Usage guidelinesPlease refer to the usage guidelines at http://sure.sunderland.ac.uk/policies.html or alternatively contact sure@sunderland.ac.uk. 1 Abstract:Up to 50 % of patients have Zinc deficiency before bariatric surgery. Roux-en-Y Gastric Bypass (RYGB) is the commonest bariatric procedure worldwide. It can further exacerbate Zinc deficiency by reducing intake as well as absorption. British Obesity and Metabolic Surgery Society, therefore, recommends that Zinc level should be monitored routinely following gastric bypass. However, the American guidance does not recommend such monitoring for all RYGB patients and reserves it for T Z after RYGB. Routine monitoring of Zinc levels is hence unnecessary for asymptomatic patients after RYGB and should be reserved for patients with skin lesions, hair loss, pica, dysgeusia, hypogonadism or erectile dysfunction in male patients, and unexplained iron deficiency anaemia.

Bariatric and metabolic surgery (BMS), the only effective option for patients with obesity with or without comorbidities, has been stopped temporarily due to the ongoing novel corona virus disease (COVID-19) pandemic. However, there has been a recent change in the governmental strategy of dealing with this virus from 'Stay at Home' to 'Stay Alert' in many countries including India. A host of health services including elective surgeries are being resumed. In view of the possibility of resumption of BMS in near future, Obesity and Metabolic Surgery Society of India (OSSI) constituted a committee of experienced surgeons to give recommendations about the requirements as well as precautions to be taken to restart BMS with emphasis on safe delivery and high-quality care.

RRYGB is safe and effective to be used as a revisional bariatric procedure. The weight loss outcomes and complication rates compare favorably with the published results of laparoscopic technique, although the small sample size may not be enough to reach definite conclusions.

Use of robotic technology is of benefit in performing minimally invasive retroperitoneal surgery.

Use of robot assistance to perform RYGB is safe and may reduce the associated complications, namely, anastomotic leak, gastrojejunostomy (GJ) stricture, and hemorrhage. Excess weight loss at 2 years after RRYGB is comparable to laparoscopic RYGB.