastric bypass (RYGB), LSG is less technically complex with no anastomosis. Being limited to the stomach makes it simpler and avoids the risk of internal hernias or other complications such as severe micronutrient and protein deficiency [45][46][47].In this chapter, we will describe the technical aspects of the LSG in order to perform the procedure safely and avoid simple errors that can occur.

Background COVID-19 pandemic varies greatly and has different dynamics in every country, city, and hospital in Latin America. Obesity increases the risk of SARS-CoV-2 infection, and it is one of the independent risk factors for the most severe cases of COVID-19. Currently, the most effective treatment against obesity available is bariatric and metabolic surgery (BMS), which further resolves or improves other independent risk factors like diabetes and hypertension. Objective Provide recommendations for the resumption of elective BMS during COVID-19 pandemic. Method This document was created by the IFSO-LAC Executive Board and a task force. Based on data collected from a survey distributed to all IFSO-LAC members that obtained 540 responses, current evidence available, and consensus reached by other scientific societies. Results The resumption of elective BMS must be a priority maybe similar to oncological surgery, when hospitals reach phase I or II, treating obesity patients in a NON-COVID area, avoiding inadvertent intrahospital contagion from healthcare provider, patients, and relatives. Same BMS indication and types of procedures as before the pandemic. Discard the presence of SARS

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BACKGROUND: The influence of the placement of a band on the outcomes of one anastomosis gastric bypass (OAGB) has not been appropriately studied yet. OBJECTIVE: To compare early weight loss and glucose metabolism parameters following banded versus non-banded OAGB. METHODS: A prospective randomized study, which evaluated 20 morbidly obese individuals who underwent banded and non-banded OAGB and were followed-up for three months. Weight loss (percentage of excess weight loss - %EWL and percentage of body mass index loss - %BMIL) and glucose metabolism outcomes (glucose, insulin and homeostasis model assessment - HOMA) were compared. RESULTS: The banded group presented a significantly higher %EWL at one month (29.6±5.5% vs 17.2±3.4%; P<0.0001) and two months post-surgery (46±7% vs 34.2±9%; P=0.004544), as well as a significantly higher %BMIL at one month (9.7±1.1% vs 5.8±0.8%; P<0.0001), two months (15±1.4% vs 11.5±2.1; P=0.000248), and three months (18.8±1.8% vs 15.7±3.2%; P=0.016637). At three months, banded OAGB led to significant decreases of insulin (14.4±4.3 vs 7.6±1.9; P=0.00044) and HOMA (3.1±1.1 vs 1.5±0.4; P=0.00044), whereas non-banded OAGB also led to significant decreases of insulin (14.8±7.6 vs 7.8±3.1; P=0.006) and HOMA (3.2±1.9 vs 1.6±0.8; P=0.0041). The percent variation of HOMA did not significantly differ between banded and non-banded OAGB (P=0.62414); overall, the percent variation of HOMA was not correlated with %EWL (P=0.96988) or %BMIL (P=0.82299). CONCLUSION: Banded OAGB led to a higher early weight loss than the standard technique. Banded and non-banded OAGB led to improvements in insulin resistance regardless of weight loss.

BACKGROUND: The long-term effects of bariatric surgery on the course of non-alcoholic fatty hepatopathy (NAFLD) are not fully understood. OBJECTIVE: To analyze the evolution of NAFLD characteristics through noninvasive markers after Rouxen-Y gastric bypass (RYGB) over a five-year period. DESIGN AND SETTING: Historical cohort study; tertiary-level university hospital. METHODS: The evolution of NAFLD-related characteristics was evaluated among 49 individuals who underwent RYGB, with a five-year follow-up. Steatosis was evaluated through the hepatic steatosis index (HSI), steatohepatitis through the clinical score for non-alcoholic steatohepatitis (C-NASH) and fibrosis through the NAFLD fibrosis score (NFS). RESULTS: 91.8% of the individuals were female. The mean age was 38.3 ± 10 years and average body mass index (BMI), 37.4 ± 2.3 kg/m 2 . HSI significantly decreased from 47.15 ± 4.27 to 36.03 ± 3.72 at 12 months (P < 0.01), without other significant changes up to 60 months. C-NASH significantly decreased from 0.75 ± 1.25 to 0.29 ± 0.7 at 12 months (P < 0.01), without other significant changes up to 60 months. NFS decreased from 1.14 ± 1.23 to 0.27 ± 0.99 at 12 months (P < 0.01), and then followed a slightly ascending course, with a marked increase by 60 months (0.82 ± 0.89), but still lower than at baseline (P < 0.05). HSI variation strongly correlated with the five-year percentage total weight loss (R = 0.8; P < 0.0001). CONCLUSION: RYGB led to significant improvement of steatosis, steatohepatitis and fibrosis after five years. Fibrosis was the most refractory abnormality, with a slightly ascending trend after two years. Steatosis improvement directly correlated with weight loss.

Background: The SARS-CoV2 virus pandemic pandemic has been characterized for its rapid global dispersion. Obesity is an independent risk factor for the most severe cases of COVID -19. The impact in Argentina differs from others since it was able to anticipate public health interventions in order to flatten the contagion curve. Early quarantine achieved better control of the pandemic and, following the recommendations of scientific societies in countries with higher affectation, elective bariatric surgeries (BS) and in-person consults were suspended. Objective: Bariatric surgeons were surveyed to assess the impact of the pandemic and the measures undertaken on the practice of BS in Argentina.Method: Between April 17 and 21, 2020, an online survey in Google forms was disseminated to bariatric surgeons residing in Argentina. It consists of 40 specific and non-specific questions regarding BS practice and COVID pandemic. Consent to participate was obtained from surgeons by completing the survey.Results: 83 surgeons averaging 47.17 years of age responded the survey. Together they performed 10515 BS in 2019. More than 65% stated that more than 50% of their income derives from this activity, and more than 40% depend on more than 75% of it. The average hospital stay was 1.6 days and 85% reported using Intensive Care Unit (ICU) in less than 1% of their patients. According to the scores of hospital affectation issued by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), 54% reported being in Phase I and 34% had not yet been affected by the pandemic. All, except one, suspended the elective BS 7.7 days on average before the appearance of the first local case. 95.7% offer virtual consults, but 48% obtain no retribution for them. 26% would consider performing BS without a previous endoscopic evaluation.90% of the surgeons surveyed (75) continue performing other types of surgeries via laparoscopy. In case of operating a patient without suspected SARS-CoV-2 virus infection, 80% would use N95 masks and 56.6% would use face protection shields; two thirds would use smoke filters for the pneumoperitoneum and only 10.8% would continue with the usual protection measures. To restart the elective activity, 56.6% proposed that the hospital should be in phase 0 or I, that the patient should meet certain characteristics for their selection and that the scientific society must recommend the way to restart of the activity.Patient selection criteria with greater consensus were testing to rule out asymptomatic COVID-positive patients, epidemiology, absence of chronic lung disease, age under 60, and immunological integrity. 19.2% regard sleeve gastrectomy as the ideal BS during the pandemic, and 88% of the surgeons would not change their chosen BS technique based on infection risk. Conclusion: Elective BS is currently suspended in Argentina, although epidemiologically the conditions in the country are not unfavorable. Economic impact for those involved is significant. Short-term vision is pessimistic, but recommendations originating from the scientific societies that nucleate them are expected in order to guide health authorities towards appropriate regulations suitable for the local practice.