Professor Amir Nisar's Expertise in Bariatric Surgery & its Complications, especially Heartburn after Sleeve Gastrectomy, Gastric Bypass and Mini Gastric Bypass
Historic Background in Bariatric Surgery
Professor Amir Nisar’s fascination for Bariatric surgery led him to organize the first Laparoscopic bypass operation conducted in the United Kingdom in Royal Surrey County hospital in 1999. He visited the best centers in Europe to learn the techniques in bariatric surgery. He worked with Professor Alberic Fiennes, the president of BOMSS (British Obesity and Metabolic Syndrome surgery).
He set up centers for bariatric teams and surgery in 5 hospitals from scratch in Kent, United Kingdom. He has managed to achieve excellent outcomes and results in his patients through thorough assessment and offering them appropriate surgical options advice. He is meticulous with surgery and follows a robust post-operative follow-up plan for the patients, crucial for good outcomes.
Heartburn/Reflux after Weight-loss Surgery
Bariatric surgery/ weight loss surgery for Obesity / Metabolic Syndrome surgery has been done for decades. The journey from wiring of the patient’s teeth of the two jaws together to the modern laparoscopic / keyhole options for weight loss had had its rewards and failures.
The number of options or operations to tackle one disease like obesity means that none is perfect and the jury is still out.
While looking at the end point of weight loss surgery in terms of success is weight loss without complications is very optimistic in most cases. The small percentage of cases who develop some complications can also be dealt with effectively with corrective surgery. However the answer to one complication has disturbed the Bariatric surgeons globally; Reflux (GORD / GERD) after bariatric surgery; Laparoscopic Proximal Gastric Bypass Surgery (LGBP), Laparoscopic Sleeve Gastrectomy surgery (LSG) or Mini Gastric bypass. There has been no effective answer to it until 2018. Professor Amir Nisar’s innovation “Amir’s Dubai Repair (ADR)” is a safe and feasible option and has helped some patients to recover from this complex complication and somewhat and maintaining their weight loss as well without any major resectional re-do surgery.
Probably Professor Amir Nisar’s expertise and understanding of the anti-reflux surgery and bariatric surgery and divine help, helped him to find a relatively simple solution for this complex issue in the form of Amir’s Dubai repair.
GERD (Gastro Esophageal Reflux Disease) which causes heartburn or food coming to throat can affect many patient’s lives after weight loss surgery, like Sleeve Gastrectomy or Gastric Bypass.
Amir’s Dubai Repair (ADR) is Professor Amir Nisar’s innovative technique to help such patients, thus improving their quality of life and allowing them to stop taking their medicines.
Professor Nisar’s extensive experience and interest in GORD / GERD (Gastro-Oesophageal reflux disease) have helped him to deal with the very complex scenarios after bariatric surgery:
- Heartburn/GERD after Sleeve Gastrectomy
- Heartburn/GERD after Proximal gastric bypass surgery
- Heartburn/GERD after Mini Gastric bypass
Amir’s Dubai Repair (ADR) World's 1st
It is an innovative surgical technique to cure Reflux / Heartburn / Food, Acid or Bile regurgitation in mouth after Weight loss surgeries like Sleeve Gastrectomy, Gastric bypass and Mini Gastric bypass.
It is based on and compliant with the standard and published principles of anti-reflux surgery.
Our results over the last few years show that Amir’s Dubai repair (ADR) is a safe and feasible option for the treatment of complex issues in patients with reflux (GORD / GERD) after Bariatric surgery / Metabolic Syndrome surgery for weight loss (Sleeve Gastrectomy and Proximal Gastric Bypass operations.)
Amir’s Dubai Repair (ADR) Operation
The surgery in minimally invasive and performed laparoscopically. There are 4-5 small cuts less than half cm each. Surgery is done with fine instruments and in most cases, it takes about 60 to 120 minutes to perform the surgery.
Correcting any other complications from the initial Sleeve Gastrectomy, Gastric Bypass or Mini Gastric Bypass in addition to curing reflux, during Amir’s Dubai Repair – ADR operation
While the primary aim of ADR is to cure the heartburn / reflux, however any other complications from weight loss surgery can also be corrected during the same operation.
While performing ADR, we also correct the other complications from the initial bariatric operation ((Gastric tube spiral, Gastric tube stenosis, lax Gastrojejunostomy post gastric bypass, just to name a few).
Amir’s Dubai Repair – ADR an antireflux operation
Amir’s Dubai Repair – ADR operation is primarily an operation to prevent reflux, heartburn and food or acid regurgitation into mouth. It is compliant with the well-established principles of Antireflux surgery and follows all the four cardinal rules of antireflux surgery.
Amir’s Dubai Repair(ADR) helps and supports patient’s journey of weight loss
Amir’s Dubai Repair – ADR is primarily not supposed to be a weight loss operation and is purely an antireflux operation. However, we have noted a success after ADR in weight loss as expected after the original weight loss operation. This weight loss might have stopped after their initial sleeve gastrectomy or gastric bypass.
Restrictive component of the weight loss surgery, where a patient eats a smaller portion of food and gets satiety (feels full) is an integral part of weight loss surgery. This feeling of fullness (Satiety) is generally lost when a patient has incompetent (loose) Lower Esophageal Sphincter (LES).
Amir’s Dubai Repair – ADR operation restores the integrity of Lower Esophageal Sphincter LES and thus satiety as well.
In our experience the patients who had stopped losing weight after weight loss surgery, started losing weight successfully after Amir’s Dubai Repair – ADR operation, if they were compliant and followed the diet plan. However, if a patient was non-compliant then weight loss may not be achieved as after any weight loss operation.
We consider the restoration of Satiety and continued weight loss a bonus after Amir’s Dubai Repair – ADR operation, which controls the debilitating reflux in these patients in the first place.
Results of Amir’s Dubai Repair (ADR)
Our initial and mid-term results (3moths to 30 months) have been excellent.
There were no major complications. All the patients reported complete resolution of reflux symptoms and positive restriction at the Gastroesophageal junction post ADR.
All reported improvement in their need to take medication for reflux, with no reliance on long term Proton Pump Inhibitors (PPI) therapy, or minimal use of PPIs on as and if required basis.
All the patients in our study have expressed significant improvement in quality-of-life post ADR, including factors such as:
- Able to eat better and appropriately
- Ability to lie flat at night
- Managing to sleep through the night without symptoms
- No need to sleep propped up or sitting after ADR
- Absence of heartburn, volume reflux
- No more coughing, sore throat and associated symptoms
- Improved satiety after ADR
- Amir’s Dubai Repair (ADR) controlled their reflux and also helped them to continue their weight loss journey with fresh hope and vigor.
Amir’s Dubai repair (ADR) is a better than the current treatment options
Amir’s Dubai Repair – ADR Surgery is better than the other surgical options that are offered at present in following aspects:
- ADR is minimal invasive
- It is not resectional (cutting the stomach and rejoining) surgery
- Its potential risk of complications is much less than the other options
- Recovery is quicker after Amir’s Dubai Repair – ADR
- Reflux is improved and cured in most cases, improving quality of life
- Restrictive component of initial sleeve gastrectomy surgery is restored, helping further weight loss
- Satiety is also restored thus improving quality of life for the patient
- Patient satisfaction is very high for Amir’s Dubai Repair – ADR
Expected hospital stay after Amir’s Dubai Repair (ADR)
The hospital stay is mostly 1-2 nights in the hospital after surgery.
In some cases, if another operation is combined to correct the complications of previous sleeve gastrectomy/ Gastric Bypass or any other issues, then the stay can be longer. In case of any complications from surgery, one may need to stay in longer too.
Recovery After Amir’s Dubai Repair (ADR)
Patients will be mobilising on the day of surgery after recovering from the anaesthetic. They will walk the following day and will be discharged home, if everything is fine.
Light walks can be commenced within 3-5 days.
Driving can be commenced, once one is pain free and moving comfortably. This is generally day 5 to day 7 after the operation
Light gym exercise and yoga can be commenced after 2 weeks
Heavy exercise and weights should be best avoided for 6 weeks after surgery
Diet after Amir’s Dubai Repair (ADR) surgery
- Patient will be commenced on liquid diet on the day of surgery with juices and soups
- Soft diet like scrambled eggs can be taking the day after surgery
- Light diet is allowed from day 3 post operatively onwards
- Generally, after two weeks a patients tend to commence eating normal diet
- It can take up to six weeks or longer to establish a “back to normal” diet
- In some patients after ADR with associated complications from previous surgery it may take longer. It is important to remember that after weight loss surgery in the first place, one has to have modified eating patterns and they are never the same as they might have been before their first operation.
Life After Amir’s Dubai Repair (ADR)
Our medium-term results (up to 5 years after ADR – Amir’s Dubai Repair surgery done for previous sleeve gastrectomy or bypass) have shown excellent results and 100% satisfaction rate. Patients have reported good quality of life. They have recommended surgery to their family and friends